Tracheal Intubation without the Use of Muscle Relaxants: Remifentanil in Combination with Propofol / 대한마취과학회지

BACKGROUND: Using alfentanil followed by an anesthetic induction dose of propofol provides adequate conditions for tracheal intubation without neuromuscular blocking drugs in most patients. Providing an option for intense opioid effect without compromising recovery after short operations, remifentanil might offer benefits over alfentanil. In this study intubating conditions after remifentanil-propofol were evaluated. METHODS: Sixty healthy premedicated patients were divided randomly into 3 groups. Anesthesia was intravenously induced with propofol (4 microgram/ml) followed by remifentanil. Group R(2), R(3), R(4) received 2, 3, 4 microgram/kg remifentanil, respectively. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubation conditions were assessed as excellent, good or poor. The hemodynamic changes were measured at preinduction (base), preintubation, postintubation (immediately, 3 minute, 5 minute after intubation). RESULTS: Clinically acceptable intubating conditions were observed in 65%, 95%, and 95% of patients in the R(2), R(3), and R(4) groups, respectively. Clinically acceptable intubating conditions were significantly (P < 0.05) less likely to occur in Group R(2). The mean arterial pressure decreased immediately after induction in all groups. There was no significant elevation in heart rate after tracheal intubation in all groups. There were no significant differences among groups. CONCLUSIONS: Healthy, premedicated patients with favorable airway anatomy can be reliably intubated with good or excellent conditions 90 seconds after the administrations of remifentanil 3-4 microgram/kg and propofol.

Epidural Blood Patch in Patient with Spontaneous Intracranial Hypotension: A case report / 대한마취과학회지

Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The headache is usually resolved in a few days or weeks if the patient remains in bed with good hydration. Relief can usually be obtained by the application of a blood patch, by injecting 10-20 ml of the patient's own blood into the epidural space close to the leakage site. In the overwhelming majority of patients, the leak is at the level of the spine, particularly the thoracic spine and cervicothoracic junction. Spontaneous intracranial hypotension presenting with mental change has rarely been reported. We report a 39 years old male patient who was diagnosed with spontaneous intracranial hypotension. The patient experienced continuous headache followed by slight mental change. The patient was successfully managed by 3 episodes of epidural blood patch.

Epidural Blood Patch in Patient with Spontaneous Intracranial Hypotension: A case report / 대한마취과학회지

Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The headache is usually resolved in a few days or weeks if the patient remains in bed with good hydration. Relief can usually be obtained by the application of a blood patch, by injecting 10-20 ml of the patient's own blood into the epidural space close to the leakage site. In the overwhelming majority of patients, the leak is at the level of the spine, particularly the thoracic spine and cervicothoracic junction. Spontaneous intracranial hypotension presenting with mental change has rarely been reported. We report a 39 years old male patient who was diagnosed with spontaneous intracranial hypotension. The patient experienced continuous headache followed by slight mental change. The patient was successfully managed by 3 episodes of epidural blood patch.