A Comparative Study of Propofol-Fentanyl and Propofol-Ketamine Anesthesia for Spine Surgery under Somato-Sensory Evoked Potential Monitoring / 대한마취과학회지

BACKGROUND: Somato-sensory evoked potential (SSEP) monitoring has been used to help minimize neurologic morbidity during spinal surgery. However, SSEP is affected by anesthetics, technical errors and physiologic aspects. We reviewed 50 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. METHODS: Fifty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl (Group I, P-F) or ketamine (Group II, P-K), and monitored by SSEP. We checked the changes of blood pressure and heart rates during the operation, recorded latency and amplitude of SSEP in the pre-induction, post-induction, during screw insertion and post-distraction periods. Also, we checked the number transfers to the ICU and application of a ventilator. RESULTS: Systolic and diastolic blood pressure were increased significantly in the propofol-ketamine group (P < 0.05), but there was no difference in heart rate between both groups. In addition there were no statistical differences in latencies and amplitudes of SSEP. The number of patients transferred to the ICU and placed on a ventilator showed no statistical difference. CONCLUSIONS: We think that the combination of propofol and fentanyl or ketamine used for total intravenous anesthesia is a very useful method in spinal surgery under SSEP monitoring.

Comparison of Post-operative Liver Function after Induced Hypotention between Thoracic Epidural Bldegrees Ckade and Esmolol / 대한마취과학회지

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provies better visibility. May methods have been used for induced hypotension. Recently Esmolol is favored in induced hypotension because of its short action of sympathetic beta-1 receptor antagonist and easy to control. Thoracic epidural bldegrees Ck can provide cadiovascular stability in induced hypotension. The purpose of the study is to compare postoperative liver function after induced hypotension between thoracic epidural bldegrees Ckade and esmolol combined with general anesthesia with isoflulane. METHOD: Fourty patients scheduled for spinal posterior fusion under general anesthesia were randomly divided into two groups. In thoracic epidural bldegrees Ckade group(Group I, 20 patients), 8~10 ml of 2% liddegrees Caine was injected into the epidural catheter ldegrees Cated in T6~7 interspace in a bolus. In Esmolol group(Group II, 20 patients) received 0.5 mg/kg as loading dose and 50~150 microgram/kg/min continuously. We measured preoperative and postoperative 1, 3, 5, 7 day's serum glutamic-oxaloacetic transaminase(SGOT), serum glutamic-pyruvate transaminase(SGPT) and alkaline phosphatase(ALP). RESULT: In the thoracic epidural bldegrees Ckade group, there was statistically significant increase of SGOT level above normal range on postoperative 1 day, which decreased on postoperative 3 and 5 day(p<0.05). But it was within normal range on postoperative 7 day. SGPT was increased within normal range. Similarly, in the esmolol group, there was statistically significant increase of SGOT level above normal range on postoperative 1 day, which decreased on postoperative 3 and 5 day(p<0.05). But it was within normal range on postoperative 7 day. SGPT was increased within normal range. The level of ALP was increased within normal range in both groups. There was no statistically significant difference in liver function between two groups. CONCLUSION: We consider that postoperative liver function is little influenced with induced hypotension by thoracic epidural bldegrees Ckade and esmolol combined with general anesthesia with isoflurane.