Intrathecal Triamcinolone for Intractable Postherpetic Neuralgia / 대한마취과학회지

BACKGROUND: There is no effective treatment for intractable postherpetic neuralgia. Some reports noticed effectiveness of intrathecal steroid administration which was injected at L2/3, L3/4 interspace. We tried the same procedure but injection site was differed to reduce the steroid dose. And then we evaluated the effectiveness and neurologic complications. METHODS: We studied 9 patients with postherpetic neuralgia. The patients received intrathecal triamcinolone and mepivacaine (2ml of 0.5% mepivacaine with 15 mg of triamcinolone). Each weekly dose was injected into the lesion site or near the site. Pain was evaluated 1 week, 1 month and then more than 3 months after the treatment. RESULTS: We found that pain intensity was decreased by 69.7% one week after the treatment, by 70% 3-9 months after the treatment. During the treatment, all patients except two took analgesics but did not at the end of treatment. CONCLUSIONS: The results of this trial indicated that the intrathecal administration of triamcinolone was effective for postherpetic neuralgia pain management.

Comparing the Analgesic Effect between Continuous Intravenous Infusion of Fentanyl with Clonidine and Fentanyl Only after Cesarean Section / 대한마취과학회지

BACKGROUND: Clonidine, alpha2-adrenoreceptor agonist, has nonopiate antinociceptive properties, which might be an alternative for postoperative analgesia free of opioid induced side effects. The aim of this study was to evaluate the fentanyl sparing effect of clonidine and reducing side effects with intravenous administration. METHODS: Fourty seven patients undergoing a cesarean section were randomly allocated to two groups to be given the following agents by intravenous administration. Group I, fentanyl 0.2ng/kg/h with clonidine 0.2ng/kg/h for 72 h adding normal saline for a total of 150 cc. Group II, fentanyl 0.4ng/kg/h for 72 h adding normal saline for a total of 150 cc and analgesia was provided intravenously via patient -controlled analgesia (PCA; basal rate = 2 ml, rescure dose = 1 ml, lock-out time = 10 min). Postoperative analgesia was assessed by VAS at 2, 4, 8, and 24 h after extubation. In addition, we also checked the vital sign sedation score. RESULTS: There were no differences of VAS scores, hemodynamic values except systolic pressure (P < 0.05), or side effects between group I and group II. The frequency of nausea was 8.7% in group I and 29% in group II, and dizziness was 4.3% in group I and 8.3% in group II. CONCLUSIONS: Intravenous clonidine with narcotics is a possible approach to postoperative pain management in patients recovering from major surgery, especially spine surgery, and clonidine spares and reduces side effects in narcotics.

The Relation of Maximal Sensory Block Level and the Duration of Sensory Block in Spinal Anesthesia Using a Fixed Dose of Bupivacaine / 대한마취과학회지

BACKGROUND: The duration of spinal anesthesia depends upon two factors; concentration of local anesthetics in the CSF and vascular absorption of the local anesthetics. However, there are some arguments on the relationship between the maximum block level and the duration of the block in spinal anesthesia. METHODS: Fifty seven patients scheduled for surgery on a lower limb or perineum underwent spinal anesthesia with 11 mg of 0.5% hyperbaric bupivacaine. After confirming final block heights (T12-T3, range), we took two study groups, group I (block height > OR = T6, n = 30) and group II (block height < OR = T9, n = 27). We checked the maximal sensory block level, the time to maximal sensory block level, a two-segment regression time, the duration of sensory block to T12, and L5 during the first 30 minutes at 2.5 minute intervals and then, at 30 minutes intervals. Blood pressure and pulse rate were measured in the same time interval. RESULTS: The maximal sensory block level and the time to maximal sensory block level of group I was T5.0, 14.6 minutes and that of group II were T9.7, 11.4 minutes. The mean cephalad spread of analgesia in group I was more rapidly increased at 20 minutes and there were statistically significant differences between the two groups from 5 min to 110 minutes. The duration of sensory block to T12, L5 was similar in group I and II. No significant differences in blood pressure and pulse rate were found between the two groups. CONCLUSIONS: We found that there was no relationship between the sensory block level and duration of the block in spinal anesthesia using a fixed does of local anesthetic.

The Influence of Anesthetic Technique on the Responses of White Blood Cells and Interleukin-6 in Patients Undergoing Low Abdominal Surgery / 대한마취과학회지

BACKGROUND: Surgical trauma and anesthesia are associated with postoperative immune suppression. Alterations in immune response have been suggested in the same surgery, according to anesthetic techniques. Therefore, this study was conducted to investigate whether regional anesthesia or premedication with clonidine change postoperative circulating neutrophils, lymphocytes and monocytes, and interleukin 6 (IL-6) responses. METHODS: Thirty patients undergoing elective low abdominal surgery were randomly divided into 3 groups: the control group and spinal group received no premedication and the clonidine group received general anesthesia with clonidine premedication. Blood samples were obtained to measure subpopulations of white blood cells (WBC) and IL-6 at pre-induction, immediately after the operation, and 24 h after incision. RESULTS: Increase in total WBC and percentage of neutrophils, decrease in percentage of lymphocytes and monocytes, and increase in IL-6 levels were significant after surgery, compared to the baseline values within the three groups. However, no significant differences of subsets of WBC and IL-6 level were seen among the groups throughout the study periods. CONCLUSIONS: Anesthetic technique did not influence the levels of circulating WBC and IL-6.

Stellate Ganglion Block for the Preventive Effect on the Attacks of Cluster Headache: A case report / 대한마취과학회지

Cluster headaches are recurrent, unilateral attacks of severe pain that almost always occur on the same side of the head. They are oculofrontal or oculotemporal, with radiation to the upper jaw. The precise cause of cluster headaches are still unknown and treatments are very difficult. A 34 year old male patient suffering from severe classical cluster headache was refered to the pain clinic from department of neurosurgery. The patient complained of severe pain on right oculotemporal area and his symptoms had been refractory to any other treatment. His symptoms were effectively relieved after oxygen inhalation and sphenopalatine ganglion block with 4% lidocaine 2 ml during his attack. I could effectively prevent the attack of the cluster headache using stellate ganglion block (SGB) with 0.25% bupivacaine 5 ml twice daily during 3 weeks.

The Effect of Frequency of Stimulation on Partial Twitch Depression in a Rat Phrenic Nerve Hemidiaphragm Preparation / 대한마취과학회지

Background: This study was designed to determine whether presynaptic receptor blockade could be differentiated from postsynaptic receptor blockade by examining the effect of increasing frequencies of indirect stimulation on partial twitch depression in vitro rat phrenic nerve hemidiaphragm preparations. Methods: After isolating rat phrenic nerve hemidiaphragm preparation, T200/T1 ratio (twitch height of the 200th stimuli divided by that of the 1st stimuli) at frequencies of 0.2, 0.5, 1.0, and 2.0 Hz using a drug concentration which provided approximately 20% twitch depression at 0.1 Hz was calculated. To compare T200/T1 ratios with TOF ratios, 2.0 Hz TOF response was measured immediately after 200th stimuli at either frequency of stimulation. Results: Hexamethonium caused a marked decrease in T200/T1 ratio at 0.5~2.0 Hz of stimulation, whereas alpha-bungarotoxin caused no change in T200/T1 ratios at up to 2.0 Hz of stimulation. The T200/T1 ratios produced by d-tubocurarine, vecuronium, mivacurium, and rocuronium located intermediate between alpha-bungarotoxin and hexamethonium, however significant differences among four drugs were found at 2.0 Hz. The propensity for decrease in T200/T1 ratios at 2.0 Hz might differ from this study: hexamethonium >d-tubocurarine >rocuronium >mivacurium = vecuronium >alpha-bungarotoxin. T200/T1 ratios at 2.0 Hz were not different from TOF ratios. Conclusions: When the observed effects in this study were provided with result of alpha-bungarotoxin acting predominantly at postsynaptic receptors and hexamethonium acting predominantly at presynaptic receptors, the effects of nondepolarizing muscle relaxants at each binding site could be differentiated by examining the T200/T1 ratios at 2.0 Hz.

Effects of Augmented Minute Ventilation on Cardiovascular and Ventilatory Changes during the Laparoscopic Cholecystectomy under General Anesthesia / 대한마취과학회지

BACKGROUND: The pneumoperitoneum created by CO2 insufflation during laparoscopic cholecystectomy has several potential hemodynamic and respiratory consequences. The purpose of this study is to investigate the effects of augmented minute ventilation on cardiovascular and ventilatory changes and to prevent hypercarbia due to CO2 insufflation during laparoscopic cholecystectomy. METHODS: Thirty-six patients were divided into three groups according to the level of minute ventilation. The three groups were: control group C (minute ventilation 100 ml/kg, respiratory rate 12 per minute), group R (MV 150 ml/kg, RR is 18 per minute) and group V (MV 150 ml/kg, tidal volume is 1.5 times as much as group C). We repeatedly measured mean arterial pressure , pulse rate , arterial blood gas analysis and end tidal carbon dioxide and peak inspiratory airway pressure before CO2 insufflation, 15 and 30 minutes after CO2 insufflation and 15 minutes after CO2 deflation. RESULTS: During CO2 insufflation, MAP significantly increased but PR showed little changes in all three groups. PaCO2 and PetCO2 increased in group C, whereas in group R and V, they remained unchanged during CO2 insufflation. But the level of PaCO2 in group V decreased more than in the other two groups after CO2 deflation,. PIP in group V increased 3 times as much as the control value. CONCLUSIONS: These results suggest that augmented minute ventilation in group R and V, prevented hypercarbia during CO2 insufflation and increasing the tidal volume in controlled ventilation was more effective than increasing respiratory rate after CO2 deflation.