Comparison of effects of intraoperative esmolol and ketamine infusion on acute postoperative pain after remifentanil-based anesthesia in patients undergoing laparoscopic cholecystectomy / 대한마취과학회지

BACKGROUND: Remifentanil is a short-acting drug with a rapid onset that is useful in general anesthesia. Recently, however, it has been suggested that the use of opioids during surgery may cause opioid-induced hyperalgesia (OIH). Researchers have recently reported that esmolol, an ultra-short-acing beta1 receptor antagonist, reduces the postoperative requirement for morphine and provides more effective analgesia than the administration of remifentanil and ketamine. Hence, this study was conducted to determine whether esmolol reduces early postoperative pain in patients who are continuously infused with remifentanil for anesthesia during laparoscopic cholecystectomy. METHODS: Sixty patients scheduled to undergo laparoscopic cholecystectomy were randomly divided into three groups. Anesthesia was maintained with sevoflurane and 4 ng/ml (target-controlled infusion) of remifentanil in all patients. Esmolol (0.5 mg/kg) was injected and followed with a continuous dosage of 10 microg/kg/min in the esmolol group (n = 20). Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 microg/kg/min in the ketamine group (n = 20), while the control group was injected and infused with an equal amount of normal saline. Postoperative pain score (visual analog scale [VAS]) and analgesic requirements were compared for the first 6 hours of the postoperative period. RESULTS: The pain score (VAS) and fentanyl requirement for 15 minutes after surgery were lower in the esmolol and ketamine groups compared with the control group (P < 0.05). There were no differences between the esmolol and ketamine groups. CONCLUSIONS: Intraoperative esmolol infusion during laparoscopic cholecystectomy reduced opioid requirement and pain score (VAS) during the early postoperative period after remifentanil-based anesthesia.

Pharmacodynamic Changes of Mivacurium in Liver Cirrhosis Model in Rabbits Using Carbon Tetrachloride Intoxication / 대한마취과학회지

BACKGROUND: A reproducible animal model of liver cirrhosis by administering multiple doses of carbon tetrachloride (CCl4) is highly desirable for appropriate metabolic and therapeutic studies. The current study was undertaken to evaluate the neuromuscular blockade of mivacurium in CCl4 induced liver cirrhosis in rabbits. METHODS: Cirrhosis was induced in rabbits by CCl4 treatment for 11 weeks. Rabbits were randomly assigned to two groups; control group: corn oil 0.5 ml/kg/2 days IM for 11 weeks; study group: CCl4 0.5 ml/kg/2 days mixed 1:1 with corn oil IM for 11 weeks. In the first study, the dose-response relations of mivacurium were studied in twenty rabbits during thiopental anesthesia. They received mivacurium 10, 20, and 30 microgram/kg in control group, and mivacurium 20, 30, and 40 microgram/kg in study group, respectively. In the second study, time course of mivacurium 0.18 mg/kg in twenty rabbits was evaluated in each groups. Three fragments of each liver lobe at the end of the experimental period were performed for the histological examination. RESULTS: Eleven-weeks CCL4 treatment resulted in liver cirrhosis, decreased pseudocholinesterase to 1/6 of control level, and increased AST and ALT compared with controls. In the first study, There were significant differences between two groups. In the second study, There were significant differences between two groups. CONCLUSIONS: It is suggested that mivacurium should be used with caution in patients with hepatic insufficiency and that, in such patients, monitoring of neuromuscular function is desirable.

The Effect of Small Dose of Hydrocortisone to the Recovery Index from Neuromuscular Blockade Induced with Vecuronium / 대한마취과학회지

Several investigators have described an interaction between muscle relaxants and hydrocortisones which have showed different results. The exact mechanism of this action is not clear and ther conflicting results have further confusion. The experimental methods were two ways. In the one of method, a group that vecuronium 0.1mg/kg was given intravenously is control and a group that hydrocortisones of various doses(0.3, 0.5 and 1 mg/kg) were administered into vein when T1 was appeared is compared. In the another of method, a control group was anticholinesterase(pyridostigmine 0.12 mg/kg, robinul 0.004mg/kg) were given at the time when T1 reached 25% and a group treated with hydrocortisone 0.5 mg/kg when T1 was appeared is compared. Neuromuscular blockade was measured by recording the twitch response following ulnar nerve stimulation by EMG(ABM, Datex Co. 2Hz 30mA supramaximal voltage). The recovery time from 25% to 75% recovery of twitch height was measured according to recovery index(RI). The results obtained were as follows: `) The RI of control group treated with vecuronium 0.1mg/kg alone was 40.32+/-20.24 minutes and the group which hydrocortisone 0.5mg/kg was combined, was shorten to 18.79+/-5.17 minutes, but in the group combined with hydrocortisone 1.0mg/kg and 0.3mg/kg, the RI was also tended to short, but not significant. 2) In the RI of vecuronium 0.1mg/kg, anticholinesterases were given, was 8.46+/-5.06 minutes and the group combined with hydrocortisone 0.5mg/kg was shorten to 4.77+/-1.82 minutes significantly. Conclusively, in the small doses of hydrocortisone, there is a effect of antagonism to the vecuronium induced blockade and a potentiated effect to the anticholinesterase activity to the vecuronium.