Effects of Adding of Fentanyl or Morphine to Bupivacaine for the Epidural Anesthesia in the Cesarean Section / 대한마취과학회지

The effects of adding 50 ug fentanyl or 3 mg morphine to 0,5% bupivacaine for the epidural anesthesia in cesrean section were evaluated. The 59 women for elective cesarean section were randomly allocated into 3 groups. The first group (n=15) was administered epidurally with 0,5% bupivacaine alone, the second group (n=18), 0.5% bupivacaine mixed with 50 ug fentanyl, and the third group (n=l6), 0.5% bupivacaine mixed with 3 mg morphine. No significant differences among the groups were noted in systolic and diastolic blood pressure, heart rate, respiratiory rate, and tidal volume. There were no significant differences among the groups in the incidence of adverse effects (nausea, vomiting, dizziness, hypotension, pruritus, urinary retention, respiratory depression) in the perianesthetic period and in the onset time of anesthesia up to T4 sensory dermatome. Durations of the anesthesia and postoperative analgesia are prolonged significantly in the second and third groups compared with the first. We found no differences in the neonatal outcome among the groups. Therefore, we conclude that the addition of 50 ug fentanyl or 3 mg morphine to 0.5% bupivacaine during epidural anesthesia for the cesarean section significantly prolongs the duration of anesthesia and postoperative analgesia with no deleterious effects on neonatal or maternal outcome.

Statistical Methods in the Articles of the Journal of the Korean Society of Anesthesiologists from 1981 to 1990 / 대한마취과학회지

The purpose of this study is to investigate the error of using statistics in the articles of the Journal of the Korean Society of Anesthesiologists from 1981 ta 1990 and to present a program that may be of some help correcting the statistical error. We classified statistically the journals into original articIe, review and case report, and original articles into that of usng inferential statistics, descriptive statistics and no statistics. Then, we analyzed the articles of inferential statistics in the aspect of our criteria for statistical errors. The proportion of using erroneous inferential statistics was 80-100% from 1981 to 1986 and it decreased by 60% afterwards. But the proportion was still 67% in 1990. The representative errors are the no statistical analysis in spite of the necessary cases, the p-value only without the description of statistical method and using t test inappropriately in the comparison of more than 3 groups without Bonferroni correction. The other errors in using statistics were confusion between related data and independent data, inadequate numbers for Chi-square test, inapproate follow-up to variance analysis and inapproate parametric test for data in nominal or ordinal scales.

Statistical Methods in the Articles of the Journal of the Korean Society of Anesthesiologists from 1981 to 1990 / 대한마취과학회지

The purpose of this study is to investigate the error of using statistics in the articles of the Journal of the Korean Society of Anesthesiologists from 1981 ta 1990 and to present a program that may be of some help correcting the statistical error. We classified statistically the journals into original articIe, review and case report, and original articles into that of usng inferential statistics, descriptive statistics and no statistics. Then, we analyzed the articles of inferential statistics in the aspect of our criteria for statistical errors. The proportion of using erroneous inferential statistics was 80-100% from 1981 to 1986 and it decreased by 60% afterwards. But the proportion was still 67% in 1990. The representative errors are the no statistical analysis in spite of the necessary cases, the p-value only without the description of statistical method and using t test inappropriately in the comparison of more than 3 groups without Bonferroni correction. The other errors in using statistics were confusion between related data and independent data, inadequate numbers for Chi-square test, inapproate follow-up to variance analysis and inapproate parametric test for data in nominal or ordinal scales.

The Effect of Percutaneous Epidural Stimulation of the Spinal Cord for Brachial Plexopathy / 대한마취과학회지

Spinal dorsal column stimulation is one of the effective treatment for some patients with medically and surgically intractable pain. The rationale for dorsal column stimulation has been the "gate theory" of pain proposed by Melzack and Wall. We procedured the percutaneous epidural stimulation of the spinal cord in the patient with left brachial plexopathy by the traffic accident. The pain was causalgic and intractable to the conventional treatment. The procedure was done in the operating room with aseptic technique under C-arm radiographic guidance. The 16G Tuohy needle was advanced through the T3-4 interspace into the epidural space and then the electrode was inserted through the needle and advanced in the epidural space so that the tip rested on C2 body. The position of the tip of electrode was checked by fluoroscopy with image intensification with C-arm. The test stimulation was carried out using 3.5 volt for one week. The patient experienced a good pain relief and also a comfortable paresthesia of the painful left upper extremity and had no major complications. The electrode was removed to be replaced with a permanent one.

The Studies in Bedside Eletrolyte Monitoring with VIA 1-01 / 대한마취과학회지

In case of cardiopulmonary bypass, organ transplantation and massive transfusion, the electrolyte(Na+, K+, Ca++) and pH are very changeable, and it is very important to correct the pH and electrolyte immediately. We studied the bedside electrolyte monitoring with VIA(Vascular Intermittent Access) 1-01 and its accuracy validation. We selected 13 patients who went an open heart surgery in the Seoul National University HospitaL The patient was catheterized with 16 G triple lumen catheter into the SVC-right atrium junction via right internal jugular vein. Then we connected VIA 1-01 to one lumen. The electrolyte samplings were done during perianesthetic period. The electrolyte values(Na+, K+, ionized Ca++) of each sample was measured by laboratory, NOVA of PAR(postanesthetic recovery room) and VIA 1-01. We compared the values with correlation. The Pearson product-moment coefficient(r) of laboratory vs VIA 1-01 are 0.9073(Na+), 0.9471(K+) 0.6485(Ca++). The r of NOVA vs VIA 1-01 are 0.6348(Na+), 0.9330 (K+), 0.5206(Ca++ ). The r of laboratory vs NOVA are 0.6719(Na+), 0.9532(K+ ), 0.8221(Ca+). All pvalues of r were lower than 0.01. We conclude that bedside electrolyte monitoring with VIA l- 01 is very useful to critically ill-patient and major operations during anesthesia and it improves the prognosis of such patients.

Changes in Pulmanary Gas Exchange during General Anesthesia for Laparoscopic Cholecystectomy / 대한마취과학회지

The recent development of laparoscopic cholecysteetomy has introduced the technique of laparoscopy to the general surgical operation. During this procedure, the deliberate pneumoperitoneum with carbon dioxide(CO2) insufflation in order to visualize better the abdominal viscera may causes some problems-hypercarbia, hypertension, pneumomediastinum, subcutaneous emphysema and cardiovascular impairment, We studied the changes of cardiovascular system and pulmonary gas exchanges clinically during general anesthesia for laparoscopic eholecystectomy in the 16 patients of Seoul National University Hospital. After induction of anesthsia, ventilation was controlled with tidal volume 10 ml/kg and respiration rate 10-15/min to maintain PaCO2 35 mmHg before insufflation of carbon dioxide. After measuring of control value of mean arterial pressure(MAP), heart rate(HR) and arterial blood gas analysis before insufflation of CO2, ventilation setting was not changed throughout the operation. MAP, HR, arterial blood gas analysis were measured at 30 min interval until the end of operation. The changes of MAP, HR and PaO2, throughout the operation are not statistically significant in comparison to control(preinsufflation) values. The PaCO2 was increased significantly by 8-10 mmHg in comparison to control values(p-value<0.01). In conclusion, minute ventilation should be corrected during general anesthesia for laparoscapic cholecysteetomy with CO2 insufflation according to continuous monitoring of end tidal CO2 and arterial carbon dioxide tension.

A Case Report of the Cancer Pain Treatment by the Percutaneous Radiofrequency Posterior Root Rhizotomy / 대한마취과학회지

Painful neuralgias of the chest and abdominal wall usutaly respond well to root surgery, especially when the radicular level of the lesion is well defined. We could less invasively perform this procedure with percutaneous radiofrequency thermocoagulation technique instead of more invasive proecdure such as laminectomy and thus can treat the pain without significant sideeffeets. We did percutaneous radiofrequency thermocoagulation of the dorsaI root at the thoracic level ta treat our three patients with intractable chest and abdominal wall pain. The procedures were performed at the operation room with continuous monitoring of the blood pressure and electrocardiogram findings, and with the precise x-ray control of the needle position. The patients are now pain-free and have numbeness of the target dermatome without significant side-effects. The ease and simplicity of this technique may make it useful for treating intractable chronic or cance pain of chest and abdominal wall.

A Study on the Best Positive End - expiratory Pressure of Dogs in Acute Respiratory Failure Induced by Oleic Acid / 대한마취과학회지

Controlled mechanical ventilation with positive end-expiratory pressure(PEEP) is a widely accepted method for the treatment of acute respiratory failure. But artificial ventilation with large tidal voume, high airway pressure and an inspired oxygen concentration of l00% are necessary for adequate arterial oxygenation in severe acute pulmonary parenchymal failure. It has been suspected that such therapy may cause irreversible pulmonary damage. The extracorporeal respiratory support has been called extracorporeal membrane oxygenation (ECMO), extracorporeal CO, removal(ECCO2R) or extracorporeal lung assist(ECLA). They are prolonged venoarterial(VA) or venovenous(VV) bypass for the refractory hypoxemia which provides the diseased lung with rest. The respiratory rate can be lowered down to about 4~8 rates/min during ECLA. PEEP is known to improve the ventilation perfusion distribution with alveolar recruitment. Low frequency positive pressure ventilation is accompanied by PEEP to keep alveoli open during ECLA. The level of PEEP must be determined adequately because high PEEP may decrease the cardiac output especially during VV ECLA. The experimental model for acute respiratory failure was induced by the intravenous injection of oleic acid 0.07ml/kg on six mongrel dogs(15.8+/-0.7kg). After values of arterial oxygen saturation(SaO2) and end-tidal CO2(E(T)CO2) were stabilized on the monitor, we measured control values of hemodynamic parameters. The stepwise increase of PEEP from 5 cmH2O to 15 cmH2O via 10 cmH2O was followed by the comparison of the respective hemodynamic values at each PEEP with control. Compared with control, PEEP of 5 cmH2O did not cause any changes and PEEP of 15 cmH, decreased cardiac output. At PEEP of 10 cmHO, the cardiac output and oxygen flux was maintained with normoxia. It was concluded that PEEP of 10 cmHO can be applied to clinical VV ECLA.

The Effects of the Small Doses of Nondepolarzing Muscle Relaxants Administered Just Prior to Succinylcholine on Intragastric and Intraocular Pressures / 대한마취과학회지

Succinylcho1ine(Sch) may provoke regurgitation of gastric contents by producing fasciculations of abdominal musculatrue, which in turn may increase intragastric pressure. And it has been also believed that Sch increases intraocular pressure in part by contracture of the extraocular muscles. The purpose of this study was to determine whether these increases and the degree of fasciculation could be reduced by prior administration of a nondepolarizing muscle relaxant. Simultaneous administration of pancuronium or vecuronium with Sch significantly reduced the degree of fasciculation and also decreased the elevation of the intragastric pressure, but did not show any remarkable effect on the intraocular pressure, We might say that wed better use the small amount of nondepolarizing muscle relaxant with Sch to prevent the increase of intragastric pressure, thereby decrease the chance of regurgitation and aspiration during induction period.