Analgesia-based Sedation Using Remifentanil during Percutaneous Endoscopic Lumbar Discectomy / 대한마취과학회지

BACKGROUND: The aim of this study was to examine the safety and efficacy of sedation and analgesia using remifentanil during percutaneous endoscopic lumbar discectomy (PELD). METHODS: Eighty ASA patients with physical status 1 or 2 who underwent a PELD were enrolled in this study. They were randomized to receive one of two treatments: a fentanyl bolus of 0.7microgram/kg 5 min before the procedure and of 0.7microgram/kg during the procedure (n = 40, group F), or a remifentanil titration at an infusion rate of 0.1-0.3microgram/kg/min available throughout the procedure according to the appeal of pain, level of sedation and side-effects (n = 40, group R). The observer's assessment of alertness/sedation (OAA/S) scale, blood pressure, heart rate, respiratory rate, SpO2, and end tidal CO2 were assessed and measured during and/or after the procedures. The visual analogue scale of pain (VAS), and the patient and endoscopist satisfaction scale were assessed after the procedures. RESULTS: There were no significant differences between the two groups in terms of the recovery characteristics, incidence of complications and satisfaction score of patients. In 92.5% of the cases among the remifentanil group, the spine surgeon made uniform judgements that remifentanil worked better than the usually used fentanyl procedure, whereas in 7.5% of the cases the effects were indifferent. The VAS score of the R group was significantly lower than that of the F group. CONCLUSIONS: We concluded that sedation and analgesia with remifentanil is very useful for painful local procedures such as PELDs.

The Effect of Continuous Infusion of Ondansetron on Nausea and Vomiting during Intravenous Patient-controlled Analgesia / 대한마취과학회지

BACKGROUND: This study was designed to determine the effectiveness of the continuous infusion of ondansetron for the prevention of postoperative nausea and vomiting (PONV) in intravenous patient-controlled analgesia (PCA). METHODS: One hundred and sixty patients undergoing spinal surgery were randomized into four groups according to the method of ondansetron administration, placebo (n = 40, group 1), ondansetron 8 mg mixed to IV PCA (n = 40, group 2), ondansetron 4 mg IV before induction or after surgery in addition to 8 mg mixed to IV PCA (n = 40, group 3 or n = 40, group 4). The incidences of nausea, vomiting, and side effects were recorded for 48 hr postoperatively. RESULTS: The incidence of nausea in group 1 (43 %) was significantly higher than in the other groups (group 2; 18%, group 3; 15%, group 4; 18%) (P < 0.05), and vomiting was one in group 1. CONCLUSIONS: Continuous ondansetron infusion is effective at preventing PONV, but the effects of additional bolus injections to continuous infusion of ondansetron were not different from continuous infusion only.