The Effective Steroid Dose of Caudal Epidural Injection with Unilateral Epidural Catheter Position in Patients with Symptomatic Herniated Nucleus Purposus / 대한마취과학회지

BACKGROUND: The epidural steroid injection is commonly used in the management of chronic low back pain and radiating pain. We compared the efficacy of 40, 60, and 80 mg of methylprednisolone acetate in patients with lumbar herniated disc disease treated with caudal epidural block. METHODS: Seventy-two patients with lumbar herniated nucleus purposes on magnetic resonance imaging were included.All patients received fluoroscopically guided caudal epidural injections, with the guidewire-reinforced epidural catheter introduced through a Tuohy needle.After confirming the catheter tip position at the affected nerve root, contrasts were injected until patients felt discomfort in their site of pain.24 patients in each group received 40 mg, 60 mg, 80 mg of methylprednisolone acetate, respectively.We evaluated the improvements by pain relief scale (0-100%) after 2 weeks. RESULTS: There are no significant differences in the pain improvement between three groups (P = 0.537 ). CONCLUSIONS: Sixty and 80 mg methylprednisolone acetate injection during caudal epidural block showed no further benefit compared to 40 mg injection.

Comparison of cardiopulmonary hemodynamic changes according to different ethanol bolus injection doses in piglets: the applicability of the study of ethanol injection effects on cardiopulmonary hemodynamic changes in sclerotherapy of congenital arterioven / 대한마취과학회지

BACKGROUND: Ethanol injection during a sclerotherapy for the treatment of arteriovenous malformation, which performed under general anesthesia, can cause significant hemodynamic changes, even cardiovascular collapse. However, guideline for adequate management of hemodynamic change or preventing detrimental complication has still not been proposed. METHODS: Twenty-two piglets were randomly allocated to one of two groups: a 2.5 ml and a 4.0 ml ethanol. After baseline hemodynamic measurements, 2.5 ml or 4.0 ml of absolute ethanol was repeatedly administered in distal portion of renal vein with 10 minute intervals, and hemodynamic parameters were measured immediately before and after bolus injection of absolute ethanol until 10 minutes after final injection. RESULTS: Compared with 2.5 ml group, systolic, mean and diastolic pulmonary arterial pressures (PAP) and pulmonary vascular resistance (PVR) of 4.0 ml group showed significant differences from the first bolus injection of absolute ethanol. Hemodynamic parameters of 2.5 ml group did not show the increasing or decreasing tendency during a session, whereas, in 4.0 ml group, systolic, mean and diastolic PAP and PVR showed significantly increasing tendency. However, systemic arterial blood pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure, cardiac output, and systemic vascular resistance did not show increasing or decreasing tendency in both groups. CONCLUSIONS: Based on the hemodynamic alterations observed from piglet model, the bolus injection of absolute ethanol during sclerotherapy in congenital arteriovenous malformation requires careful hemodynamic monitoring. We strongly recommend that anesthesiologist should carefully monitor the hemodynamic parameters after injection of relatively large amount of absolute ethanol.

Effects of ascorbic acid on coagulation during living donor liver transplantation in adults / 대한마취과학회지

BACKGROUND: Prompt correction of hemostatic and thrombotic derangements during liver transplantation can play a key role in preventing excessive blood transfusion or thrombotic complications. It is well known that reactive oxygen species can affect coagulant and anticoagulant systems. Therefore, we investigated whether ascorbic acid (AA), one of potent antioxidant agents, can improve the coagulation during living donor liver transplantation (LDLT). METHODS: Thirty three adult patients undergoing LDLT were enrolled in this study. The blood samples of these patients were collected at 90 minutes after the beginning of operation and at 150 and 300 minutes after reperfusion. At each time period, blood samples were categorized into hypocoagulation, normal, and hypercoagulation. Within each category, the samples were further divided into three groups: whole blood (WB) (0.36 ml of native WB), AA (0.33 ml of native WB mixed with 0.03 ml of AA solution), and normal saline (NS) groups (0.33 ml of native WB mixed with 0.03 ml of NS), and these samples were analyzed using thromboelastogram (TEG). We compared the parameters of TEG (gamma time, K time, alpha angle, maximum amplitude (MA), and LY60) in each coagulation status. RESULTS: AA did not significantly affect TEG parameters in hypocoagulation or normal coagulation during LDLT. However, AA significantly decreased gamma time, alpha angle and MA at 150 minutes, and, K time and alpha angle at 300 minutes after reperfusion in the blood samples of hypercoagulation category. CONCLUSIONS: We may conclude that ascorbic acid inhibits hypercoagulation after reperfusion period during living donor liver transplantation.

Comparison of Dextrose Water and Hartmann's Solution in Each Low and High Doses for Adult Ambulatory Anesthesia: Effect on Recovery from Anesthesia / 대한마취과학회지

BACKGROUND: Adequate fluid administration for ambulatory anesthesia has not been widely studied because most patients are healthy and operations are short durations and not invasive. However, long pre-operative nothing per os (NPO) time is known to affect post-operative complications like pain, headache, dizziness, drowsiness, fatigue, nausea, vomiting, thirsty, sore throat, or well-being sensation. And amount of administered fluid or inclusion of dextrose during the operation could exercise great influence on those symptoms. Therefore, we compared four fluid regimens; 5% dextrose water 2 ml/kg (D/W2), 20 ml/kg (D/W20) and Hartmann's solution 2 ml/kg (H/S2), 20 ml/kg (H/S20) regarding to post-operative complications of ambulatory anesthesia. METHODS: One hundred and sixty ambulatory anesthesia patients of ASA 1 or 2 undergoing general anesthesia or monitored anesthesia care were randomly assigned into D/W2, D/W20, H/S2 or H/S20. Each group of patients received 5% dextrose water 2 ml/kg, 20 ml/kg, Hartmann's solution 2 ml/kg, or 20 ml/kg for 30 min, respectively. Complications like pain, headache, dizziness, drowsiness, fatigue, nausea, vomiting, thirsty, sore throat, or well-being sensation of patients were checked with systemized questionnaire check box graded 4 scales at recovery room, at evening and at 24 hours later. RESULTS: H/S20 group was better in nausea, thirsty and well-being sensation. Sixteen percent of patients showed hypoglycemia before anesthesia. Dextrose water resulted transient hyperglycemia and osmotic diuresis. CONCLUSIONS: Large amount of Hartmann's solution was generally better regarding post-operative complications. We should pay attention at peri-operative hypoglycemia for ambulatory anesthesia.

Transient Hypertension, Cardiac Arrhythmia and Prolonged ST-depression due to High Concentration Epinephrine-soaked Gauze Application during Whole Face Resurfacing for Acne Scar with Erbium-Yag Laser : A case report

Subcutaneous and topical epinephrine are widely used for hemostasis during dermatologic procedure. There was substantial variation in the amount of systemic absorption on the basis of patient's general condition, blood supply of wounds. Increased or unpredictable absorption after topical administration may increase anesthetic and cardiovascular risks. There have been no reports about cardiovascular complications developed during laser resurfacing. We experienced a case of transient hypertension, cardiac arrhythmia and ST-depression during whole face resurfacing by Erbium-Yag laser due to application of high concentration epinephrine gauze on the face. The hypertension and arrhythmia were normalized in 2 minutes, and ST-depression was sustained for about 4 hours.

The Effects of the Preoperative Education about Analgesics and Patient-Controlled Analgesia (PCA) on the Consumption of Analgesics after Operation / 대한마취과학회지

BACKGROUND: The purpose of this study is to evaluate the patients' general perception about the analgesics and the effects of the preoperative education about analgesics and patient-controlled analgesia (PCA). METHODS: One hundred patients scheduled for elective gastrectomy were randomly allocated into two groups. In control group (n = 50), patients were given conventional preanesthetic visit with questionnaire survey on PCA one day before operation. In study group (n = 50), patients were sufficiently explained about postoperative analgesia and PCA by anesthesiologist and given precise explanation sheet about PCA. Total amounts of drug used in PCA as well as rescue analgesics, the pain scores, and side effects were compared. RESULTS: 62.2% of patients had much information from various sources that analgesics effects positively in the recovery phase, but actually 73.7% of patients considered that analgesics do not seem to have any influence on the recovery after operation. There was no difference between the amounts of total PCA used, rescue analgesics, and the pain scores. However, the educated patients complained less dizziness at postoperative days (POD) one. Also, the number of patients excluded from study due to the PCA discontinuation secondary to related side effects was less in educated patients (P = 0.025). CONCLUSIONS: Preoperative education about analgesics and PCA failed to demonstrate significant decrease in the amount of analgesics and of pain scores. However, it lowered the incidence of PCA discontinuation due to side effects.

Ca2+/Calmodulin-Dependent and -Independent Mechanisms are Involved in Angiotension II-induced Contraction of Rat Aortic Smooth Muscle / 대한마취과학회지

BACKGROUND: Angiotensin II (Ang II) appears to play important roles in the pathogenesis of hypertension. However, the mechanism by which Ang II induces vascular smooth muscle contraction is not fully understood. The phosphorylation of myosin light chain (MLC) is an essential trigger of the cascade that initiates of smooth muscle contraction. In this study, we investigated the role of MLC phosphorylation on Ang II-induced vascular smooth muscle contraction. METHODS: Rat thoracic aortas were used as an experimental substrates. We measured isometric tension, myosin light chain phosphorylation, intracellular Ca2+ concentration, mitogen-activated protein kinase phosphorylation, and tyrosine phosphorylation. RESULTS: 100 nM Ang II increased smooth muscle contraction transiently in rat thoracic aorta. Ang II also increased intracellular Ca2+ and 20 kDa MLC phosphorylation. Pretreatment with 10microM verapamil and 30microM La3+ abolished the contraction developed at 30 seconds by Ang II, whereas pretreatment with 10microM verapamil and 30microM La3+ abolished the contraction and the intracellular Ca2+ increase induced at 2 minutes by Ang II. Moreover, pretreatment of 10microM verapamil, 30microM La3+ and 1microM thapsigargin abolished the contraction as well as intracellular Ca2+ increase developed at 30 seconds and 2 minutes by Ang II. However, MLC phosphorylation was not affected. GF109203X attenuated Ang II-induced contraction more so than ML-7. 100 nM Ang II increased tyrosine phosphorylation of mitogen-activated protein kinase, 68 and 125 kDa proteins. The 125 kDa protein was confirmed as paxillin in primary vascular smooth muscle cell culture. CONCLUSIONS: Ang II-induced contraction involves Ca2+-dependent and independent components, and Ca2+-dependent contraction by Ang II is mediated by voltage-dependent Ca2+ channel. Moreover, protein kinase C and the mitogen-activated protein kinase activation pathway are involved in Ang II-induced contraction.

Sudden Cardiac Arrest in the Anhepatic Phase of Living-Related Liver Transplantation: A case report / 대한마취과학회지

We experienced a case of unexpected sudden cardiac arrest, which developed during the anhepatic phase of living-related liver transplantation. The patient was a 56-year old man diagnosed with liver cirrosis. He had stable angina and congestive heart failure. Preoperative EKG, chest x-ray, arterial blood gas analysis and vital signs were all within normal limits. Cardiac echography was normal except for left atrial enlargement and diastolic dysfunction (grade I). Coronary angiography showed no coronary stenosis. About 10 min after the inferior vena cava had been clamped, the sinus rhythm changed suddenly to ventricular tachycardia. Lidocaine was administered and the PA catheter removed immediately but ventricular fibrillation and asystolic cardiac arrest followed. Cardiac rhythm returned about 15 min after the onset of asystole, followed by supraventricular tachycardia (up to 180 beats/min). The EKG suddenly returned to a normal sinus rhythm. He had no further episodes of arrhythmia and recovered without complication.

The Effects of Intravascular Volume Expansion on the Stability of Hemodynamic Responses in Patients undergoing Carotid Endarterectomy / 대한마취과학회지

BACKGROUND: During carotid endarterectomy, hemodynamic stability is very important to reduce the incidence of cerebral stroke and myocardial infarction. Therefore, we studied the effects of intravascular volume expansion using colloid solution on hemodynamic stability. METHODS: We studied 22 patients undergoing elective surgery under general anesthesia. Preanesthetic mean arterial blood pressure (MABP) and heart rate (HR) were checked, and the intraoperative target range was taken +/- 20% of these values. Following standardized anesthetic technique including intravenous induction with thiopental sodium and vecuronium, standard intraoperative monitoring and direct arterial blood pressure monitoring were instituted. Patients were randomly assigned to a Hartmann's solution group (group H, n = 11) or a pentastarch group (group P, n = 11). Distinct intraoperative episodes beyond the predetermined target range, and the number of episodes requiring interventional therapy were recorded. RESULTS: The pentastarch group had a significantly lower incidence of episodes requiring interventional drug therapy during the pre-reperfusion period. No difference was found between out of target incidents in MABP and HR. CONCLUSIONS: During carotid endarterectomy, the infusion of pentastarch solution reduced drug therapy requirement for hemodynamic stability during pre-reperfusion period only.

Anesthetic Management of Pulmonary Arterial Pressure Change during the Ethanol Sclerotherapy of Peripheral Arteriovenous Malformations / 대한마취과학회지

BACKGROUND: We frequently experience the elevation of pulmonary arterial pressure (PAP) during ethanol sclerotherapy of arteriovenous malformations. But, the study on the degree of PAP elevation during ethanol sclerotherapy has not yet been made. Therefore, we evaluated the PAP elevation during ethanol sclerotherapy. METHODS: We retrospectively reviewed PAP changes in 124 procedures conducted on 41 arteriovenous malformation patients during ethanol sclerotherapy. We investigated the degree of elevation of PAP and the incidences of pulmonary arterial hypertension during ethanol sclerotherapy. RESULTS: High incidences of pulmonary arterial hypertension were observed during ethanol sclerotherapy (53/124 procedures, 42.7%). The mean highest PAP values were 33.8 +/- 10.9 mmHg (systolic), 25.2 +/- 7.9 mmHg (mean), and 18.3 +/- 7.4 mmHg (diastolic). Incidence of nitroglycerine administration was 47.5% (59/124 procedures). Mean PAP values at the end of procedure was 29.1 +/- 9.1 mmHg (systolic), 22.0 +/- 7.0 mmHg (mean), and 16.1 +/- 6.4 mmHg (diastolic). Conclusion: The incidences of pulmonary hypertension during ethanol sclerotherapy were high. Therefore, cautious management and close cooperation between anesthesiologist and interventional radiologist are essential to prevent dreadful outcome.

The Effect of Prehydration on Sensory Block Level in the Isobaric Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Even though the effect of prehydration on the spinal anesthesia-induced hypotension has not yet been concluded, prehydration prior to spinal anesthesia is recommended in order to reduce the incidence and severity of hypotension. We investigated the effects of prehydration on hemodynamic change during spinal anesthesia with isobaric 0.5% tetracaine. METHODS: We prospectively performed this study on 96 patients who underwent elective transurethral surgery from October 2002 to January 2004. Patients were randomly allocated to receive either no prehydration or 10 ml/kg crystalloids administered over 10 15 min prior to spinal anesthesia. We compared dermatomal spreads of spinal anesthesia, hemodynamic parameters (blood pressure, heart rate), incidences of hypotension and bradycardia between two groups. RESULTS: Hemodynamic parameters, incidences of hypotension and bradycardia showed no statistically significant differences during spinal anesthesia between two groups. There were statistically significant differences in the dermatomal spread of sensory levels between two groups from 5 to 90 min after spinal anesthesia. Sensory block levels in prehydration group were statistically lower than no prehydration group. CONCLUSION: We hypothesized that prehydration can be one of factors that influence on dermatomal spread of local anesthetics in isobaric spinal anesthesia. The difference of dermatomal spread between two groups may be caused by brain blood barrier (BBB)-freely passing crystalloids, which may influence on the volume and density of cerebrospinal fluids. To verify this phenomenon found in our study, further investigation is still warranted.

Effects of Intravenous Patient Controlled Analgesia with Morphine, Meperidine or Fentanyl on Bowel Function after Gastrectomy / 대한마취과학회지

BACKGROUND: Although opioids are widely used and effectively control postoperative pain, they contribute to the delayed recovery of gastrointestinal function. The aim of this study was to investigate the effects of intravenous patient controlled analgesia (iv PCA) with morphine, meperidine or fentanyl on postoperative bowel function. METHODS: Sixty ASA physical status I or II adult patients who were scheduled for elective gastrectomy were randomly allocated to morphine, meperidine, or fentanyl groups. After administering an initial bolus dose of morphine 5 mg, meperidine 25 mg, or fentanyl 50microgram at OR, each iv PCA pump was started at PACU. The following program was used: morphine group-concentration 3 mg/ml, basal infusion rate 1.5 mg/hr, bolus 1.5 mg, meperidine group-concentration 15 mg/ml, basal infusion rate 7.5 mg/hr, bolus 7.5 mg, fentanyl group-concentration 30microgram/ml, basal infusion rate 15microgram/hr, bolus 15microgram. The lockout time was 15 min in all groups. Postoperative pain at rest was evaluated with NRS (0-100) 6, 24, 48 and 72 hr after the end of surgery. Times from end of surgery to the passage of the first flatus were recorded. RESULTS: Pain scores were comparable at rest in the three groups over the three postoperative days. Time from the end of surgery to the first postoperative flatus was 116.6 +/- 13.2 hr in morphine group, 97.5 +/- 17.6 hr in meperidine group, and 91.8 +/- 19.1 hr in fentanyl group. Time from the end of surgery to first postoperative flatus was significantly longer in the morphine group than in the other two groups (P = 0.002, P = 0.000). Side effects were not significantly different among the groups. CONCLUSIONS: Meperidine or fentanyl were found to have an advantage in terms of bowel function over morphine when used for iv PCA after gastrectomy.

The Effects of 0.45% and 0.9% Saline Solutions on Serum Sodium Concentrations in Chronic Renal Failure Patients / 대한마취과학회지

BACKGORUND: To choose optimal potassium free solutions in chronic renal failure patients, we studied the effects of 0.45% or 0.9% saline solutions on the serum sodium concentrations of patients undergoing kidney transplantation surgery. METHODS: Sixty two patients, ASA physical status iii iV, undergoing kidney transplantation surgery, were allocated to receive either 0.45% saline (n = 26) or 0.9% saline solutions (n = 36). The patients received 2 L of 0.45% or 0.9% saline solutions with a CVP of 10 mmHg prior to a renal vein anastomosis. Serum sodium and potassium concentrations were measured before (Na0, K0) and after the administration of 2 L of 0.45% or 0.9% saline solutions (Na2, K2), respectively. RESULTS: Serum sodium concentrations decreased after the administration of 0.45% saline solutions, and after administrating 2 L of 0.9% saline, the serum sodium concentrations increased in patients with baseline serum sodium concentrations lower than 136 mEq/L. When we administered 0.9% saline, which had a sodium concentration lower than the serum sodium concentration, the serum sodium concentration measured after 2 L of 0.9% saline infusion proportionally decreased in patients with baseline serum sodium concentration greater than 136 mEq/L (P<0.001). CONCLUSiONS: For ideal fluid selection in chronic renal failure patients, this study suggests a 0.45% saline solution for chronic renal failure patients with a baseline serum sodium concentration below the normal range and a 0.9% saline solution for patients with a baseline sodium concentration within the normal range.

Clinical Experience of the Anesthetic Management of Mucopolysaccharidosis / 대한마취과학회지

Mucopolysaccharidosis is characterized by the progressive accumulation of glycosaminoglycans in multiple organs. Valve and coronary involvement, upper airway obstructive disease, joint stiffness, and mental retardation are associated perioperative anesthetic risks. Nineteen patients and 23 anesthetic cases were presented for elective surgery. The mean patient age was 10.8 years. General anesthesia was administered in 21 cases and intubation was failed in two. Mask ventilation without intubation was performed in two cases in day surgery unit. In one case, spinal anesthesia was performed. Otolaryngologic procedures, i.e., tonsillectomy and adenoidectomy, and ventilation tube insertion were most common. Percutaneous endoscopic gastrostomy and herniorrhaphy were also frequent. Dexamethasone was given to all intubated cases and all patients were extubated in the postanesthesia care unit or in the intensive care unit. There was no perioperative mortality. Cautious airway management until intubation is recommended and mask ventilation with short-acting inhalation or intravenous anesthetics is enough to manage relatively short procedures. For herniorrhaphy, a spinal block could be used.

Persistent Myoclonus after Propofol Anesthesia / 대한마취과학회지

There are a few case reports describing prolonged myoclonus following propofol. A previously fit 26 year old woman presented for a left knee lateral impingement under general anesthesia as a day case. She had no personal or family history of epilepsy. Induction was smooth and anesthesia was maintained with propofol TCI, nitrous oxide 65% and oxygen 35%. 30 minutes after stopping of the propofol infusion, the patient developed involuntary movement and shivering that recurred intermittently. After drug therapy and psychotic therapy the patient was progressively stabilized. However 4 hours later the patient developed involuntary movement and myoclonus. She was admitted to the department of neurology under the diagnosis of propriospinal myoclonus. Forty days later she was discharged without long term sequelae.

The Negative Effects of Patient Controlled Sedation Using Midazolam for Cataract Surgery under Retrobulbar Block / 대한마취과학회지

BACKGROUND: Careful sedation is needed for cataract operation that requires absolute cooperation of elderly patients. Patient-controlled sedation (PCS) allows patients themselves change the dose of sedatives along with their need. The goal of this study was to find out midazolam PCS could achieve an adequate sedation without complications during cataract surgery and the differences of patients who needed PCS or not. METHODS: PCS with midazolam was applied to 33 patients undergoing cataract surgery using retrobulbar block (midazolam, bolus 0.5 mg, lock out interval 3 minutes, 1 hour limit 4.5 mg). PCS pump was given to patients 30 min before retrobular block. And patients themselves decided to use or not to use PCS after full explanation on PCS. Sedation score, visual analogue scale of anxiety, cognitive function, side effects and satisfaction of PCS were measured. RESULTS: PCS users were 22 (67%). Mean midazolam dosage of PCS users was 2.03 mg. Preoperative and intraoperative anxiety score were 40.2 mm and 13.0 mm in PCS users and 15.5 mm and 21.8 mm in non-users. The difference between PCS users and non-users was only preoperative anxiety levels. Age, sex, weight, education levels, previous cataract surgery, preoperative desired sedation levels did not influence on the PCS using. There was positive correlation of midazolam doses with only preoperative anxiety levels. 76% of surgeons and 85% of patients were satisfied with PCS but 7 patients showed involuntary movement. Cognitive functions and discharge time were not influenced by PCS. CONCLUSIONS: Although patients and surgeons were satisfied with the midazolam PCS, 33% of patients did not need PCS and deep sedation with involuntary movement that could bring surgical complications was resulted in some PCS users. We conclude that PCS for cataract surgery would be safer when it is administered under careful supervision of anesthesiologist.

Identification of Epidural Space with a Pressure Detection Apparatus / 대한마취과학회지

BACKGROUND: Techniques for identification of the epidural space have advantages and disadvantages. We made an electronic apparatus to ensure an epidural space by detecting the reduction of pressure. We investgated the instrument to see if this could be adequately used for identification of the epidural space. METHODS: Thirty adult patients scheduled to receive an epidural injection for surgery were selected for the investigation. We connected the apparatus with an epidural Tuohy needle of which the tip was in the ligamentum flavum. We injected air to increase the pressure inside the epidural needle to 50 mmHg or 100 mmHg, and then the epidural needle was advanced slowly until we heard the alarm from the epidural detector when pressure inside the epidural needle suddenly decreased under the set point, suggesting the epidural needle reached the epidural space. After ensuring the epidural space we injected the anesthetics to induce epidural anesthesia. RESULTS: In both groups, we obtained successful anesthesia results and there were no complications. The volume of air injected into the epidural space was 0.64 +/- 0.1 in 50 mmHg group and 0.95 +/- 0.2 in 100 mmHg group. CONCLUSIONS: The use of the epidural detector in 30 patients demonstrated that this instrument could be a safe and effective means of identifying the epidural space. It allows the reduction of air injected into the epidural space, reducing the chance of complications due to an overinjection of air.

Total Intravenous Anesthesia for Freeman-Shelden Syndrome / 대한마취과학회지

Freeman-Sheldon syndrome (FSS) is a rare congenital myopathy and dysplasia characterized by a whistling mouth and hand-foot anomalies. There are several anesthetic challenges like difficult airway and intravenous access, and the possibility of malignant hyperthermia. We controlled the anesthetic management of a patient with FSS undergoing contractured thumb correction. Intubation was done with a tracheal tube by direct laryngoscopy after three failed attempts. An anesthetic technique triggering malignant hyperthermia was not used. Anesthetic agents used were ketamine, propofol, fentanyl and nitrous oxide under spontaneous respiration. The child had an uneventful anesthetic course and no sign or symptoms of malignant hyperthermia.

The Effects of Oral Clonidine on the Cytokines and Stress Hormone Responses in Patients Undergoing Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: Surgery cause alterations in immune and neuroendocrine responses. Cytokines and stress hormones are importanat mediators which modulate the various immune reactions. The aim of present study is to investigate whether clonidine premedication can affect on the concentrations of cytokines and stress hormones in abdominal hysterectomy patients. METHODS: Twenty two healthy women undergoing abdominal hysterectomy were randomly allocated to two groups: eleven control patients and eleven clonidine(0.15 mg) pretreated patients. Variations in blood cytokines, Interleukin-1beta(IL-1beta), IL-2, IL-6 and tumor necrosis factor-alpha(TNF-alpha), and stress hormones, cortisol and ACTH were studied. Blood sampling were conducted 4 times in each patient: after induction, after incision, after surgery 1 h and 3 h. Cytokines assays were carried out with commercially available ELISA kits, and cortisol with radioimmunoassay and ACTH with immunoradiometric assay. RESULTS: IL-1beta increased early and the concentrations of IL-1beta in clonidine treated group were significantly lower than control. The mean concentrations of IL-2 at 1 and 3 h after surgery were slightly higher than after induction in clonidine treated group. IL-6 increased significantly at 3 h after surgery in both groups. Clonidine lowered IL-6 during the whole period. TNF-alpha, and cortisol and ACTH concentraitons were not affected by clonidin. CONCLUSIONS: Clonidine pretreatment decreased IL-1beta and IL-6 concentrations, but not stress hormones in response to abdominal hysterectomy.

Comparision of Effects and Complications of Diprivan (ICI Pharm Co.) and Pofol (Dong - guk Pharm Co.) / 대한마취과학회지

BACKGROUND: Propofol is a rapidly acting alkylphenol compound. Pofol is another alkylphenol compound that was made by Dong-guk Pharm Co. in Korea. This study was performed to evaluate the efficacy and complications of pofol in comparison with diprivan. METHOD: Fourty three unpremedicated patients were randomly allocated to receive one of two i.v. anesthetic agents(pofol and diprivan). We assessed the induction dose, the time to loss of consciousness, time to opening eyes on command, changes of vital sign and various complications of the two drugs. RESULT: There were no differences in induction dose and maintenance dose between pofol group (P) and diprivan group (D). The induction times of P were shoter than those of D and the recovery times of P longer than those of D. Both groups produced a significant fall in mean arterial pressure(MAP) and heart rate(HR) but there were no differences in changes of vital sign between two groups. There was no difference in incidence of pain between D and P (83% Vs 80%). Even though the characters of adverse events to P and D, the incidence rate was not different between two groups. CONCLUSION: There is no differences in efficacy and complication of pofol in comparison with diprivan except differences in induction times and recovery times between two groups. So we can use the pofol as the i.v. anesthetics as diprivan and further evaluations in induction times and recovery times are needed.