The effect of spectral entropy monitoring on propofol use and recovery in children

BACKGROUND: The evaluation of anesthetic depth using electroencephalography showed reduction in recovery time from anesthesia and decrease in the amount of anesthesia used. This research compared the dosage of propofol and the recovery characteristics when anesthesia was controlled using spectral entropy monitoring and when it was controlled by hemodynamic changes. METHODS: Seventy children of the American Society of Anesthesiologists physical class I-II, ages 3-10, that were scheduled for general anesthesia were randomly distributed into two groups. The children were sedated with midazolam (0.15 mg/kg), and anesthesia was induced with fentanyl (2.0 microg/kg), propofol (2.5 mg/kg), and rocuronium (0.6 mg/kg). Anesthesia was maintained with propofol continuous IV infusion under N2O in O2. For the Entropy Group, the state entropy (SE) was maintained at 40-60, and for the Standard Group, anesthesia was maintained so that the heart rate and systolic blood pressure were at 20% of the standard value. RESULTS: Last 10 minutes of the surgery, the SE and RE (Response entropy) were significantly higher for the Entropy Group when compared to the Standard Group (P < 0.05). The maintenance dose of propofol was significantly lower for the Entropy Group when compared to the Standard Group (P < 0.05). The times taken for recovery were all significantly shorter for the Entropy Group than the Standard Group (P < 0.05). CONCLUSIONS: Entropy guided anesthetic administration was associated with reduced propofol use and faster recovery in children compared to standard practice.

Efficacy and Safety of Positive Pressure Ventilation through A ProSeal Laryngeal Mask Airway during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: We evaluated the efficacy and safety of positive pressure ventilation (PPV) with a ProSeal laryngeal mask airway (PLMA), as compared with an endotracheal tube (ETT) and with a classic laryngeal mask airway (LMA) during laparoscopic cholecystectomy. METHODS: One hundred, ASA 1, 2 adults scheduled for elective laparoscopic cholecystectomy were randomly assigned to ETT, LMA or PLMA. Anesthesia was induced with fentanyl 2 microgram/kg, lidocaine 0.5 mg/kg and propofol 2 mg/kg and maintained with a continous infusion of propofol 6-12 mg/kg/h in 67% N2O, atracurium and fentanyl. ETT, LMA or PLMA was placed with atracurium 0.5 mg/kg. Respiratory and hemodynamic parameters were measured before and after intraabdominal CO2 insufflation. The surgeon assessed the degree of gastric distension change using a laparoscope. RESULTS: Oxygen saturation, end tidal CO2, inspiratory pressure, expiratory tidal volume and compliance of the respiratory system were similar in the three groups. Blood pressure and heart rate were lower in the PLMA and LMA groups than in the ETT group 5 min after induction (P < 0.05). Audible gas leakage occurred more so in the LMA group (48.5%) than in the PLMA group (8.8%). Because of inadequate ventilation, endotracheal intubation was changed in one case in the LMA group. The degrees of gastric distension change were similar in the three groups. The PLMA and LMA resulted in less coughing after removal than ETT (P < 0.05). A postoperative sore throat and dysphagia were similar in the three groups, but dysphonia was more frequent in the ETT group. CONCLUSION: During laparoscopic cholecystectomy, PPV with PLMA provide more effective pulmonary ventilation than LMA and fewer side effects than ETT.

Accidental Intrathecal Adminstration of Acetylcysteine: A case report / 대한마취과학회지

We report a case of accidental intrathecal administration of Nucomyt(R)(acetylcysteine), a mucolytic agent used for intratracheal instillation. A 21-year-old healthy female with a complete syndactyly at the 4th and 5th toes was scheduled for a web release under spinal anesthesia. Immediately after accidental intrathecal administration of Nucomyt(R)2.4 ml instead of bupivacaine for spinal anesthesia, tonic extension developed at first in the lower extremities and then the upper extremities, too. Thiopental sodium 200 mg was injected intravenously twice. Endotracheal general anesthesia with N2O- enflurane-vecuronium was maintained for the operation for about two hours. For about 1 hour after emergence of general anesthesia, tonic extension intermittently developed in the lower extremities and was controlled with midazolam. Mild elevated blood pressure, tachycardia, tachypnea, high fever (up to 38.5degrees C) and respiratory acidosis occurred. Thirty minutes later, she became mentally clear with a normal neurologic examination. No delayed sequelae were detectable at a follow-up visit 1 month and 1 year after surgery.

The Relationship of the Estimates of Effective Concentration Calculated by Logit, Probit, and Sigmoid Emax / 대한마취과학회지

BACKGROUND: This study is to demonstrate that the estimates of effective concentration (EC) inferred by logit, probit, and sigmoid Emax can be declared to be similar. METHODS: The estimates of EC (5, 25, 50, 75, 95 [%]) of 24 vecuronium concentration-single twitch response data were obtained with three pharmacodynamic methods. A paired t-test with Bonferroni's correction was used. RESULTS: The distribution of estimates by probit were narrower than that of those by logit and sigmoid Emax. The estimates of logit and sigmoid Emax were closely similar. CONCLUSIONS: It suggests that the EC estimates of other paper analysed by the different pharmacodynamic method could be lower or higher.