Patient Controlled Analgesia Using Surgical Wound Infusion / 대한마취과학회지

BACKGROUND: This study was undertaken to evaluate the analgesic effect of a self administered surgical wound infusion of local anesthetic alone compared to combination of local anesthetic and morphine or ketorolac. METHOD: Forty eight patients undergoing minor surgery were randomly classified into four groups: Group 1 (saline, n = 10), Group 2 (bupivacaine only, n = 11), Group 3 (bupivacaine with morphine, n = 14), and Group 4 (bupivacaine with ketorolac, n = 13). A two-hole 19 G epidural catheter was tunneled subcutaneously into the surgical wound and was connected to 100 ml elastometric balloon pump filled with either 0.5% bupivacaine only, 0.5% bupivacaine and morphine 40 mg, or 0.5% bupivacaine and ketorolac 80 mg. We assessed the postoperative visual analogue scale (VAS) pain scores at postoperative 0.5, 1, 2, 6, 12, 24, 36, and 48 hours, and the side effects, sedation score and total amount of infused bupivacaine were recorded. RESULTS: VAS pain score were significantly decreased until 36 hours in groups 2, 3, and 4 compared to group 1, and significantly lower at 1, 2, 12, and 24 hrs in groups 3, 4 than in group 2 (P < 0.05). The total requirement of infused bupivacaine in groups 3, 4 is significantly decreased compared to that of group 2. Side effects like nausea, vomiting, urinary retension, pruiritis, respiratory difficulty, sedation, and dizziness did not occur in the four groups but seroma did in one case. CONCLUSION: Patient-controlled surgical wound infusion of bupivacaine reduced postoperative pain after minor surgery without any side effects. The combination of bupivacaine with morphine or ketorolac gave rise to a significant additive effect to local analgesia.

The Effects of Propofol on Cardiac Toxicity of Intravenous Bupivacaine in Rabbits / 대한마취과학회지

BACKGROUND: Propofol is an intravenous anesthetic agent, which has a protective effect on cardiovascular and CNS toxicity of local anesthetics compared with an inhalational agent. Also lipids have a has protective effects on local anesthetic cardiovascular toxicity. So, we had questioned that the protective effect on local anesthetic toxicity comes from the lipid solvent of propofol or propofol itself. METHODS: Eighteen healthy rabbits, weighing 3.0 Kg, were divided into three groups during continuous intravenous infusion of bupivacaine: the control group received normal saline (n = 6), the propofol group received propofol (n = 6), and the intralipid group received intralipid (n = 6). The changes in mean arterial pressure, heart rate and the electrocardiogram were observed during the continuous intravenous infusion of bupivacaine. RESULTS: The onset time of QRS widening and dysrhythmia was significantly prolonged in the propofol group compared with the control and intralipids group. The time required for 25% and 50% decrease in mean arterial pressure and heart rate during bupivacaine infusion was significantly prolonged in experimental groups compared with the control group. In the propofol group compared with the intralipids group, the time required for a 25% and 50% decrease in mean arterial pressure and heart rate were prolonged. CONCLUSIONS: This study suggests that infusion of propofol protection on cardiac toxicity of intravenous infusion by an bupivacaine, the dosage for sedation without cardiovascular adverse effects, is more profound than intarlipids.

The Effect of Co-administration of Midazolam on Induction and Recovery Using Continuous Propofol Infusion / 대한마취과학회지

BACKGROUND: Previous reports have demonstrated the synergistic interaction of midazolam and propofol in the induction of hypnosis. But there haer been some different views expnrsscd as to whether the synergism extended to hemodynamic effects. So we studied the effect of the co-administration of midazolam on induction dose, hemodynamic response, and recovery with the use of continuous infusion of propofol for induction, and the maintenance of anesthesia. METHODS: Thirty-five patients undergoing elective surgery within 2 hours were randomly assigned to one of two groups formed according to the induction agents: Group P (continuous propofol infusion 1,200 mg/h), Group MP (midazolam 2 mg followed by continuous propofol infusion 1,200 mg/h). After induction, anesthesia was maintained with fentanyl (50 microgram), N2O (70%), andpropofol (5 15 mg/kg/h). Outcome measures were propofol doses (induction and maintenance), hemodynamic responses (heart rate, blood pressure) during the induction period, emergence time (eye-opening to command), postoperative nausea and dizziness. RESULTS: The induction dose of propofol was 29% less in Group MP compared to Group P but there was no significant difference in maintenance doses between the two groups. Heart rates showed no differences between the two groups, but the changes of mean arterial pressures from base line at 30 sec, 2 min and 5 min after intubation were greater and the emergence time was delayed in Group MP compared to Group P (P < 0.05). CONCLUSIONS: Midazolam potentiates the hypnotic action of propofol synergistically, but there was no evidence that the synergism extended to the blunting effect of propofol against the hypertensive response to intubation.

The Effect of Co-administration of Midazolam on Induction and Recovery Using Continuous Propofol Infusion / 대한마취과학회지

BACKGROUND: Previous reports have demonstrated the synergistic interaction of midazolam and propofol in the induction of hypnosis. But there haer been some different views expnrsscd as to whether the synergism extended to hemodynamic effects. So we studied the effect of the co-administration of midazolam on induction dose, hemodynamic response, and recovery with the use of continuous infusion of propofol for induction, and the maintenance of anesthesia. METHODS: Thirty-five patients undergoing elective surgery within 2 hours were randomly assigned to one of two groups formed according to the induction agents: Group P (continuous propofol infusion 1,200 mg/h), Group MP (midazolam 2 mg followed by continuous propofol infusion 1,200 mg/h). After induction, anesthesia was maintained with fentanyl (50 microgram), N2O (70%), andpropofol (5 15 mg/kg/h). Outcome measures were propofol doses (induction and maintenance), hemodynamic responses (heart rate, blood pressure) during the induction period, emergence time (eye-opening to command), postoperative nausea and dizziness. RESULTS: The induction dose of propofol was 29% less in Group MP compared to Group P but there was no significant difference in maintenance doses between the two groups. Heart rates showed no differences between the two groups, but the changes of mean arterial pressures from base line at 30 sec, 2 min and 5 min after intubation were greater and the emergence time was delayed in Group MP compared to Group P (P < 0.05). CONCLUSIONS: Midazolam potentiates the hypnotic action of propofol synergistically, but there was no evidence that the synergism extended to the blunting effect of propofol against the hypertensive response to intubation.

Anesthetic Management of Patient with Cis A2B3 Blood Group: A case report / 대한마취과학회지

The inheritance of ABO blood type group is actually determined by triple allelic gene, A, B and O. Transmission of blood group AB by a single chromosome, instead of by two separate chromosomes, was reported and called cis AB. The anesthesiologists, who meet many cases of the transfusions, may anesthetize cis AB patients for surgery. Recently the authors have experienced one case of patient with cis AB blood type undergoing emergency craniotomy and removal of hematoma. We transfused the patient with Rh+O packed red blood cell without any significant transfusion reactions.