Hemodynamic Evaluation of Thoracic Epidural Analgesia Combined with General Anesthesia in Coronary Artery Bypass Surgery / 대한마취과학회지

BACKGROUND: High dose fentanyl anesthesia has been recommended for circulatory stability during coronary artery bypass grafting (CABG), but hypertension and tachycardia in response to noxious stimulation have been noted. The purpose of this study was to evaluate the hemodynamic effects of extensive thoracic epidural analgesia (TEA) combined with general anesthesia (GA). METHODS: The hemodynamic effects in CABG were evaluated in 30 patients. They were randomized into two groups ; the GA group receiving high dose fentanyl (50-70 mcg/kg), the TEA group receiving 10 ml bupivacaine 5 mg ml 1 followed by 5 ml every two hours epidurally GA (N2O-O2). The hemodynamic parameters were evaluated before induction of anesthesia, 20 minutes after induction of anesthesia, after sternotomy, and 30 minutes after end of cardiopulmonary bypass. RESULTS: Heart rate and mean arterial pressure were significantly lower after sternotomy in the TEA group compared to the GA group. Significant increase in cardiac index and decrease in central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure were found after induction of anesthesia and sternotomy in the TEA group compared to the GA group. Especially, the pulmonary vascular resistance was significantly lower during all the period in the TEA group compared to the GA group. No differences were observed in stroke volume index, systemic vascular resistance, left ventricular stroke work index between two groups. CONCLUSIONS: The present study suggests a more effective blockade of the stress response during CABG with TEA than with GA. So, we consider that TEA could be used as an adjunctive anesthetic method during CABG.

The Analgesic and Hemostatic Effects of Diclofenac as Adjuvant of Intravenous Opioid Using PCA after Cesarean Section / 대한마취과학회지

BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvant for postoperative pain management using intravenous Patient Controlled Analgesia (PCA). The analgesic and hemostatic effects of diclofenac were measured in 80 paturients after Cesarean section. METHODS: Eighty parturients were randomly allocated to four groups and each group had 20 women. The parturients were given loading dose of meperidine in D group and morphine in M group and then postoperative pain was controlled with PCA device for up to 48 hours after Cesarean section when the parturients awoke and complained pain. The parturients received intramuscular diclofenac 75 mg followed by loading dose of meperidine in DV group and morphine in MV group. Diclofenac was repeated every 12 hours. We evaluated the effects of diclofenac on postoperative opioid requirement, numerical rating score of pain and hemostasis at 48 hours after operation. RESULT: Diclofenac decreased almost 50% of opioid requirement and pain score lowered significantly at 12, 24 hours in DV group and at 12 hours in MV group. But there was no difference in laboratory data including hemoglobin, hematocrit, platelet count and bleeding time among the groups. CONCLUSION: We concluded that diclofenac is effective and safe adjuvant for postoperative pain management without hemostatic abnormality. But it is necessary to try further evaluation of hemostatic effect of diclofenac.