Comparison of Intrathecal Meperidine, Fentanyl, or Placebo Added to 0.5% Hyperbaric Bupivacaine for Cesarean Section / 대한마취과학회지

BACKGROUND: The addition of various opioids to 0.5% hyperbaric bupivacaine intrathecally seems to potentiate analgesic effects of bupivacaine and to prolong the duration of analgesia. We compared the effect of intrathecal meperidine 0.25 mg/kg and 0.5 mg/kg, fentanyl 0.15 microgram/kg, and placebo when administered together with 0.5% hyperbaric bupivacaine 9 mg for cesarean section. METHODS: Forty-four healthy term parturients were randomly allocated (n = 11 per group) to receive the test solution (1 ml) containing preservative-free normal saline (control group), fentanyl 0.15 microgram/kg, meperidine 0.25 mg/kg, or meperidine 0.5 mg/kg intrathecally, immediately followed by the injection of 0.5% hyperbaric bupivacaine 9 mg. We observed the effective postoperative analgesic duration (time to VAS > or = 4), quality of anesthesia and side effects. RESULTS: The effective postoperative analgesic duration significantly increased in the groups receiving opioid compared with the control group (P < 0.05); control group 101.4 +/- 28.6 min; fentanyl group 192.3 +/- 29.2 min; meperidine 0.25 mg/kg group 208.8 +/- 21.7 min; meperidine 0.5 mg/kg group 289.8 53.6 min (data expressed as mean +/- SD). The quality of anesthesia was excellent in 100% of the meperidine group but in 82% of the fentanyl group and 91% of the control group. The incidence of nausea and vomiting were higher in the meperidine 0.5 mg/kg group (73%) than in the remaining groups (P < 0.05). CONCLUSIONS: The addition of fentanyl 0.15 microgram/kg or meperidine 0.25 mg/kg to 0.5% hyperbaric bupivacaine 9 mg for spinal anesthesia improves intraoperative analgesia and provides analgesia into the immediate postoperative period with no adverse effects on mother or neonate.

Combination Therapy of Verapamil and Esmolol for the Paroxysmal Supraventricular Tachycardia Recurred during the Central Venous Catheterization: A case report / 대한구급학회지

Combination therapy of beta-blocker and a calcium channel blocker is not recommened because their additive effect on the myocardium and the atrioventricular node may precipitate heart block in susceptible patients. We experienced a 68 years old female patient who had paroxysmal supraventricular tachycardia that was treated with verapamil and esmolol. She had been taking verapamil for 2 years because of her paroxysmal supraventricular tachycardia. She was planned for left ureteronephrectomy due to left ureteral tumor. After epidural catheterization for the postoperative pain control, she was anesthetized with isoflurane and vecuronium. During central venous catheterization, SVT (H.R. from 98 beats per minute to 190 BPM) was suddenly developed with hypotension (B.P. from 120/65 mmHg to 75/42 mmHg) when guide wire was introduced. We treated her with combination therapy of verapamil 7.5 mg and esmolol 18 mg under the monitoring of blood pressure, electrocardiogram, end-tidal CO2 tension, central venous pressure and pulse oximeter. After 20 minutes of vigorous treatment, her heart rate and blood pressure returned to a normal range.