Comparison of Intranasal and Sublingual Midazolam as a Preanesthetic Medication in Pediatric Patients / 대한마취과학회지

BACKGROUND: The perfect preanesthetic medication and its ideal route of administration are still debated. Transmucosal administration of midazolam has been of interest because of the rapid, reliable onset of action, predictable effects and avoidance of injections. Because many medications are well absorbed from the mucosa, we conducted a randomized, prospective, blinded study to compare acceptance and efficacy of intranasal and sublingual administration of midazolam as a preanesthetic medication in children. METHODS: One hundred twenty eight patients aged 0.5-12year were stratified by age: 38 infants and toddlers, 0.5-3yr; 48 preschoolers, 3.1-7yr; and 42 school age, 7.1-12yr. They were randomized to received 0.2 mg/kg of midazolam in the nose or under the tongue. Hemoglobin oxygen saturation by pulse oximetry and sedation score were recorded before drug administration, at 2.5min intervals for 15min, at separation from parents and during induction with enflurane in O2. Retention time of sublingual drug and duration of crying were recorded. RESULTS: The incidence of crying at the time of administration of midazolam was greater following intranasal compared with sublingual administration(60% vs 17%, p<0.05). Within age groups, only infants and toddlers showed a significant difference in the incidence of crying between treatment groups. Significant changes in sedation occured in both groups from 2.5min after administration. CONCLUSIONS: Sublingual midazolam is better accepted than intranasal midazolam as a preanesthetic sedative in children.

Recovery Pattern after Anesthesia with Propofol or Thiopental/Isoflurane / 대한마취과학회지

One of the goals of anesthesia is complete, comfortable and rapid recovery without sequelae from anesthesia. We compared the recovery pattern between anesthesia with propofol and thiopental/isoflurane. The fifty patients undergoing emergency appendectomy were allocated randomly to receive one of the anesthesia with propofol or thiopental/isoflurane. All of the patients were also given fentanyl, atracurium in equivocal dosage per weight and 50% N2O. Group 1(patient No; 25) was received anesthesia with fentanyl, atracurium, N2O and continuous injection of 6~12 mg/kg/hour of propofol. Group 2(patient No; 25) was received anesthesia with thiopental, fentanyl, atracurium, N2O and 1~2 MAC(minimal alveolar concentration) of isoflurane. We studied the duration of return of self respiration from discontinuation of anesthetics and recovery pattern in time sequence. The results were as following; The group 1 compared with group 2 at early recovery phase. 1) The duration of return of self respiration from discontinuation of anesthetics retured more rapid. 2) Emergence time was more rapid. 3) Postoperative sequelae(nausea, vomiting, sedation, drowsiness, memory dysfunction, pain) rate was less severe. But at recovery phase after 24 hours, there were no significant difference in postoperative sequelae and recovery condition in both groups. Therefore, we concluded that propofol is better than thiopental/isoflurane for anesthesia of emergency appendectomy in view of early recovery pattern.

Effects of Patient Controlled Analgesia with Morphine after Obstetric or Gynecologic SurgerAnesthesia for Traumatic Diaphragmatic Hernia Detected after Operation of the Femur Fracture / 대한마취과학회지

Injury of diaphragm mainly occur in penetrating, crush and blunt injuries to the lower chest or upper abdomen, and it is most often secondary to automobile accidents. Diaphragmatic rupture is most frequent in blunt chest trauma and the rate is below 1% of them. Traumatic rupture of the diaphragm is responsible for the herniation of abdominal viscera. Physical finding and radiographic sign of diaphragmatic hernia is nonspecific and misreading. Therefore, the diagnosis of traumatic rupture of diaphragm may be difficult during the early period after the injury, especially when clinical features are dominated by associated injuries. Emergency surgical management is necessary when it is complicated with serious complication. We experienced the case of traumatic diaphragmatic hernia detected after the operation of femur fracture. The patient was injured by motor vehicle accident 6 days before the operation of the femur fracture. There was no specific symptom and sign and the manifestation of the diaphragmatic hernia. in radiographic studies until operation of the femur fracture was done. Diaphragmatic hernia was confirmed by chest X-ray and arterial blood gas analysis after operation of the femur fracture. The repair of the diaphragmatic hernia was directly performed after the diagnosis. The prognosis was favorable, and she was discharged to ward from intensive care unit after 1 day of operation. We must consider the possibility of traumatic diaphragmatic hernia in the patient who have the history of blunt chest or abdominal trauma.