The Effects of Epidural Droperidol on the Analgegic and Side Effects of Epidural Morphine / 대한마취과학회지

BACKGROUND: Epidural morphine is effective in the treatment of postoperative pain, but the incidence of associated side effects is high. To evaluate the reduction of opioid sideeffects by epidural use of droperidol mixture, this study was performed. METHODS: Randomly sampled sixty patients undergoing upper abdominal surgery were divided into two groups. To assess a reduction of opioid side effects by droperidol, group I (n=30) were received 3mg morphine and 0.15% bupivacaine 10ml through the indwelling epidural catheter before the conclusion of operation, followed by an infusion of 6 mg morphine plus 0.15% bupivacaine 100ml with the two day infusor. Group II (n=30) were treated with the same protocol as group I but 1.5 mg of droperidol was added to initial bolus and 5mg of droperidol to the two day infusor. Analgesic effect and side effect were 48 hours after operation. RESULTS: No significant differences in intensity of analgesiaand sedation were seen. The intensity of nausea and vomiting in the group II was significantly less than in the group I at 8, 12 hours after operation (p<0.05). The intensity of pruritus in group II was significantly less than in group I at 4, 8 hours of postoperative period (p<0.05). The frequency of nausea, vomiting, pruritus and urinary retention in group II were less than in group I. respiratory depression. Epidural injection of droperidol did not result in any local or systemic side effects. CONCLUSION: The addition of epidural droperidol significantly reduced the side effects of epidural morphine without altering the effect on analgesia.

Comparison of the Analgesic Consumption in Patient-Controlled Analgesia (PCA) with and without a Basal Infusion after Caesarean Section / 대한마취과학회지

Bakground : Patient-Controlled Analgesia (PCA) has become popularized for postoperative pain control. Theoretically, addition of a basal infusion would ameliorate the pain control as related to less need for additional demands. Regardless of theoretical background, usefulness of a basal infusion in PCA is controversial. Therefore, in this study we compared the analgesic consumption between PCA only and PCA plus basal infusion and assessed if the use of a basal infusion improves the analgesic efficacy in intravenous PCA. METHODS: 40 patients undergoing caesarian section, were assigned randomly to PCA only group (group 1) and PCA plus basal infusion group (group 2). Group 1 was programmed to deliver 1.5 ml of bolus infusion with 10 minutes of lockout interval and four times per hour of the maximum usage of patient control module. In group 2, 0.5 ml of basal infusion was added to the same PCA. The analgesic solution contained 60 mg of morphine, 180 mg of ketorolac and 5 mg of droperidol in total volume of 60 ml. PCA was started at the time of the peritoneal closure with 2 ml of loading dose in all patients. Postoperative assessments were pain score, sedation score, side effect, total analgesic consumption and the degree of patients, satisfaction. RESULTS: Total analgesic consumption was significantly greater in group 2 than in group 1. Pain score, sedation score, complication and the degree of the satisfaction were almost the same at all time interval in each group. CONCLUSION: We concluded that there was no significant benefit of basal infusion in intravenous PCA after caesarean section.

Analgesic Effect with Epidural Bupivacaine and Verapamil in Lower Abdominal Surgery / 대한마취과학회지

BACKGROUND: Activation of N-methyl-D-aspartic acid (NMDA) receptors leads to Ca++ entry into the cell and initiates a series of central sensitization such as wind up and longterm potentiation in the spinal cord. Therefore, it can be postulated that the central sensitization would be prevented by blocking Ca++ entry with verapamil. In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to verify whether preoperative epidural anesthesia can preempt postoperative pain and to investigate the possible role of calcium channel blocker, verapamil, in the central sensitization. METHODS: Sixty patients (ASA class I-II) scheduled for lower abdominal surgery were randomly assigned to one of three groups of equal size. Group 1 (PR) is preincisional epidural bupivacaine group. Group 2 (PO) is postincisional epidural bupivacaine group. Group 3 (PRV) is preincisional epidural bupivacaine and verapamil group. Visual analogue pain and mood scores, Prince Henry Scores, sedation scores, cumulative PCA (patient controlled analgesia) morphine consumptions, and the incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. RESULTS: Cumulative PCA morphine consumptions in PRV group was significantly lower than in PR and PO group at 24, 48 hours after surgery. The incidence of side effects had no difference among three groups. CONCLUSIONS: Preoperative epidural anesthesia with 10ml of bupivacaine would be insufficient to preempt postoperative pain in lower abdominal surgery. However, addition of verapamil to preoperative epidural bupivacaine would decrease postoperative pain possibly by preventing the establishment of central sensitization.

Risk of Pulmonary Aspiration under General Inhalation Anesthesia with Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: The laryngeal mask airway(LMA) is a new type of airway that has many advantages compared with the tracheal tube, but its potential problem might be pulmonary aspiration. This study therefore was designed to investigate the risk of pulmonary aspiration during general anesthesia using LMA. METHODS: We studied 101 patients who received general inhalation anesthesia with LMA and mechanical positive pressure ventilation for gynecological operations. Methylene blue was poured into the oropharynx after the LMA was placed, and the presence or absence of the dye staining of the larynx, tracheal and main stem bronchi with fiberoptic bronchoscope through the LMA shaft lumen was observed one and/or two hour(s) after LMA placement. RESULTS: In two out of 101 patients there was staining of the larynx with methylene blue dye. One was one hour after and the other was stained two hours after LMA placement. CONCLUSIONS: Dye staining of the larynx suggests that even mechanical positive pressure ventilation with LMA placement have the risk of pulmonary aspiration. Therefore LMA is contraindicated if the stomach is not emptied.

A Case of Airway Obstruction due to Subglottic Necrotic Tissue Following Endotracheal Intubation / 대한마취과학회지

Acute airway obstruction is a serious emergency in children. This is a case report of airway obstruction due to subglottic necrotic tissue following endotracheal intubation. This 7-year old male patient was performed an endotracheal intubation for airway keep after car acident. The endotracheal tube remained in place for approximately 6 hours. After extubation, he was suffered from dyspnea and this symptom was exacerbated gradually. 3 days later, necrotic granulation tissue on subglottic area was removed by surgical intervention. After this procedure his problem and symptom was improved. It was considered that the formation of necrotie granulation tissue on subglottic area was a complication of endotracheal intubation. Histopathologic finding showed acute and chronic inflammatory cell infiltration and degeneration with necrotic change.

Prolongation of Spinal Anesthesia with T-Cain by Epinephrine and Clonidine / 대한마취과학회지

Vasoconstrictors such as epinephrine or phenylephrine have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an areceptor agonist, has been proved to have analgesic effect and to prolong epidural and spinal anesthesia. We used 0.3mg of epinephrine, 75 ug and 150 ug of clonidine in spinal anesthesia with 12 mg of T-Cain respectively and compared hemodynamic and analgesic effects of each drug. Heart rate and blood pressure were checked before, during and after anesthesia. Sensory level was checked by pin-prick method and motor blockade was measured by Bromages scale. The results were as follows. 1) Heart rate changed little in the epinephrine group and decreased significantly in all other groups.2) Systolic blood pressure decreased significantly in all groups except the epinephrine group. Both 75 ug and 150 ug of clonidine caused a significant fall in diastolic pressure. 3) The onset time for sensory and motor blockade varied little among all groups. 4) Sensory blockade was significantly higher in the 150 ug of clonidine group than the control group. Time to achieve the maximum level of sensory blockade was significantly faster in control group than 150 ug of clonidine group. 5) The duration of sensory and motor blockade was significantly prolonged in epinephrine and clonidine group than control group. The results indicate that clonidine, when used as an adjunct to T-Cain spinal anesthesia, is as effective as epinephrine in prolongation of motor and sensory blockade.

The Effect of Discontinuation of N2O on the Middle Ear Pressure during General Endotracheal Anesthesia / 대한마취과학회지

N2O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N2O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N2O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N2O in O2; group 2=60% administration of N2O in O2). The middle ear pressures after N2O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N2O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N2O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N2O discontinuation while the end-tidal N2O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N2O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N2O is carefully administered in patients with middle ear and/or upper airway disesses.

The Effect of Discontinuation of N2O on the Middle Ear Pressure during General Endotracheal Anesthesia / 대한마취과학회지

N2O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N2O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N2O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N2O in O2; group 2=60% administration of N2O in O2). The middle ear pressures after N2O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N2O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N2O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N2O discontinuation while the end-tidal N2O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N2O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N2O is carefully administered in patients with middle ear and/or upper airway disesses.