Comparison of 0.5%, 0.75% Ropivacaine and 0.5% Bupivacaine for Caudal Anesthesia / 대한마취과학회지

BACKGROUND: Ropivacaine is a long acting, amide-type local anesthetic with a chemical structure similar to that of bupivacaine. In this study we investigated the efficacies of 18 ml of 0.5% bupivacaine, and of 0.5% and 0.75% ropivacaine to provide caudal anesthesia. METHODS: Sixty ASA physical status 1 or 2 patients undergoing hemorrhoidectomy were randomly allocated to 3 parallel treatment groups to receive either 18 ml of 0.5% bupivacaine, or 0.5% or 0.75% ropivacaine. Caudal anesthesia was performed using the loss of resistance method via sacral hiatus. Soft touch testing around the anal sphincter muscle, the pin prick method at the S3 dermatome, onset time of loss of anal sphincter reflex, and sensory block were checked following local anesthetic injection. Duration of sensory block was assessed at 30 minute intervals through out block duration. Quality of muscle relaxation was assessed by the surgeon at the end of each operation. Blood pressures were measured and the incidences of nausea, vomiting and dizziness were recorded. RESULTS: Significant differences were observed between the 0.5% ropivacaine and 0.75% ropivacaine groups (P <0.05) with regard to onset time of loss of anal sphincter muscle reflex and sensory block. The 0.75% ropivacaine group showed a longer duration of analgesia. No significant differences were found between the 0.5% bupivacaine, or the 0.5% or 0.75% ropivacaine groups in terms of the onset time of loss of anal sphincter muscle reflex or sensory block, or the duration of analgesia. Quality of muscle relaxation was similar in the three groups. CONCLUSION: In our study the 0.75% ropivacaine group showed rapid loss of anal sphincter tone, rapid onset of sensory block, and longer analgesia duration than the 0.5% ropivacaine group, and 0.75% ropivacaine was similar to 0.5% bupivacaine in these respects. These results suggest that 0.5% or 0.75% ropivacaine may be as useful as 0.5% bupivacaine in caudal anesthesia for hemorrhoidectomy.

Anesthetic Management during Laparoscopic Excision of an Urachal Cyst in a Pediatric Patient: A case report / 대한마취과학회지

A 14-month-old female patient was admitted for the laparoscopic excision of a complicated urachal cyst. General anesthesia was induced with thiopental and rocuronium and maintained with sevoflurane and the intermittent administration of vecuronium. During the insufflation of CO2 her intra-abdominal pressure was maintained below 12 cmH2O to avoid excessive hypercarbia. Thirty minutes after CO2 insufflation initiation, end tidal CO2 increased to 74 mmHg at a peak inspiratory airway pressure of 24 cmH2O. Laparoscopic excision of the urachal cyst was performed within 2 hours without a further change in end tidal CO2, blood pressure, heart rate, or O2 saturation. Before extubation, O2 saturation by pulse oxymetry was 99% and end tidal CO2 was 45-50 mmHg. The patient was discharged without any problem 5 days after the operation. We report on this clinical experience and include a brief review of the literature.

Anesthetic Management of a Pregnant Patient with Severe Form of Preeclampsia and Cardiac Tamponade associated with Hypothyroidism for Emergency Cesarean Section: A case report / 대한마취과학회지

A 29-year-old gravida 1, para 0 patient was admitted at 31 weeks gestation with hypertension, proteinuria and generalized edema. Three days after admission, she developed cardiac tamponade, a severe form of preeclampsia, and premature labor. Anesthesia for pericardiocentesis consisted of local anesthetic infiltration of the anterior chest wall, supplemented with an oxygen mask(5 L/min). After drainage of pericardial fluid, emergency cesarean section was performed under general anesthesia. After surgery, she was studied for the cause of the cardiac tamponade, and subsequently was diagnosed to have hypothyroidism. Pericardial effusion as a hypothyroidism associated sign, is something that is frequently found; nevertheless, cardiac tamponade as the first sign of this disease may be considered exceptional especially in a pregnant woman. We exprienced a case of hypothyroidism during a 29-year-old woman's first pregnancy, complicated by a severe form of preeclampsia and pericardial effusion.

The Effects of the Induction of Anesthesia and Tracheal Intubation with Sevoflurane on Blood Pressure, Heart Rate and BIS Value in Adults / 대한마취과학회지

BACKGROUND: Sevoflurane permits the rapid induction and control of anesthetic depth, and its lack of pungency permits anesthesia to be induced by administering it using a face mask. The goal of this study was to evaluate the possibility of induction and tracheal intubation without neuromuscular blocking drugs in adult patients given high inspired concentrations of sevoflurane (8%). METHODS: Fifty adult patients received 8% sevoflurane with nitrous oxide (2 L/min) and oxygen (2 L/min) by face mask until tracheal intubation. Patients exhaled to residual volume and deeply inspired the gas mixture following introduction. The time of response loss from introduction was noted as the induction time. The change of blood pressure, heart rate and bispectral index (BIS) value during induction and tracheal intubation were also determinated. Jaw relaxation, vocal cords position, and intubating response were used to assess intubation condition. RESULTS: Mean time for induction of anesthesia was 42.4+/-4.7 seconds and mean time to acceptable intubating conditions was 300.5+/-32.7 seconds. The average BIS values at the time of induction and at the time of intubation were 79.3+/-22.0 and 23.8+/-10.6 respectively. The average time for a BIS value under 40 was 105.5+/-30.8 seconds. Systolic blood pressure, heart rate and BIS values were decrease significantly during the induction of anesthesia (P < 0.05). A significant increase was observed in systolic blood pressure, diastolic blood pressure, heart rate and BIS values were noted after tracheal intubation (P < 0.05). In response to intubation, the incidence of good tracheal intubation was 16%, acceptable 69% and poor 15%. CONCLUSIONS: The induction of anesthesia in adult patients administered sevoflurane at highconcentration (8%), by face mask, approached the speed of intravenous induction. But the technique did not always make produce satisfactory tracheal intubating conditions without neuromuscular blocking drugs.