Patient-Controlled Sedation for Local Anesthesia Patients in Plastic Surgery / 대한마취과학회지

BACKGROUND: Patient-controlled sedation (PCS) involves the patient self administering the sedative agent to the point at which the patient is satisfied with the level of sedation with the advantage to overcome the phamacodynamic differences between individual patients. We performed the PCS with two different dosages of propofol and compared the efficacy and side effects for local anesthesia patients in plastic surgery. METHODS: Thirty patients underwent propofol PCS with Perfusor fm (B. Braun, Germany) PCA pump during nasal inhalation of O2 3 L/min with continuous monitoring of SpO2. PCS settings were 10 mg of bolus dose, 30 mg of initial loading dose, 1 min of lockout interval, 100 mg/hr of continuous infusion in group 1 and 20 mg of bolus dose, 60 mg of initial loading dose, 1 min of lockout interval, 100 mg/hr of continuous infusion in group 2. All the patients received local anesthesia with 1% lidocaine before operation. Observer's assessment of alertness/sedation (OAA/S) scale, SpO2, mean infusion rate of propofol, duration of induction and recovery, recall of operative procedure, and patient's and surgeon's satisfaction were checked. RESULTS: The mean infusion rate (group 1; 32.2 +/- 19.4, group 2; 38.3 +/- 20.5 ug/kg/min), duration of induction (group 1; 4.9 +/- 1.9, group 2; 3.1 +/- 1.4 min), duration of recovery (group 1; 1.7 +/- 1.2, group 2; 2.5 +/- 1.3 min), and mean OAA/S scale (group 1; 3.8 +/- 1.6, group 2; 3.1 +/- 1.5) were not significantly different between the groups (mean +/- SD). Inadequate sedation occurred more frequently in group 1 (13%) than group 2 (0%), and incidences of respiratory depression (SpO2 < 95%) were more higher in group 2 (20%) than group 1 (0%). Numbers of satisfaction of patient and surgeon were 100% and 87% in group 1, and 87% and 93% in group 2. CONCLUSIONS: 10 mg or 20 mg as a bolus dose and 30 mg or 60 mg as a initial loading dose of propofol for PCS provided effective sedation and patient's and surgeon's satisfaction without significant side effect for local anesthesia patients in plastic surgery. (Korean J Anesthesiol 2004; 46: 583~588)

Anesthetic Management of Cesarean Section in Parturient with Systemic Sclerosis / 대한마취과학회지

Systemic sclerosis is a multisystemic disorder of unknown etiology characterized by fibrosis of skin, blood vessel, and visceral organ. A 38-week pregnant, 29 year-old woman with systemic sclerosis and migraine was scheduled for cesarean section under lumbar epidural anesthesia because of dyspnea, decreased diffusion lung capacity and Raynaud's phenomenon. She suffered from sudden onset of severe headache, repetitive nausea, vomiting, and hypertension during cesarean section under the epidural anesthesia. The above symptoms did not respond to beta-blocker, vasodilator during the operation period. In the recovery room, the headache and vomiting were relieved by intravenous injection of ketorolac and metoclopramide. She experienced single tonic-clonic generalized seizure and intermittent migraine after operation in the ward, and discharged 7 days after operation.