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Background Minimum alveolar concentration (MAC) has traditionally been used to compare the potency of volatile anesthetics. However, as it reflects the spinal mechanism of immobility rather than the cerebral mechanism of analgesia and hypnosis, it is doubtful that equi-MAC connotes equivalent analgesic or hypnotic potency. The level of analgesia and hypnosis can be assessed using surgical pleth index and bispectral index (BIS) values, respectively. This study was designed to compare the surgical pleth index and BIS values produced by equi-MAC of desflurane and sevoflurane in patients undergoing single-agent volatile anesthesia. Methods Eighty-nine patients were randomly allocated to two groups receiving either desflurane (n = 44) or sevoflurane (n = 45). Anesthesia was only maintained with assigned volatile anesthetic of age-corrected 1.0 MAC. Surgical pleth index values as an analgesic estimate and BIS values as a hypnotic estimate were obtained under standard tetanic stimulation. Results Post-stimulation surgical pleth index values (mean ± SD), the primary outcome, were significantly lower for the desflurane group than those for the sevoflurane group (49 ± 10 vs. 64 ± 14, difference, 15 [95% CI, 10 to 20], P < 0.001). The desflurane group showed significantly lower poststimulation BIS values (median [interquartile range]) than the sevoflurane group (36 [31 to 41] vs. 41 [38 to 47], difference, 6 [95% CI, 2 to 9], P = 0.001). Conclusions During a steady-state of 1.0 MAC, desflurane and sevoflurane did not cause similar surgical pleth index and BIS values under the standardized nociceptive stimulus. These findings suggest that equi-MAC of desflurane and sevoflurane may not ensure equivalent analgesic or hypnotic potency.

Background: Sevoflurane and desflurane are widely used in balanced anaesthesia in combination with opioid analgesics. The opioid remifentanil is frequently chosen because of its extremely rapid pharmacokinetics. However, intraoperative high-dose remifentanil is associated with increased postoperative pain and rescue analgesic use owing to acute tolerance and opioid-induced hyperalgesia. This study aimed to compare intraoperative remifentanil requirements during equiminimum alveolar concentration (MAC) sevoflurane and desflurane anaesthesia via surgical pleth index-guided remifentanil administration. Methods: Eighty-two subjects undergoing laparoscopic cholecystectomy were randomly allocated to two groups receiving either sevoflurane (n¼40) or desflurane (n¼42). Anaesthesia was maintained with the assigned inhaled anaesthetics and remifentanil. End-tidal anaesthetic concentration was maintained at age-corrected 1.0 MAC, and remifentanil infusion was continuously adjusted to achieve a surgical pleth index of 20e50. Mean remifentanil infusion rate, which was the primary outcome of the study, was calculated as the total infused remifentanil dose per kg body weight per minute of total operative time. Results: Mean remifentanil infusion rate [mean (standard deviation)] was significantly higher in the sevoflurane group than in the desflurane group [0.192 (0.064) vs. 0.099 (0.033) mg kg À1 min À1 ; difference, 0.093 (95% confidence interval, 0.071e0.115); P<0.001]. Conclusions: During equi-MAC anaesthesia of 1.0 MAC, sevoflurane and desflurane did not show similar intraoperative remifentanil consumption under surgical pleth index-guided opioid administration. Further studies using other monitors with different measuring mechanisms are warranted to determine the cause of this difference. Clinical trial registration: NCT02830243 (ClinicalTrials.gov).

The single strategy using SI alone is as effective as the combined strategy of SI and RM for removing residual carbon dioxide and consequently preventing PLSP. Therefore, considering the potential risks of pulmonary or hemodynamic complications associated with RM, the single strategy using SI alone might be a better choice than the combined strategy.

Background Rotator cuff tendinopathy is a primary cause of shoulder pain and dysfunction. Several effective nonsurgical treatment methods have been described for chronic rotator cuff tendinopathy. Prolotherapy with polydeoxyribonucleotide (PDRN), which consists of active deoxyribonucleotide polymers that stimulate tissue repair, is a nonsurgical regenerative injection that may be a viable treatment option. The objective of this study was to assess the efficacy of PDRN in the treatment of chronic rotator cuff tendinopathy. Method The records of patients with chronic rotator cuff tendinopathy (n=131) were reviewed retrospectively, and the patients treated with PDRN prolotherapy (n=32) were selected. We measured the main outcome of the shoulder pain and disability index score on a numerical rating scale of average shoulder pain. Results Compared with baseline data, significant improvements in the shoulder pain and disability index and pain visual analog scale scores were demonstrated at one week after the end of treatment, and at one month and three months later. Conclusions PDRN prolotherapy may improve the conservative treatment of painful rotator cuff tendinopathy for a specific subset of patients.

Background: Traditionally, minimum alveolar concentration (MAC) has been used as the standard measure to compare the potencies of volatile anesthetics. However, it reflects the spinal mechanism of immobility rather than the subcortical mechanism of analgesia. Recently, the surgical pleth index (SPI) derived from photoplethysmographic waveform was shown to reflect the intraoperative analgesic component. This study was designed to compare the SPI values produced by equi-MAC of two commonly used volatile anesthetics, sevoflurane and desflurane.Methods: Seventy-two patients undergoing arthroscopic shoulder surgery were randomly assigned to two groups receiving either sevoflurane (n = 36) or desflurane (n = 36). General anesthesia was maintained with the respective volatile anesthetic only. A vaporizer was adjusted to maintain end-tidal anesthetic concentration at age-corrected 1.0 MAC throughout the study period. The SPI value as an analgesic estimate and the bispectral index (BIS) value as a hypnotic estimate were recorded at predefined time points during the standardized surgical procedure.Results: During the steady state of age-corrected 1.0 MAC, mean SPI values throughout the entire study period were significantly higher in the sevoflurane group than in the desflurane group (38.1 ± 12.8 vs. 30.7 ± 8.8, respectively, P = 0.005), and mean BIS values were significantly higher in the sevoflurane group than in the desflurane group (40.7 ± 5.8 vs. 36.8 ± 6.2, respectively, P = 0.008).Conclusions: Equi-MAC of sevoflurane and desflurane did not produce similar surgical pleth index values. Therefore, sevoflurane and desflurane may have different analgesic properties at equipotent concentrations.

Penile growth is under androgenic control. Human chorionic gonadotropin (hCG) has a stimulatory effect on testicular steroidogenesis and penile growth. The purpose of this study was to evaluate the effect of hCG treatment on the gonadal response and penile growth in male idiopathic hypogonadotrophic hypogonadism (IHH) presenting with micropenis. A total of 20 IHH patients who met the criteria for micropenis were included in this study. hCG (1,500-2,000 IU) was administrated intramuscularly, 3 times per week, for 8 weeks. Basic laboratory and hormonal indexes (including serum testosterone and LH levels), penis length (flaccid and stretched), and testicular volume were measured before and 24 weeks after hCG treatment. The patients' mean age was 18.9 years (range, 12 to 24 years). The mean serum testosterone level was significantly increased after hCG treatment (baseline, 2, 4, 12, and 24 weeks: 0.90±1.35 ng/ml, 1.77±1.31 ng/ml, 3.74±2.24 ng/ml, 5.49±1.70 ng/ml, and 5.58±1.75 ng/ml, respectively; p<0.05). Mean penile length also increased significantly 24 weeks after treatment (flaccid length: from 3.39±1.03 cm to 5.14±1.39 cm; stretched length: from 5.41±1.43 cm to 7.45±1.70 cm; p<0.001). Mean testicular volumes increased significantly as well (left: from 5.45 cc to 6.83 cc; right: from 5.53 cc to 7.03 cc). There were no remarkable adverse effects of the hCG treatment. The hCG treatment increased the serum testosterone level, penile length, and testicular volume in IHH patients. Our results suggest that hCG treatment has a beneficial effect on gonadal function and penile growth in patients with IHH presenting with micropenis.

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