Kaohsiung J Med Sci
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Kaohsiung J Med Sci · Sep 2015
Randomized Controlled Trial Comparative StudyComparison of the postoperative analgesic effects of paracetamol-codeine phosphate and naproxen sodium-codeine phosphate for lumbar disk surgery.
The aim of this study was to compared the efficacy of paracetamol-codeine phosphate and naproxen sodium-codeine phosphate on postoperative pain and tramadol consumption during the first 24 hours after a lumbar disk surgery. After Ethics Committee approval and informed consent had been obtained, 64 patients were allocated into three groups. Patients received oral paracetamol-codeine (300 mg + 30 mg; Group P), naproxen sodium-codeine (550 mg + 30 mg; Group N), or placebo tablets (Group C) 30 minutes prior to induction of anesthesia. ⋯ Side effects were similar between the groups. Preemptive administration of paracetamol-codeine and naproxen sodium-codeine combination significantly reduced tramadol consumption and provided more effective analgesia compared with placebo. The paracetamol-codeine combination was superior to naproxen sodium-codeine with regard to tramadol consumption.
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Kaohsiung J Med Sci · Aug 2015
Assessment of intra-interobserver reliability of the sonographic optic nerve sheath diameter measurement.
Diagnosis and measuring the level of increase in intracranial pressure (ICP) is critical, especially for the management of trauma patients in the emergency department and intensive care unit. However, measurements are operator-dependent as in all of the sonographic diagnoses. The aim of this study is to assess the operator variations in the measurement of optic nerve sheath diameter (ONSD). ⋯ The levels of compatibilities for most of the measurements were found at acceptable levels statistically. However, it is not possible to say that there was a perfect compatibility among the sonographers according to the previously conducted reliability studies of ultrasound measurements. According to our results, it is hard to say that sonographic measurement of the ONSD is a highly reliable method both in longitudinal and transverse planes.
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Kaohsiung J Med Sci · Aug 2015
Radiofrequency ablation assisted by real-time virtual sonography for hepatocellular carcinoma inconspicuous under sonography and high-risk locations.
Radiofrequency ablation (RFA) is an effective and real-time targeting modality for small hepatocellular carcinomas (HCCs). However, mistargeting may occur when the target tumor is confused with cirrhotic nodules or because of the poor conspicuity of the index tumor under ultrasonography (US). Real-time virtual sonography (RVS) can provide the same reconstruction computed tomography images as US images. ⋯ The results showed that the complete ablation rate is 87.5% (7/8) in the US undetectable group and 75% (15/20) in the US detectable group. A comparison between six tumors with incomplete ablation and 22 tumors with complete ablation showed higher alpha-fetoprotein level (mean, 1912 ng/mL vs. 112 ng/mL) and larger tumor size (mean diameter, 26 mm vs. 16 mm) in the incomplete ablation nodules (both p < 0.05). In conclusion, RVS-assisted RFA is useful for tumors that are difficult to detect under conventional US and may also be useful for tumors in high-risk locations because it may prevent complication induced by mistargeting.
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Kaohsiung J Med Sci · Apr 2015
Establish a perioperative check forum for peripheral intravenous access to prevent the occurrence of phlebitis.
The prevalence of intravenous (IV) catheter-related infections is 0.5 per 1000 device days, and these infections cause tenderness, erythema, swelling and phlebitis. Catheter-related bloodstream infections (CRBSI) may independently increase hospital costs and length of stay; the aim of the study was to set up a standard operating procedure (SOP) for the maintenance of peripheral vein catheter patency and the prevention of IV catheter-related complications. This is a retrospective study, enrolling patients who received anesthesia between April 2010 and January 2011. ⋯ Overall IV therapy-related events declined significantly (p < 0.01), and the presence of phlebitis was associated with age (p < 0.05). An SOP established to assess IV patency through a checklist can reduce phlebitis and improve quality. The checklist increases ward nurses' and nurse anesthetists' awareness of IV patency, and the feedback circuit substantially reduces IV event rate.
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Kaohsiung J Med Sci · Mar 2015
Comparative StudyA comparison of propofol target controlled infusion-based and sevoflurane-based anesthesia in adults undergoing elective anterior cervical discectomy and fusion.
The target controlled infusion (TCI) of propofol with fentanyl facilitates easy titration of the depth of anesthesia, and thereby may improve the quality of anesthesia. The aim of this study is to investigate if propofol TCI-based anesthesia is practical for anterior cervical discectomy and fusion (ACDF), one of the most common surgical interventions in spine procedures, when compared with sevoflurane-based anesthesia with respect to the quality of anesthesia. Patients were classified into two groups according to the anesthesia regimen of maintenance of anesthesia with fentanyl and either propofol TCI (group FP) or inhalational sevoflurane (group FS), respectively. ⋯ No differences in average length of intensive care unit (ICU) stay and hospital stay were noticed. However, opioid consumption and blood loss during the operation for patients in group FP were significantly higher than those of patients in group FS (551.28 ± 193.98 vs. 446.86 ± 177.15 μg, p = 0.005; 52.06 ± 58.25 vs. 28.33 ± 40.74 mL, p = 0.019, respectively). In these adult patients undergoing ACDF, propofol TCI-based anesthesia appears to be as efficacious as sevoflurane-based anesthesia but consumed more fentanyl and experienced higher blood loss.