ABSTRACT
BACKGROUND: The purpose of this study is to compare the effectiveness of thoracic epidural anesthesia (TEA) and general anesthesia (GA) in terms of side effects, postoperative pain control and the cost of anesthesia for breast mass excision surgery. METHODS: Forty-three patients rated as ASA physical status class 1 or 2 who underwent breast mass excision surgery were included in the study. In the TEA group (n = 20), 2% lidocaine (3 ml) and 0.5% bupivacaine (3 ml) were administered via the epidural route. Blood pressure and heart rate were measured before and at 3, 6, 9, 12, 15, 18 21, 24, 27 and 30 minutes after epidural injection. In the GA group (n = 23) patients were maintained by general anesthesia with enflurane and 50% nitrous oxide in oxygen. After the operation, patients were given NSAID-diclofenac sodium as they wanted. Analgesic requirement, satisfaction score, and anesthesia-related side effects were recorded 1 day after surgery. Satisfaction scores of the surgeons and patients were recorded as excellent (4 point), good (3 point), fair (2 point), and unacceptable (1 point). RESULTS: Overall satisfaction scores and side effects were not significantly different between the TEA group and the GA group. Anesthesia cost (80,883.2 +/- 3956.9 vs 32,284.8 +/- 1209.4 won) were significantly lower in the TEA group than in the GA group. CONCLUSIONS: There were not significant differences in satisfaction scores and postoperative side effests between the TEA and GA groups. TEA provided lower anesthesia cost than GA for breast mass excision surgery.
Subject(s)
Humans , Anesthesia , Anesthesia, Epidural , Anesthesia, General , Blood Pressure , Breast , Bupivacaine , Enflurane , Heart Rate , Injections, Epidural , Lidocaine , Nitrous Oxide , Oxygen , Pain, Postoperative , Sodium , TeaABSTRACT
BACKGROUND: Recent studies suggested that preoperative block of N-methyl-D-aspartate (NMDA) receptor with NMDA antagonists may reduce postoperative pain. In this double-blind study, we administered magnesium sulfate, a natural NMDA receptor antagonist, to investigate the preemptive effect of magnesium sulfate on postoperative pain. METHODS: Seventy-three patients scheduled for gastrectomy were randomly assigned to one of three groups. Groups 2 and 3 received intravenous magnesium sulfate (Group 2: 50 mg/kg bolus, 7.5 mg/kg/h for 20 h, preoperatively, Group 3: 50 mg/kg bolus, 7.5 mg/kg/h for 20 h, postoperatively). Group 1 received normal saline as the control group. Visual analog scale (VAS) for postoperative pain and mood, cumulative analgesic comsumption, recovery of pulmonary function and side effects were evaluated at 6, 24, 48 and 72 hours after the operation. RESULTS: In groups 2 and 3, plasma concentration of magnesium were significantly higher than group 1 after 6 and 20 hours after infusion. There were no significant differences in the pain, mood, cumulative analgesic comsumption, and recovery of pulmonary function and the incidence of side effects at 6, 24, 48 and 72 hours after the operation among the three groups. CONCLUSIONS: We conclude that intravenous infusion of magnesium is not effective in reducing postoperative pain.
Subject(s)
Humans , Double-Blind Method , Gastrectomy , Incidence , Infusions, Intravenous , Magnesium Sulfate , Magnesium , N-Methylaspartate , Pain, Postoperative , Plasma , Receptors, N-Methyl-D-Aspartate , Visual Analog ScaleABSTRACT
Epilepsy surgery is performed in patients with epilepsy of focal origin and seizures which are refractory to medical treatment. Electrophysiologic mapping of the epileptic foci and other cortical areas (e.g., language, memory, sensorimotor) is frequently used to maximize the resection of the epileptogenic lesion while minimizing the neurologic deficits. For language area mapping, general endotracheal anesthesia can not be used because a patient can not vocalize. So awake craniotomy is frequently used. However, during awake craniotomy for language area mapping with local infiltration anesthesia and intravenous sedation and narcotics supplementation analgesia, respiratory arrest or depression and hypoxemia may occur. The airway securement is crucial to the patients. As an alternative to tracheal tubes, laryngeal mask airway can secure the airway and does not interference the vocalization. We could successfully performed the language area mapping in a 17-year-old male patient with laryngeal mask airway under deep intravenous anesthesia with local infiltration anesthesia of the scalp.
Subject(s)
Adolescent , Humans , Male , Analgesia , Anesthesia , Anesthesia, Intravenous , Anesthesia, Local , Hypoxia , Craniotomy , Depression , Epilepsy , Laryngeal Masks , Memory , Narcotics , Neurologic Manifestations , Scalp , SeizuresABSTRACT
Epilepsy surgery is performed in patients with epilepsy of focal origin and seizures which are refractory to medical treatment. Electrophysiologic mapping of the epileptic foci and other cortical areas (e.g., language, memory, sensorimotor) is frequently used to maximize the resection of the epileptogenic lesion while minimizing the neurologic deficits. For language area mapping, general endotracheal anesthesia can not be used because a patient can not vocalize. So awake craniotomy is frequently used. However, during awake craniotomy for language area mapping with local infiltration anesthesia and intravenous sedation and narcotics supplementation analgesia, respiratory arrest or depression and hypoxemia may occur. The airway securement is crucial to the patients. As an alternative to tracheal tubes, laryngeal mask airway can secure the airway and does not interference the vocalization. We could successfully performed the language area mapping in a 17-year-old male patient with laryngeal mask airway under deep intravenous anesthesia with local infiltration anesthesia of the scalp.