Changes in Heart Rate Variability in Elderly Hypertensive Patients during Combined Spinal-Epidural Anesthesia / 대한마취과학회지

BACKGROUND: We evaluated the changes in heart rate variability (HRV) in elderly patients with or without hypertension before and after combined spinal-epidural anesthesia (CSE). METHODS: Elderly hypertensive (group H, n = 28) and non-hypertensive patients (group C, n = 32) were recruited. We analyzed the spectral components of HRV, total power ( or = T6 [H]) according to fixed analgesia level. RESULTS: Before CSE, group H showed significantly lower LnLF than that of group C (P < 0.05). Fifteen and 10 min after CSE, decrease of SBP and increase of HR in group HH were significantly greater compared with group CL and lesser with group CH, respectively. LnTP, LnLF and LnHF in both control groups (CL and CH) were significantly decreased 15-20 min after CSE compared with pre-CSE values. LnLF and LnHF in group HH were significantly lower than those in group HL 10-15 min after CSE. But there were no significant changes of LFnorm, HFnorm and LF/HF in all four groups. CONCLUSIONS: The group H showed significantly lower LnLF than that of group C before CSE. In group HH, LnLF and LnHF were significantly lower than those in group HL 10-15 min after CSE, but the balance of the autonomic nervous system was not changed significantly.

The Effect of Midazolam for Reducing Myoclonus after Etomidate / 대한마취과학회지

BACKGROUND: Etomidate is a rapid acting sedative agent used for the induction of general anesthesia. One of the side effects of etomidate limiting its usage is myoclonus. This study was designed to determine whether a small dose of midazolam decreases the incidence of myoclonus after infusion of etomidate. METHODS: Eighty ASA physical status 1 or 2, 16-60 year old patients undergoing elective surgery were randomly allocated into two groups. Group 1 (n = 40) received normal saline 0.04 ml/kg and group 2 (n = 40) received midazolam 0.04 mg/kg 3 minutes before the administration of etomidate 0.3 mg/kg. We measured and compared the incidence, severity, onset time and duration of myoclonus, and blood pressure and heart rate. RESULTS: There were significant differences in the onset time and severity of myoclonus, but no significant differences in the incidence and duration of myoclonus. Systolic blood pressure was significantly higher in group 1 than group 2 at 3 minutes after pretreatment drug administration, immediatly after etomidate administration and 3 minutes after etomidate administration. CONCLUSIONS: An infusion of 0.04 mg/kg midazolam 3 minutes before etomidate decreases the severity of myoclonus and the onset of myoclonus.

The BIS Change and Neonatal Effect during General Anesthesia for a Cesarean Section / 대한마취과학회지

BACKGROUND: The problem of psychological complications (trauma) by intraoperative awareness is a well discussed issue recently. The bispectral index (BIS) is reported to be closely related to the sedation and consciousness of anesthetics. This study was to observe the effects of ketamine injection and enflurane inhalation on the BIS, Apgar score of the neonate and blood gas analysis of umbilical cord artery and vein with general anesthesia for a Cesarean section. METHODS: The subjects of the study were 30 pregnant women who received a Cesarean section with general anesthesia. Before the delivery enflurane 1.0% inhalation group (group 1, n = 10), ketamine 20 mg injected group (group 2) and both ketamine 20 mg injected and enflurane 1.0% inhalation group (group 3) were assessed by BIS, blood pressure, heart rate, induction-delivery time, Apgar score of the neonate at 1, 5 minutes and blood gas analysis of the umbilical artery and vein. RESULTS: The BIS of all groups was over 70 after tracheal intubation and the ketamine injected group (group 2) was higher than the enflurane inhalation group (group 1) from 2 minutes after tracheal intubation. The BIS of the both ketamine 20 mg injected and enflurane 1.0% inhalation group (group 3) was lower than the ketamine injected group (group 2), 4 minutes after tracheal intubation. The Apgar score of neonates and blood gas analysis of the umbilical cord artery and vein had no significant differences between these groups. CONCLUSIONS: In the anesthetics injected before delivery in a cesarean section under general anesthetics, a small dose of ketamine can increase the BIS while a small dose of ketamine with 1.0% enflurane inhalation decreases the BIS, but in all groups the BIS was over 70 which can cause intraoperative awareness. Thus to avoid this problem, more studies are needed on the methods of anesthesia and multifactorial approaches to increase the utility of BIS monitoring.

Considerations of Pulmonary Thromboembolism and Anesthesia / 대한마취과학회지

BACKGROUND: Pulmonary embolism can occur in various clinical situation and its diagnosis is difficult to be made but once it happens it can be a fatal disease to cause a death. We investigated 27 autopsied cases in the recent three years at National Institute of Scientific Investigation (NISI) who received anesthesia and diagnosed as pulmonary thromboembolism as cause of death and evaluated clinial situation and mortality by reviewing medical records. METHODS: Among 6848 autopsied cases in NISI from 1/1997 to 12/1999, 27 cases who were recieved anesthesia and whose cause of death were confirmed as pulmonary thromboembolism were investigated through its autopsy record, clinical record and statement. RESULTS: The type of anesthesia of 17 cases was general anesthesia, 4 cases was local anesthesia and 6 cases was unknown. As clinical distribution, obstetric were 17 cases, orthopedic 7 cases and thoracic surgery, general surgery and urology were 1 cases. By comparing the time interval between operation and death, 7 cases of obstetric were on postoperative 1 2 days. Deep thromboembolism was observed on lower extremities by 22 cases and anatomocally heart lesion was observed by 14 cases by autopsy. CONCLUSIONS: Pulmonary thromboembolism is one of the leading causes of sudden postoperative death, but because reliable symptoms, signs and diagnostic methods were absent, physician have to be aware of the problem and make effort to diagnose if possible.

Considerations of Pulmonary Thromboembolism and Anesthesia / 대한마취과학회지

BACKGROUND: Pulmonary embolism can occur in various clinical situation and its diagnosis is difficult to be made but once it happens it can be a fatal disease to cause a death. We investigated 27 autopsied cases in the recent three years at National Institute of Scientific Investigation (NISI) who received anesthesia and diagnosed as pulmonary thromboembolism as cause of death and evaluated clinial situation and mortality by reviewing medical records. METHODS: Among 6848 autopsied cases in NISI from 1/1997 to 12/1999, 27 cases who were recieved anesthesia and whose cause of death were confirmed as pulmonary thromboembolism were investigated through its autopsy record, clinical record and statement. RESULTS: The type of anesthesia of 17 cases was general anesthesia, 4 cases was local anesthesia and 6 cases was unknown. As clinical distribution, obstetric were 17 cases, orthopedic 7 cases and thoracic surgery, general surgery and urology were 1 cases. By comparing the time interval between operation and death, 7 cases of obstetric were on postoperative 1 2 days. Deep thromboembolism was observed on lower extremities by 22 cases and anatomocally heart lesion was observed by 14 cases by autopsy. CONCLUSIONS: Pulmonary thromboembolism is one of the leading causes of sudden postoperative death, but because reliable symptoms, signs and diagnostic methods were absent, physician have to be aware of the problem and make effort to diagnose if possible.

A Clinical and Statistical Study on Pregnancy of Elderly Primipara / 대한산부인과학회잡지

OBJECTIVE: Recently, the incidence of elderly primipara is increasing. Thus, impact of old age on pregnancy outcomes became important. Our purpose was to assess the effect of maternal age on pregnancy outcomes. METHODS: 73 cases of the elderly primipara over 35 years at the department of obstetrics and gynecology, Chon-ju presbyterian medical center, from Jan. 1, 1995 to Dec. 31, 1998, were compared with 73 cases randomly chosen young primiparas during same period. RESULTS: Elderly primipara had higher rate of infertility and spontaneous abortion history, antenatal complications, cesarean section, poorer neonatal outcome than young primipara. CONCLUSION: The pregnancy outcome of elderly primipara is considered to be less favorable than those of young primipara. Careful antenatal and intrapartal care should be performed for the elderly primipara. We think that many clinical study of congenital anomaly in elderly primipara will be necessary.