Optimal Time Interval of Rocuronium Pretreatment for Prevention of Biochemical Changes, Fasciculations and Myalgia Following Succinylcholine Administration / 대한마취과학회지

BACKGROUND: The purpose of this study was to assess the optimal time interval between rocuronium pretreatment and succinylcholine for prevention of the rise in serum potassium and creatine kinase concentrations and the increased incidence of fasciculations and myalgia following succinylcholine administration. METHODS: We have studied 60 patients undergoing a minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 2 ml (Group C), 0.05 mg/kg rocuronium one min before (Group R1) or 3 min before (Group R3) 1.5 mg/kg succinylcholine administration. Serum potassium and creatine kinase were respectively measured 5 min after succinylcholine and 24 h after the operation. Fasciculations and myalgia on postoperative day 1 and day 2 were evaluated. RESULTS: The increase in the serum potassium concentration was not attenuated in any group. The increase in creatine kinase concentration, the incidence of fasciculations and the incidence of myalgia on postoperative day 1 and day 2 were highest in Group C; however, there was no difference between the Group R1 and R3. CONCLUSIONS: Either a 1 min or 3 min pretreatment time interval of the rocuronium has a similar effect on the prevention of the rise in serum potassium and creatine kinase concentrations and an increased incidence of fasciculations and myalgia following succinylcholine administration.

Effects of Low-dose Naloxone on Postoperative Analgesia and Side Effects in Intravenous Patient-Controlled Analgesia after a Total Hysterectomy / 대한마취과학회지

BACKGROUND: Naloxone is an opioid antagonist and effective in reducing and reversing opioid-related side effects. In addition, low-dose naloxone may reverse or potentiate the analgesic effect of an opioid. The present study was designed to examine the analgesic efficacy and side effects of the combination of naloxone with morphine in patients using intravenous PCA (patient-controlled analgesia). METHODS: Patients were randomly assigned to receive one of three PCA regimens: group 1 (40 mg morphine + 90 mg ketorolac + 2.5 mg dorperidol), group 2 (40 mg morphine + 90 mg ketorolac + 0.8 mg naloxone), or group 3 (40 mg morphine + 90 mg ketorolac + 1.6 mg naloxone). All patients were given an initial loading dose of 0.1 mg/kg morphine at the end of surgery. Pain scores, side effects, and overall satisfaction were assessed at 30 min, 1, 8, 24 and 48 hr postoperatively. Blood pressure, heart rate, and respiratory rate were also monitored for 48 hours. RESULTS: The pain score was significantly lower in group 2 than in group 1 and group 3 at 8 hr and 24 hr postoperatively. Cumulative morphine usage during 48 hr was the least in group 2 compared with group 3. There were no differences in the overall incidence of side effects, patient satisfaction, and hemodynamic parameters among the groups. CONCLUSIONS: The present results suggest that a low-dose naloxone with intravenous morphine PCA is effective in reducing opioid-related side effects and in increasing the quality of analgesia.

Rocuronium and Lidocaine Pretreatment for Prevention of Biochemical Changes, Fasciculations and Myalgia following Succinylcholine Administration / 대한마취과학회지

BACKGROUND: The purpose of this study was to assess the changes in serum potassium and creatine kinase concentrations and the incidence of fasciculations and myalgia when rocuronium and lidocaine were used in combination and separately as pretreatment before succinylcholine. METHODS: We studied 60 patients undergoing a minor elective surgery, in a prospective double blinded method. Three groups each with 20 patients were pretreated before a 1.5 mg/kg succinylcholine administration with 0.05 mg/kg rocuronium three min before (group R), 1.5 mg/kg lidocaine 30 sec before (group L), or both rocuronium and lidocaine (group RL). Serum potassium and creatine kinase were respectively measured 5 min after succinylcholine administration and 24 h after the operation. Fasciculations and myalgia on postoperative day 1 and day 2 were evaluated. RESULTS: The increase in creatine kinase and incidence of myalgia on postoperative day 1 was less in the RL group than in the R group and L group. The incidence of fasciculations was higher in the L group than in the R group and RL group. There was no increase in serum potassium in any group. CONCLUSIONS: The combined use of rocuronium and lidocaine was more effective in reducing creatine kinase and postoperative myalgia than when they were used separately. However, the fasciculations were only reduced by the use of rocuronium.

The Effects of Stellate Ganglion Block on the Level of Blood Glucose, Uric Acid, and Catecholamines in the Induced Diabetic Rat / 대한마취과학회지

BACKGROUND: Stellate ganglion block (SGB) has been used to treat over 150 diseases which include diabetes mellitus and gout. This study was planned to investigate whether stellate ganglion block (SGB) could lower the levels of blood glucose, uric acid, epinephrine, and norepinephrine. METHODS: Sixty Sprague-Dawley rats within the weight of 250-350 gm were randomly devided into four groups. CS group was normal group with sham SGB with normal saline, CL group was normal group with SGB with lidocaine, DS group was diabetic group with SGB with normal saline, DL group was diabetic group with SGB with lidocaine. The diabetes was induced by intraperitoneal injection of 40 mg/kg of streptozotocin in citrate buffer (0.01 M, pH 4.5). Nondiabetic groups were given same amount of the citrate buffer. Seven days after the last injection of the streptozotocin blood glucose level was checked and more than 300 mg/dl was considered diabetic. The SGB was performed three times at right superior cervical ganglion two days apart from two days after the conformation of diabetes. Successful SGB was conformed by the ipsilateral ptosis or conjunctival congestion. Blood samplings from tail vein for the check of glucose, uric acid, and catecholamines were done before the injection of streptozotocin, seven days after the last injection of streptozotocin, and two days after the last SGB. RESULTS: The SGB with lidocaine reduced the blood glucose level only in the diabetic rats while SGB with the saline did not. The epinephrine levels were increased in the diabetics and decreased by the SGB with lidocaine without any statistical significance. Norepinephrine and uric acid levels had not been effected by the SGB and both of them had no correlationship with the glucose level. CONCLUSIONS: SGB in the diabetic rats decreases the blood glucose level. But for the effects of the SGB on the level of epinephrine further study would be needed.

Effects of Pretreated-Fentanyl on the Myocardial Function in Isolated Stunned Rat Heart / 대한마취과학회지

BACKGROUND: Fentanyl is commonly used as a anesthetics for patients who have poor cardiac reserve, because it provides cardiovascular stability. But little data exist on the effects of fentanyl on myocardial ischemia and reperfusion injury. The purpose of this study was to examine the effects of the fentanyl on the recovery of myocardial contracility, coronary flow, and myocardial oxygen balance in isolated rat hearts subjected to ischemia and reperfusion. METHODS: Isolated Sprague-Dawley rat hearts were perfused at constant pressure with oxygenated modified-Krebs solution (pH 7.4, 37oC). After stabilization period, all hearts were given fentanyl 0, 1, 10 ng/ml, respectively. Then, myocardial ischemia was induced by global ischemia for 15 minutes. Isovolumetric left ventricular pressure (LVP) and dP/dt were measured via a latex balloon and transducer. Also, coronary flow and oxygen tensions at the coronary inflow and outflow were measured. RESULTS: The application of fentanyl did not significantly affect myocardial contractility, coronary flow, and myocardial oxygen balance. After global ischemia, myocardial contractility, coronary flow, and myocardial O2 consumption were decreased, but percentage of O2 extraction was increased. However, these changes were not significantly different between fentanyl pretreated and control groups. CONCLUSIONS: These in vitro findings demonstrate that the pretreatment of fentanyl is devoid of major effects on recovery of the myocardial contracility, coronary flow, and myocardial oxygen balance in isolated stunned rat hearts.

The Effects of Combination of Fentanyl with Morphine in Intravenous Patient-Controlled Analgesia / 대한마취과학회지

Background: The highly lipid soluble opioid, fentanyl, has a rapid onset and short duration of action. The present study was designed to examine the analgesic efficacy and side effects of the combination of fentanyl with morphine in patients using intravenous PCA. Methods: Patients were randomly assigned to receive one of three PCA regimens: M4 group (40 mg morphine+90 mg ketorolac+1.5 mg dorperidol), M2F2 group (20 mg morphine+200 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol), or M2F4 group (20 mg morphine+400 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol). All patients were given initial loading dose of 0.1 mg/kg morphine plus 1 mg droperidol at the end of surgery. Pain score, side effects, and overall satisfaction were assessed at 30 min, 1 hr, 8 hr, 24 hr, and 48 hr postoperatively. Results: The pain score was significantly higher in the M2F2 group than in the M4 group and M2F4 group during 1 hr and 8 hr postoperatively. The total opioid consumption was significantly greater in the M2F4 group than in the M4 group. Patient satisfaction was better in the M2F4 than other two groups. There were no differences in the overall incidence of side effects among three groups. Conclusions: The present results suggest that the combination of fentanyl with morphine for intravenous patient-controlled analgesia is a useful method, and the double dose of fentanyl in comparison with the equipotent morphine dose is recommended in the early postoperative period.

Effects of Enflurane on the Left Ventricular Function in Isolated Diltiazem-Pretreated Rat Heart / 대한마취과학회지

BACKGROUND: Calcium channel blockers and volatile anesthetics have depressant effects on cardiac function. Both of them appear to exert, qualitatively and quantitatively, different effects on myocardial contractility, coronary flow, and myocardial oxygen balance. The aim of this study was to examine the direct cardiac effects of the enflurane in the presence of diltiazem. METHODS: Isolated Sprague-Dawley rat hearts (N=45) were perfused at constant pressure with oxygenated Modified-Krebs solution (pH 7.4, 37oC). Isovolumetric left ventricular pressure (LVP) and dP/dt were measured via a latex balloon and transducer. Also, coronary flow and oxygen tensions at the coronary inflow and outflow were measured. After stabilization period, all hearts were subjected to the application with diltiazem (100 ng/ml). Thereafter, they were subdivided into three groups; group 1, 2, 3. Groups subjected to the combination of diltiazem (100 ng/ml) with enflurane 1.1, 2.2, or 3.3 vol%, respectively. RESULTS: After the application of diltiazem, myocardial contractility and heart rate were significantly decreased, and coronary flow were significantly increased. The combination of diltiazem with enflurane depressed myocardial contractility, heart rate, myocardial O2 consumption, and percentage of O2 extraction more than diltiazem alone, and their effects were dependent on the concentration of enflurane. However, there was no difference in the change of coronary flow and oxygen delivery between diltiazem and the combination of diltiazem with enflurane. CONCLUSIONS: These in vitro findings demonstrate that the combination of diltiazem with enflurane shows greater direct negative inotropic and negative chronotropic effect, and is associated with less attenuation of coronary autoregulation, but with a larger reduction in O2 utilization. The present results suggest that high enflurane anesthesia in the diltiazem-pretreated patients could result in profound cardiac depression.

A Study on the Predictors of Hypertension in the Immediate Postoperative Period / 대한마취과학회지

BACKGROUND: Hypertension in the immediate postoperative period, if sufficiently high, can cause left heart failure, arrhythmia, myocardial infarction, and cerebral hemorrhage. The causes of postoperative hypertension are hypertension history, pain, hypoxia, emergence excitement, reaction to endotracheal tube, hypothermia, excess fluid administration, hypercarbia, etc. To know the predictable factors for the postoperative hypertension the authors tried to investigate perioperative patient care of the postoperative hypertensive cases. METHODS: One hundred twenty surgical patients in both sexes between the age of 40~60 were sampled randomly and devided into two groups. The normotensive (N) group included the patients with postoperative blood pressure below 140/90 mmHg and the hypertensive (H) group, above 140/90 mmHg. The incidence of hypertension history, hypertension on admission, hypertension on ward, change of systolic blood pressure above 20% during surgery, intra or postoperative use of antihypertensives or inotropic agents were compared between the groups. RESULTS: The incidence of history of hypertension was higher in H group (20%) than N group (6.7%). Hypertension on admission was higher in H group (43.3%) than N group (23.3%). Systolic blood pressure change above 20% was only in H group (6.7%). Use of antihypertensive was more frequent in H group (33.3%) than N group (3.3%) and use of inotropic agents was only in N group (8.3%). The blood pressure at ward, preinduction, and after induction were higher in H group. Within the group the blood pressure between preinduction and after induction has no difference. CONCLUSION: Immediate postoperative hypertension can be expected in case of history of hypertenion, hypertension on admission (above 140/90 mmHg), change of systolic blood pressure above 20%, use of antihypertensive during operation, and hypertension just before induction.

The Effects of Thoracic Epidural Anesthesia on Myocardial and Systemic Circulation after Coronary Artery Occlusion in Dogs / 대한마취과학회지

Thoracic epidural combined with general anesthesia is used for thoracic and upper abdominal surgery and postoperative pain control. This technique has advantages of reducing the hemodynamic demand on the heart because of cardiac sympathetic block and stable intraoperative hemodynamics, but it may have a potential hazard of reducing coronary perfusion pressure due to hypotension. Decreased coronary perfusion pressure may be critical hazard to coronary insufficiency patients, but coronary vascular resistance may be decreased also due to blockade of sympathetic coronary constriction. This study was done to investigate the effect of thoracic epidural anesthesia on myocardial and systemic circulation during coronary occlusion limiting flow to 50% of preocclusive value. Comnary occlusion of left circumflex coronary artery was achieved with hydraulic vascular occluder with blood flow meter distal to occluder in 20 dogs. Five of them were dead during preparation. Coronary stenosis was maintained for 30 minutes, then epidural anesthesia was done with 0.5% bupivacaine (bupiva group) or saline (saline group) 5 ml through the surgically introduced epidural catheter. Arterial, mixed venous and coronary sinus blood was collected for the measurement of metabolites and myocardial and systemic oxygen comsumption and extraction ratio. Hemodynamic parameters and blood samples were obtained before(control), 30 minutes after stenosis(stenosis), 15, 30, 60, 90 and 120 minutes after epidural blockade. The results were as follows; The thoracic epidural block caused decrease in blood pressure, heart rate, cardiac index, level of free fatty acid and glucose, and increase in lactic acid level of mixed veous and coronary sinus blood, myocardial oxygen extraction ratio, arterio-venous oxygen content difference, and systemic oxygen extraction ratio. In conclusion the high thoracic epidural block may cause hypotension thus decrease oxygen supply to myocardium but the degree of which is less than that of total body, in the dogs with acute coronary stenosis. The reason is that the high thoracic epidural block decrease myocardial oxygen consumption, and make effective distribution of blood flow in ischemic myocardium, but the normal myocardium has the highest oxygen extraction in the body, so the high thoracic epidural block in coronary stenosis may cause ill effect on myocardial oxygen equlibrium.

A Case Report of Profound Hypotension during Vaginal Hysterectomy in a Geriatric Patient / 대한마취과학회지

An anesthesiologist should keep in mind the various risk factors during anesthetic man- agement of geriatric patients. Unlike young patients, elderly patients may manifest more than one pathophysiologic process associsted with progressive degenerative changes in various organs. The successful anesthetic management requires detailed information about the cause and severity of the underlying disease, thorough understanding of geriatric specific hemodynamic particularities, and more careful monitoring by experienced personnel. We experienced a case of profound hypotension during general anesthesia for vaginal hysterectomy in a 67 year-old female patient. Anesthesia was induced with thiopental-vecuronium and was maintained with nitrous oxide, oxygen and enflurane. One hundred and five minutes after the induction, profound hypotension and bradycardia with S-T segment depression developed without specific events and were corrected by vigorous therapeutic managements. She discharged from the hospital on 7th postoperative day without complications.

A Case Report of Profound Hypotension during Vaginal Hysterectomy in a Geriatric Patient / 대한마취과학회지

An anesthesiologist should keep in mind the various risk factors during anesthetic man- agement of geriatric patients. Unlike young patients, elderly patients may manifest more than one pathophysiologic process associsted with progressive degenerative changes in various organs. The successful anesthetic management requires detailed information about the cause and severity of the underlying disease, thorough understanding of geriatric specific hemodynamic particularities, and more careful monitoring by experienced personnel. We experienced a case of profound hypotension during general anesthesia for vaginal hysterectomy in a 67 year-old female patient. Anesthesia was induced with thiopental-vecuronium and was maintained with nitrous oxide, oxygen and enflurane. One hundred and five minutes after the induction, profound hypotension and bradycardia with S-T segment depression developed without specific events and were corrected by vigorous therapeutic managements. She discharged from the hospital on 7th postoperative day without complications.

A case report of quadriparesis following general anesthesia / 대한마취과학회지

We experienced a case of postoperative quadriparesis secondary to operative position in a patient with pre-existing, asymtomatic,cervical neurilemmoma. The patient was admitted with chronic otitis media for mastoidectomy on right side. There was no specific event throughout operation and anesthesia but developed quadriparesis one hour after arrival on ward. With magnetic resonance imaging, the patient was dignosed to have cervical neurilemmoma. On seventh postoperative day the patient had second operation,cervical laminectomy and tumor removal. Ten days after second operation he was discharged without any complication. Eight months later he had mastoidectomy on the left side and was discharged without any sequale.