The Effect of Remifentanil on the Loss of Consciousness during Propofol Infusion / 대한마취과학회지

BACKGROUND: General anesthesia is a balance between hypnosis and analgesia. Remifentanil is often combined with propofol to both induce and maintain total intravenous anesthesia. This study evaluated the effect of remifentanil on the propofol requirements for a loss of consciousness. METHODS: Forty adult patients with ASA 1 or 2 were enrolled in this study. The patients were randomly given either saline or remifentanil before the induction of anesthesia with an infusion of propofol, 15 mg/kg/h. In the remifentanil group, all the patients received a computer controlled infusion of remifentanil with a effect site concentration of 4 ng/ml. The times required for the patient to lose consciousness, the propofol requirements and the bispectral index at the loss of consciousness to verbal commands were recorded. RESULTS: In the remifentanil group, loss of consciousness was attained significantly faster and with lower propofol doses than in the saline group. The bispectral indices were significantly higher at loss of consciousness in the remifentanil group. CONCLUSIONS: A remifentanil infusion before the induction of propofol anesthesia significantly reduces the propofol requirements for the loss of consciousness. Remifentanil enhances the hypnotic effect of propofol.

Anaphylactic Shock by Hemocoagulase with Increased Concentration of Mast Cell Tryptase: A case report / 대한마취과학회지

Multiple agents can cause anaphylaxis in a perioperative setting. Identifying the agent responsible is essential for avoiding future adverse reactions as well as to attenuate the progression of anaphylaxis. Being able to distinguish an anaphylactic reaction from an anaphylactoid reaction would help clarify the therapeutic and medicolegal issues. Anaphylaxis generally occurs after reexposure to a specific antigen and requires the release of proinflammatory mediators from mast cells and basophils. An increased concentration of mast cell tryptase is a highly sensitive indicator of anaphylactic reactions during anesthesia. Botropase(R) is a procoagulant hemocoagulase purified from venom of Bothrops jararaca, a Brazilian viper and in wide use in patients with high risk of bleeding. We report a case of suspected anaphylaxis to Botropase(R) in a 67 years old female patient undergoing segmental resection of the liver with elevated concentration of serum mast cell tryptase.

Effectiveness of Cold Stress Thermography in the Diagnosis of Complex Regional Pain Syndrome Type 1 / 대한통증학회지

BACKGROUND: Despite the enormous amount of basic research on neuropathic pain, there is the lack of an objective diagnostic test for complex regional pain syndrome (CRPS). The aim of this study was to evaluate the usefulness of cold stress thermography in the diagnosis of CRPS. METHODS: The study involved 12 patients with CRPS type 1, according to the IASP criteria, who were compared with 15 normal healthy volunteers. All subjects underwent thermographic examination under baseline conditions at 21degrees C. A cold stress test (CST; 10degrees C water for 1 minute) was then applied to both hands below the wrists, immediate, and after 10 and 20 minutes. RESULTS: The temperature asymmetry between the patients with CRPS and the volunteers showed significant discrimination at the baseline and after a 20 minute recovery period from the CST. Among the study subjects having temperature asymmetry of both hands of less than 1degrees C (8 out of 12 CRPS patients and 14 out of 15 volunteer), 7 (87.5%) of the 8 CRPS patients and 3 (21%) of the 14 volunteers showed a temperature difference of more than 1degrees C after the 20 minute recovery period. The actual temperature values during the four periods did not discriminate between the patients with CRPS and the volunteers. CONCLUSIONS: Thermography, under the CST, could be a more objective test for the diagnosis of CRPS. A temperature asymmetry greater than 1degrees C during the 20 minute recovery period following CST provides strong diagnostic information about CRPS, with both high sensitivity and specificity.