Effects of furosemide on perioperative serum osmolality andelectrolytes during transurethral resection of the prostate / 영남의대학술지

The purpose of this study was to prevent the dilutional effect of excessive absorption of irrigating solution by using furosemide intraoperatively during transurethral resection of the prostate. 30 patients, who belonged to physical status II or III of ASA classification, were selected randomly and divided with two groups as follows: G1 (N=15): Not-administrated furosemide (control group) G2 (N=15): Administrated furosemide (Experimental group) All patients were premedicated with Hydroxyzine (1mg/kg, IM) and were performed continuous epidural anesthesia with 2% lidocaine (1-1.5mg/segment). For irrigating solution, 5% D-sorbitol was used and Hartman's solution were given for maintenance fluid and fixed the height of irrigating container to 60 cm from symphysis pubis. With the starting of operation, 20 mg furosemide was administrated to experimental group. The blood samples for the values of Na⁺, K⁺, Glucose and BUN were performed at the periods of preoperation, 10 min, 20 min, 30 min after the starting of operation and immediate postoperation. Based these date, serum osmolality and effective osmolality were calculated. The results were as follows: 1. The sodium concentration of control group was decreased statistically significantly at 10 min, 20 min, 30 min after the starting of operation and immediate postoperative period as comparing with the preoperation value (p<0.05). But that of experimental Group was not changed significantly. 2. The serum osmolality and effective osmolality were decreased statistically significantly at 30 min after the starting of operation and immediate postoperative period as comparing with the preoperation value (p<0.05). But those of experimental group were not changed significantly. These results show that the dilutional effect of excessive absorption of irrigating solution might be prevented by using furosemide intraoperatively. And so we recommend the use of furosemide during TURP, especially in patients with congestive heart failure or renal failure.

Effects of Added Epinephrine on Plasma Concentration of Lidocaine Following Epidural Anesthesia / 대한마취과학회지

Sixteen healthy adult female patients scheduled for elective abdominal hysterectomy were divided into two groups, and the venous plasma concenrations of lidocaine for both groups were measured at 5, 10, 15, 30, 45 and 60 minutes after an epidural injection of 2% lidocaine 500 mg. Group 1 received plain lidocaine, and group 2 received lidocaine with 5 ug/ml epinephrine. We observed that the mean measured plasma concentration of lidocaine in group 2 was significantly lower than in group 1 over the entire studied time course(P<0.05). The addition of epinephrine to the lidocaine solution reduced the peak plasma concentrations by 49% (from 7.76 to 3.97); however, this did not prolong the times at which the peak concentrations were reached. We hypothesized that these results may have been caused by some reduced epidural blood flow which have decreased the amount of lidocaine absorption.

Rupture of Hedden Cerebral Aneurysm during Induction of General Anesthesia / 대한마취과학회지

Unexplained incidental intracranial hemorrhages during induction of general anesthesia are very rare. When it dose occur, anesthetists are involved in serious problems which can lead to disaster. We had a case where a hidden cerebral aneurysm ruptured during the induction in a patient. A 56 year old female was scheduled for a skin graft procedure on her face, anterior chest and both arms. For general anesthesia, she was induced with 300 mg of thiopental and 75 mg of succinylcholine. This was followed by endotraeheal intubation. The Anesthesia was maintained with N2O/O2 and enflurane. Appoximately 10 minutes after the induction was started the patient's pupil became fully dilated and we observed that her light reflexes were gone. Consequently, all anesthetics were discontinued, and the schedule was cancelled. She had a brain CT taken which showed subarachnoid hemorrhage. She died of rebleeding from cerebral aneurysm on the 12th postoperative day during the recovery process.

Measurement of Epidural Pressure / 대한마취과학회지

The epidural space is located along the entire spinal column hetween the dural mater and the external dural (periosteal) layer. It contains fat, connective tissue and numerous vessels, primarily veins. It is known that epidural pressure is negative. Negative intrathoracic pressure is thus transfered via the paravertebral spaces to the thoracic epidural spaces and to a diminishing extent to the cervical and lumbar regions. The spread of the anesthetic solution within the epidural spacea is variable according to the patient's physical characteristics such as age, arteriosclerosis according to the patients physical character-sitics such as age, arteriosclerosis, pregnancy, venous circulation and extradural fat. Other factors are under the direct control of the anesthesiologist such as positioning the patient, choosing the site of epidural puncture, orientation of the needle bevel and determining the speed of injection, volume and concentration of anesthetic solution. The epidural pressure (initial negative pr flexion pr., pr. after 10ml lidocaine injection) was measured at the lumbar 3-4 interspace by the hanging drop method. The results were summarized as follows: 1) The negative pressure was meassured in 70 cases and was observed in 95.7 percent. The lowest value was -21 cm. of water in one case and no negative pressures were observed in 2 cases. 2) The pressures after 10 ml injection exhibited three successive components: the peak, the descent and the residual values which were scattered from the injection and were observed more frequently in patients under the age of 50. A slower rate of descent and higher residual pressures were found in older patients. 3) The relationship between height, weight and epidural pressure was not observed. 4) In older patients it was observed that epidural pressures were pulsated along with the heart beats and were moved up and down with the respiratory movement.

A Clinical Analysis of 3400 Cases of Epidural Block for the Relief of Labour Pain / 대한마취과학회지

This report is a clinical analysis of 3400 cases of continuous epidural block for labour and delivery during the period of January 1985 to April 1988. Among the 3400 parturients, there were 2230 nulliparas and 1070 multiparas. From January 1985 to April 1988, total numbers of vaginal delivery were 6724 cases and epidural block were perfomred in 55.1% of the parturients for the relief of pain during labour. Drugs used for epidural block were 0.25%, 0.375%, 0.5% bupivacaine mixed with epinephrine(1:300,000) and 1.5% lidocaine mixed with epinephrine(1:300,000). Effect of pain relief was good in 90% of epidural blocks, fair in 9% and poor in 1%, 53 parturients were undergone cesarean section during the epidural analgesia due to induction failure, prolonged 2nd stage and fetal distress. Complications were recorded i.e. dural puncture(38 cases), headache(26 cases), backache(58 cases), high spinal anesthesia(2 cases), hypotension(35 cases), shivering(32 cases) and burn(1 case). According to our experiences we have obtained the following results. 1) There were little adverse clinical resctions on mothers and fetuses. 2) The progress of labour was insignificantly delayed with our procedures and drugs used for analgesia. 3) The number of parturients have increased gradually since we have started painless delivery in January 1985.