Comparison among the effect of ondansetron, lidocaine and combination of ondansetron and lidocaine on microemulsion propofol injection pain

BACKGROUND: The pain caused by injection of propofol is known to be related to the concentration of aqueous free propofol. Microemulsion propofol can cause a serious pain because it has 7 times higher concentration of aqueous free propofol. We used ondansetron, lidocaine, ondansetron lidocaine as pretreatment to compare the effect for injection pain of microemulsion propofol. METHODS: 75 patients, ASA physical status I or II were enrolled. We randomly allocated into Group L (n = 25) received 2% lidocaine 40 mg, group O (n = 25) received ondansetron 4 mg and group M (n = 25) received ondansetron 4 mg plus 2% lidocaine 40 mg as pretreatment. After instituting standard monitoring, the venous drainage was occluded using a pneumatic tourniquet at 25 cm proximal to venous line. The patients were pretreated over a period of 15 seconds with one of the pretreatment drug. After releasing the tourniquet, microemulsion propofol was injected. We asked the patient about degree of injection pain until loss of consciousness, by using 0-100 point pain intensity numerical rating scale (PI-NRS). In the recovery room, we asked the patient whether they recall injection pain. RESULTS: There were significant differences in the group L and the group M compared with group O on PI-NRS (P < 0.05). The incidence of injection pain was significantly lower in group L and group M than group O. CONCLUSIONS: Pretreatment of lidocaine and lidocaine + ondansetron is more effective than ondansetron alone for reducing pain on injection of microemulsion propofol.

Combined Spinal-epidural Anesthesia in a Patient with Severe Thoracic Kyphoscoliosis: A case report / 대한마취과학회지

Kyphoscoliosis is a deformity of the costovertebral skeletal structures characterized by an anterior flexion (kyphosis) and lateral curvature (scoliosis) of the patient's vertebral column.(1)) In kyphoscoliosis, lung volume and compliance is reduced due to the change of vertebral column. The work of breathing is increased by abnormal mechanism of the thorax and by increased airway resistance resulting from small lung volume. Airway management and respiratory problems are common and spinal deformities can cause difficulties with regional anesthesia. We had experienced a successful spinal anesthesia for closed reduction and internal fixation (CRIF) and proximal femoral nail (PFN) of fractured intertrochanteric femur in a patient with extremely severe thoracolumbar kyphoscoliosis.

A Comparative Study of Propofol-Fentanyl and Propofol-Ketamine Anesthesia for Spine Surgery under Somato-Sensory Evoked Potential Monitoring / 대한마취과학회지

BACKGROUND: Somato-sensory evoked potential (SSEP) monitoring has been used to help minimize neurologic morbidity during spinal surgery. However, SSEP is affected by anesthetics, technical errors and physiologic aspects. We reviewed 50 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. METHODS: Fifty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl (Group I, P-F) or ketamine (Group II, P-K), and monitored by SSEP. We checked the changes of blood pressure and heart rates during the operation, recorded latency and amplitude of SSEP in the pre-induction, post-induction, during screw insertion and post-distraction periods. Also, we checked the number transfers to the ICU and application of a ventilator. RESULTS: Systolic and diastolic blood pressure were increased significantly in the propofol-ketamine group (P < 0.05), but there was no difference in heart rate between both groups. In addition there were no statistical differences in latencies and amplitudes of SSEP. The number of patients transferred to the ICU and placed on a ventilator showed no statistical difference. CONCLUSIONS: We think that the combination of propofol and fentanyl or ketamine used for total intravenous anesthesia is a very useful method in spinal surgery under SSEP monitoring.

The Availability of Total Intravenous Anesthesia on Somato-Sensory Evoked Potential during Spinal Surgery / 대한마취과학회지

BACKGROUND: Somatosensory evoked potential (SSEP) has been used to help minimize neurologic morbidity during spinal surgery. But, SSEP is affected by various factors, namely technical errors, anesthetics and physiologic aspects (systemic blood pressure, temperature, blood gas tensions). We experienced 40 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. We reviewed these cases with the availability of total intravenous anesthesia during SSEP monitoring. METHODS: Forty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl, and monitored by SSEP. We recorded latency and amplitude of SSEP in the pre-induction, post-induction, during-instrument insertion and post-distraction periods. RESULTS: There were no statistical differences in latencies among pre-induction, post-induction, screw insertion and post-distraction period. The amplitude of the post-induction period was statistically higher than pre-induction period (p<0.05), but there were no differences in other periods. None of cases showed abnormal findings (i.e., delay of latency over 10% or decrease of amplitude over 50%). CONCLUSIONS: SSEP monitoring may be helpful in identifying potentially neurologically threatening surgical maneuvers during spinal surgery. To achieve better outcomes, we should consider the effects of various factors on SSEP. Total intravenous anesthesia may be useful method, which has lifter influence on SSEP monitoring.

Epidural Lipomatosis Discovered during Managing of Lower Back Pain: A case report / 대한마취과학회지

We experienced a case of lumbar epidural lipomatosis patient who had been treated with several epidural steroid injection for the management of lower back pain. This 67-years-old man, complained of lower back pain and radiating paresthetic pain to the dorsum of left foot. Epidural lipomatosis is a rare condition of focal or multiple deposition of excessive adipose tissue in epidural space. Since excessive deposited adipose tissue compresses the spinal cord or spinal root, patients complaint the atypical low back pain and low extremity radiculopathy which mimics the symptoms of spinal stenosis or herniated nucleus pulposus. In managing of lower back pain patient, especially who had been treated with steroid previously, we should consider that epidural lipomatois would be one of the cause.

Suspicious Malignant Hyperthermia in Child during General Anesthesia: A case report / 대한마취과학회지

We had a 16-month-old male presented for a surgery for degloving injury of left lower extremity. He had no considerable past or family history. High fever and increased end-tidal CO2 with tachycardia was revealed after induction of general anesthesia with thiopental sodium, vecuronium, isoflurane-N2O and O2. Arterial blood gas analysis showed a severe mixed acidosis. Under the suspicion of malignant hyperthermia, all anesthetics were discontinued. Anesthesia was maintained with fentanyl and midazolam. The patient was managed with surface cooling, gastric lavage with cold saline, sodium bicarbonate and diuretics. Dantrolene sodium 50 mg was administered. The patient survived without any sequelae and discharged after 9 days. The etiologic factors, incidence, clinical features, prevention and treatments of malignant hyperthermia are discussed.