The Effect of Epidural Triamcinolone for Prevention of Back Pain after Lumbar Epidural Anesthesia in Cesarean Section / 대한마취과학회지

BACKGROUND: Postoperative patients frequently associate postoperative backache with epidural anesthesia administered for the operation. Epidural steroids are often used for the treatment of low back pain. We performed this study to compare the effect of epidural triamcinolone on the incidence and severity of postepidural backache after cesarean section. METHODS: Eighty patients scheduled for cesarean section under epidural anesthesia using 2% lidocaine received 40 mg of triamcinolone (n=40) or 1ml of normal saline (n=40) epidurally via indwelling catheter after delivery. Backache were checked preoperatively and 24, 48, 72hr postoperatively using VAS score. A patient was considered to have postepidural backache when the postoperative VAS score was higher than the preoperative score. RESULTS: The incidence and severity of postepidural backache were much less in triamcinolone group than in control group (p<0.05). CONCLUSION: Epidural triamcinolone has a preventive effect on postepidural backache in cesarean section patients.

Efficacy of an Epidural Test Dose with Intravenous Isoproterenol in Enflurane-Anesthetized Adults / 대한마취과학회지

BACKGROUND: The efficacy of an epidural test dose for detecting inadvertent intravascular injection during general anesthesia with volatile anesthetics has not been clearly determined. The object of this study is to evaluate the efficacy of a simulated intravenous isoproterenol test dose in adult patients anesthetized with O2-N2O-enflurane. METHODS: Forty-five healthy adult patients were anesthetized with 1 vol% enflurane and nitrous oxide after endotracheal intubation and were randomized to one of three groups according to the dose of isoproterenol. Isoproterenol 1, 2 and 3 microgram groups (n = 15 each) received 3 ml of 2% lidocaine with 1, 2 and 3 microgram isoproterenol IV respectively, to simulate an intravascularly administered test dose. HR and systolic blood pressure were measured at 20-s intervals for 4 min after injection. RESULTS: Mean maximal heart rate increases were 15 8, 21 8, and 27 10 bpm (mean SD) in the isoproterenol 1, 2 and 3 microgram groups, respectively. Isoproterenol 3 microgram produced 100% sensitivity in the modified (> or = 10 bpm increase) HR criteria and 67% sensitivity in the conventional (> or = 20 bpm increase) HR criteria. CONCLUSIONS: To determine whether an epidural catheter may be in a blood vessel, various vasoactive drugs are often administered. The epidural test dose containing 3 microgram isoproterenol might be a reliable marker for intravascular injection based on the modified HR criterion.

Efficacy of an Epidural Test Dose with Intravenous Isoproterenol in Enflurane-Anesthetized Adults / 대한마취과학회지

BACKGROUND: The efficacy of an epidural test dose for detecting inadvertent intravascular injection during general anesthesia with volatile anesthetics has not been clearly determined. The object of this study is to evaluate the efficacy of a simulated intravenous isoproterenol test dose in adult patients anesthetized with O2-N2O-enflurane. METHODS: Forty-five healthy adult patients were anesthetized with 1 vol% enflurane and nitrous oxide after endotracheal intubation and were randomized to one of three groups according to the dose of isoproterenol. Isoproterenol 1, 2 and 3 microgram groups (n = 15 each) received 3 ml of 2% lidocaine with 1, 2 and 3 microgram isoproterenol IV respectively, to simulate an intravascularly administered test dose. HR and systolic blood pressure were measured at 20-s intervals for 4 min after injection. RESULTS: Mean maximal heart rate increases were 15 8, 21 8, and 27 10 bpm (mean SD) in the isoproterenol 1, 2 and 3 microgram groups, respectively. Isoproterenol 3 microgram produced 100% sensitivity in the modified (> or = 10 bpm increase) HR criteria and 67% sensitivity in the conventional (> or = 20 bpm increase) HR criteria. CONCLUSIONS: To determine whether an epidural catheter may be in a blood vessel, various vasoactive drugs are often administered. The epidural test dose containing 3 microgram isoproterenol might be a reliable marker for intravascular injection based on the modified HR criterion.

Two-dimensional Ultrasound-guided Cannulation of the Internal Jugular Vein / 대한마취과학회지

BACKGROUND: Internal jugular vein access is an essential part of patient management in many clinical settings and is usually achieved with a blind, anatomical landmark-guided technique. The purpose of this study is to evaluate whether a 2-dimensional ultrasound technique can improve on the traditional method. METHODS: Eighty patients undergoing elective open heart surgery were randomly assigned to an anatomical landmark group or ultrasound group (each n = 40). With the patient in the supine position, the head was rotated 30o to the contralateral side and triangle formed by the clavicle and both heads of the sternocleidomastoid muscle were identified. We accessed the internal jugular vein from the apex of the triangle toward the ipsilateral nipple in the anatomical landmark group. The internal jugular vein and carotid artery were visualized with two-dimensional ultrasound. We compared the number of advances made with the central venous cannulation needle, the time to blood aspiration, complications and failure rate. RESULTS: The failure rate was 22.5% using the anatomical landmark technique and 5% using the ultrasound technique. The vein was entered on the first attempt in 60% of patients using the landmark technique and in 63% using ultrasound (P>0.05). Mean attempts for puncture were 1.9 (anatomical) vs 1.6 (ultrasound-guided) (P>0.05). Complications occurred in 20% of cases using anatomical landmarks and in 5% using ultrasound (P>0.05). The average access time was 26.5 seconds by the anatomical approach and 56 seconds by the ultrasound approach (P< 0.05). CONCLUSIONS: Ultrasound-guided cannulation of the internal jugular vein did not significantly decrease failure rate, access time, complications, and attempts for puncture, nor did it increase the amount of successful first attempts. However an investigation using a larger number of patients will be needed.

The Effect of Injection Direction during Hyperbaric Tetracaine Spinal Anesthesia with Pencil-Point Needle / 대한마취과학회지

BACKGROUND: Pencil-point needle currently are used for spinal anesthesia because of an alleged lowered incidence of postdural puncture headache. Although the direction of the side hole is one of the important factors that might affect the level and the duration of anesthesia, those data are not readily available. The aim of this study was to assess if the side hole direction of pencil-point needle during hyperbaric tetracaine injection affects the level and the duration of anesthesia. METHODS: We induced spinal anesthesia in 80 young men presenting for elective orthopedic surgery. Patients were allocated randomly with the side hole direction of the 25 gauge pencil-point needle in one of the four directions; cephalad, caudad, left lateral, right lateral. Hyperbaric 0.5% tetracaine 15~17 mg (3 to 3.4 ml) was injected with the speed of 0.75 ml/sec. Maximum sensory block level, time to maximum sensory block level, duration of sensory block (2 segments regression time) were assessed by a blinded observer with the pin-prick test and degree of motor block were measured by Bromage motor scale. Data were analysed using the Kruskal-Wallis test followed by the Mann-Whitney U test and chi-square test as appropriate (SAS v. 6.04). RESULTS: Time to maximum sensory block level was significantly fast in group 'cephalad'. Other values have no statistical differences. Post-spinal headache was observed in one case in group 'caudad'. CONCLUSIONS: Using the pencil-point needle, the time to maximum sensory block level was fast in group cephalad but there were no differences in the maximum sensory block level and the duration of sensory block among the four groups.