The effects of epidural labor analgesia on the progress of labor: a retrospective study

BACKGROUND: Epidural analgesia provides effective pain control during labor. However, its influence on the course of delivery is controversial. The aim of this study was to assess the effect of epidural analgesia on the course of delivery and the perinatal outcome and to examine the changes of the cesarean delivery rates that are associated with epidural analgesia. METHODS: Among 1,200 parturients who delivered in our hospital from 2003 to 2005, we obtained the demographic and obstetric data for 240 primiparous deliveries (120 women in the epidural group [group E] and 120 women in the nonepidural group [group N]). The duration of the active phase and the second and third stages of labor, the perinatal outcome and the incidence of emergency cesarean delivery were analyzed. RESULTS: The duration of the second stage of labor was longer in group E (41 +/-23 min in group N vs. 49 +/-28 min in group E, P = 0.02). The incidences of cesarean delivery were similar between the two groups [15 (12.5%) in group N vs. 18 (15%) in group E, P = 0.6]. The incidences of fetal distress during the active phase of labor did not differ in both groups (48% vs. 41%, respectively, P = 0.4). The neonatal outcomes, including the birth weight, fetal heart rate deceleration or bradycardia during labor and the Apgar score, were similar between the two groups. CONCLUSIONS: We conclude that epidural labor analgesia does not seem to be associated with an increased incidence of cesarean delivery. In addition, epidural labor analgesia seems to have no adverse effect on the perinatal outcomes of primiparous women.

Effect of midazolam premedication on the onset of propofol and rocuronium during propofol target-controlled infusion / 대한마취과학회지

BACKGROUND: This clinical study was designed to evaluate the effect of midazolam as a premedication on the onset of propofol and rocuronium during propofol target-controlled infusion (TCI). METHODS: Seventy four patients (ASA class I or II) were randomly allocated to receive either no premedication (control group) or premedication with 0.04 mg/kg intravenous midazolam (midazolam group). Anesthesia was induced and maintained with propofol TCI. Time from propofol injection to loss of consciousness (LOC) and estimated effect concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was injected. We monitored the degree of neuromuscular blockade by acceleromyography. The following parameters were measured and compared between groups: Time from rocuronium injection to depression of twitch height below 25%, time to maximal depression of twitch height (defined as rocuronium onset time). RESULTS: Systolic blood pressure before induction was lower in midazolam group (125 +/- 15 vs 135 +/- 20 mmHg), however, there was no difference in blood pressure at LOC between groups (111 +/- 16 vs 106 +/- 21 mmHg). In midazolam group, time to LOC in propofol TCI was shorter (63 +/- 22 vs. 203 +/- 118 sec) and estimated effect site concentration of propofol was significantly lower than control group (0.9 +/- 0.3 vs. 2.2 +/- 0.4 microl/ml). The onset time of rocuronium was not different between groups (120 +/- 39 vs. 137 +/- 42 sec). CONCLUSIONS: Midazolam pretreatment fastens the onset time of propofol and decreases the propofol requirement for LOC. However, it does not influence the onset of rocuronium.

Association of 5-HT3A receptor Pro16Ser polymorphism with the incidence of PONV and the response to ondansetron in Korean patients

BACKGROUND: Postopertative nausea and vomiting (PONV) are frequent and distressing side effects of surgery. Even though many drugs has been developed, PONV still remains unsolved problem. Ondansetron is a commonly used 5-HT3 receptor antagonist. It acts through specific binding to the 5-HT3A, 5-HT3B receptor complex. We hypothesized that patients with genetic variation in 5-HT3A receptor might have variable incidence of PONV and respond differently to ondansetron. METHODS: We included 204 patients undergoing gynecologic laparoscopic surgery. PONV were documented during 24 hours after operation. Ondansetron was injected to every patient who had PONV at PACU and PONV reassessed after 15 minutes. DNA was extracted from blood and 5-HT3A Pro16Ser missense mutation was analyzed by using real-time PCR. RESULTS: The incidence of PONV were 50% for wild type, 53% for heterozygote and 0% for homozygote. There were no significant differences between wild type and heterozygote in VAS of nausea and VAS change after ondansetron. CONCLUSIONS: 5-HT3A receptor Pro16Ser polymorphism is not associated with the incidence of PONV and the response to ondansetron in Korean patients.

General anesthesia for laparoscopic cholecystectomy in a patient with Kennedy's disease: A case report / 대한마취과학회지

Kennedy's disease is a rare lower motor neuron disease affecting the limbs and bulbar musculature. Regional anesthesia is generally the recommended anesthetic technique in patients with Kennedy's disease because of bulbar involvement and airway clearing disturbance. We administered general anesthesia in a patient with Kennedy's disease who was undergoing a laparoscopic cholecystectomy. We closely monitored the degree of neuromuscular blockade throughout the operation and injected atracurium on demand. There was no exacerbation of neurologic signs or symptoms postoperatively. Therefore, we report the successful administration of general anesthesia for laparoscopic cholecystectomy in a patient with Kennedy's disease.

Anesthetic Management of Emergent Cesarean Section in a Patient with Allergic Reaction to an Antibiotic: A case report / 대한마취과학회지

Allergic reactions developed in parturients can cause fetal asphyxia and some difficulties in anesthetic management. We performed general anesthesia for an emergent cesarean section on 30 yrs old woman who showed an allergic reaction to an antibiotic. Dyspnea, urticaria, sweating, generalized edema and fetal bradycardia suddenly occurred after an intravenous injection of the antibiotic. Dexamethasone 10 mg was administered intravenously. General anesthesia was induced with pentothal and succinylcholine. Despite of severe airway edema, endotracheal intubation was successful. During the operation, the allergic signs became decreased. After the operation, no additional problems were evident. Potential epitopes should be removed in susceptible parturients and medical staff should be familiar with anesthetic management in allergic patients during pregnancy.