Comparison of General Anesthesia and Thoracic Epidural Anesthesia for Breast Mass Excision Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study is to compare the effectiveness of thoracic epidural anesthesia (TEA) and general anesthesia (GA) in terms of side effects, postoperative pain control and the cost of anesthesia for breast mass excision surgery. METHODS: Forty-three patients rated as ASA physical status class 1 or 2 who underwent breast mass excision surgery were included in the study. In the TEA group (n = 20), 2% lidocaine (3 ml) and 0.5% bupivacaine (3 ml) were administered via the epidural route. Blood pressure and heart rate were measured before and at 3, 6, 9, 12, 15, 18 21, 24, 27 and 30 minutes after epidural injection. In the GA group (n = 23) patients were maintained by general anesthesia with enflurane and 50% nitrous oxide in oxygen. After the operation, patients were given NSAID-diclofenac sodium as they wanted. Analgesic requirement, satisfaction score, and anesthesia-related side effects were recorded 1 day after surgery. Satisfaction scores of the surgeons and patients were recorded as excellent (4 point), good (3 point), fair (2 point), and unacceptable (1 point). RESULTS: Overall satisfaction scores and side effects were not significantly different between the TEA group and the GA group. Anesthesia cost (80,883.2 +/- 3956.9 vs 32,284.8 +/- 1209.4 won) were significantly lower in the TEA group than in the GA group. CONCLUSIONS: There were not significant differences in satisfaction scores and postoperative side effests between the TEA and GA groups. TEA provided lower anesthesia cost than GA for breast mass excision surgery.

CT-Guided Celiac Plexus Block with Absolute Alcohol: the Anterior Approach

PURPOSE: To evaluate the safety and efficacy of CT-guided celiac plexus block (CPB) using an anterior approach, and to determine the role of CT in this procedure. MATERIALS AND METHODS: CPB was attempted in 15 patients (10 men and 5 women; mean age, 62.3 years) with intractable upper abdominal pain due to terminal malignancy of the pancreas, liver, bowel, and kidney. To permit an anterior approach, patients lied supine on the CT scan table during the procedure. One or two 21-guage needles were placed just anterior to the diaphragmatic crus at or between the levels of the celiac and superior mesenteric arteries and 10-40 ml of 99.9% alcohol was injected. Pain relief following the procedure was assessed and pain was graded on a visual analogue scale (VAS) from 0 to 10. RESULTS: There were no technical failures and no neurologic or hemorrhagic complications. Abdominal pain during alcohol injection occurred in all patients, and transient hypotension in three. One patient with recurrent cancer of the pancreatic head died of sepsis five days after the procedure; the cause of sepsis was difficult to determine, but there was thought to be a biliary source of infection. Two days after block, 13 of 15 procedures (86.7%) had produced at least partial pain relief ; in 12 patients, relief was good. With CT guidance, more directed positioning of the needle is possible, allowing alcohol to be deposited in specific ganglion areas. CONCLUSION: CT-guided celiac plexus block using an anterior approach was an easy and effective way of reducing intractable upper abdominal pain due to terminal malignancies. CT guidance allowed precise needle placement and a safer procedure.

The Influence of Fentanyl on the Action of Epidural Bupivacaine / 대한마취과학회지

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.

The Influence of Fentanyl on the Action of Epidural Bupivacaine / 대한마취과학회지

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.

Changes in End - tidal Carbon Dioxide Tension during Laparoscopy Using Carbon Dioxide under General Endotracheal Anesthesia / 대한마취과학회지

Laparoscopy is a useful technique for a diagnostic purpose of pelvic diseases in gynecologic patients, but it may be associated with many complications related to a steep Trendelenburg position and a usage of Trocar. It may also be developed that a large amount of CO2 insufflation into the peritoneal cavity causes respiratory acidemia and its related hemodynamic changes. To investigate the influence of the CO2, insufflation and the positional changes on the end-tidal CO2, tension (P>CO2), blood pressure and heart rate during laparoscopy in gynecologic patients, the authors observed the changes in PetCO2,heart rate, and blood pressure before the CO2, insufflation, at 1,3,5,7 and 10 minutes after the CO2, insufflation and at 2,5 and 10 minutes after the CO2, exsufflation respectvely under general endotracheal anesthesia with controlled ventilation (tidal volume 10 ml/kg, ventilatory rate 10 breaths/min). The results were as follows. 1) Pet>CO2 was increased until 10 minutes after CO2 insufflation. 2) PetCO2 was decreased at 2,5 and 10 minute after CO2 exsufflation but increased from the control value. 3) Heart rate was decreased at 1,3,5,7 and 10 minutes after CO2 insufflation and at 2,5 and 10 minutes after CO2 exsufflation from the control value respectively. 4) Systolic and diastolic blood pressures were increased after CO insuffiation and unti15 minutes after CO2 exsufflation. On the basis of the above results, because an increase of the PetCO2, and the hemodynamic changes occur during the laparoscopy using CO2 under general endotracheal anesthesia with controlled ventilation, it is recommended to monitor carefully PetCO2, heart rate and blood pressure to control adequately ventilation, blood pressure and heart rate.