Awareness and Recall During Anesthesia with Propofol-N2O or Thiopental-Enflurane-N2O for Cesarean Section / 대한마취과학회지

BACKGROUND: Experience of awareness and recall during general anesthesia would be most distressing for patients. Especially for the cesarean section, medical team must consider both maternal awareness and fetal safety. Authors tried to know the possibility of propofol use as induction and maintenance agent of anesthesia for the cesarean section in respect of maternal awareness, recall and fetal safety. METHODS: Forty patients (ASA physical status 1, 2) were allocated randomly to either propofol (n=20) (P) or thiopental-enflurane (n=20) (T-E) group. We checked B.P, pulse rate, and the incidence of maternal awareness using the isolated forearm technique (IFT). The postoperative interview was conducted between 12~24h after operation. RESULTS: The incidence of maternal awareness signaled by flexing fingers in response to voice commands were significantly lower in the T-E group (20% after induction, no response during other times) than the P group (45% after induction, then 35%, 30%, after 5, 10 min delivery respectively). Seven patients had postoperative recall of introspective awareness in the P group but no patients in the T-E group. The 1 min Apgar score of the newborn were significantly lower in the P group than the T-E group but both groups were within normal range. CONCLUSIONS: Our date indicated that, in comparison with thiopental-enflurane, propofol infusion (6 mg/kg/h) were associated with a greater incidence of awareness during surgery and recall.

Incomplete Preemptive Analgesic Effects of Tenoxicam on Continuous Intravenous Analgesia with Morphine after Cesarean Section / 대한마취과학회지

BACKGROUND: The analgesic properties of the nonsteroidal antiinflammatory drugs (NSAIDs) have been attributed to their effects on the peripheral synthesis of prostaglandins. Although the preoperative use of NSAIDs has been increasing because of concerns regarding the side effects of opioid analgesics but results of clinical preemptive analgesia studies remain inconclusive. So, we studied the efficacy of preemptive analgesic effects of tenoxicam, new NSAID, on postoperative continuous intravenous analgesia with morphine. METHODS: We studied 40 parturients, undergoing cesarean section, ASA class I or II, randomly divided into two groups. Tenoxicam group were injected tenoxicam 0.3 mg/kg and control group were injected normal saline 3 ml at ten min. before induction. For both groups morphine 0.1 mg/kg was administered as loading dose and 0.015 mg/kg/hr as maintenance dose. We examined verbal quantitative score (VQS) at postoperative 30 min, 1, 6, 12, 24 and 48 hr. Maternal satisfaction, side effects, hepatic and renal function also evaluated after pain control. RESULTS: The values of VQS showed no significant differences between two groups 30 min, 1 and 6hr after start of morphine infusion, but there was significant decrease in tenoxicam group compared to control group 12, 24 and 48 hr after start of morphine infusion (p<0.05). There was no significant difference in maternal satisfaction between two groups and also there were no significant differences in the overall incidences of side effects between two groups. CONCLUSIONS: Preoperative single injection of tenoxicam showed incomplete preemptive analgesic effects on postoperative pain control after cesarean section.