Comparison of 0.5% ropivacaine with fentanyl and 0.75% ropivacaine used in extension of a preexisting labor epidural for emergency cesarean section: retrospective study

BACKGROUND: Various regimens have been studied in extension of a preexisting labor epidural for emergency cesarean section. Lumbar epidural analgesia for delivery is safe and efficient. We compared retrospectively 0.5% ropivacaine with fentanyl and 0.75% ropivacaine in extension of a preexisting labor epidural for emergency cesarean section. METHODS: We investigated medical records of 61 parturients in extension of a preexisting labor epidural for emergency cesarean section. There were two regimens which was 0.5% ropivacaine with fentanyl (group 1) and 0.75% ropivacaine (group 2). We recorded demographic data, local anesthetic dose, surgical readiness time, maximum level of sensory block, surgery time, intravenous supplementation, number of hypotension and total dose of ephedrine between two groups. RESULTS: There were no differences between the study groups in demographic data, surgical readiness time, maximum sensory block level, intravenous supplementation, incidence of hypotension and total dose of ephedrine. Local anesthetic volume was larger in group 1 than group 2, but local anesthetic doses were lower in group 1 than group 2. CONCLUSIONS: 0.5% Ropivacaine with fentanyl regimen is as fast and efficacious as 0.75% ropivacaine in extension of a preexisting labor epidural for cesarean section and reduces the requiring total local anesthetic dose.

General anesthesia for cesarean section in a patient with multiple sclerosis: A case report

A 34-year-old female with multiple sclerosis (MS) was scheduled Cesarean section. She had been suffering from MS for 10 years and the symptoms of MS were paraplegia and urinary incontinence. After informed consent, anesthesia was induced with propofol and maintained with nitrous oxide, sevoflurane and fentanyl. Rocuronium was used for muscle relaxation and tracheal intubation. Train of four (TOF) ratio and bispectral index scale were monitored for adequate muscle relaxation and depth of anesthesia. She gave birth to a baby within 7 minutes after skin incision. When operation was over, TOF ratio was 0.8. She emerged from general anesthesia smoothly and was extubated. There was no febrile event or exacerbation of MS after Cesarean section under general anesthesia. We report a safe anesthetic management of the parturient with MS, using sevoflurane.

The optimal effect-site concentration of remifentanil to attenuate the pain caused by propofol / 대한마취과학회지

BACKGROUND: The injection pain of propofol is a frequent and well-known adverse effect. This study was designed to determine the optimal effect-site concentration of remifentanil for minimizing injection pain during induction with propofol. METHODS: A total intravenous anesthetic technique was used for patients undergoing general anesthesia and remifentanil was pretreated to reach a certain target concentration before propofol injection. Using Dixon's up-and-down method, the degree of pain described by the patient was used to adjust the target concentration of remifentanil for the next patient. Ten success-failure curves (crossovers) were sought to find the effect-site concentration (EC) of remifentanil for minimizing injection pain of propofol. RESULTS: The EC of remifentanil in 50% and 95% of adult female population (EC50 and EC95) for minimizing injection pain of propofol were 3.09 ng/ml (95% confidence limits [CI] 2.92-3.30 ng/ml) and 3.78 ng/ml (95% CI 3.45-3.95 ng/ml), respectively. Clinically significant hemodynamic compromise or respiratory complications were not found during remifentanil infusion. CONCLUSIONS: Maintaining 3.78 ng/ml EC of remifentanil during induction with propofol attenuate propofol injection pain without serious adverse events in female patients undergoing general anesthesia and this method may provide the patient's comfort without preparing other drugs for pain relief.

Comparison of clinical effects according to dosage of fentanyl added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section

BACKGROUND: Spinal anesthesia for cesarean section is widely used technique for rapid induction, high success rate and excellent intraoperative and postoperative analgesia. Potentiating the effect of intrathecal local anesthetics by addition of opioid for cesarean section is well known. In this study, we compared the clinical effects when different doses of fentanyl were combined with intrathecal hyperbaric bupivacaine. METHODS: Ninety six healthy term parturients were randomly divided into four groups: Group C (control), : Group F10 (fentanyl 10 microg), : Group F15 (fentanyl 15 microg), F: Group F20 (fentanyl 20 microg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen. We observed the maximal level of the sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and the side effects. RESULTS: There were no significant differences between four groups in maximal level and recovery rate of sensory and motor block. Quality of intraopertive analgesia and muscle relaxation was increasing by increasing dosage of intrathecal opioids. Duration of effective analgesia was significantly prolonged in Group F15 and F20 than Group C and F10, but there were no differences between Group F15 and F20. And the frequencies of side effects such as hypotension, max sedation level were increasing by increasing dosage of intrathecal opioids. The Apgar scores were normal, and there were no differences between the four groups. CONCLUSIONS: The addition of fentanyl 15 microg for spinal anesthesia provides adequate intraoperative analgesia and good postoperative analgesia without significant adverse effects.

Topical Epinephrine-soaked Gauze-induced Ventricular Tachycardia during Skin Grafting: A Case Report / 대한구급학회지

Topical epinephrine is useful to reduce bleeding during skin grafting. However, even though a clear operative field is obtained, systemic absorption of topical epinephrine can occur and this may cause severe hypertension, arrhythmias, ventricular tachycardia, myocardial ischemia, pulmonary edema, or cardiac arrest. We managed a case of cardiac arrhythmia during general anesthesia, which was induced by gauze soaked in topical epinephrine used for skin grafting of burn wounds. A 26-year-old woman developed premature ventricular complexes and ventricular tachycardia during surgery when epinephrine-soaked gauze was applied to the skin donor and burn wound sites to control oozing. The patient was resuscitated immediately and within 10 minutes the vital signs had normalized. It is recommended that caution is exercised when epinephrine-soaked gauze is applied to a large area of skin.

Continuous Femoral Nerve Block Guided by Ultrasound Sonography in Metastatic Cancer Patient: A case report / 대한마취과학회지

Terminal cancer pain is always a challenge to pain doctors.If the focus of the cancer pain is located in the restricted area, it is easy to control the pain. However, if the focus of cancer pain is widespread, it is very difficult to control the pain and it makes pain doctors embarrassed.Nowadays, the ultrasound-guided nerve block become a popular method. It is easy to find the nerve and helps to insert the catheter around the nerve for the continuous nerve block. We encountered a patient who was 59 years old with a stomach cancer and vertebral metastasis. He complained about the pain in his abdomen, back and left thigh. His abdominal and back pain vanished with the use of continuous lumbar epidural injection. However, the patient still complained about the pain and numbness on the left thigh, because of this, he couldn't get any sleep.We tried a continuous femoral nerve block under the ultrasound guidance, after that his pain was gone.The ultrasound-guided nerve block will be very helpful to control the pain.