Comparison of Postoperative Analgesia and Side Effects according to Different Loading Doses of Morphine with the Same Total Dose / 대한마취과학회지

BACKGROUND: Epidural coadministration of opioids and local anesthetics has provided excellent analgesia during the postoperative period. The appropriate amount of epidural morphine for pain control with minimum side effects has been studied. Recently, we gave 6 mg of epidural morphine for 2 day pain control and discovered it was a safe and effective dose like the previous study result. This study was performed to compare postoperative analgesia and side effects according to different loading and infusion doses of morphine with the same total dose. METHODS: Forty-three patients having epiduro-general anesthesia for a hysterectomy were randomly divided into 2 groups. The patients received 2 mg (Control group, n = 19) or 3 mg (Experimental group, n = 24) of epidural morphine by bolus and a continuous epidural infusion was started using a two day infusor containing 4 mg (Control group) or 3 mg (Experimental group) of morphine in 100 ml of 0.125% bupivacaine. Visual analog scale (VAS) for pain, severity of nausea, itching and respiratory depression were assessed at 2, 4, 8, 16, 32 and 48 hours postoperatively. All data was evaluated with unpaired t-test for significances between the two groups. RESULTS: Analgesia between the two groups showed good results. The VAS in the experimental group were higher than the control group in the early postoperative period. Nausea scores were no different between the two groups. The itching scores in the experimental group were lower than the control group at postoperative 16 and 32 hours. No respiratory depression was reported in either group. CONCLUSIONS: This study suggests that different loading and infusion doses of the same total epidural morphine between two groups provided good postoperative pain relief without any differences in side effects.

Cerebral Hemorrhage Following Anesthesia for a Patient with Takayasu's Arteritis: A case report / 대한구급학회지

Takayasu's arteritis is a nonspecific inflammatory arteritis involving the aorta and its major branches. Stroke may be an important and predictive complication for the prognosis in such patient. A 48-year-old woman got a bypass operation 3 months ago because of both subclavian artery and left common carotid artery occlusion, but she still suffered from headache, dizziness and tingling sensation and had no pulse of right arm. So, she got a bracheoaxillary bypass reoperation. Anesthesia was performed with enflurane-N2O-O2. At the recovery room, her mental state was deep drowsy and she revealed high blood pressure and abnormal neurological sign. Her brain computed tomography revealed cerebral hemorrhage at left frontotemporal basal ganglion area. Emergent hematoma removal of brain was done. Post- operatively this patient sustained an intracerebral hemorrhage in the initial hemorrhagic site despite immediate reoperation. She was discharged home without improvement at postoperative 5 days. This report is a description of Takayasu's arteritis with massive cerebral hemorrhage following a reoperation of occluded bypass surgery.

Acute Respiratory Failure after Embolectomy in Patient with Chronic Pulmonary Embolism: A case report / 대한마취과학회지

Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism. In desperated cases, however, pulmonary embolectomy is recommended despite its high mortality rate. We experienced acute respiraory failure after embolectomy performed under cardiopulmonary bypass in patient with chronic massive pulmonary embolism. The patient recovered sucessfully with postoperative management in the intensive care unit.

Anesthestic Experience for Hepatic Retransplantation: A case report / 대한마취과학회지

Orthotopic liver transplantation has been an established medical therapy for almost any end-stage liver disease. In spite of improved survival rates following transplantation, acute or chronic allograft failure requiring hepatic retransplantation still occurs with an incidence of 9% to 22%. We experienced one case of anesthesia for liver retransplantation in 30-year-old male patient with posttransplantation hepatic arterial thrombosis. He had taken primary liver transplantation due to hepatocelluar carcinoma 15days before retransplantation. The operation was finished successfully after 10hours of anesthesia with anhepatic time of 65 minutes. Careful attention was paid to eletrolyte balance, blood coagulation function as well as cardiovascular and respiratory function. Hemodynamic value was relatively stable throughout the operation and postoperative mechanical ventilatory support was required for about 15 hours.