Target-Controlled Infusion of Alfentanil for Conscious Sedation / 대한마취과학회지

BACKGROUND: Opioids are frequently used to relieve pain or to induce sedation during monitored anesthesia care and regional anesthesia. Infusion rates for alfentanil range from 0.25-0.72 microgram/kg/min. This study was performed to define the optimal range of blood concentration of alfentanil to produce a conscious sedation without significant vital sign changes and side effects in spinal anesthesia patients. METHODS: One hundred patients were administered spinal anesthesia with 0.5% hyperbaric bupivacaine 12-18 mg and then a target controlled infusion (TCI) of alfentanil using a syringe pump equiped with a stelpump program. The target concentrations of alfentanil were 20 ng/ml (n = 20, group A20), 25 ng/ml (n = 20, group A25), 30 ng/ml (n = 20, group A30), 35 ng/ml (n = 20, group A35) and 40 ng/ml (n = 20, group A40). Sedation scale, bispectral index (BIS), systolic and diastolic blood pressure, heart rate, SpO2, and anxiety score were checked during the operation and postoperatively one hour later in the recovery room. RESULTS: The sedation scale was significantly higher in groups A30, A35, and A40 than in the other two groups (P < 0.05), but there were no significant difference in BIS among the groups. Mean infusion rates of alfentanil were 0.27-0.46 microgram/kg/min. Time from end of alfentanil infusion to response to a verbal command was significant delayed in groups A30, A35, and A40 than in the other two groups. Recall of operative procedure occurred in 50 65%. Intraoperative hypotension, bradycardia, and respiratory depression occurred more frequently in groups A35, and A40 than in the other three groups (P < 0.05). Incidences of postoperative nausea and vomiting were significantly higher in groups A35, and A40 than in the other three groups (P < 0.05). Heart rate and systolic and diastolic pressures were more significantly lowered during the operation in groups A35, and A40 than in the other three groups (P < 0.05). CONCLUSIONS: Alfentanil has an effective sedation effect at 40% of the analgesic dosage during spinal anesthesia. But, incidences of side effects, like hypotension, bradycardia, and nausea and vomiting increased with alfentanil target concentrations. TCI of alfentanil at 30 ng/ml produces effective sedation, antianxiety effect, and fewer side effects during spinal anesthesia.

The Effect of Timing of Ondansetron Administration on Nausea and Vomiting during Intravenous Patient-Controlled Analgesia / 대한마취과학회지

BACKGROUND: This study was designed to establish the optimal timing of administration of ondansetron for prevention of postoperative nausea and vomiting (PONV) during intravenous patient-controlled analgesia (IV-PCA). METHODS: Eighty women undergoing a total abdominal hysterectomy under general anesthesia were randomized to receive a placebo (n = 20, group 1), ondansetron 2 mg before induction and 2 mg after surgery (n = 20, group 2), ondansetron 4 mg before induction (n = 20, group 3), or ondansetron 4 mg after surgery (n = 20, group 4). An IV-PCA using butorphanol and ketorolac was connected to the patients after waking from the anesthesia. The incidences and severity of nausea and vomiting were recorded for 48 hr postop. RESULTS: The incidences of nausea and vomiting in group 1 (75%, 40%) were significantly decreased after ondansetron administration but there were no significant differences among the ondansetron groups (group 2; 45%, 20%, group 3; 45%, 15%, group 4; 40%, 10%) (P < 0.05). CONCLUSIONS: The prophylactic administration of ondansetron is effective in preventing PONV during IV-PCA, but the timing of ondansetron administration has no effect on its efficacy.

Primary Spinal Oncocytic Paraganglioma

Paraganglioma is a generic term applied to tumors of paraganglia, regardless of location, and composed largely of paraganglionic chief cells. It is a rare tumor, especially in the spinal region. When it appears in the craniospinal axis, it is restricted to the cauda equina or filum terminale, and less commonly, the spinal nerve root. We report a case of oncocytic paraganglioma in the spinal nerve root of 13-year-old girl. The tumor was located in intradural and extramedullary areas from the 12th thoracic to the 1st lumbar vertebra. Histologically, the tumor cells with abundant eosinophilic cytoplasms show diffuse compact clusters, which are surrounded by fibers in a reticulin stain, like a nested pattern. The nuclei are round to ovoid in shape with mild atypia. Immunohistochemically, the tumor cells are positive for synaptophysin, neuron-specific enolase and vimentin but are negative for cytokeratin, chromogranin and glial fibrillary acidic protein. Some cells are positive for S-100 protein. The MIB-1 labeling index is low. Ultrastructurally, dense core neurosecretory granules are not found but mitochondrias are commonly noted.

Effects of cytokine combinations on lymphokine-activated killer(LAK) cell generation / 대한암학회지

No abstract available.