Treatment of Refractory Angina Pectoris with High Thoracic Epidural Analgesia / 대한마취과학회지

A 64-year-old woman presented with severe chest pain and indigestion for ten days. She had been repeatedly admitted for the same symptoms, and had been treated with oral medication with no improvement. Coronary angiography revealed total occlusion of the left anterior descending and circumflex arteries. The patient was referred to our department because the other medical treatments had been unsuccessful and neither angioplasty nor coronary artery bypass surgery was safe. An epidural catheter was placed at the T2-3 level and a 5 mL bolus of 0.25% bupivacaine completely relieved the patient's angina. The arterial blood pressure and heart rate remained unchanged and the IV nitrates were discontinued. An infusion of 100 mL 0.0625% bupivacaine with 10 mg morphine was started at 4 mL/h. During the following 13 days, the patient remained pain free with 5 mL of 0.25% bupivacaine. Her symptoms continued to diminish and she remained free of pain even after discontinuing the high thoracic epidural anesthesia (HTEA), but she still took an occasional oral dose of nitrates.

Tranexamic Acid Versus a Placebo in Decreasing Blood Loss in Patients Undergoing Spine Surgery / 대한마취과학회지

BACKGROUND: Major spine surgery can be associated with dramatic blood loss, thereby requiring a high-volume transfusion. Tranexamic acid inhibits fibrinolysis and it has been used in general surgery. The effect of tranexamic acid on blood loss and transfusion requirements during spine surgery was prospectively studied. METHODS: Twenty-two patients scheduled for orthopaedic surgery for spinal stenosis under general anesthesia were randomly selected to receive, either tranexamic acid administered as a bolus of 15 mg/kg, or the equivalent volume of saline, during the operation and postoperatively. The anesthetic and perioperative management were standardized. The total blood loss of each patient and transfusion requirements were noted. Hematocrit, PT, PTT, and platelet count measure were performed before and after surgery. RESULTS: The tranexamic acid group demonstrated a significantly less amount of blood loss (859.5 +/- 280.0 ml) compared to the placebo group (1366.0 +/- 333.7 ml). In addition the fluid and homologous transfusion requirements in the placebo group were greater than in the tranexamic acid group. CONCLSIONS: Tranexamic acid during major spine surgery significantly reduces both blood loss and consequent blood transfusion requirements.

The Effect of Epidural Phenylephrine on Hypotension Induced by Epidural Anesthesia for Cesarean Delivery / 대한마취과학회지

BACKGROUND: Hypotension can occur after high level of epidural anesthesia. Like ephedrine, epidural phenylephrine is known to reduce the incidence of hypotension induced by the epidural administration of lidocaine. The purpose of this study was to determine whether combining epidural phenylephrine can reduce the incidence of hypotension in epidural anesthesia. METHODS: Ninety-two patients undergoing a cesarean section were divided into three groups. Patients assigned to three groups received 20-25 ml of lidocaine containing fentanyl 50 microgram with one of three doses of phenylephrine; 0 microgram (Group 1), 100 microgram (Group 2), or 200 microgram (Group 3), injected via the lumber epidural catheter. The mean blood pressure and heart rate were recorded every 10 min for 1 h after injection and were compared among the groups. Pinprick testing was performed to determine the highest level of sensory block and the time to two-segment regression. Also, the incidence of hypotension and ephedrine required were investigated. RESULTS: The incidence of hypotension was 37%, 28%, and 40% in Group 1-3, respectively. The time to two-segment regression was 94.7 +/- 21.6 in group 1, 100.8 +/- 20.1 min in Group 2, compared to 118.2 +/- 26.3 min in Group 3. CONCLSIONS: We found that epidural phenylephrine significantly prolonged the duration of epidural anesthesia, but it was ineffective for preventing hypotension induced by lidocaine epidural anesthesia.

Postoperative Unstable Angina Pectoris Occured in the Recovery Room: Case report / 대한구급학회지

The leading cause of death after anesthesia and operations is cardiac complications, defined as myocardial infarction, unstable angina, congestive heart failure. We experienced a case of transient chest pain mimicking to myocardial ischemia after total intravenous anesthesia using propofol. The patient was 56 year-old female who underwent metatarsal osteotomy and distal soft tissue procedure. There was no specific abnormality on preoperative laboratory tests. Anesthesia induction and intraoperative course were completely uneventful. Immediately after transfered to the recovery room, the patient revealed transient cyanosis and complained anterior chest pain with tightness after fully awakening. In the study of electrocardiogram, there were ST abnormality in II, III, AVF and then T inversion in II, III, AVL, AVF, V2-6 leads. In the simultaneous study of echocardiogram, there was hypokinetic wall movement in the distal septum area. After treatment of nitroglycerine, the pain was subsided and the patient was discharged without any sequelae.