Transcutaneous Electrical Stimulation of the P6 Acupoint Reduces Postoperative Nausea after Minor Breast Surgery / 대한마취과학회지

BACKGROUND: The present study was undertaken to investigate whether the transcutaneous electrical stimulation of the P6 acupoint prevents postoperative nausea and vomiting (PONV) after minor breast surgery. METHODS: In this prospective, randomized, double-blind and placebo-controlled study, we investigated ASA I or II female patients who underwent minor breast surgery under general anesthesia using sevoflurane. We used a ReliefBand(R) device (NSTTM 600, Woodside Biomedical Inc, USA) for the transcutaneous electrical stimulation of the P6 acupoint. The patients were randomly divided into two groups; in the P6 group (n = 33) the activated ReliefBand(R) was placed at the P6 acupoint; in the placebo group (n = 33) the inactivated ReliefBand(R) was placed at the P6 acupoint. The ReliefBand(R) was applied 10 min before the end of surgery and it remained in place for 24 h. We evaluated the incidence and severity of PONV, and the need for palliative antiemetics during the first 6 h and 24 h after surgery. RESULTS: The incidence of nausea was significantly lower in the P6 group (33%) than in the placebo group (67%) during the first 24 h after surgery. The severity of nausea was also significantly lower in the P6 group than in the placebo group. However, the incidence of vomiting and the need for palliative antiemetics was not different between the two groups. CONCLUSIONS: Transcutaneous electrical stimulation of the P6 acupoint significantly reduced the incidence and severity of nausea, but not the incidence and severity of vomiting, for female patients undergoing minor breast surgery during the first 24 h after surgery.

Pharmacodynamic and Pharmacokinetic Study on the Neuromuscular Blocking Action of Rapacuronium: a Comparison with Other Muscle Relaxants / 대한마취과학회지

BACKGROUND: We evaluated the pharmacodynamic and pharmacokinetic properties of rapacuronium, a new non-depolarizing muscle relaxant. METHODS: The EC50 and EC95 values of rapacuronium, vecuronium, and rocuronium were determined on rat hemidiaphragm, and reversal effects were determined using edrophonium or pyridostigmine. In 57 healthy adults, neuromuscular transmission was monitored at the adductor pollicis. Patients received a single dose of succinylcholine (1.0 mg/kg), rapacuronium (1.5 mg/kg), rocuronium (0.6 mg/kg), or mivacurium (0.16 mg/kg). Onset time, clinical duration, recovery index (RI), total duration (TD), train of four (TOF) ratio at over 95% recovery of control first twitch height, cardiovascular effect, and intubation scores were measured. RESULTS: By in vitro study, the EC50 and EC95 of rapacuronium were 4 to 10 fold larger than those of vecuronium and rocuronium, and by clinical study, the onset time of rapacuronium was similar to those of succinylcholine. The clinical duration of rapacuronium was not different from those of succinylcholine and mivacurium. RI and TD of rapacuronium (9.6 +/- 3.5 min and 30.9 +/- 10.7 min) were longer than those of succinylcholine (3.5 +/- 1.1 min and 18.1 +/- 4.4 min) and mivacurium (6.5 +/- 0.9 min and 23.0 +/- 4.4 min) for spontaneous recovery, but not different during reversal by pyridostigmine (5.0microgram/kg). The TOF ratio was increased after pyridostigmine than during spontaneous recovery. Intubation conditions of rapacuronium were similar to those of succinylcholine. Heart rates were significantly increased (15% of control) within 2 min, but not mean arterial pressure after rapacuronium was administration. CONCLUSIONS: Rapacuronium can be considered a valid alternative to succinylcholine and had no observed cardiovascular effect.