Caudal Anesthesia for Postoperative Pain Control in Pediatric Urologic Patients / 대한마취과학회지

In this study, caudal anesthesia was performed with 0.25% bupivacaine and 0.25% bupivacaine-1% lidocaine mixtures at the end of operation. Anesthetics were administered randomly with the volume of 0.5 ml/kg, 0.75 ml/kg, 1.0 ml/kg and 1.25 ml/kg individually. The results were as following: 1) The more the volume of loeal anesthetics administered, the higher the spinal dermatome was blocked(P<0.005) and adequate analgesic levels were achieved. Body height classification by under and over 100 cm does not have statistically significant to determined of local anesthetic dosage. 2) Volume of local anesthetic solution required to block a spinal segment and body weight was most correlated to each other. At least 0.75 ml/kg or 1.0 ml/kg of local anesthetics are average amount for adequate pain control of pediatric urologic patients. 3) Only 17(24%) in 70 patients were required additive analgesic during postoperation 24 hours. 4) Local anesthetic volume required to block per a spinal segment was gradually increased with increased age and it markedly increased from 7 years old patients, this results have statistically significant correlationship. 5) The average volume of local anesthetic solution in patients under and over 100 cm in body height were 0.95+/-0.235 ml/spinal segment and 1.576+/-0.443 ml/spinal segment respectively(P< 0.0005). 6) Analgesic duration did not depend on operation site and body height(cm), analgesic duration tend to prolonged a little in patients who had undergone penoscrotal operation. 7) There was no statistical difference in analgesic durations between 0.25% bupivacaine group and 0.25% bupivacaine-1% lidocaine mixture group. With above results, we suggest that caudal analgesia in pediatric urologic patients who had undergone inguinal or penoscrotal operation would be simple, safe and effective method for postoperative pain relief.

Anesthetic Management for Patient with Hemophilia A / 대한마취과학회지

Numerous advances have been applied for the management of hemophiliac patients and the life expectancy of them was markedly improved. But they have many problems yet such as transmission of infections, adverse reactions to plasma products, development of factor VIII inhibitor and inadequate coagulation in the medical and/or surgical treatment. Anesthetic care should be managed with gentle, atraumatic intubation and careful positioning of patient pointing to the prevention of bleeding from hemorrhagic diathesis. We present a case of hemophilia A who had in operation for olecranon fracture of left ulna. It is important that anesthesiologist should realize that certain pathophysiological changes, especially coagulation disorders, might be occurred during surgical procedures and that perioperative preparation and management for them should be kept well.