Analgesic Effect and Adverse Effects of Intrathecal Neostigmine Used in Spinal Anesthesia for Orthopedic Surgery / 대한마취과학회지

BACKGROUND: Intrathecal injection of analgesic agents sush as opioids, clonidine, ketamine and nalbuphine with a local anesthetic agent during spinal anesthesia for operation is an easy and convenient way to get postoperative analgesia. Intrathecal neostigmine causes an increased ACh concentration in CSF and also has an analgesic effect. This study was designed to examine its postoperative analgesic effect and adverse effects such as nausea/vomiting and urinary retention etc. METHODS: We divided 27 patients who were supposed to receive orthopedic surgery of lower extremities into 3 groups. The control group as injected with heavy bupivacaine 13 mg and normal saline and the N50 and N75 groups were injected with the same amount of bupivacaine combined with neostigmine 50 mcg and 75 mcg respectively. We examined total amount of fluid intake and side effects during operation, and time to first rescue analgesic medication, time to first urination, total applications of rescue analgesic agent, total number of urinary catheterizations for 24 hr after intrathecal injection, and adverse effects of intrathecal neostigmine in the ward. RESULTS: The N75 group showed a significantly longer analgesic duration compared with the control and N50 groups, but the incidence of urinary retention and number of urinary catheterizations increased in the N75 group significantly. Nausea/Vomiting significantly increased in N75 compared with control. Shivering was more common in N50. 2 patients who recieved neostigmine 75 mcg complained of chest discomforts suggesting myocardial ischemia in EKG taken in those episodes. CONCLUSIONS: Neostigmine 75 mcg has better analgesic effect but more frequent adverse effects than control or neostigmine 50 mcg. Therefore, we suggest using high doses of neostigmine cautiously and being aware of its side effects.

The Comparison of Anesthetic Agents and Adjuvants between University Hospitals, General Hospitals and Hospitals / 대한마취과학회지

BACKGROUND: This study was performed to compare anesthetic agents and adjuvants for general anesthesia or regional anesthesia between university hospitals, resident-training general hospitals and hospitals without training program of residents. METHODS: We surveyed university hospitals, resident-training hospitals and hospitals without training program of residents and divided randomly each hospital groups to become twenty hospitals. We compared the use frequency of inhalation anesthetics, muscle relaxants, induction agents, reversing agents, local anesthetics, premedicants, cardiovascular drugs and plasma expanders. RESULTS: Enflurane was most commonly used inhalation anesthetic in all hospital groups. Isoflurane was less commonly used inhalation anesthetic in hospitals without training program of residents. Pancuronium was most commonly used muscle relaxant in university hospitals. Midazolam, ketamine, fentanyl, propofol were commonly used induction agents during induction in university hospitals and resident-training general hospitals. Differences of use frequency of local anesthetics among hospital groups were not significant, but epinephrine mixing with local anesthetics was more frequent in university hospitals and resident-training general hospitals. Midazolam as a premedicant and norepinephrine, phenylephrine, amrinone, esmolol, pentastarch were less used in hospitals without training program of residents. CONCLUSIONS: These results suggest that university hospitals and resident-training general hospitals didn't show difference in anesthestics or adjuvants but hospitals without training program of residents used less commonly isoflurane, atracurium, midazolam, ketamine, propofol, fentanyl, cardiovascular drugs and pentastarch.

Epidural Pentazocine for Postoperative Pain Relief ( II ) / 대한마취과학회지

The analgesic effect of epidural pentazocine for the postoperative pain relief was studied. In our previous report, we used the pentazocine diluted to normal saline, however in this study, pentazocine was diluted with distilled water and made to 10ml mixture. Fourty patients were divided into four groups (n=10) as follows: Group I: control, distilled water of 10 ml, Group II: pentazocine 0.2 mg/kg, Group III: pentazocine 0. 3mg/kg, Group IV: pentazocine 0.4mg/kg, all pentazocine groups were diluted to 10ml of distilled water. We have carried out the study to see the effects on the time of peak analgesia, the duration of analgesia, the degree of analgesia and the side effects. The results are as follows: 1) Seven cases (70%) in the control group showed rapid but short duration of analgesia. 2) The pentazocine 0.3 and 0.4 mg/kg groups were significantly different from the control group (p< 0.05). 3) In the pentazocine 0.3 and 0.4 mg/kg groups, the time of peak analgesia occured 8-9 minutes, the duration of analgesia was 10 hours and the degree of analgesia showed moderate to good degree. 4) Nine cases (90%) in the control group complained of back pain during epidural injection and 16 cases (53%) in the pentazocine group conplained of drowsiness.