Effect of Intrathecal Neostigmine on Post-Cesarean Section Analgesia / 대한마취과학회지

BACKGROUND: Intrathecal (IT) neostigmine produces analgesia in animal and human. This study was designed to evaluate the efficacy and safety of IT neostigmine for post-cesarean section analgesia. METHODS: Forty-five women undergoing cesarean section under spinal anesthesia were randomly assigned into 3 groups to receive; normal saline 0.2 ml, or neostigmine 12.5 microgram, or neostigmine 25 microgram intrathecally with 0.5% hyperbaric bupivacaine 12 mg. Degrees of sensory and motor blocks, maternal hemodynamic changes, and side effects were recorded. Apgar scores and umbilical vein blood gas analysis (UVBGA) were checked for evaluation of fetal status. Postoperative analgesia was provided by intravenous patient-controlled analgesia (PCA) using fentanyl 500 microgram and ketorolac 150 mg in 100 ml. Pain scores with 10-cm visual analogue scale (VAS), time to first PCA use, cumulative PCA consumptions, and side effects were assessed at 1, 2, 4, 8, 12, 24, and 48 hr after IT injection. RESULTS: There were no significant differences among the three groups in characteristics of spinal anesthesia, maternal blood pressure and heart rate, Apgar scores, and UVBGA data. Compared to saline group, IT neostigmine significantly prolonged time to first PCA use and decreased 24 hr- and 48 hr-PCA consumptions (P<0.05). Pain scores in neostigmine groups were significantly lower than those in saline group for first 4 hr after which there were no differences among the three groups. There were significantly higher incidences of nausea and vomiting in neostigmine groups than in saline group. CONCLUSIONS: These data indicate that IT neostigmine can be an alternative postoperative analgesic without adverse fetal effects for cesarean section. However, high incidence of nausea and vomiting seem to limit its clinical usefulness. Further studies are necessary to enhance its analgesic effects and to decrease its adverse effects.

Epidural Nalbuphine Reduces the Side Effects from Epidural Morphine after Cesarean Section / 대한마취과학회지

BACKGROUND: This study was undertaken to reduce the side effects of epidural morphine through the addition of nalbuphine in 37 cesarean delivery. METHODS: Forty patients were divided into 2 groups; M(control) group: bolus administration of morphine 2 mg in 0.5% bupivacaine and continuous epidural 41 hour-infusion of morphine 7mg, N(experimental) group: bolus administration of morphine 2 mg in 0.5% bupivacaine combined with nalbuphine 10mg and continuous epidural 41 hour-infusion of morphine 7mg combined with nalbuphine 10mg via the Paragon infusor. RESULTS: During the postoperative 48 hours, their pain scores and side effects were recorded at 6, 12, 18, 24, 30, 36, 42 and 48 hours. The analgesic effects were good in two groups(mean VAS <3.0) and pain scores were statistically significant at 18 and 30 hour. The incidence of pruritus, nausea, vomiting and urinary retention was decreased in group N(p<0.05). CONCLUSIONS: We concluded that continuous epidural morphine combined with nalbuphine was one of recommendable methods to reduce side effects of morphine.

Changes of Immunoglobulin G , A , M and Complement C3 , C4 during Cardiopulmonary bypass under Fentanyl Anesthesia / 대한마취과학회지

The authors evaluated the stress response to cardiopulmonary bypass by measuring plasma Ig G, A, M and C3, C4concentrations. Anesthesia was induced with fentanyl, and all patients were underwent open heart surgery using bubble type heart-lung machine. Blood samples were obtained pre-induction, sternotomy, 10 min. and 30 min. after cardiopulmonary bypass, and 10 min. after termina tion of cardiopulmonary bypass and after transport to L.C.U. IgG, A, M and complement C3, C4concentrations were measured by Turbidmeter using Behring Turbidquant. The results were as follows: 1) Plasma concentrations of IgG, A, M and C3, C4 at preinduction period were 1345. 00+/-194. 42, 289. 10+/-100.4, 177.43+/-72.65, 59.20+/-16.33, 20.50+/-7.54 mg/dl., respectively. 2) Ten min. after cardiopulmonary bypass, the plasma concentration was significantly decreased when compared with the baseline values (p<0.01). 3) Thirty min. after cardiopulmonary bypass, the plasma concentration of the complenent C3, C4 were significantly decreascd (p<0.01). 4) In the 1ntensive care unit, Ig and complement C3, C4 were increased, but did not reach control values. Considering the above results, we conclude that the decrease of plasma Ig G, A, M and complenent C3, C4concentrations are related to mechanical stress of the cardiopulmonary bypass, and to certain activators such as denaturated protein, heterogenous RBCs, and foreign materials, etc.