Effect of lidocaine (40 mg) mixed to prevent injection pain of propofol on the intubating conditions and onset time of rocuronium / 대한마취과학회지

BACKGROUND: To analyze how lidocaine 40 mg mixed prevents injection pain of propofol affects the onset time of rocuronium, tracheal intubating conditions and intubation related hemodynamic changes. METHODS: This study consisted of 70 patients with an American Society of Anesthesiologists (ASA) physical status class 1 or 2 for general anesthesia. All the patients were randomly allocated into two groups: propofol 2 mg/kg plus normal saline 2 ml (Group C) and propofol 2 mg/kg plus 2% lidocaine 40 mg (Group L). Each group was administrated intravenously during induction and the patient was intubated 1 minute after an injection of 0.6 mg/kg of rocuronium. The time at disappearance of the first twitch and intubation scores were recorded. Also, blood pressure and heart rate were measured at the baseline, after intravenous injection of propofol, before intubation, and at 0, 1, 2, 3 and 5 minutes after intubation. RESULTS: There were no significant differences between group C and L (P > 0.05). CONCLUSIONS: 40 mg of lidocaine mixed with propofol to prevent injection pain did not affect the onset time of rocuronium, intubating conditions and intubation related hemodynamic changes.

An anesthetic experience in a patient with Stickler sydrome: A case report

Stickler syndrome is a connective tissue dysplasia disorder with characteristic midface hypoplasia, retromicrognathia, cleft palate, and a moon-shaped appearance. Incidence of the syndrome is estimated at around 1/10000 and the disorder is considered to be caused by mutations in the COL2A1, COL11A1, COL11A2, COL9A1 procollagen genes of type 2 and 11 collagen. Patients with a mandibular hypoplasia like Stickler syndrome present the anesthesiologist with considerable problems when mask ventilation or endotracheal intubation is attempted. We report a successful anesthetic experience, including blind endotracheal intubation with rigid laryngoscope without neuromuscular blockade, in a 9-year-old boy with Stickler syndrome for scleral buckling with cryotherapy.

Anesthetic experience for performing a cesarean section for a woman with refractory status epilepticus: A case report

The occurrence of seizure increases 15-30% in women who become pregnant while being treated for epilepsy, due to pharmacological changes in the antiepileptic drugs and, changes in the emotional status and hormones. It is reported that 1-2% of pregnant women experience status epilepticus. When refractory status epilepticus occurs in a pregnant woman, parturition may be an important method of treatment. We report here on a case of a 28 weeks pregnant woman who had epilepsy for 21 years and she had status epilepticus in a refractory status and so she underwent general anesthesia for cesarean section.

Effect of a small dose of propofol or ketamine to prevent coughing and laryngospasm in children awakening from general anesthesia / 대한마취과학회지

BACKGROUND: Coughing during emergence from general anesthesia may be detrimental in children. We compared the effect of a small dose of propofol or ketamine administered at the end of sevoflurane anesthesia on the incidence or severity of coughing in children undergoing a minimal invasive operation. METHODS: One hundred and eighteen children aged between 3 and 15 years, American Society of Anesthesiologists (ASA) status I, were enrolled in this randomized double blind study. Anesthesia was induced with propofol or ketamine and maintained with sevoflurane in N2O/O2. Each group received propofol 0.25 mg/kg or ketamine 0.25 mg/kg and the control group received saline 0.1 ml/kg. The decision to perform tracheal extubation was based on specified criteria, including the resumption of spontaneous respiration. During emergence from anesthesia and extubation, coughing was observed and graded at predefined times. RESULTS: The incidence of emergence without coughing was higher in the propofol group than in the ketamine and control group (19%, 11% and 6%, respectively), whereas the incidence of severe coughing was higher in the control group than in propofol and ketamine group (17.14%, 10.0% and 6.98%, respectively). CONCLUSIONS: The addition of propofol 0.25 mg/kg decreased the incidence of coughing after sevoflurane general anesthesia in children undergoing non-painful procedures.

Assessment of airway length of Korean adults and children for otolaryngology and ophthalmic surgery using a fiberoptic bronchoscope / 대한마취과학회지

BACKGROUND: Knowledge regarding normal upper airway anatomy is essential for airway management and is required to prevent malpositioning of endotracheal tubes. We evaluated the length of the upper airway in Korean children and adults who had no abnormality of the upper airway using a fiberoptic bronchoscope. METHODS: Eighty seven patients aged 5 to 81 years undergoing noninvasive elective surgery were included in this study. After induction of anesthesia was complete, we measured the distance from the upper incisor to various components of the upper airway by fiberoptic bronchoscopy. RESULTS: In adults, the mean length between the upper incisor and midtrachea was found to be 21.8 +/- 1.8 cm in males and 19.9 +/- 1.3 cm in females, while the mean length of the trachea was 10.1 +/- 1.3 cm in males and 10.3 +/- 1.6 cm in females. The length between the upper incisor and midtrachea (IT) were correlated with height both in children (IT [cm] = 2.531 + 0.109 x height [cm]) and adults (IT [cm] = 0.167 + 0.127 x height [cm]), which shows that they differ from the western standard (length of tube [cm] = 5 + 0.1 x height [cm]). CONCLUSIONS: In adults and children, the length from the incisor to the midtrachea was significantly different when compared with western standards. Therefore, re-evaluation of the proper and precise depth of endotracheal tube in Koreans should be considered.

Comparing the effects of esmolol and remifentanil on the cardiovascular and catecholamine response to endotracheal intubation during the induction of general anesthesia / 대한마취과학회지

BACKGROUND: Esmolol and remifentanil are widely used drugs that minimize the increase of the blood pressure and the heart rate in response to endotracheal intubation during the induction of anesthesia. The purpose of this study is to compare the effect of esmolol and remifentanil on the cardiovascular and catecholamine responses to endotracheal intubation. METHODS: Sixty ASA I and II patients were randomly allocated to three groups. Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.9 mg/kg and this was maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. The patients received 10 ml intravenous saline (control group), 1.5 mg/kg esmolol (esmolol group) or 1microgram/kg remifentanil followed by an infusion of 0.1microgram/kg/min (remifentanil group) before intubation. The noninvasive blood pressure and heart rate were recorded before induction (baseline), before intubation and at 1, 2, 3 and 5 minutes after intubation. The blood catecholamine level (epinephrine and norepinephrine) was measured before induction and at 1 and 5 minutes after intubation. RESULTS: The systolic, diastolic and mean arterial pressures after endotracheal intubation were similar in the control and esmolol groups, but they were lower in the remifentanil group (P 0.05). CONCLUSIONS: 1microgram/kg remifentanil followed by an infusion of 0.1microgram/kg/min is more effective than 1.5 mg/kg esmolol for inhibiting the cardiovascular responses following endotrachal intubation during the induction of general anesthesia.

Comparing the effects of esmolol and remifentanil on the cardiovascular and catecholamine response to endotracheal intubation during the induction of general anesthesia / 대한마취과학회지

BACKGROUND: Esmolol and remifentanil are widely used drugs that minimize the increase of the blood pressure and the heart rate in response to endotracheal intubation during the induction of anesthesia. The purpose of this study is to compare the effect of esmolol and remifentanil on the cardiovascular and catecholamine responses to endotracheal intubation. METHODS: Sixty ASA I and II patients were randomly allocated to three groups. Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.9 mg/kg and this was maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. The patients received 10 ml intravenous saline (control group), 1.5 mg/kg esmolol (esmolol group) or 1microgram/kg remifentanil followed by an infusion of 0.1microgram/kg/min (remifentanil group) before intubation. The noninvasive blood pressure and heart rate were recorded before induction (baseline), before intubation and at 1, 2, 3 and 5 minutes after intubation. The blood catecholamine level (epinephrine and norepinephrine) was measured before induction and at 1 and 5 minutes after intubation. RESULTS: The systolic, diastolic and mean arterial pressures after endotracheal intubation were similar in the control and esmolol groups, but they were lower in the remifentanil group (P 0.05). CONCLUSIONS: 1microgram/kg remifentanil followed by an infusion of 0.1microgram/kg/min is more effective than 1.5 mg/kg esmolol for inhibiting the cardiovascular responses following endotrachal intubation during the induction of general anesthesia.