Comparison of the Effects of Etomidate and Propofol on Redistribution Hypothermia during General Anesthesia / 대한마취과학회지

BACKGROUND: Redistribution hypothermia can be modified by the effects of induction anesthesia on the systemic vascular resistance. This study compared the effects of etomidate and propofol on redistribution hypothermia during general anesthesia. METHODS: Forty patients were randomly allocated into one of two groups, based on the induction agent used: Group E (n = 20) received 0.2 mg/kg of etomidate and group P (n = 20) received 2.5 mg/kg propofol. After intubation, anesthesia was maintained with sevoflurane and 50% nitrous oxide in oxygen in both groups. The core and peripheral temperatures were measured, and the peripheral temperature gradients (forearm minus fingertip) were used as an index of an arteriovenous shunt. RESULTS: The patients in both groups demonstrated intense vasoconstriction prior to the induction of anesthesia with similar skin-temperature gradients. After induction, group P showed more rapid and significant vasodilation than group E (P = 0.02). The difference in vasodilation between the two groups disappeared from 5 minutes after intubation. The pre-induction core temperatures were similar in both groups. After induction, the core temperatures in group P were consistently lower than those in group E (P < 0.01). The core temperatures during the first hour of anesthesia decreased by 1.5 +/- 0.4 degrees C in group P but only by 0.9 +/- 0.4 degrees C in group E. Conclusions: Propofol caused more rapid and aggravated redistribution hypothermia during surgery than etomidate due to the earlier arteriovenous shunt vasodilation.

The Usefulness of Three-phase Bone Scan and Thermography for Making the Diagnosis of CRPS-I / 대한통증학회지

BACKGROUND: Complex regional pain syndrome (CRPS) is a painful and disabling disease, yet the diagnosis of this can be difficult to confirm by purely objective measures. Therefore, we performed three-phasic bone scans and thermography as a work up in order to determine their predictive value and usefulness for making the diagnosis of CRPS. METHODS: 44 patients who had been diagnosed with CRPS type-1, according to the modified criteria, were evaluated. All the patients were examined by performing a three-phasic bone scan and thermography as part of a work-up for diagnostic confirmation. The diffuse increased tracer uptake in the delayed image (phase III) was estimated by the positive findings. The findings were considered positive for CRPS if the thermographic findings showed temperature asymmetries between the affected and non-affected extremities of more than 1.00 degrees C RESULTS: A review of the three-phasic bone scan for 44 patients indicated that 16 patients (36.4%) had diffusely positive scans, and thermographic abnormalities were noted in 35 of 44 patients (79.5%). CONCLUSIONS: The use of thermography in clinical settings can play an important role in the diagnosis of CRPS. However, a three-phasic bone scan alone cannot provide a completely accurate diagnosis, so it is imperative that the three-phasic bone scan data be integrated with the clinical evaluation and the other relevant tests.

Optimal Dose of Remifentanil to Suppress Cardiovascular Responses to Laryngoscopic Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Laryngoscopic tracheal intubation causes acute hemodynamic changes such as hypertension and tachycardia. Adjuvant opioids during induction have been used to attenuate such responses. The aim of this study was to determine the optimal dose of bolus remifentanil, a newly developed ultra short acting opioid, to suppress cardiovascular responses immediately after laryngoscopic endotracheal intubation in patients anesthetized with N2O-O2-sevoflurane. METHODS: Sixty ASA I or II patients who requiring endotracheal intubation were randomly allocated to one of the four groups; C, R0.5, R1, and R2. Each group received normal saline, 0.5, 1, or 2microgram/kg of remifentanil respectively. Predetermined drugs for each group were administered over 30 seconds after induction of anesthesia with thiopental, rocuronium and 2 vol% of sevoflurane with 50% nitrous oxide. Laryngoscopic endotracheal intubation was carried out 60 seconds after the study drug administration. Mean arterial pressure (MAP) and heart rate (HR) were recorded at pre-anesthesia (PA), pre-intubation (PI) and during 5 minutes after intubation (IT-1 to IT-5). Statistical analysis was done for comparison of time and dose dependent changes among the groups. RESULTS: Baseline values were similar among the groups. IT-1 values did not change compared to PI values in R1 and R2. However, MAP and HR in R2 were significantly lower than PA values during post-intubation period. CONCLUSIONS: Bolus injection of 1microgram/kg of remifentanil blocks MAP and HR elevation after laryngoscopic endotracheal intubation without adverse effects in patients under N2O-O2-sevoflurane anesthesia.

Immunohistochemical Study of the Ligamentum Flavum in the Lumbar Spinal Stenosis / 대한정형외과학회잡지

Lumbar ligimentum flava obtained from 21 patients of spinal stenosis and 10 patients who underwent surgery for vertebral fracture(control group) were studied with hematoxylin-eosin stain, Verhoff s elastic stain, and immunohistochemical stains for S-100 protein ad fibronectin. The chondroid metaplasia of ligamentum flavum found more frequently and widely in the group of spinal stenosis compared with control group. The elastic fibers were decreased in number and irregu- larly arranged at the bone attached area in the group of spinal stenosis. There was tendency to increase the amount of fibronectin in the stroma of the ligamentum flavum in the group of spinal stenosis. Above findings suggest that chondroid metaplasia and changes of the elastic fiber in the peripheral area of the ligamentum flavum are able to contribute the pathogenesis of spinal stenosis.