Comparison of the Optimal Depth of the Internal Jugular Venous Catheterization between Right and Left / 대한마취과학회지

BACKGROUND: The purpose of this study was to measure and compare the optimum depth of the internal jugular venous catheterization between the right and left side. METHODS: Forty-four patients were enrolled for this study and divided into two groups (22 patients each). The optimum depth of the catheterization was calculated using the sum of two component (A and B); the advanced length of the catheter from the level of the cricoid cartilage (A) and the distance from the catheter tip to the junction of the superier vena cava and right atrium (B). RESULT: The optimum depths of the internal jugular venous catheterization were 16.0 1.0 cm (right) and 18.4 1.5 cm (left) respectively. Left side was significantly longer than right side (p<0.05). In this study, we experienced some complications; arterial punctures (5 cases) and migration of the catheter to the opposite subclavian vein (1 case). Five complications were associated with left internal jugular venous cannulation and one was associated with the right side cannulation. CONCLUSION: We concluded that the optimum depth of the internal jugular venous catheterization was longer in the left side than in the right side.

Neuromuscular Blocking and Cardiovascular Effects of Pipecuronium Comparing with Pancuronium and Vecuronium / 대한마취과학회지

BACKGROUND: Pipecuronium bromide is a long-acting steroidal neuromuscular blocking drug. This study was designed to evaluate the neuromuscular-blocking action and the cardiovascular effects of pipecuronium in patients under O2-N2 O-enflurane anesthesia, by comparing with those of pancuronium and vecuronium. METHODS: Fifty-one adult patients (ASA class 1 or 2) were randomly received pipecuronium 0.1 mg/kg (n=17), pancuronium 0.12 mg/kg (n=17), or vecuronium 0.1 mg/kg (n=l7) as a single intravenous bolus dose. Anesthesia was induced with thiopental 5 mg/kg, followed by one of the muscle relaxants. Patients were then given O2 (2 L/min) - N2O(2 L/min)-enflurane(1.8 vol%) by face mask. Trachea was intubated, and anesthesia was maintained with O2 (2 L/min)- N2O(2 L/min)-enflurane(1-2.5 vol%) during whole study period. Neuromuscular blocking effect was assessed by response of the adductor pollicis muscle in 2Hz train-of-four(TOF) stimulation of ulnar nerve every 20 seconds. The times from administration of initial dose to loss and reappearance of four twitches to TOF were measured. Systolic and diastolic blood pressure(SAP,DAP) and heart rate(HR) were noninvasively measured. RESULTS: The onset times of pipecuronium, pancuronium, and vecuronium were 278+/-99, 268+/-67, and 208+/-56 seconds, respectively. The duration of action of pipecuronium, pancuronium, and vecuronium were 148+/-99, 145+/-35, and 52+/-12 minutes, respectively. SAP and DAP with pancuronium were significantly greater than those with pipecuronium or vecuronium I minute after the administration. No significant difference in SAP and DAP was found until 5 minutes after the administration among the agents. HR was increased significantly until 20 minutes after the administration of pancuronium. CONCLUSION: Pipecuronium is a long-acting drug suitable for longer operations in which cardiovascular stability is required.

Blood Pressure and Heart Rate Changes and the Patient Response following I.V. Administration of Fentanyl during Awake Fiberoptic Nasotracheal Intubation / 대한마취과학회지

The purpose of this prospective study was to evaluate the patient response and the changes of blood pressure and heart rate following intravenous administration of various dosage of fentanyl during awake fiberoptic nasotracheal intubation. After verbal informed consent, the 44 ASA status I or II patients undergoing oral and maxillofacial surgery were randomly assigned to receive 0(N=11), 1(N=11), 2(N=11), 3(N=l1) ug/kg of fentanyl, On arrival to operating room, midazolam 2 mg and glycopyrrolate 0.2 mg were administered for premedication. And then, EKG, blood pressure and peripheral O2 saturation were monitored continuously. Local anesthesia was induced with the gargling of 4% lidocaine 10ml, the transtracheal injection of 4% lidocaine 3ml and nasal spray 10% lidocaine 0.5ml. After that each dose of fentanyl was given to each groups. And then fiberoptic intubation was performed with continuous verbal contact to confirm the patient response and ventilatory status during intubation. During fiberoptic intubation, the peak level of blood pressure and heart rate were recorded. We compare the difference of blood pressure and heart rate between the value of just before fiberoptic intubation and the peak value during fiberoptic intubation and discomfort score according to fentanyl dosage on the first day of postoperation. The change of blood pressure and the time required for intubation was less and shortest in the 2 ug/kg of fentanyl group. But there were no significant differences in heart rate and discomfort score. We conclude that 2 ug/kg of fentanyl minimize the change of blood pressure as well as intubation time. But the change of dosage of fentanyl was not helpful to decrease the discomfort score.