Comparison of Propofol and Midazolam for Patient Controlled Sedation during Local Anesthesia / 대한마취과학회지

BACKGROUND: Surgical procedures carried out under local anesthesia are associated with patient discomfort and apprehension. The purpose of this study is to compare propofol and midazolam with regard to their suitability for the patient controlled sedation (PCS) technique during local anesthesia. METHODS: Forty unpremedicated, ASA physical status I day surgery patients undergoing elective minor surgery were randomly divided into two equal groups of patients who self-administered either propofol or midazolam intraoperatively. All patients initially received 0.5 g.kg-1 fentanyl. The bolus dose was either 20 mg (2 ml over 25 sec) of self-administered propofol or 0.5 mg (2 ml over 25 sec) of midazolam and lock-out period was 1 min. RESULTS: The onset of sedation following propofol was significantly faster than midazolam (p<0.05) and demands of propofol was significantly less than midazolam (p<0.05). There were no significant differences for postoperative recovery, sedation and comfort scale. CONCLUSIONS: Propofol was judged the more suitable agent for PCS than midazolam, because of its more rapid onset of sedation and less demands of drug.

Prevention and Management in a Patient with Family History of Malignant Hyperthermia / 대한마취과학회지

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia, skeletal muscle rigidity, tachycardia, respiratory and metabolic acidosis, cyanosis etx. There is no simple noninvasive test to identify the susceptible individuals. A history of hyperpyrexia and/or muscle rigidity during previous general or a family history of such a condition provides the anesthesiologist with valuable information. Avoidance of potent inhalational anesthetic agents and other triggering agenta, and the selective use of regional anesthesia with either a local anesthetic agent or neuroleptic anesthesia, are the usual acceptable guidelines in the anesthetic management of susceptible individuals. Dentrolene sodium has been shown to be effective in the prevention and treatment of malignant hyperthermia in malignant hyperthermia susceptible swine. We gave Dantrolene sodium orally as a part of the prophylaxia for malignant hyperthermia in a 34yearts-old woman who underwent an emergency bilateral salpingectomy and who had a family history of malignant hyperthermia. We report on this patient with a family history of hyperthermia and reviewed the literature concerning malignant hyperthermia.

Bilateral Tension Pneumothorax during General Anesthesia - Case report / 대한마취과학회지

Pneumothorax was recognized as a potential hazard of mechanical ventilation shortly after the introduction of the technique of tracheal intubation in the 19th century. Because the gases used in anesthesia are delivered from cylinders and wall outlets at higher than atmoshperic pressure, the possibility of damage to the lung is ever present. Immediate, prompt and adequate management of bilateral tension Pneumothorax are essentil, otherwise the patient dies rapidly. We had a case of bilateral tension Pneumothorax in a 3 year-old boy who underwent a B-E amputation of a severely crushed hand. We report this case along with a review of the literature on Pneumothorax.

Malignant Hyperthermia during General Anesthesia ( A case report ) / 대한마취과학회지

Malignant hyperthermia is a recently described and drmatic syndrome which rarely occurs during anesthesia, but when & dose occur is still fatal in the majority of cases with unknown etiology. It si a rypermetabolic condition characterized by tachycardia, tachypnea, skeletal muscle rigidity, respiratory and metabolic acidosis and cyanosis etc. A case is presented of a 20 year old gerveralcy healthy female with a family history of congenital eye-ild ptosis in herself as well as in all her brothers and sisters( male 2, female 4) and a generalized muscle weakness of unknown origin for several years in her father. She underwent a minor operation for correction of the congenital eyelid ptosis under N2O-O2-tachycardia developed followed by severe arrhythmia with unstable BP, minutes after induction tachycardia developed followed by sever arrhythmia with unstable BP, muscle rigiditiy and hyperpyrexia. 15 minutes after induction anesthesia was stopped and aggressive emergency treatment was atlemted. Unfortunately, she died postoperatively on the 8th day after anesthesia. Possible etiologic factors, the clinical features and management of malignant hyperthermia are discussed.