Popliteal sciatic nerve block versus spinal anesthesia in hallux valgus surgery / 대한마취과학회지

BACKGROUND: We compared clinical properties and patient satisfaction between spinal anesthesia and popliteal sciatic nerve block (PSNB) for hallux valgus surgery. METHODS: Forty patients undergoing hallux valgus surgery were divided into spinal group (spinal anesthesia with 2.5 ml of 0.5% bupivacaine [n = 20]) and PSNB group (PSNB with 30 ml of 0.75% ropivacaine mixed with 10 ml of normal saline solution using a nerve stimulator [n = 20]). The PSNB group used a patient-controlled-analgesia (PCA) pump for postoperative pain control. The quality and side effects were compared between the two groups. A questionnaire was used to evaluate patient satisfaction with the use of anesthetic techniques and postoperative pain control in the PSNB group. This study was assessed 3 days postoperatively by a blinded observer. RESULTS: Procedure time and time from anesthesia until start of sugery were significantly shorter in the spinal group than those in the PSNB group (P < 0.01). Anesthesia-related complications such as hypotension, bradycardia, shivering, nausea/vomitting, post-dural puncture headache (PDPH) and urinary retension were observed in 15%, 10%, 5%, 5%, 10%, and 20% of patients in the spinal group, respectively. PSNB was not associated with these complications. Patient satisfaction was slightly higher for PSNB than for spinal anesthesia. In the PSNB group, patient satisfaction with postoperative pain-control was 95% above ordinary satisfaction. CONCLUSIONS: Despite the long duration of the procedure, PSNB is relatively safe, provides an adequate level of anesthesia, effectively controls postoperative pain and reduces side effects. Therefore, PSNB could be a potential anesthetic technique for hallux valgus surgery.

Pneumomediastinum after functional endoscopic sinus surgery under general anesthesia: A case report / 대한마취과학회지

The occurrences of pneumothorax and pneumomediastinum are rare, but considered to be potentially life-threatening conditions in patients undergoing functional endoscopic sinus surgery under general anesthesia. Tracheobronchial rupture may results in serious complications, such as pneumothorax and pneumomediastinum. It may occur accidentally by endotracheal tube when the patient's neck is flexed or extended. We report the case of a 48-year-old female patient who developed massive subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum seven hours after functional endoscopic sinus surgery under general anesthesia.

Resilience of Families with Elderly Patients with Dementia / 정신간호학회지

PURPOSE: The purpose of this study was to pave the way for developing nursing intervention strategies to enhance family resilience by identifying unique patterns of resilience in families of elderly patients with dementia. METHODS: The Q-methodology was used to define types and describe characteristics of family resilience. After in-depth interviews with 12 family members of patients with dementia and study of related literature, final 50 Q-samples were selected by collecting the opinions of experts. The selected 50 Q-statements were sorted by 30 family members (P-samples). The PC-QUNAL program was used to analyze Q-sort data. RESULTS: Four distinctive Q-factors for family resilience were identified: I. Seeking positive meaning, II. Developing reasonable cooperation with family members, III. Accepting reality passively, IV. Depending on external resources. CONCLUSION: Families caring for elderly patients with dementia show unique patterns of family resilience, which result from multi-factors, such as their own belief systems or culture, organizational patterns, and communication processes, in dealing with crisis. The results of this study can be useful in confirming the types of resilience of families of patients with dementia and their characteristics, and the underlying data can be used as to develop tailored nursing strategies for strengthening family capacities to master adversity.

The relationship between the predictors of obstructive sleep apnea and difficult intubation / 대한마취과학회지

BACKGROUND: The study was performed in order to determine the risk factors for difficult tracheal intubation in obstructive sleep apnea patients. METHODS: For 115 male patients with obstructive sleep apnea syndrome and who were undergoing palatal muscle resection (PMR), we investigated the correlation between their age, height, weight, body mass index (BMI), their Epworth Sleepiness Scale (ESS), their apnea-hypopnea index (AHI), their neck circumference and the difficulty of tracheal intubation. RESULTS: The factors significantly related to difficult tracheal intubation in obstructive sleep apnea patients were a high AHI and a large neck circumference. There was no significant correlation between weight, BMI, arterial hypertension, ESS and difficult tracheal intubation in obstructive sleep apnea patients. CONCLUSIONS: In this study, a high AHI and a large neck circumference can predict difficult tracheal intubation in obstructive sleep apnea patients.

The effect of perioperative esmolol infusion on the postoperative nausea, vomiting and pain after laparoscopic appendectomy / 대한마취과학회지

BACKGROUND: Perioperative opioid administration results in postoperative nausea and vomiting (PONV) and acute opioid tolerance that manifests in increased postoperative pain. Esmolol is an ultra short acting cardioselective beta1-adrenergic receptor antagonist, and it has been successfully used for perioperative sympatholysis and it reduces the opioid requirement during total intravenous anesthesia. We tested the hypothesis that perioperative esmolol administration results in decreased PONV and postoperative pain. METHODS: Sixty patients undergoing laparoscopic appendectomy were randomly assigned to two groups (Group E and Group C). The Group E patients were administered 5-10 microgram/kg/min esmolol with remifentanil that was titrated to the autonomic response. The Group C patients received normal saline that was of the same volume as the esmolol in Group E, and the remifentanil was also titrated to the vital sign. Before intubation and extubation, the Group E patients were administered 1.0 mg/kg esmolol, and the Group C patients were administered normal saline of the same volume. The incidence and severity of PONV, the pain score, the rescue antiemetics and the rescue analgesics were assessed 30 min, 6 h and 24 h after surgery. The mean arterial pressure and heart rate under anesthesia were also recorded. RESULTS: PONV and postoperative pain were significantly increased in Group C. These patients needed more antiemetics and analgesics in the first 24 postoperative hours. The mean arterial pressure and heart rate were significantly higher in Group C at the time of intubation and extubation. CONCLUSIONS: Perioperative esmolol administration contributes to the significant decrease in PONV and postoperative pain, and so this facilitates earlier discharge.

Comparison of time to awareness between obese patients and non-obese patients after total intravenous anesthesia with propofol and remifentanil

BACKGROUND: The rate of obesity has reached epidemic proportions and is on the rise.There have not been adequate studies on the differences in anesthesiology in obese patient. For this reason, we designed this study to determine the effect of obesity on time to awareness, comparing the use of propofol and remifentanil in general anesthesia. METHODS: We enrolled 55 patients into the study, between ages 16 and 45 years, who had an ASA physical status 1, 2 and who were undergoing general anesthesia for an elective obstetric operation. According to the Asia-Pacific obesity criteria, we divided the patients into 2 groups, the obesity group (BMI > or = 25), and the non-obesity group (BMI < 25). Propofol and remifentanil were infused using TCI for general anesthesia. The bispectral index score (BIS) was used for monitoring depth of anesthesia.During each operation, we tried to keep the BIS between 40 and 55 by controling the target concentration of TCI.We compared the time-to- awareness between the obese patient group and the non-obese patient group. RESULTS: The obesity and the non-obesity group did not show significant difference in awareness times between the obesity group, 412.4 +/- 102.5 s and the non-obesity group, 434.1 +/- 49.1 s. CONCLUSIONS: There was no evidence of a significant difference in time-to-awareness between the obese patient group and the non-obese patient group.The use of remifentanil and propofol work equally well in obese and in non-obese patients anesthesized for elective surgery.

Green urine in a patient who received a continuous infusion of propofol: A case report / 대한마취과학회지

The color of urine in patients who receive anesthetic gives much medical information to a medical team. So, we must check the urine color and know the cause of discoloration of the urine from anesthetic patients. Green urine is rare indeed and it is a benign potential side effect of propofol; this phenomenon is related to the metabolism of propofol. We experienced green urine from a long-term anesthetized patient who received a continuous infusion of propofol. We report here on this unusual case and we review the relevant literature.

Appropriate Dose of Remifentanil for the Prevention of Emergence Agitation after Total Intravenous Anesthesia (TIVA) in Pediatric Patients Undergoing Tonsillectomy

BACKGROUND: Pediatric tonsillectomy may be associated with a high incidence of emergence agitation. The aim of this study was to determine the appropriate dose of remifentanil continuously administered in the postanesthetic care unit (PACU) to reduce the incidence of emergence agitation and side effects after total intravenous anesthesia (TIVA). METHODS: Sixty children aged from 4 to 12 years undergoing tonsillectomy were randomly assigned to 3 groups. Anesthesia was induced with 1.5 mg/kg of propofol, 1microg/kg of remifentanil and was maintained with continuous infusion of propofol 100microg/kg/min, remifentanil 0.25microg/kg/min. At the end of surgery, each group received 0.025 (group 1), 0.05 (group 2), or 0.1 (group 3)microg/kg/min of remifentanil, respectively and the infusion was discontinued at 10 min before PACU discharge. Duration of anesthesia and emergence time were evaluated at the operating room. Agitation score, the time of stay in PACU and postoperative side effects were evaluated at the PACU. RESULTS: The emergence time and the time of stay in PACU were prolonged in the group 3 compared to the other groups (P < 0.05). The Group 2 and 3 had lower agitation score in comparison with that of the group 1 in the PACU (P < 0.05). CONCLUSIONS: For reducing emergence agitation after TIVA, we recommend infusion dose of remifentanil 0.05microg/kg/min.

A Comparative Study of Recovery Characteristics between Propofol-Remifentanil and Sevoflurane-Nitrous Oxide Anesthesia in Children / 대한마취과학회지

BACKGROUND: Remifentanil and sevoflurane are characterized by rapid emergence from anesthesia. Therefore, propofol-remifentanil anesthesia (PR) and sevoflurane-nitrous oxide anesthesia (SN) were compared with regard to the recovery characteristics in children. METHODS: Sixty children scheduled for tonsillectomy were randomly assigned to receive PR (n = 30) or SN (n = 30). The PR group was induced by remifentanil, propofol and vecuronium, maintained with infusion of remifentanil and propofol. The SN group was induced by sevoflurane, nitrous oxide, vecuronium maintained with sevoflurane in 50% nitrous oxide. At the end of operation, all anesthetics were discontinued and 100% oxygen was inspirated in both groups. The times to spontaneous breathing, extubation, eye opening, PACU discharge were assessed and postoperative nausea/vomiting, agitation were noted. RESULTS: Spontaneous breathing occurred after 9.29 +/- 1.02 minutes (PR) versus 6.85 +/- 0.60 minutes (SN) (P < 0.05), extubation after 9.19 +/- 0.91 minutes versus 8.87 +/- 0.67 minutes, eye opening after 9.47 +/- 1.01 minutes versus 14.85 +/- 0.80 minutes (P < 0.05) and PACU discharge after 21.32 +/- 2.01 minutes versus 27.55 +/- 1.72 minutes (P < 0.05). The occurrence of postoperative nausea/vomiting was 7% (PR) versus 13% (SN), and the incidence of agitation was 60% (PR) versus 83% (SN). CONCLUSIONS: It was observed that the recovery of propofol-remifentanil anesthesia was faster than that of sevoflurane-nitrous oxide anesthesia, except spontaneous breathing. The incidences of postoperative nausea/vomiting were low in both groups, and the incidences of agitation were higher in SN group than in PR group.

The Effectiveness of Low Dose Fentanyl Bolus Injection in Cesarean Section after Umbilical Cord Clamping / 대한마취과학회지

BACKGROUND: For anesthesia in cesarean section N2O and low concentrations of inhalation anesthetics are regarded as the anesthetic agent of choice. But a low level of anesthesia frequently leads to increased maternal hemodynamic responses and awareness. The effects of a 3 microgram/kg fentanyl bolus injection after umbilical cord clamping was evaluated in 20 full-term parturients, scheduled for elective cesarean section, versus to 20 parturients without fentanyl. METHODS: The forty parturients (ASA physical status 1, 2) scheduled for cesarean section were randomized to either a N2O-enflurane (E group) or a N2O-enflurane-fentanyl (F group). Thiopental sodium (4 mg/kg) and succinylcholine (1.5 mg/kg) were administered intravenously for the induction and endotracheal intubation. Anesthesia was maintained with 50% N2O and 1% enflurane in oxygen until delivery. After delivery, the intravenous injection of 0.5 mg/kg of atracurium was administered, controlled ventilation was applied to maintain PetCO2 at 30 to 35 mmHg with N2O (3 L/min) and O2 (1.5 L/min). Immediately after clamping the umbilical cord, 3 microgram/kg of fentanyl (F group only) was administered. Heart rate, blood pressure, awareness, recovery time, postoperative complication and recall were evaluated. RESULTS: Heart rate values at 10 and 20 min after umbilical cord clamping and 5 min after extubation, and mean arterial pressure at 5, 10 and 20 min after umbilical cord clamping in group F were found to be significantly lower than in group E. CONCLUSIONS: We conclude that N2O-enflurane-fentanyl at 3 microgram/kg is clinically satisfactory in anesthesia for cesarean section, having no adverse effects on the mother.

The Effects of Epidural Bupivacaine and Morphine Mixture on Bowel Motility after Upper Abdominal Surgery / 대한마취과학회지

BACKGROUND: The stress of operation inhibits bowel motility. The blockade of efferent sympathetic nerve is helpful to recovery of bowel motility. So we tried to examine that the extent of sympathetic blockade by alterations of bupivacaine infusion rate affected the recovery of bowel motility. METHODS: Group 1 (N = 25) received postoperative meperidine intramuscular injection on demand as a control group, group 2 (N = 25) received postoperative epidural 0.125% bupivacaine 100 ml plus morphine 10mg by infusion pump, 1 ml/hour, for 4days, group 3 (N = 25) received 0.125% bupivacaine 400 ml plus morphine 10mg by infusion pump, 4 ml/hour, for 4days. The Group 2 and 3 received additional morphine 2mg in 0.2% bupivacaine 10 ml epidurally as a single bolus when the peritoneum was closed. The time interval from termination of operation to the first passage of flatus was estimated. RESULTS: In group 1, bowel motility was regained at 92+/-23 hours, group 2 ; 90+/-19 hours and group 3 ; 91+/-19 hours. All values are not significantly different among the groups (p>0.05). CONCLUSIONS: The alteration of epidural bupivacaine and morphine infusion rate did not affect the recovery of postoperative bowel motility.

Bradycardia and Hyprtension during General Anesthesia in a Diabetic Patient with Autonomic Neuropathy / 대한마취과학회지

The major risk factors for diabetics undergoing surgery are the end-organ diseases associated with diabetes. Autonomic neuropathy is relatively common in diabetic patients and associated with an increased risk of perioperative cardiovascular instability. We experienced a case of severe bradycardia and hypotension during general anesthesia for subtotal gastrectomy in a 59 year-old male diabetic patient. Anesthesia was induced with thiopental and vecuronium, and was maintained with nitrous oxide, oxygen and enflurane. Five minutes after induction, severe bradycardia and hypotension developed without specific events. The bradycardia was unresponsive to intravenous atropine and ephedrine, but the blood pressure was restored by administration of ephedrine. During operation his blood pressure was maintained in normal range but the bradycardia was not restored by additional administration of atropine. Postoperatively, myocardial infarcton was ruled out. The test performed after operation suggested that his cardiovascular autonomic nervous system was severely impaired. We think that cardiovascular autonomic dysfunction should be evaluated during preoperative period to plan the anesthetic management and to prevent severe cardiovascular complications in diabetic patients.