The Influence of Nitrous Oxide on Postoperative Bowel Function Recovery for Gynecologic Patients

BACKGROUND: Nitrous oxide may cause distension of the intestine. We studied the influence of nitrous oxide on the recovery of bowel function and the incidence of complications of bowel distension. METHODS: Fifty patients scheduled for abdominal hysterectomy were anesthetized with sevoflurane and oxygen and were randomly assigned to be given 50% nitrous oxide (n = 25) or 50% air (n = 25) in two groups. A surgeon assessed the closing condition. Patients reported pain, nausea and vomiting after surgery. The lapse of time before the passing of flatus was recorded. RESULTS: There was no difference between the two groups with respect to body weight, duration of surgery, alfentanil and atracurium requirements, pain score, nausea and vomiting, and closing condition. The time elapsing before the passing of flatus was significantly greater for the patients that received nitrous oxide. CONCLUSIONS: Our results suggest that avoiding nitrous oxide administration during prolonged intraabdominal surgery shortens the time for recovery of bowel function.

Delayed Cardiac Arrest after Brachial Plexus Block in a Patient Taking a beta-Adrenoreceptor Antagonist and Calcium Channel Blocker: A case report / 대한마취과학회지

A Bezold-Jarisch reflex (BJR) mediated vasovagal syncope is the most common neurally mediated reflex characterized by the sudden failure of the autonomic nervous system and have been reported in patients undergoing a peripheral nerve block. The concomitant administration of a beta-adrenoreceptor antagonist and calcium channel blocker have a synergistic suppressant effect on the autonomic nervous system and interact with the anesthetics significantly. We report a case of a 57-year-old female patient with essential hypertension controlled with lercanidipine and carvedilol. Cardiac arrest developed with spontaneous respiration 50 min after the brachial plexus block to remove a plate in the humerus. Epinephrine was administered and the pulse immediately returned to a normal sinus rhythm. This event might be vasovagal syncope mediated by BJR, and realted to the antihypertensive medication used.

Anesthetic Management of Myotonic Dystrophy: A case report / 대한마취과학회지

Myotonic dystrophy is a muscle disorder characterized by progressive muscle wasting and weakness associated with myotonia. It is a systemic disease transmitted in an autosomal dominant pattern. Myotonia may be precipitated by hypothermia, shivering, and mechanical or electrical stimulation. Furthermore, sensitivity to sedative, anesthetic and neuromusclular blocking agents may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. Therefore, a patient with myotonic dystrophy is at high risk for complications from anesthetic management. We report the successful anesthetic management of such a patient undergoing a total abdominal hysterectomy, in which we used an epidural technique for intraoperative anesthesia and postoperative analgesia.