Comparison of the streamlined liner of the pharynx airway (SLIPA™) with the I-gel™ in paralyzed, anesthetized patients

BACKGROUND: I-gel™ and Streamlined Liner of the Pharynx Airway (SLIPA™) are the second generation supraglottic airway devices characterized by disposability and non-inflatable cuff that provide adequate sealing pressure and easy use. This study was designed to compare oro-pharyngeal leakage pressure of the I-gel™ with the SLIPA™. METHODS: Seventy-eight adult patients were randomly assigned to undergo general anesthesia with either I-gel™ or SLIPA™. Hemodynamic changes and Oro-pharyngeal leakage pressure were assessed at one minute after the insertion. The total insertion time, number of attempts, ease of insertion, and presence of blood staining and regurgitation were recorded. After surgery, postoperative sore throat and other complications (dysphonia, dysphagia or paresthesia of tongue) were evaluated. RESULTS: Oro-pharyngeal leakage pressure after device insertion was higher in the SLIPA™ group than the I-gel™ group. Insertion time was significantly shorter in the I-gel™ group than the SLIPA™ group. Blood staining was presented in 21.1% of the SLIPA™ group vs. 2.6% of the I-gel™ group. In the recovery room, postoperative sore throat measured in visual rating scale (VAS) was significantly higher in the SLIPA™ group than in the I-gel™ group. Ease of insertion, regurgitation, respiratory index and hemodynamic change after insertion showed no significant differences. CONCLUSIONS: In this study, the SLIPA™ devices provided higher oro-pharyngeal leakage pressure than I-gel™. However, the results verified ease of insertion, and safety of ventilation and hemodynamic changes, without any severe complications in both I-gel™ and SLIPA™.

Accidental middle turbinectomy by nasotracheal intubation: A case report

Nasotracheal intubation is an anesthetic technique widely used for maxillofacial surgery. It has the advantage of easier access to the surgical site to surgeon. However, when the nasothracheal intubation is performed a few complications may occur, such as nasal mucosa damage, epistaxis, sinusitis by sinus drainage occlusion and transient bacteremia. In addition, concha bullosa is a common anatomic variant of the middle turbinate, which is pneumatized, and very susceptible to trauma. We report a case of accidental middle turbinectomy by nasotracheal intubation, in the patient who had bilateral concha bullosa.

Unanticipated difficult endotracheal intubation due to an undiagnosed pharyngeal web / 대한마취과학회지

No abstract available.

Spinal anesthesia during cesarean section in a patient with severe osteogenesis imperfecta: A case report / 대한마취과학회지

Obstetric anesthesia in a parturient with severe osteogenesis imperfecta is challenging in many aspects, particularly concerning maternal pathophysiological problems and the technical difficulties of anesthesia. Here, we report a case of successful spinal anesthesia, instead of general or epidural anesthesia, during a cesarean delivery in a patient with severe osteogenesis imperfecta.

Correlations between Mean Arterial Blood Pressure, Cardiac Index, and Systemic Vascular Resistance Index in Laparoscopically-assisted Vaginal Hysterectomy (LAVH) / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the correlations between mean blood pressure (MBP), cardiac index (CI), and systemic vascular resistance index (SVRI) in patients undergoing laparoscopically-assisted vaginal hysterectomy (LAVH). METHODS: The authors enrolled 47-female patients prior to a LAVH. Hemodynamic parameters were measured before anesthetic induction, just after tracheal intubation, before skin incision, and 2, 5, 10, 20, and 30 min after pneumoperitoneum with CO2 by noninvasive cardiac output measurement using the partial carbon dioxide rebreathing method. RESULTS: CI was significantly reduced 2 and 5 min after pneumoperitoneum (2.6 +/- 0.7 L/min/m2, and 2.5 +/- 0.7 L/min/m2, respectively), and then returned to the pre-skin incision level. SVRI increased significantly after pneumoperitoneum and was then restored to that measured pre-skin incision at 20 min after pneumoperitoneum. MBP before anesthetic induction was found to be correlated with CI at 20 and 30 min after pneumoperitoneum (R = 0.37, P = 0.022, R = 0.37, P = 0.036, respectively). A moderate correlation was observed between MBP before anesthetic induction and SVRI at 2, 5, 10, 20, and 30 min after pneumoperitoneum (R = 0.39 0.60, P < 0.05). CONCLUSIONS: MBP before anesthetic induction correlated with CI at 20, and 30 min after pneumoperitoneum and with SVRI at 2, 5, 10, 20, and 30 min after pneumoperitoneum. Howerer, reduced CI at 2, 5, and 10 min after pneumoperitoneum was not correlated with MBP before anesthetic induction.

Hemodynamic and Preemptive Analgesic Effect of Preoperative Epidural Analgesia during Laparoscopic Hysterectomy / 대한마취과학회지

BACKGROUND: A laparoscopic hysterectomy is gaining popularity on account of its many benefits. The trendelenburg position and pneumoperitoneum necessary for a laparoscopy causes intraoperative hemodynamic fluctuations. The aim of this study was to evaluate the intraoperative hemodynamic and postoperative analgesic effects of preemptive epidural analgesia in a laparoscopic hysterectomy. METHODS: Fifty ASA 1 and 2 patients were randomized to two groups. Nothing was applied to the control group before inducing general anesthesia. In the epidural group, an epidural catheter was inserted through the L2-3 space and 1% lidocaine 10 ml was injected. The blood pressures, heart rates, cardiac outputs, stroke volumes and cardiac indexes were measured using NICO(TM) (Non-Invasive Cardiac Output using partial carbon dioxide rebreathing technique, fast mode, Novametrix Medical Systems Inc, USA) at time before induction (T1), post-intubation (T2), post-insufflation and in the trendelenburg position (T3), post-intubation 10 (T4), 20 (T5), 30 (T6) and 60 minutes (T7), post-exsufflation (T8) and post-neutral position (T9). The pain scores were assessed by the patients using a 100 mm visual analogue scale at 1, 3, 6, 12 and 24 hours postoperatively. RESULTS: There were important differences in the blood pressures, cardiac outputs, stroke volumes and cardiac indexes between the two groups. No significant changes in the heart rate were observed during surgery in either groups. The postoperative pain scores were significantly lower in the epidural group compared with the control group. CONCLUSIONS: Preemptive epidural analgesia produces a more stable hemodynamic state during a laparoscopic hysterectomy and reduces the level of postoperative pain.

Does Methergine Aggravate Chest Symptom and/or Electrocardiographic Changes during Cesarean Delivery under Spinal Anesthesia? / 대한마취과학회지

BACKGROUND: Complaints of chest symptoms including pressure, tightness, or pain frequently occur during cesarean delivery under regional anesthesia. The aim of this study was to test whether methergine (methylergonovine maleate) aggravates chest symptoms and/or ECG changes during cesarean section under spinal anesthesia, and to determine if these changes are associated with any discernable intraoperative event. METHODS: After delivery, patients were given intravenous methergine 0.2 mg and diluted oxytocin 10 i.u. in 1000 ml Ringer's lactate solution (Methergine group, n = 30) or diluted oxytocin 20 i.u. (Control group, n = 29). ECG and hemodynamic responses were monitored continuously on 12 leads perioperatively. RESULTS: Methergine significantly increased the incidence of chest symptoms compared to the control group (30% vs. 3.4%, P 0.05). CONCLUSIONS: Methergine-induced chest symptoms per se do not signify evident myocardial ischemia during cesarean delivery. However, anesthesiologists must not overlook the possibility of a small coronary arteriolar spasm, especially in high-risk patients.

Preoperative Glycemic Status Affects the Risk for Acid Aspiration Pneumonia in Elective Cesarean Delivery / 대한마취과학회지

BACKGROUND: Although there are many studies of hypo- or hyperglycemia on gastric function, no studies have been conducted to determine the effect of glycemic status on preoperative gastric contents especially in pregnant women. We investigated the effect of dextrose infusion on preoperative gastric contents and serum gastrin in overfasting pregnant patients. METHODS: After six hours of fasting, forty pregnant patients scheduled for elective cesarean section were randomly assigned to one of two groups to receive either 120 ml/h of 5% dextrose fluid (Dextrose group, n = 20) or same rate of normal saline (Control group) until the induction of anesthesia. Before the start of combined spinal-epidural anesthesia, gastric contents were gently aspirated using a 14-F multiorifice nasogastric tube (Levin tube, Yushin Medical, Shiheung, Korea). Blood samples for the serum gastrin and glucose concentrations were taken. RESULTS: Aspirated gastric pH (2.7 vs. 2.9) and volumes (28.5 vs. 26.5 ml) were similar in the two groups. However, significantly more patients (40%) in the control group were found to be at risk of aspiration syndrome, pH 25 ml, than in the dextrose group (20%). The serum gastrin concentrations of the two groups were not significantly different (32.8 vs. 27.1 pg/ml). Preoperative glucose concentration did not correlate with gastric pH or volumes, but with serum gastrin concentration (tau-b = -0.347, vs. -0.466, P = 0.02). CONCLUSIONS: Preoperative dextrose infusion can decrease the number of patients at risk for pulmonary acid aspiration in overfasting pregnant women undergoing cesarean delivery.

Effects of Preoperative Anxiety on Gastric Fluid Acidity and Volume

The aim of this study was to evaluate the effect of preoperative anxiety on the gastric pH and volume. We studied 96 female patients aged 16-60 yr who underwent elective gynecological surgery. We classified the subjects into 2 groups, those presenting preoperative anxiety scores using visual analogue scale (VAS, 0-10) less than 5 (L-group, n=59), and those with 5 and more (H-group, n=37). Immediately after tracheal intubation, gastric contents were aspirated using a 14-F multiorifice nasogastric tube. The gastric acidity and volume of the two groups were not statistically different. Mean pH were 3.0+/-1.8 and 3.0+/-2.0 in each group (L-group and H-group) and mean gastric volume (mL) were 15.3 +/-11.7 and 11.8 +/-11.8, respectively. Nine (15.3%) patients in the L-group were considered to be 'at risk i.e. gastric pH 25 mL' and one patient (2.7%) in the H-group (p<0.05). The mean serum gastrin concentrations in both groups were similar (21.6+/-9.8 vs. 20.2+/-11.0 pg/mL). The pH and volume of preoperative gastric contents were not correlated with the preoperative anxiety. The results suggest that a low level of preoperative anxiety can be considered a risk factor for aspiration pneumonitis.

Gastric Volume and Acidity in Pregnant and Non-pregnant Women / 대한마취과학회지

BACKGROUND: Studies of gastric volume and pH during various stages of pregnancy have not confirmed a consistently evaluated volume or acidity, but point out that these patients may be at risk. The aim of this study was to evaluate the volume and acidity of gastric contents in pregnant and non-pregnant patients. METHODS: Thirty pregnant patients scheduled for elective cesarean section under spinal anesthesia (pregnant group) and thirty non-pregnant female patients that underwent gynecologic surgery with general anesthesia (non-pregnant group) were enrolled. Preoperative fasting times and anxiety score, using a visual analogue scale from 0 to 10, were obtained from all patients. After the induction of anesthesia, gastric contents were aspirated gently using a 14-F multiorifice nasogastric tube and syringe. Gastric volume and acidity were measured. RESULTS: The gastric volume (ml) in the pregnant group was 42.8 +/- 35.0 (mean +/- SD, range: 5-130), and in the non-pregnant group 15.8 +/- 11.9 (range: 3-50). The gastric pH in the pregnant group was 2.1 +/- 0.9 (range: 1.3-5.4), and in the non-pregnant group 2.8 +/- 1.7 (range: 1.3-6.5). CONCLUSIONS: We confirm that pregnant women have more acidic and greater gastric volumes than non-pregnant women.

Comparison of Sevoflurane-Nitrous Oxide and Target- Controlled Propofol with Fentanyl Anesthesia for Hysteroscopy

A randomized prospective study was performed on the anesthetic induction, maintenance, and recovery characteristics of sevoflurane-nitrous oxide, compaired to that of target- controlled propofol and fentanyl anesthesia, for forty day-case hysteroscopic surgery. The patients in the sevoflurane group (n = 20) received sevoflurane-nitrous oxide for both induction (8%) and maintenance (1 - 2%) of anesthesia, while the patients in the propofol group (n = 20) received target-controlled propofol (4 microgram/ml, 3-6 microgram/ml as occasion demanded) with fentanyl (1 microgram/kg). In both groups, the airway was maintained by a facemask with the patient breathing spontaneously during the surgery. The mean times to unconsciousness and readiness for surgery were similar in both groups, with those for the sevoflurane group, compared to the propofol group being 80.4 18.9 vs. 83.6 38.8 sec, and 220.1 76.9 vs. 231.0 95.4 sec, respectively. Propofol was associated with significantly higher incidences of involuntary movement (30% vs. 5%) and apnea (35% vs. 0%) during the induction period than with sevoflurane. Hemodynamic variables were similar with the exception of significantly lower blood pressures during the first 5 minutes of induction with propofol. Emergence times to eye opening, hand squeezing and orientation for sevoflurane compared to propofol were: 316.6 79.3 vs. 507.4 218.8 sec, 390.0 69.3 vs. 653.1 201.6 sec and 380.6 80.8 vs. 666.3 208.7 sec, respectively, all of these being significantly faster for sevoflurane than propofol. The postanesthetic Aldrete's recovery scores of the patients immediately after surgery were higher in the sevoflurane group. Propofol was associated with more drowsiness, with sevoflurane being associated with more nausea, in the recovery period; however, neither delayed the time to discharge (103.7 28.1 vs. 99.0 36.2 min). In conclusion, sevoflurane-nitrous oxide appears to be superior for day-case hysteroscopic surgery, than target-controlled propofol with fentanyl, with regards to the speed of recovery from anesthesia and the return to hemodynamic stability.

A Comparison of the Effects of Ondansetron and Granisetron on the Prevention of Postoperative Nausea and Vomiting after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the effects of ondansetron and granisetron on the prevention of postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: In a randomized placebo-controlled study, 200 gynecologic patients were divided into 5 groups. Each patient received one of 5 medications: placebo (saline 3 ml), ondansetron 4 mg (O4), ondansetron 8 mg (O8), granisetron 1.5 mg (G1.5) and granisetron 3 mg (G3). They were administered intravenously immediately before the induction of anesthesia. A standardized inhalation anesthesia and a postoperative intravenous patient-controlled analgesia were applied. Twenty four hours after anesthesia, the incidence and severity of PONV and other adverse effects were assessed. RESULTS: The incidence of PONV was 88%, 83%, 75%, 70% and 60% in the placebo, O4, O8, G1.5 and G3 groups, respectively, which showed significantly lower value in the G3 group than in the placebo and O4 groups (P< 0.05). The severity of PONV was also significantly lower in the G3 group than in the placebo group (P < 0.05). CONCLUSIONS: In this study, granisetron 3 mg showed a better prophylactic effect in the mitigation of PONV in gynecologic patients then a placebo or ondansetron 4 mg.

A Comparison of the Effects on Postoperative Course of Hypothermic Circulatory Arrest Versus Continuous Cardiopulmonary Bypass in Infants Arterial Switch Operation / 대한마취과학회지

BACKGROUND: Hypothermic circulatory arrest is a widely used support technique during heart surgery in neonate and infants, but the difference in the effects of perfusion methods, total arrest versus continuous flow, on postoperative course has been controversial. METHODS: This study was retrospectively designed to examine the difference in effects of deep hypothermic circulatory arrest or continuous flow perfusion on postoperative courses including mortality and neurologic morbidity after arterial switch operation through chart review. We also examined the relationship between intraoperative data and postoperative outcomes. RESULTS: Of 72 patients, 44 patients (Total Circulatory Arrest (TCA) group; 26 patients had intact ventricular septum, 18 patients had ventricular septal defect) were treated with total arrest, and 28 patients (Continuous Perfusion Flow (CPF) group; 13 patients had intact ventricular septum, and 15 patients had ventricular septal defect) were treated with continuous flow. Hospital course, postoperative hemodynamic profiles, incidence of complications excluding neurology and mortality were not different between two groups. The incidence of neurologic abnormalities was higher two times in TCA group than in CPF group but was not significantly different. CONCLUSIONS: We could not confirm the differences in postoperative outcomes between both techniques, total circulatory arrest and continuous flow perfusion during arterial switch operation in neonates and infants.

The Effects of Perfusion Variables on the Neurologic Sequelae in the Infants Who had Arterial Switch Operation Using Continuous Flow Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Neurologic sequelae of open heart surgery for congenital heart disease were related with preexisting brain lesion as well as intraoperative causes. These causes are microemboli, blood flow, and blood distribution. METHODS: This study was designed to examine neurologic sequelae and postoperative course in patients with arterial switch operation using continuous flow cardiopulmonary bypass through retrospective chart review. RESULTS: Of 22 patients 4 had neurologic sequelae. Cooling rate, extubation time, and duration of ICU admission and hospital admission were statistically different between the patients with neurologic sequelae or not. Patients with neurologic sequelae had more rapid cooling rate and longer duration of intubation, ICU stay, and hospital admission than patients without neurologic sequelae. CONCLUSIONS: Cooling rate (time to lower 1oC body temperature) is the only factor among perfusion variables to affect on neurologic sequelae. Neurologic complications make it longer to wean the mechanical ventilation, and to stay at ICU and hospital.

The Adequate Timing of Arterial Blood Sampling during the Changes of Inspired Oxygen Fraction by Nitrous Oxide / 대한구급학회지

BACKGOUND: Arterial blood gas analysis is essential on diagnosis and treatment of hypoxia and acid-base imbalance. It is important to decide the timing of arterial blood sampling as well as sampling method, sample transport, and analysis of the results. So we investigated to the adequate timing of sampling when inspired oxygen fraction is changed from 0.5 to 1.0. METHODS: 20 patients were anesthetized with enflurane-N2O-O2 (FiO2=0.5), and paralyzed with pancuronium 0.07~0.08 mg/kg. Ventilation was controlled with Ohmeda 7000 ventilator (BOC Health Care Inc., Madison, USA), using a constant tidal volume of 10 ml/kg and respiration rate of 12/min. After 1 hour of anesthesia, the nitrous oxide inhalation was stopped and 100% oxygen was inhaled, and then arterial blood gas values were measured at 2 min intervals for 20 min, 5 min intervals for next 30 min, and 10 min later. Blood samlpes were drawn from the radial artery and measured immediately on a blood gas analyzer (Civa-Corning 288 Blood Gas System, Civa-Corning Diagnostic Corp., Medifield, USA). Determining the optimal time of sampling was performed with the rate of variation of PaO2 according to time progression, then the point at which the slope decreased abruptly was regarded as statistically significant timing. RESULTS: After 12 minute, arterial oxygen partial pressure was not any more changed significantly. There were no change of pH, arterial carbon dioxide partial pressure, oxygen saturation, base excess, and bicarbonate. CONCLUSION: The timing of arterial blood gas sampling in change with inspired oxygen fraction from 0.5 to 1.0 is about 12 minute later.

Effects of Pelviscopy on the PaCO2 and Hemodynamics / 대한마취과학회지

BACKGROUND: Pelviscopy has become popular because of the advantage of which less painful, less scarring, and shortening the hospitalizing stays, so to reduce the cost. This procedure require lithotomy- Trendelenburg position and pneumoperitoneum with carbon dioxide(CO2) gas insufflation, that affect arterial blood gas and hemodynamics. We studied the effects of pelviscopy on the PaCO2 and hemodynamics. METHODS: Twenty patients scheduled for pelviscopic hysterectomy were studied. All patients anesthetized with enflurane (2.0 vol%) - nitrous oxide (1.5 L/min) and oxygen (1.5 L/min), and controlled ventilation(tidal volume 10 ml/kg, respiratory rate 12 /min). Central venous pressure, blood pressure, heart rate and PaCO2 measured at postinduction(control), position change with CO2 gas insufflation, and every 15 minutes after pneumoperitoneum. RESULTS: Central venous pressure increased (P<0.05) through the procedure after position change and CO2 gas insufflation. Systolic blood pressure and heart rate decreased at 45min after pneumoperitoneum(P<0.05). Mean arterial pressure decreased at 75 min after pneumoperitoneum. PaCO2 increased at 15 min after position change and pneumoperitoneum(P<0.05). CONCLUSION: In our study, because central venous pressure and PaCO2 increased, we should attend to patients with hypertension, increased intracranial pressure, and increased PaCO2.