Dong Chan Kim

Background: The reliability and validity of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans (K-HADS-A) has not been studied in Korean surgical patients. This study aimed to validate the usefulness of K-HADS-A for measuring preoperative anxiety in Korean surgical patients. Additionally, the effect of preoperative anxiety on postoperative quality of recovery was evaluated.Methods: Preoperative anxiety in 126 inpatients with planned elective surgery was measured using the K-HADS-A. The postoperative quality of recovery was measured using the Korean version of the Quality of Recovery-15. The validity and reliability of the K-HADS-A were evaluated. The differences in quality of recovery on the first and seventh day postoperatively were then compared between the anxious and non-anxious groups.Results: There was a statistical correlation between the K-HADS-A and Anxiety Likert Scale. The goodness-of-fit indices of the structural equation model showed how well the data from the K-HADS-A match their concept. The Kaiser-Meyer-Olkin value was 0.848, and the P value of Bartlett’s test of sphericity was < 0.001. Cronbach’s alpha was high at 0.872. The K-HADS-A had an acceptable level of validity and reliability. Postoperative quality of recovery was significantly lower in the anxious group (postoperative day 1: t = 2.058, P = 0.042; postoperative day 7: t = 3.430, P = 0.002).Conclusions: The K-HADS-A is an acceptable tool for appropriately assessing preoperative anxiety in Korean surgical patients. Assessing preoperative anxiety is valuable, because preoperative anxiety affects the postoperative quality of mental and physical recovery.

Sepsis-induced acute kidney injury (AKI) is a common complication in critically ill patients, often resulting in high rates of morbidity and mortality. Previous studies have demonstrated the effectiveness of casein kinase 2 alpha (CK2α) inhibition in ameliorating ischemia–reperfusion-induced AKI. In this study, our aim was to investigate the potential of the selective CK2α inhibitor, 4,5,6,7-tetrabromobenzotriazole (TBBt), in the context of sepsis-induced AKI. To assess this, we initially confirmed an upregulation of CK2α expression following a cecum ligation and puncture (CLP) procedure in mice. Subsequently, TBBt was administered to a group of mice prior to CLP, and their outcomes were compared to those of sham mice. The results revealed that, following CLP, the mice exhibited typical sepsis-associated patterns of AKI, characterized by reduced renal function (evidenced by elevated blood urea nitrogen and creatinine levels), renal damage, and inflammation (indicated by increased tubular injury score, pro-inflammatory cytokine levels, and apoptosis index). However, mice treated with TBBt demonstrated fewer of these changes, and their renal function and architecture remained comparable to that of the sham mice. The anti-inflammatory and anti-apoptotic properties of TBBt are believed to be associated with the inactivation of the mitogen-activated protein kinase (MAPK) and nuclear factor κB (NF-κB) signaling pathways. In conclusion, these findings suggest that inhibiting CK2α could be a promising therapeutic strategy for treating sepsis-induced AKI.

Rationale: Several hereditary myopathies that can predispose to malignant hyperthermia (MH) are reported. However, the risk of MH in myotonic dystrophy type I (DM1) has been suggested equal to general population, although the evidence is limited to only a few case reports. Patient concerns: We encountered a rare case of MH during anesthesia induction with sevoflurane in a male adolescent with previously undiagnosed DM1. Diagnoses: After the event, genetic testing revealed the presence of a previously unknown heterozygous missense mutation in ryanodine receptor 1 (RYR1) associated with MH (c.6898T > C; p.ser2300Pro). Concomitantly, the patient was diagnosed with DM1 with abnormal cytosine-thymine-guanine triplet expansion in the DMPK gene. Interventions: Dantrolene was administered to treat the hypermetabolic manifestations in 20 minutes after the identification of MH. Outcomes: The patient was successfully treated and discharged without any complications. Laboratory abnormalities were recovered to baseline at postoperative 4 days. Lessons: The authors suggest that possible MH susceptibility in DM1 patients may be refocused. Genetic testing can be a screening tool for MH susceptibility in these population, prior to receiving general anesthesia.

Background: The qulity of recovery-40 questionnaire (QoR-40) has been widely used to assess quality of recovery after surgery, but it is too lengthy for clinical use. The short form of QoR-40, QoR-15, has been validated in many languages; however, an official Korean version of the QoR-15 (QoR-15K) has not yet been established. This study aimed to develop and validate QoR-15K.Methods: Based on the previously-validated Korean QoR-40, we selected 15 items; the QoR-15K was patterned on the original QoR-15. We analyzed 210 subjects who had been scheduled for elective surgery under general anesthesia. The patients completed the questionnaire before surgery and on postoperative days one and two. The validity, reliability, and responsiveness of the QoR-15K were evaluated. Results: We obtained excellent convergent validity on visual analog scale for recovery (VAS) (ρ = 0.88, P < 0.001). The duration of anesthesia, post-anesthesia care unit, and overall hospital stay with the QoR-15K showed a significant negative correlation (ρ = -0.183, -0.151, and -0.185, respectively). Cronbach’s α was 0.909. Cohen’s effect size and standardized response mean were 0.819 and 0.721. The recruitment and completion rate were 92.9% and 100%, respectively. We based the above calculations on the results obtained on the first day following surgery.Conclusions: The validity and reliability of the QoR-15K are comparable to those of the English version. The QoR-15K would be a good instrument to assess the quality of recovery in Korean patients after surgery.

Although the quality of postoperative recovery may be affected by factors, there are few investigations whether the type of anesthesia also affects it. In this single-blinded, prospective, observational study, we compared the quality of postoperative recovery in patients undergoing orthopedic forearm surgery under general or regional anesthesia (brachial plexus block). Ninety-seven subjects, aged 18-65 years and American Society of Anesthesiologists physical status I or II, undergoing orthopedic forearm surgery, were allocated to general or regional anesthesia group. The quality of postoperative recovery was assessed using a validated Korean version of Quality of Recovery-40 (QoR-40K) questionnaire. Patients were surveyed three times, the day before surgery (baseline) and 1st and 7th day after the surgery, and the scores of both groups were compared. We analyzed 47 and 50 patients in general and regional anesthesia, respectively. The global QoR-40K score and those of each of its five dimensions were not significantly different between the two groups at baseline, 1st and 7th day postoperatively. In two-way RM ANOVA, the global QoR-40K score at postoperative 1st day was significantly lower than that of baseline (P < 0.001) and postoperative 7th day (P < 0.001), respectively, in both general and regional anesthesia groups. However, there was no significant difference at each timepoint between the two groups. The present study suggests that brachial plexus block with intravenous dexmedetomidine infusion does not improve the quality of postoperative recovery compared to sevoflurane inhalation anesthesia with remifentanil infusion in patients undergoing orthopedic forearm surgery.

The Quality of Recovery-40 (QoR-40) is a widely-used, self-rated, and self-completed questionnaire for postoperative patients. The questionnaire is intended to elicit information from each patient regarding the quality of recovery during the postoperative period. It is noteworthy, however, that an official Korean version of the QoR-40 (QoR-40K) has not been established. The purpose of this study was to develop the QoR-40K by translation and cultural adaptation process and to evaluate the validity and reliability of the QoR-40K. After pre-authorization from the original author of the QoR-40, the translation procedure was established and carried out based upon Beaton's recommendation to create a QoR-40K model comparable to the original English QoR-40. Two hundred surgical patients were enrolled, and each completed the questionnaire during the preoperative period, on the third day, and 1 month after surgery. The QoR-40K was compared with the visual analogue scale (VAS) and another health-related questionnaire, the Short-form Health Survery-36 (SF-36). The method of validation for QoR-40K included test-retest reliability, internal consistency, and level of responsiveness. Spearman's correlation coefficient for test-retest reliability was 0.895 (P < 0.001), and Cronbach's alpha of the global QoR-40K on the third day after surgery was 0.956. A positive correlation was obtained between the QoR-40K and the mental component summary of SF-36 (ρ = 0.474, P < 0.001), and a negative correlation was observed between QoR-40K and VAS (ρ = -0.341, P < 0.001). The standardized responsive mean of the total QoR-40K was 0.71. The QoR-40K was found to be as acceptable and reliable as the original English QoR-40 for Korean patients after surgery, despite the apparent differences in the respective patients' cultural backgrounds.

Although the positive effects of preoperative oral carbohydrate administration on clinical outcomes following major surgery have been reported continuously, there are few investigations of them in minor surgical patients. The present study was designed to examine the effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in patients undergoing thyroidectomy. Fifty adults aged 20-65 years and scheduled for elective thyroidectomy in first schedule in the morning were allocated to one of two groups. The Control group (n = 25) was requested to obey traditional preoperative fasting after midnight prior to the day of surgery. The Carbohydrate group (n = 25) also fasted overnight but drank 400 ml of carbohydrate-rich drink 2 hours before induction of anesthesia. Patient well-being (thirst, hunger, mouth dryness, nausea and vomiting, fatigue, anxiety and sleep quality) and satisfaction were assessed just before the operating room admission (preoperative) and 6 hours following surgery (postoperative). Other secondary outcomes including oral Schirmer's test and plasma glucose concentrations were also evaluated. The two groups were homogenous in patient characteristics. Seven parameters representing patient well-being evaluated on NRS (0-10) and patient satisfaction scored on a 5-point scale were not statistically different between the two groups preoperatively and postoperatively. There were no statistically significant differences in secondary outcomes. Preoperative oral carbohydrate administration does not appear to improve patient well-being and satisfaction compared with midnight fasting in patients undergoing thyroidectomy in first schedule in the morning.

Lee JW, et al. Korean J Crit Care Med. 2016 May;31(2):111-117. http://dx.doi.org/10.4266/kjccm.2016.31.2.111

This study aimed to explore the relationship between students' seating preferences and academic achievement in medical school.The subjects of this study were 109 second-year students in C medical school. The pattern of seat selection of 109 students was surveyed by participant observation for 48 days, and a questionnaire was administered to determine the factors that were considered by students. Using SPSS version 12.0, we analyzed the factors that students considered with regard to seat selection and seat preference and the frequency of seat movements between areas. We performed one-way ANOVA to analyze the differences in academic achievement between students who moved seats versus those who did not.The most common reasons for seat selection were to focus better on the lecture (60 students), to focus better on lecture, and to feel familiar with the same seat (60 students). Students' preferred seats were in rows A4, A7, A5, and A3 (in descending order), which are primarily the central sections, and columns B15, B1, B14, B19 (in descending order), which are primarily both ends of the division. The difference in academic achievement between students who moved seats and those who did not was not significant (p>0.05). Among students who did not move seats, the difference in academic achievement between 9 seating areas was not significant in 6 subjects (p>0.05).The results of this study suggest that we should reconsider a professor's general perception regarding academic achievement according to seat location.