Chih-Peng Lin | National Taiwan University (original) (raw)

Papers by Chih-Peng Lin

British Journal of Anaesthesia, 2002

A case of an infant receiving orthotopic heart transplantation with over-sized donor heart was re... more A case of an infant receiving orthotopic heart transplantation with over-sized donor heart was reported. Left lower pulmonary venous obstruction after sternotomy closure was detected by transoesophageal echocardiography (TOE) and the decision to delay sternal closure was made and the clinical outcome was very satisfactory. The usefulness of intraoperative TOE monitoring and postoperative TOE follow-up for infant heart transplantation, especially in those cases of size mismatch, was well demonstrated.

Journal of Pain Research

People with pain problems are highly vulnerable to cultural disparities, and it is imperative to ... more People with pain problems are highly vulnerable to cultural disparities, and it is imperative to reduce these inequalities. This cross-sectional study aimed to develop a culturally sensitive Chronic Pain Cognition Scale (CPCS) for Chinese-/Chinese dialectspeaking populations and investigate its psychometric properties. Patients and Methods: Adult patients with chronic low back pain or chronic neck pain who visited pain clinics at a medical center in northern Taiwan were enrolled. Participants completed the demographic, intensity of pain, and two other related sensations, "Sng ()" and "Ma ()", often reported in Chinese-speaking populations, CPCS, Chronic Pain Acceptance Questionnaire-8, and Pain Self-Efficacy Questionnaire. Results: 200 patients were included. Patients' mean age was 64.84 ± 14.33, 126 (63.0%) were female, and 83 (41.5%) had 13+ years of education. The average duration of pain was 77.25 ± 97.46 months, the intensity of pain was 6.04 ± 2.50, Ma was 3.43 ± 3.24, and Sng was 4.54 ± 3.14. The CPCS comprised four factors: pain impact (how pain impact one's life), losing face (how one being disrespected due to pain), helplessness, and avoidance, with good structural validity and adequate reliability (Cronbach α, 0.60-0.81) and satisfactory criterion-related validity. Moreover, losing face, an essential concept in Chinese relationalism, was significantly related to pain, Sng, and Ma (r = 0.19, 0.15 and 0.16), but not to pain acceptance or self-efficacy, indicating a culturally specific element in pain measurement. Conclusion: The CPCS has good psychometric properties and is suitable for evaluating chronic pain in the clinical setting, and might be generalizable to other Chinese-/Chinese dialect-speaking populations.

Acta anaesthesiologica Sinica, 2003

We present a successful thromboembolectomy under intraoperative transesophageal echocardiography ... more We present a successful thromboembolectomy under intraoperative transesophageal echocardiography (TEE) monitoring on a woman with massive pulmonary embolism (PE). Sudden onset of dyspnea happened 7 days after lumbar spine surgery and ventilation/perfusion scan and angiography performed right away were suggestive of PE. Operation was performed 17 days later after invalid anticoagulant treatments and unavailing catheter fragmentation. Intraoperative TEE showed massive emboli in the main and right pulmonary arteries (MPA and RPA) and dilated right atrium (RA) with deviated intraatrial septum. Removal of the emboli was performed smoothly under TEE monitoring. The dilation of RA, right ventricle (RV) and PA were resolved soon after thromboembolectomy. The patient was extubated the next day with obvious improvement of clinical symptoms and discharged two weeks later without neurological sequale. We conclude that TEE can be an excellent tool not only for early diagnosing PE in high risk pa...

Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists, 2004

Adenosine with its rapid onset and brief duration of action has a number of clinical applications... more Adenosine with its rapid onset and brief duration of action has a number of clinical applications including treatment of paroxysmal supraventricular tachycardia and maximal coronary vasodilatation during pharmacologic stress testing. The adverse effects of adenosine include dyspnea, nausea, headache, chest pain, flushing and bronchospasam. Although there were few reports which mentioned the occurrence of bronchospam after administration of adenosine, a number of studies indicated that the use of adenosine was not contraindicated in patients with chronic obstructive pulmonary disease (COPD) or asthma. We report here a male patient with pulmonary emphysema and lung bullous disease who developed severe constriction of the main bronchi after intravenous adenosine during general anesthesia. After treatment, the patient was discharged without complications. We have reviewed the related current literature and herein discuss the reason and management of the adenosine induced bronchospasm.

We have designed a novel apparatus, the Sunscope, which integrates a semiconductor image sensor i... more We have designed a novel apparatus, the Sunscope, which integrates a semiconductor image sensor into a compact video-guided intubation system. This device consists of three separate modules: viewer, console and visual tube. The 4-inch LCD viewer panel displays the real-time video image with optimal view angle. The console is designed with respect to ergonomics allowing comfortable manipulation and internally accommodating the power supply, image processing components and connector platform for both viewer and probe. The distal end of the detachable probe is packaged with a high resolution lens, CMOS sensor, and four LEDs. The proximal end is a 6-pin connector which can be readily removed and attached on demand. The probe is detachable and disposable with length and diameter adaptable to the size of the endotracheal tube. In our preliminary test, the video-guided apparatus helped inexperienced performers to identify the vocal cords correctly and improve the success rate of intubation on the simulation model. With further improvements on the miniature design, all captured images could be transmitted to remote devices through standard wireless transmission and could thus be stored in a specific database station. The wireless technique enables image sharing on multiple devices while a powerful database can provide valuable resources for training, data mining and serial case studies. We demonstrate that the CMOS image sensor combined with advanced reduced instruction set computer machine can serve as a visual aid for tracheal intubation. The disposable station will become a revolutionary technology both in clinical practice and medical education.

Objective: Ketorolac added to tramadol as an injection mixture convenient for clinical use has be... more Objective: Ketorolac added to tramadol as an injection mixture convenient for clinical use has been shown to be an effective balanced analgesic regimen in alleviating moderate-to-severe pain. However, analytical confirmation of the compatibility and stability of this combination is not available. This study examined the compatibility and stability of this combination. Methods: Two different mixtures containing ketorolac tromethamine and tramadol hydrochloride were examined: ketorolac (10 mg/mL) and tramadol (33.3 mg/mL) prepared as injection concentrate in ampoule mingled together in the ratio of one ampoule to one ampoule; diluted ketorolac (2 mg/mL) and tramadol (20 mg/mL) prepared in saline infusion solution, with or without pH adjustment. The mixtures were visually inspected for precipitation and color change. Quantitative chemical analysis was performed on days 0, 1, 3 and 7 by high-performance liquid chromatography. Results: When stored at room temperature under ambient light, the ketorolac (10 mg/ mL)−tramadol (33.3 mg/mL) injection concentrate and ketorolac (2 mg/mL)−tramadol (20 mg/mL) solution, without pH adjustment and adjusted to pH 5−8, were physicochemically stable, and neither visible precipitation nor loss of concentration was found. With the ketorolac (2 mg/mL)−tramadol (20 mg/mL) solution adjusted to pH 9, however, precipitation occurred immediately, resulting in a significant loss of tramadol. Conclusion: This study suggests that a ready-to-use ketorolac−tramadol mixture, either undiluted or diluted in physiological saline solution, can be prepared, with a shelf life of at least 7 days when stored at room temperature under ambient light.

This is the case report on a 1-year 9-month-old boy suffering from spondyloepiphyseal dysplasia c... more This is the case report on a 1-year 9-month-old boy suffering from spondyloepiphyseal dysplasia congenita who was successfully intubated with our modified lightwand intubation procedure for general anesthesia to undergo bilateral herniorrhaphy despite the great likelihood of facing a difficult airway because of unstable cervical spine. We bent the pediatric wand after it was encased in an endotracheal (ET) tube of appropriate diameter. The light tip of the wand was let to protrude just out of the bevel of the ET tube. Once the light bulb properly transilluminated the trachea, the ET tube was threaded gently into the trachea. The patient recovered from anesthesia smoothly and was discharged on the next day. This maneuver can facilitate both visual and tactile confirmations of the position and proper tube size. The effectiveness and safety of our modified lightwand intubation procedure is well demonstrated.

Weak opioid combined with acetaminophen (APAP) has been proven to provide better analgesic effica... more Weak opioid combined with acetaminophen (APAP) has been proven to provide better analgesic efficacy and cause fewer complications than either drug alone. However, there are questions about whether different opioids, tramadol and propoxyphene, provide similar efficacy or safety. Thus, we investigated Ultracet (37.5 mg tramadol/325 mg APAP) and Depain-X (65 mg propoxyphene/650 mg APAP). The primary aims of this study were to compare the analgesic efficacy and adverse effects of single-dose oral Ultracet versus Depain-X in acute postoperative pain. This was a randomized, open-label, active-controlled parallel study on patients with postsurgical pain. Sixty patients who sustained moderate postsurgical pain (visual analog scale(3)3 cm) after undergoing implantation of venous access were randomized to two groups to receive either Ultracetor Depain-X for postoperative analgesia. Assessment items included pain intensity and pain relief ratings at the first 4 hours, and adverse events. There were initially 107 patients who were enrolled in this trial, but up to 45 (42.1%) of them were withdrawn during the study. In these 62 patients who complied with treatment (Ultracet: Depain-X = 29: 33), pain relief scale indicated that Ultracet could provide a better analgesic effect than Depain-X provided at 1 hour (p < 0.05). At 4 hours, the pain score in the Ultracet group was significantly lower than that in the Depain-X group (p < 0.05). Adverse events, such as drowsiness, dizziness, and skin itching did not differ in both groups. Among patients with mild to moderate postoperative wound pain, single-dose Ultracet can provide slightly better analgesic efficacy than Depain-X in terms of onset and duration. Depain-X is no longer marketed in Europe, America, Taiwan and other countries, therefore, Ultracet can serve as a good substitute for treating postoperative pain.

Effective airway management requires both proper technique and the appropriate devices. With the ... more Effective airway management requires both proper technique and the appropriate devices. With the widespread implementation of advanced life-support techniques in emergency medical services (EMS), orotracheal intubation is now performed not only by professional practitioners but, in many occasions, nonprofessionals. With extensively diversified skill equipped, we tested whether the Sunscope, a patented tracheal intubation device with a digital display, is able to facilitate tracheal intubation by naïve EMS personnel with various training backgrounds. We conducted a study to determine rate of success and time required to insert an orotracheal tube into a mannequin using Sunscope. The participants were placed into the professional group (i.e., anesthesiologists and emergency medical paramedics; EMT-P) or the nonprofessional group (i.e., emergency medical technicians; EMT). Intubation required three steps: equipment preparation, vocal cord exposure, and tube insertion. The time required for each step was recorded by a senior staff member, and the data were analyzed by nonparametric statistics. Each consecutive step in the operating procedure was significantly shorter for the professional group in comparison with the nonprofessional group during the first trial: equipment preparation, 10.5 ± 2.1 vs. 11.9 ± 4.1 seconds; vocal cord exposure, 7.4 ± 7.7 vs. 12.2 ± 7.7 seconds; tube insertion, 8.8 ± 4.8 vs. 17.6 ± 9.4 seconds; and total time required for intubation, 26.7 ± 8.8 vs. 35.8 ± 19.6 seconds. The professional practitioners showed no significant improvement, in terms of time reduction, on the following three trials. On the other hand, the nonprofessional practitioners showed no significant differences, in terms of time required to expose the vocal cords and total operation time, following the third trial in comparison with the professional practitioners. Our research demonstrates that professional practitioners are able to use the Sunscope on their first attempt. Despite a lack of training in conventional endotracheal intubation, emergency medical technicians (EMT-I and -II) were able to complete intubation on their first attempt; a significant reduction in the time required to intubate was noted after repeated practice. All levels of naïve EMTs were able to readily visualize the vocal cords through Sunscope and, thereby, reliably insert the endotracheal tube in less than 1 minute, regardless of their skills before testing.

Transplantation of adult-sized kidneys to pediatric patients weighing less than 10 kg is a challe... more Transplantation of adult-sized kidneys to pediatric patients weighing less than 10 kg is a challenge to both surgical and anesthetic management. For survival of the graft, a large-size kidney graft transferred to a pediatric patient needs extraphysiological cardiac output to compensate for adequate renal blood flow. We report here a boy weighing 8.4 kg who received transplantation of a kidney donated by his 56.4-kg mother. Since monitoring of the central venous pressure was not accurate enough and Swane Ganz catheterization was not feasible in this patient for monitoring the fluid status and cardiac function, we used transesophageal echocardiography to guide intravascular volume expansion and to titrate inotropic support during the surgery. It was demonstrated to be a useful tool for optimization of renal perfusion in this scenario. The transplanted graft served its function well.

The role of ultrasound examination in detection of postprocedure complications from totally impla... more The role of ultrasound examination in detection of postprocedure complications from totally implantable venous access devices (TIVAD) placement is still uncertain. In a cohort of 665 cancer outpatients, we assessed a quick ultrasound examination protocol in early detection of mechanical complications of catheterization. Immediately after TIVAD placement, an ultrasound examination and chest radiography were performed to detect hemothorax, pneumothorax, and catheter malposition. The two methods were compared. Of the 668 catheters inserted, 628 were placed into axillary veins and 40 into internal jugular veins. The ultrasound examination took 2.5 ± 1.1 min. No hemothorax was detected, and neither pneumothorax nor catheter malposition was evident among the 40 internal jugular vein cannulations. Ultrasound and chest radiography examinations of the 628 axillary vein cannulations detected five and four instances of pneumothorax, respectively. Ultrasound detected all six catheter malpositions into the internal jugular vein. However, ultrasound failed to detect two out of three malpositions in the contralateral brachiocephalic vein and one kinking inside the superior vena cava. Without revision surgery, the operating time was 34.1 ± 15.6 min. With revision surgery, the operating time was shorter when ultrasound detected catheter malposition than when chest radiography was used (96.8 ± 12.9 vs. 188.8 ± 10.3 min, p < 0.001). Postprocedure ultrasound examination is a quick and sensitive method to detect TIVAD-related pneumothorax. It also precisely detects catheter malposition to internal jugular vein thus reduces time needed for revision surgery while chest radiography remains necessary to confirm catheter final position.

The pivotal role of glial activation and up-regulated inflammatory mediators in the opioid tolera... more The pivotal role of glial activation and up-regulated inflammatory mediators in the opioid tolerance has been confirmed in rodents but not yet in humans. Here, the authors investigated the intraspinal cytokine and chemokine profiles of opioid-tolerant cancer patients; and to determine if up-regulated chemokines could modify opioid tolerance in rats. Cerebrospinal fluid samples from opioid-tolerant cancer patients and opioid-naive subjects were compared. The cerebrospinal fluid levels of tumor necrosis factor-alpha, CXCL1, CXCL10, CCL2, and CX3CL1 were assayed. The rat tail flick test was utilized to assess the effects of intrathecal CXCL1 on morphine-induced acute antinociception and analgesic tolerance. CXCL1 level in cerebrospinal fluid was significantly up-regulated in the opioid-tolerant group (n = 30, 18.8 pg/ml vs. 13.2 pg/ml, P = 0.02) and was positively correlated (r = 0.49, P < 0.01) with opioid dosage. In rat experiment, after induction of tolerance by morphine infusion, the spinal cord CXCL1 messenger RNA was up-regulated to 32.5 ± 11.9-fold. Although CXCL1 infusion alone did not affect baseline tail-flick latency, the analgesic efficacy of a single intraperitoneal injection of morphine dropped significantly on day 1 to day 3 after intrathecal infusion of CXCL1. After establishing tolerance by intrathecal continuous infusion of morphine, its development was accelerated by coadministration of CXCL1 and attenuated by coadministration of CXCL1-neutralizing antibody or CXCR2 antagonist. CXCL1 is up-regulated in both opioid-tolerant patients and rodents. The onset and extent of opioid tolerance was affected by antagonizing intrathecal CXCL1/CXCR2 signaling. Therefore, the CXCL1/CXCR2 signal pathway may be a novel target for the treatment of opioid tolerance.

BMC Anesthesiology, 2014

Background: Precise control of anesthetic depth during electroconvulsive therapy (ECT) is crucial... more Background: Precise control of anesthetic depth during electroconvulsive therapy (ECT) is crucial because most intravenous anesthetics have anticonvulsant effects. In this study, we investigated the association between anesthetic depth measured by the Alaris auditory evoked potential index (AAI) and seizure inducibility and seizure duration during ECT. Methods: Sixty-four ECTs were evaluated in 12 consecutive patients. General anesthesia was performed with a thiopental-based method. The relationship between the pre-ictal AAI, seizure activity and seizure duration was analyzed, and a possible threshold pre-ictal AAI to induce a seizure duration of at least 25 seconds was calculated. Results: Forty-one of the 64 ECT stimuli successfully induced seizure activity that lasted longer than 25 seconds. Pre-ictal AAI was significantly correlated to seizure duration (r = 0.54, p < 0.001) and the threshold pre-ictal AAi value was calculated to be 26 (area under curve: 0.76, sensitivity: 70.3% and specificity: 73.9%, p < 0.001). ECT with a pre-ictal AAI ≧ 26 had a higher incidence of successful seizure activity ( p < 0.001) and a longer seizure duration (55 ± 35 v.s. 21 ± 27 seconds, p < 0.001).

The Pain Clinic, 2007

ABSTRACT Introduction: Ketorolac added to morphine solution as a convenient regimen for pain mana... more ABSTRACT Introduction: Ketorolac added to morphine solution as a convenient regimen for pain management is common in clinical practice in many centers. However, the analytical confirmation of the compatibility and stability of this combination has rarely been performed. This study examined the compatibility and stability of ketorolac tromethamine and morphine hydrochloride combined in 0.9% sodium chloride injection. Materials and methods: Ketorolac tromethamine and morphine hydrochloride were mixed together in 0.9% sodium chloride injection at pH 5–9 at a final concentration of 2 mg/ml for ketorolac and 1 mg/ml for morphine. In addition, 20 different ketorolac–morphine mixture solutions were prepared by combing various concentrations of each individual drug. The compatibility and stability of these solutions were studied using high performance liquid chromatography. Results: There was no significant loss of drug, neither ketorolac tromethamine nor morphine hydrochloride, with the ketorolac (2 mg/ml) + morphine (1 mg/ml) solution at pH 5–9 at room temperature over a period of 3 days. All solutions with a multiplication product of the initial ketorolac and morphine concentration (the [K] × [M] product) of ≤ 6.25 mg2/ml2 remained stable at room temperature over a period of 14 days. However, solutions with a [K] × [M] product ≥ 7.5 mg2/ml2 were stable for no more than 3 days. Conclusions: A ketorolac (2 mg/ml) + morphine (1 mg/ml) solution can be used at physiological pH and is stable for at least 3 days at room temperature. However, mixture solutions with a [K] × [M] product greater than 7.5 mg2/ml2 may not be suitable for use after a 3-day storage period because of poor drug compatibility and stability.

Spine, 2004

Case report. To report a previously undescribed complication of prolonged retraction on the norma... more Case report. To report a previously undescribed complication of prolonged retraction on the normal common carotid artery after anterior cervical spine surgery. Previous study showed that prolonged retraction could decrease the blood flow of the common carotid artery during anterior cervical spine surgery. A case report revealed that prolonged retraction could induce the formation of thrombosis in the atherosclerotic common carotid artery. Notes review. Computed tomography of the brain was performed on the first and the fourth postoperative day. Carotid Doppler ultrasound and transcranial Doppler ultrasound were performed to evaluate the left common carotid artery and the left intracranial cerebral arteries. After lengthy anterior cervical spinal surgery, the patient did not regain his consciousness during the stay in the postoperative care unit. Large infarction of left cerebral hemisphere was revealed by computed tomography. The patient died on the seventh postoperative day of perioperative lethal stroke. We suggest that prolonged retraction, even on the normal common carotid artery, could induce lethal stroke after anterior cervical spine surgery. We recommend that retractor should be placed carefully and cerebral perfusion should be maintained adequately.

Journal of the Formosan Medical Association, 2012

3e7, whereas 150 mg/kg IVA produced short analgesia for only 3 hours after surgery. Neither low-d... more 3e7, whereas 150 mg/kg IVA produced short analgesia for only 3 hours after surgery. Neither low-dose SNB nor low-dose IVA had a significant effect. When high-dose SNB and high-dose IVA were combined, a strong antiallodynic effect was shown in an additive manner. No synergism was evidently displayed by the combination. Conclusion: Our results indicated that in an incisional pain model, multimodal analgesia is superior to single or no pretreatment; however, the combination of multimodal analgesic treatments should be individually discerned depending on nociceptive types and analgesic mechanisms.

Journal of the Formosan Medical Association, 2012

Background/Purpose: Between 10% and 20% of cancer pain patients fail to obtain adequate pain reli... more Background/Purpose: Between 10% and 20% of cancer pain patients fail to obtain adequate pain relief despite comprehensive medical management. The totally implantable programmable intrathecal drug delivery system (IDDS) is an attractive option for managing refractory cancer pain. In suitable patients, IDDS can provide reliable long-term analgesia without any permanent nerve or plexus destruction. IDDS can also allow patient care on an outpatient basis. In Taiwan, however, the experience of using IDDS in terminally ill cancer patients is very limited. Methods: This retrospective study, describes experience of managing totally implantable programmable IDDS in 6 refractory cancer pain patients including patient selection, intraspinal morphine trial, surgical techniques, complications, and drug adjustment. Pain scores and functional status were compared before and after IDDS. Results: By delivering liberal dose of intrathecal morphine, patients' pain scores decreased from 10 to 3.5. Due to much better pain control and improved quality of life, Eastern Cooperative Oncology Group performance status also improved in 4/6 patients. During the mean 5 AE 4.1 months of follow-up, two patients experienced pocket seroma, and resolved spontaneously after short-term abdominal binder compression. Otherwise, no serious complication was noted. Conclusion: Intrathecal morphine delivery by using totally implantable programmable IDDS is an effective method to relieve refractory cancer pain.

Journal of the Formosan Medical Association, 2013

Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, t... more Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations. We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of a health check-up were recruited. Neuropsychological testing on the full cognitive spectrum was evaluated at 15 minutes and 120 minutes after low-dose midazolam administration. The modified reliable change index (RCI) was used for intrapersonal comparisons and controlling for practice effects. Midazolam affected psychomotor speed (48%), memory (40%), learning (32%), working memory (17%), and sustained attention (11%), while sparing orientation and the fluency aspect of executive function at the acute stage. Residual memory (10%) and learning (10%) impairments at 2 hours after administration were evidenced in some patients. The three object recall and digit symbol coding tests can serve as useful screening tools. Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state.

Journal of Gastroenterology and Hepatology, 2006

Background: Factors determining post-colonoscopy abdominal pain remain poorly understood. Accordi... more Background: Factors determining post-colonoscopy abdominal pain remain poorly understood. Accordingly, a prospective study was conducted to reveal the key determinants. Methods: One thousand consecutive and asymptomatic patients (569 men, 431 women; mean age 51 years, range 19-84 years) undergoing total colonoscopy were evaluated to assess their abdominal pain. Their demographic data, psychological profiles (determined on the Brief Symptom Rating Scale and Maudsley Personality Inventory), and endoscopic findings were treated as independent variables in polytomous logistic regression in which pain severities were treated as outcome variables. Factors affecting the duration of pain were evaluated on multivariate linear regression. Results: Colonoscopy duration (s; odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1-1.002, P < 0.01) and female sex (OR: 1.368, 95%CI: 1.02-1.853, P = 0.03) were significantly associated with abdominal pain, but age, body mass index, psychological traits, conscious sedation, use of i.v. hyoscine butylbromide, and colonic preparation were not. Duration of the colonoscopy was longer in female than male subjects ( P = 0.04). On stepwise linear regression, irritable bowel syndrome (regression coefficient: 27.47, 95%CI: 6.99-47.67, P < 0.01) and conscious sedation (regression coefficient: − 22.17, 95%CI: − 42.52 to − 1.42, P = 0.036) were the best predictors of prolonged pain in 485 patients who had pain. Conclusions: Female sex and duration of colonoscopy increased the likelihood of postprocedural abdominal pain. Conscious sedation temporarily suppressed the pain but had no effect on its occurrence. Irritable bowel syndrome may have prolonged the discomfort.

British Journal of Anaesthesia, 2002

A case of an infant receiving orthotopic heart transplantation with over-sized donor heart was re... more A case of an infant receiving orthotopic heart transplantation with over-sized donor heart was reported. Left lower pulmonary venous obstruction after sternotomy closure was detected by transoesophageal echocardiography (TOE) and the decision to delay sternal closure was made and the clinical outcome was very satisfactory. The usefulness of intraoperative TOE monitoring and postoperative TOE follow-up for infant heart transplantation, especially in those cases of size mismatch, was well demonstrated.

Journal of Pain Research

People with pain problems are highly vulnerable to cultural disparities, and it is imperative to ... more People with pain problems are highly vulnerable to cultural disparities, and it is imperative to reduce these inequalities. This cross-sectional study aimed to develop a culturally sensitive Chronic Pain Cognition Scale (CPCS) for Chinese-/Chinese dialectspeaking populations and investigate its psychometric properties. Patients and Methods: Adult patients with chronic low back pain or chronic neck pain who visited pain clinics at a medical center in northern Taiwan were enrolled. Participants completed the demographic, intensity of pain, and two other related sensations, "Sng ()" and "Ma ()", often reported in Chinese-speaking populations, CPCS, Chronic Pain Acceptance Questionnaire-8, and Pain Self-Efficacy Questionnaire. Results: 200 patients were included. Patients' mean age was 64.84 ± 14.33, 126 (63.0%) were female, and 83 (41.5%) had 13+ years of education. The average duration of pain was 77.25 ± 97.46 months, the intensity of pain was 6.04 ± 2.50, Ma was 3.43 ± 3.24, and Sng was 4.54 ± 3.14. The CPCS comprised four factors: pain impact (how pain impact one's life), losing face (how one being disrespected due to pain), helplessness, and avoidance, with good structural validity and adequate reliability (Cronbach α, 0.60-0.81) and satisfactory criterion-related validity. Moreover, losing face, an essential concept in Chinese relationalism, was significantly related to pain, Sng, and Ma (r = 0.19, 0.15 and 0.16), but not to pain acceptance or self-efficacy, indicating a culturally specific element in pain measurement. Conclusion: The CPCS has good psychometric properties and is suitable for evaluating chronic pain in the clinical setting, and might be generalizable to other Chinese-/Chinese dialect-speaking populations.

Acta anaesthesiologica Sinica, 2003

We present a successful thromboembolectomy under intraoperative transesophageal echocardiography ... more We present a successful thromboembolectomy under intraoperative transesophageal echocardiography (TEE) monitoring on a woman with massive pulmonary embolism (PE). Sudden onset of dyspnea happened 7 days after lumbar spine surgery and ventilation/perfusion scan and angiography performed right away were suggestive of PE. Operation was performed 17 days later after invalid anticoagulant treatments and unavailing catheter fragmentation. Intraoperative TEE showed massive emboli in the main and right pulmonary arteries (MPA and RPA) and dilated right atrium (RA) with deviated intraatrial septum. Removal of the emboli was performed smoothly under TEE monitoring. The dilation of RA, right ventricle (RV) and PA were resolved soon after thromboembolectomy. The patient was extubated the next day with obvious improvement of clinical symptoms and discharged two weeks later without neurological sequale. We conclude that TEE can be an excellent tool not only for early diagnosing PE in high risk pa...

Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists, 2004

Adenosine with its rapid onset and brief duration of action has a number of clinical applications... more Adenosine with its rapid onset and brief duration of action has a number of clinical applications including treatment of paroxysmal supraventricular tachycardia and maximal coronary vasodilatation during pharmacologic stress testing. The adverse effects of adenosine include dyspnea, nausea, headache, chest pain, flushing and bronchospasam. Although there were few reports which mentioned the occurrence of bronchospam after administration of adenosine, a number of studies indicated that the use of adenosine was not contraindicated in patients with chronic obstructive pulmonary disease (COPD) or asthma. We report here a male patient with pulmonary emphysema and lung bullous disease who developed severe constriction of the main bronchi after intravenous adenosine during general anesthesia. After treatment, the patient was discharged without complications. We have reviewed the related current literature and herein discuss the reason and management of the adenosine induced bronchospasm.

We have designed a novel apparatus, the Sunscope, which integrates a semiconductor image sensor i... more We have designed a novel apparatus, the Sunscope, which integrates a semiconductor image sensor into a compact video-guided intubation system. This device consists of three separate modules: viewer, console and visual tube. The 4-inch LCD viewer panel displays the real-time video image with optimal view angle. The console is designed with respect to ergonomics allowing comfortable manipulation and internally accommodating the power supply, image processing components and connector platform for both viewer and probe. The distal end of the detachable probe is packaged with a high resolution lens, CMOS sensor, and four LEDs. The proximal end is a 6-pin connector which can be readily removed and attached on demand. The probe is detachable and disposable with length and diameter adaptable to the size of the endotracheal tube. In our preliminary test, the video-guided apparatus helped inexperienced performers to identify the vocal cords correctly and improve the success rate of intubation on the simulation model. With further improvements on the miniature design, all captured images could be transmitted to remote devices through standard wireless transmission and could thus be stored in a specific database station. The wireless technique enables image sharing on multiple devices while a powerful database can provide valuable resources for training, data mining and serial case studies. We demonstrate that the CMOS image sensor combined with advanced reduced instruction set computer machine can serve as a visual aid for tracheal intubation. The disposable station will become a revolutionary technology both in clinical practice and medical education.

Objective: Ketorolac added to tramadol as an injection mixture convenient for clinical use has be... more Objective: Ketorolac added to tramadol as an injection mixture convenient for clinical use has been shown to be an effective balanced analgesic regimen in alleviating moderate-to-severe pain. However, analytical confirmation of the compatibility and stability of this combination is not available. This study examined the compatibility and stability of this combination. Methods: Two different mixtures containing ketorolac tromethamine and tramadol hydrochloride were examined: ketorolac (10 mg/mL) and tramadol (33.3 mg/mL) prepared as injection concentrate in ampoule mingled together in the ratio of one ampoule to one ampoule; diluted ketorolac (2 mg/mL) and tramadol (20 mg/mL) prepared in saline infusion solution, with or without pH adjustment. The mixtures were visually inspected for precipitation and color change. Quantitative chemical analysis was performed on days 0, 1, 3 and 7 by high-performance liquid chromatography. Results: When stored at room temperature under ambient light, the ketorolac (10 mg/ mL)−tramadol (33.3 mg/mL) injection concentrate and ketorolac (2 mg/mL)−tramadol (20 mg/mL) solution, without pH adjustment and adjusted to pH 5−8, were physicochemically stable, and neither visible precipitation nor loss of concentration was found. With the ketorolac (2 mg/mL)−tramadol (20 mg/mL) solution adjusted to pH 9, however, precipitation occurred immediately, resulting in a significant loss of tramadol. Conclusion: This study suggests that a ready-to-use ketorolac−tramadol mixture, either undiluted or diluted in physiological saline solution, can be prepared, with a shelf life of at least 7 days when stored at room temperature under ambient light.

This is the case report on a 1-year 9-month-old boy suffering from spondyloepiphyseal dysplasia c... more This is the case report on a 1-year 9-month-old boy suffering from spondyloepiphyseal dysplasia congenita who was successfully intubated with our modified lightwand intubation procedure for general anesthesia to undergo bilateral herniorrhaphy despite the great likelihood of facing a difficult airway because of unstable cervical spine. We bent the pediatric wand after it was encased in an endotracheal (ET) tube of appropriate diameter. The light tip of the wand was let to protrude just out of the bevel of the ET tube. Once the light bulb properly transilluminated the trachea, the ET tube was threaded gently into the trachea. The patient recovered from anesthesia smoothly and was discharged on the next day. This maneuver can facilitate both visual and tactile confirmations of the position and proper tube size. The effectiveness and safety of our modified lightwand intubation procedure is well demonstrated.

Weak opioid combined with acetaminophen (APAP) has been proven to provide better analgesic effica... more Weak opioid combined with acetaminophen (APAP) has been proven to provide better analgesic efficacy and cause fewer complications than either drug alone. However, there are questions about whether different opioids, tramadol and propoxyphene, provide similar efficacy or safety. Thus, we investigated Ultracet (37.5 mg tramadol/325 mg APAP) and Depain-X (65 mg propoxyphene/650 mg APAP). The primary aims of this study were to compare the analgesic efficacy and adverse effects of single-dose oral Ultracet versus Depain-X in acute postoperative pain. This was a randomized, open-label, active-controlled parallel study on patients with postsurgical pain. Sixty patients who sustained moderate postsurgical pain (visual analog scale(3)3 cm) after undergoing implantation of venous access were randomized to two groups to receive either Ultracetor Depain-X for postoperative analgesia. Assessment items included pain intensity and pain relief ratings at the first 4 hours, and adverse events. There were initially 107 patients who were enrolled in this trial, but up to 45 (42.1%) of them were withdrawn during the study. In these 62 patients who complied with treatment (Ultracet: Depain-X = 29: 33), pain relief scale indicated that Ultracet could provide a better analgesic effect than Depain-X provided at 1 hour (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). At 4 hours, the pain score in the Ultracet group was significantly lower than that in the Depain-X group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Adverse events, such as drowsiness, dizziness, and skin itching did not differ in both groups. Among patients with mild to moderate postoperative wound pain, single-dose Ultracet can provide slightly better analgesic efficacy than Depain-X in terms of onset and duration. Depain-X is no longer marketed in Europe, America, Taiwan and other countries, therefore, Ultracet can serve as a good substitute for treating postoperative pain.

Effective airway management requires both proper technique and the appropriate devices. With the ... more Effective airway management requires both proper technique and the appropriate devices. With the widespread implementation of advanced life-support techniques in emergency medical services (EMS), orotracheal intubation is now performed not only by professional practitioners but, in many occasions, nonprofessionals. With extensively diversified skill equipped, we tested whether the Sunscope, a patented tracheal intubation device with a digital display, is able to facilitate tracheal intubation by naïve EMS personnel with various training backgrounds. We conducted a study to determine rate of success and time required to insert an orotracheal tube into a mannequin using Sunscope. The participants were placed into the professional group (i.e., anesthesiologists and emergency medical paramedics; EMT-P) or the nonprofessional group (i.e., emergency medical technicians; EMT). Intubation required three steps: equipment preparation, vocal cord exposure, and tube insertion. The time required for each step was recorded by a senior staff member, and the data were analyzed by nonparametric statistics. Each consecutive step in the operating procedure was significantly shorter for the professional group in comparison with the nonprofessional group during the first trial: equipment preparation, 10.5 ± 2.1 vs. 11.9 ± 4.1 seconds; vocal cord exposure, 7.4 ± 7.7 vs. 12.2 ± 7.7 seconds; tube insertion, 8.8 ± 4.8 vs. 17.6 ± 9.4 seconds; and total time required for intubation, 26.7 ± 8.8 vs. 35.8 ± 19.6 seconds. The professional practitioners showed no significant improvement, in terms of time reduction, on the following three trials. On the other hand, the nonprofessional practitioners showed no significant differences, in terms of time required to expose the vocal cords and total operation time, following the third trial in comparison with the professional practitioners. Our research demonstrates that professional practitioners are able to use the Sunscope on their first attempt. Despite a lack of training in conventional endotracheal intubation, emergency medical technicians (EMT-I and -II) were able to complete intubation on their first attempt; a significant reduction in the time required to intubate was noted after repeated practice. All levels of naïve EMTs were able to readily visualize the vocal cords through Sunscope and, thereby, reliably insert the endotracheal tube in less than 1 minute, regardless of their skills before testing.

Transplantation of adult-sized kidneys to pediatric patients weighing less than 10 kg is a challe... more Transplantation of adult-sized kidneys to pediatric patients weighing less than 10 kg is a challenge to both surgical and anesthetic management. For survival of the graft, a large-size kidney graft transferred to a pediatric patient needs extraphysiological cardiac output to compensate for adequate renal blood flow. We report here a boy weighing 8.4 kg who received transplantation of a kidney donated by his 56.4-kg mother. Since monitoring of the central venous pressure was not accurate enough and Swane Ganz catheterization was not feasible in this patient for monitoring the fluid status and cardiac function, we used transesophageal echocardiography to guide intravascular volume expansion and to titrate inotropic support during the surgery. It was demonstrated to be a useful tool for optimization of renal perfusion in this scenario. The transplanted graft served its function well.

The role of ultrasound examination in detection of postprocedure complications from totally impla... more The role of ultrasound examination in detection of postprocedure complications from totally implantable venous access devices (TIVAD) placement is still uncertain. In a cohort of 665 cancer outpatients, we assessed a quick ultrasound examination protocol in early detection of mechanical complications of catheterization. Immediately after TIVAD placement, an ultrasound examination and chest radiography were performed to detect hemothorax, pneumothorax, and catheter malposition. The two methods were compared. Of the 668 catheters inserted, 628 were placed into axillary veins and 40 into internal jugular veins. The ultrasound examination took 2.5 ± 1.1 min. No hemothorax was detected, and neither pneumothorax nor catheter malposition was evident among the 40 internal jugular vein cannulations. Ultrasound and chest radiography examinations of the 628 axillary vein cannulations detected five and four instances of pneumothorax, respectively. Ultrasound detected all six catheter malpositions into the internal jugular vein. However, ultrasound failed to detect two out of three malpositions in the contralateral brachiocephalic vein and one kinking inside the superior vena cava. Without revision surgery, the operating time was 34.1 ± 15.6 min. With revision surgery, the operating time was shorter when ultrasound detected catheter malposition than when chest radiography was used (96.8 ± 12.9 vs. 188.8 ± 10.3 min, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Postprocedure ultrasound examination is a quick and sensitive method to detect TIVAD-related pneumothorax. It also precisely detects catheter malposition to internal jugular vein thus reduces time needed for revision surgery while chest radiography remains necessary to confirm catheter final position.

The pivotal role of glial activation and up-regulated inflammatory mediators in the opioid tolera... more The pivotal role of glial activation and up-regulated inflammatory mediators in the opioid tolerance has been confirmed in rodents but not yet in humans. Here, the authors investigated the intraspinal cytokine and chemokine profiles of opioid-tolerant cancer patients; and to determine if up-regulated chemokines could modify opioid tolerance in rats. Cerebrospinal fluid samples from opioid-tolerant cancer patients and opioid-naive subjects were compared. The cerebrospinal fluid levels of tumor necrosis factor-alpha, CXCL1, CXCL10, CCL2, and CX3CL1 were assayed. The rat tail flick test was utilized to assess the effects of intrathecal CXCL1 on morphine-induced acute antinociception and analgesic tolerance. CXCL1 level in cerebrospinal fluid was significantly up-regulated in the opioid-tolerant group (n = 30, 18.8 pg/ml vs. 13.2 pg/ml, P = 0.02) and was positively correlated (r = 0.49, P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) with opioid dosage. In rat experiment, after induction of tolerance by morphine infusion, the spinal cord CXCL1 messenger RNA was up-regulated to 32.5 ± 11.9-fold. Although CXCL1 infusion alone did not affect baseline tail-flick latency, the analgesic efficacy of a single intraperitoneal injection of morphine dropped significantly on day 1 to day 3 after intrathecal infusion of CXCL1. After establishing tolerance by intrathecal continuous infusion of morphine, its development was accelerated by coadministration of CXCL1 and attenuated by coadministration of CXCL1-neutralizing antibody or CXCR2 antagonist. CXCL1 is up-regulated in both opioid-tolerant patients and rodents. The onset and extent of opioid tolerance was affected by antagonizing intrathecal CXCL1/CXCR2 signaling. Therefore, the CXCL1/CXCR2 signal pathway may be a novel target for the treatment of opioid tolerance.

BMC Anesthesiology, 2014

Background: Precise control of anesthetic depth during electroconvulsive therapy (ECT) is crucial... more Background: Precise control of anesthetic depth during electroconvulsive therapy (ECT) is crucial because most intravenous anesthetics have anticonvulsant effects. In this study, we investigated the association between anesthetic depth measured by the Alaris auditory evoked potential index (AAI) and seizure inducibility and seizure duration during ECT. Methods: Sixty-four ECTs were evaluated in 12 consecutive patients. General anesthesia was performed with a thiopental-based method. The relationship between the pre-ictal AAI, seizure activity and seizure duration was analyzed, and a possible threshold pre-ictal AAI to induce a seizure duration of at least 25 seconds was calculated. Results: Forty-one of the 64 ECT stimuli successfully induced seizure activity that lasted longer than 25 seconds. Pre-ictal AAI was significantly correlated to seizure duration (r = 0.54, p < 0.001) and the threshold pre-ictal AAi value was calculated to be 26 (area under curve: 0.76, sensitivity: 70.3% and specificity: 73.9%, p < 0.001). ECT with a pre-ictal AAI ≧ 26 had a higher incidence of successful seizure activity ( p < 0.001) and a longer seizure duration (55 ± 35 v.s. 21 ± 27 seconds, p < 0.001).

The Pain Clinic, 2007

ABSTRACT Introduction: Ketorolac added to morphine solution as a convenient regimen for pain mana... more ABSTRACT Introduction: Ketorolac added to morphine solution as a convenient regimen for pain management is common in clinical practice in many centers. However, the analytical confirmation of the compatibility and stability of this combination has rarely been performed. This study examined the compatibility and stability of ketorolac tromethamine and morphine hydrochloride combined in 0.9% sodium chloride injection. Materials and methods: Ketorolac tromethamine and morphine hydrochloride were mixed together in 0.9% sodium chloride injection at pH 5–9 at a final concentration of 2 mg/ml for ketorolac and 1 mg/ml for morphine. In addition, 20 different ketorolac–morphine mixture solutions were prepared by combing various concentrations of each individual drug. The compatibility and stability of these solutions were studied using high performance liquid chromatography. Results: There was no significant loss of drug, neither ketorolac tromethamine nor morphine hydrochloride, with the ketorolac (2 mg/ml) + morphine (1 mg/ml) solution at pH 5–9 at room temperature over a period of 3 days. All solutions with a multiplication product of the initial ketorolac and morphine concentration (the [K] × [M] product) of ≤ 6.25 mg2/ml2 remained stable at room temperature over a period of 14 days. However, solutions with a [K] × [M] product ≥ 7.5 mg2/ml2 were stable for no more than 3 days. Conclusions: A ketorolac (2 mg/ml) + morphine (1 mg/ml) solution can be used at physiological pH and is stable for at least 3 days at room temperature. However, mixture solutions with a [K] × [M] product greater than 7.5 mg2/ml2 may not be suitable for use after a 3-day storage period because of poor drug compatibility and stability.

Spine, 2004

Case report. To report a previously undescribed complication of prolonged retraction on the norma... more Case report. To report a previously undescribed complication of prolonged retraction on the normal common carotid artery after anterior cervical spine surgery. Previous study showed that prolonged retraction could decrease the blood flow of the common carotid artery during anterior cervical spine surgery. A case report revealed that prolonged retraction could induce the formation of thrombosis in the atherosclerotic common carotid artery. Notes review. Computed tomography of the brain was performed on the first and the fourth postoperative day. Carotid Doppler ultrasound and transcranial Doppler ultrasound were performed to evaluate the left common carotid artery and the left intracranial cerebral arteries. After lengthy anterior cervical spinal surgery, the patient did not regain his consciousness during the stay in the postoperative care unit. Large infarction of left cerebral hemisphere was revealed by computed tomography. The patient died on the seventh postoperative day of perioperative lethal stroke. We suggest that prolonged retraction, even on the normal common carotid artery, could induce lethal stroke after anterior cervical spine surgery. We recommend that retractor should be placed carefully and cerebral perfusion should be maintained adequately.

Journal of the Formosan Medical Association, 2012

3e7, whereas 150 mg/kg IVA produced short analgesia for only 3 hours after surgery. Neither low-d... more 3e7, whereas 150 mg/kg IVA produced short analgesia for only 3 hours after surgery. Neither low-dose SNB nor low-dose IVA had a significant effect. When high-dose SNB and high-dose IVA were combined, a strong antiallodynic effect was shown in an additive manner. No synergism was evidently displayed by the combination. Conclusion: Our results indicated that in an incisional pain model, multimodal analgesia is superior to single or no pretreatment; however, the combination of multimodal analgesic treatments should be individually discerned depending on nociceptive types and analgesic mechanisms.

Journal of the Formosan Medical Association, 2012

Background/Purpose: Between 10% and 20% of cancer pain patients fail to obtain adequate pain reli... more Background/Purpose: Between 10% and 20% of cancer pain patients fail to obtain adequate pain relief despite comprehensive medical management. The totally implantable programmable intrathecal drug delivery system (IDDS) is an attractive option for managing refractory cancer pain. In suitable patients, IDDS can provide reliable long-term analgesia without any permanent nerve or plexus destruction. IDDS can also allow patient care on an outpatient basis. In Taiwan, however, the experience of using IDDS in terminally ill cancer patients is very limited. Methods: This retrospective study, describes experience of managing totally implantable programmable IDDS in 6 refractory cancer pain patients including patient selection, intraspinal morphine trial, surgical techniques, complications, and drug adjustment. Pain scores and functional status were compared before and after IDDS. Results: By delivering liberal dose of intrathecal morphine, patients' pain scores decreased from 10 to 3.5. Due to much better pain control and improved quality of life, Eastern Cooperative Oncology Group performance status also improved in 4/6 patients. During the mean 5 AE 4.1 months of follow-up, two patients experienced pocket seroma, and resolved spontaneously after short-term abdominal binder compression. Otherwise, no serious complication was noted. Conclusion: Intrathecal morphine delivery by using totally implantable programmable IDDS is an effective method to relieve refractory cancer pain.

Journal of the Formosan Medical Association, 2013

Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, t... more Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations. We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of a health check-up were recruited. Neuropsychological testing on the full cognitive spectrum was evaluated at 15 minutes and 120 minutes after low-dose midazolam administration. The modified reliable change index (RCI) was used for intrapersonal comparisons and controlling for practice effects. Midazolam affected psychomotor speed (48%), memory (40%), learning (32%), working memory (17%), and sustained attention (11%), while sparing orientation and the fluency aspect of executive function at the acute stage. Residual memory (10%) and learning (10%) impairments at 2 hours after administration were evidenced in some patients. The three object recall and digit symbol coding tests can serve as useful screening tools. Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state.

Journal of Gastroenterology and Hepatology, 2006

Background: Factors determining post-colonoscopy abdominal pain remain poorly understood. Accordi... more Background: Factors determining post-colonoscopy abdominal pain remain poorly understood. Accordingly, a prospective study was conducted to reveal the key determinants. Methods: One thousand consecutive and asymptomatic patients (569 men, 431 women; mean age 51 years, range 19-84 years) undergoing total colonoscopy were evaluated to assess their abdominal pain. Their demographic data, psychological profiles (determined on the Brief Symptom Rating Scale and Maudsley Personality Inventory), and endoscopic findings were treated as independent variables in polytomous logistic regression in which pain severities were treated as outcome variables. Factors affecting the duration of pain were evaluated on multivariate linear regression. Results: Colonoscopy duration (s; odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1-1.002, P < 0.01) and female sex (OR: 1.368, 95%CI: 1.02-1.853, P = 0.03) were significantly associated with abdominal pain, but age, body mass index, psychological traits, conscious sedation, use of i.v. hyoscine butylbromide, and colonic preparation were not. Duration of the colonoscopy was longer in female than male subjects ( P = 0.04). On stepwise linear regression, irritable bowel syndrome (regression coefficient: 27.47, 95%CI: 6.99-47.67, P < 0.01) and conscious sedation (regression coefficient: − 22.17, 95%CI: − 42.52 to − 1.42, P = 0.036) were the best predictors of prolonged pain in 485 patients who had pain. Conclusions: Female sex and duration of colonoscopy increased the likelihood of postprocedural abdominal pain. Conscious sedation temporarily suppressed the pain but had no effect on its occurrence. Irritable bowel syndrome may have prolonged the discomfort.