The Effects of the Combination of Ketamine and Midazolam for Sedation during Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Epidural anesthesia is becoming an increasingly important aspect of anaesthetic practice because it has many advantages. To achieve the appropriate sedation, various methods have been described. The authors applied the ketamine for this purpose in subanesthetic dose and compared with the midazolam that has been most commonly used for intravenous sedation. METHODS: Fifty-seven adult patients undergoing lower abdominal and extremity surgery who were receiving epidural anesthesia were randomely enrolled into this clinical study. They were allocated to three groups to receive only normal saline (group C), midazolam 0.05 mg/kg (group M) and ketamine 0.5 mg/kg midazolam 0.05 mg/kg (group K) in normal saline 10ml, respectively. Hemodynamic and respiratory measurements were recorded at baseline, 1 minute, 3 minute, 5 minute, 10 minute, 20 minute and 30 minute after sedation. The degree of sedation was assessed by a blinded observer using sedation score. RESULTS: There were no significant differences for hemodynamic and respiratory parameters, but decrements of arterial pressure at 1 minute after sedation were most remarkable in the group M. Sedation was satisfactorily achieved by combination of ketamine and midazolam without significant emergence reaction. CONCLUSIONS: The combination of ketamine and midazolam was judged to be suitable alternative for sedation during epidural anesthesia.

Intraoperative Coagulation Management by TEG in a Patient with Aplastic Anemia: A case report / 대한마취과학회지

This case was an acquired aplastic anemia patient who required a major operation for excision of a mediastinal mass. The authors previewed that the coagulation abnormalities would be developed due to major operation. Thus we decided to monitoring the coagulation function using the thromboelastography during the perioperative period and checked the complete blood count, concommitantly. The total blood volume lost during operation was 1800 ml, so we gave him a transfusion of 10 U's of platelet concentrate, 10 U's of pheretic platelet rich plasma and 5 U's of whole blood. The thromboelastography was a good guide that helped us to avoid excessive treatment of the coagulation abnormalities. We concluded that the thromboelastograhy was a reliable and effective monitoring system at the intraoperative coagulation management.

Oral Clonidine Blunts the Heart Rate Response to Intravenous Atropine in Adults / 대한마취과학회지

BACKGROUND: Clonidine, which is known to have analgesic and sedative properties, has recently been shown to be an effective preanesthetic medication in humans. The drug may cause side effects, including bradycardia and hypotension. This study was conducted to evaluate the ability of intravenous atropine to increase the heart rate (HR) in awake adults receiving clonidine preanesthetic medication. METHODS: We studied HR responses to intravenous atropine in 45 patients assigned randomly to either a control group, who received no medication (group 1, n=15), or clonidine groups, who received oral clonidine of 2~2.5 mcg/kg (group 2, n=15), or 4.5~5 mcg/kg (group 3, n=15) 90 min before scheduled induction of anesthesia. When HR and blood pressure had been confirmed to be stable in operating room, all patients received incremental doses of atropine, 2.5, 2.5 and 5 mcg/kg at 2-min intervals. The HR and mean arterial pressure were recorded at 1-min intervals. RESULTS: Before atropine injection, the HR decreased significantly (P<0.05) in group 3. The increases in HR in response to a cumulative dose of atropine 10 mcg/kg were 21+/-8, 17+/-7 and 7+/-5 beats/min (mean+/-SD) in group 1, 2 and 3, respectively (P<0.05). The positive chronotropic response to intravenous atropine was attenuated significantly only in group 3 (P<0.01). CONCLUSIONS: It was concluded that oral clonidine of 4.5~5 mcg/kg decreased HR significantly, and blunted the increase in HR after intravenous atropine in awake adults although oral clonidine of 2~2.5 mcg/kg did not.

The Effect of Esmolol on Changes of Heart Rate during Induced Hypotension with Sodium Nitroprusside / 대한마취과학회지

BACKGROUND: The goal of this study was to demonstrate the effect of esmolol to prevent reflex tachycardia occurred during sodium nitroprusside(SNP) induced hypotension. METHODS: Thirty patients were randomly assigned to the SNP group(n=15) received continuous infusion of SNP at 2.72+/-0.56 mcg/kg/min or combined SNP and esmolol(SNP-ESM) group(n=l5) received combined continuous infusion of SNP at 1.54+/-0.34 mcg/kg/min and esmolol at 200 mcg/kg/min for 1 hour to maintain a 20~25% reduction of mean arterial pressure(MAP) from baseline. Heart rate(HR) and MAP were measured at baseline, during hypotensive period(5, 10, 20, 30, 60 min) and after hypotensive period(70, 80, 90,1 20 min). RESULTS: SNP-induced hypotension resulted in significant(P<0.001) increases in heart rate during hypotensive period and MAP after the end of SNP infusion. However, infusion of SNP-ESM resulted in significant(p<0.05) reduction in heart rate and SNP requirement during hypotensive period, and rebound hypertension was not observed after the end of induced hypotension. CONCLUSIONS: SNP-ESM infusion is a safe and effective pharmacologic means and provides several advantages over single SNP that include reduction in SNP requirement, no reflex tachycardia during induced hypotension and no rebound hypertension following hypotensive period.

The Effect of Esmolol on Changes of Heart Rate during Induced Hypotension with Sodium Nitroprusside / 대한마취과학회지

BACKGROUND: The goal of this study was to demonstrate the effect of esmolol to prevent reflex tachycardia occurred during sodium nitroprusside(SNP) induced hypotension. METHODS: Thirty patients were randomly assigned to the SNP group(n=15) received continuous infusion of SNP at 2.72+/-0.56 mcg/kg/min or combined SNP and esmolol(SNP-ESM) group(n=l5) received combined continuous infusion of SNP at 1.54+/-0.34 mcg/kg/min and esmolol at 200 mcg/kg/min for 1 hour to maintain a 20~25% reduction of mean arterial pressure(MAP) from baseline. Heart rate(HR) and MAP were measured at baseline, during hypotensive period(5, 10, 20, 30, 60 min) and after hypotensive period(70, 80, 90,1 20 min). RESULTS: SNP-induced hypotension resulted in significant(P<0.001) increases in heart rate during hypotensive period and MAP after the end of SNP infusion. However, infusion of SNP-ESM resulted in significant(p<0.05) reduction in heart rate and SNP requirement during hypotensive period, and rebound hypertension was not observed after the end of induced hypotension. CONCLUSIONS: SNP-ESM infusion is a safe and effective pharmacologic means and provides several advantages over single SNP that include reduction in SNP requirement, no reflex tachycardia during induced hypotension and no rebound hypertension following hypotensive period.