The efficiency of IV PCA with remifentanil and ketorolac after laparoscopic-assisted vaginal hysterectomy / 대한마취과학회지

BACKGROUND: This randomized, double-blinded clinical study was designed to evaluate the efficiency and safety of remifentanil with ketorolac for IV PCA after laparoscopic-assisted vaginal hysterectomy. METHODS: Eighty patients were randomly allocated into four groups. Group R received IV PCA using only remifentanil at a basal rate of 0.025 microg/kg/min and a bolus of 0.375 microg/kg. Group RK1 received IV PCA using remifentanil at a basal rate of 0.015 microg/kg/min and a bolus of 0.225 microg/kg. Group RK2 received IV PCA using remifentanil at a basal rate of 0.0075 microg/kg/min and a bolus of 0.1125 microg/kg. Group F received IV PCA using fentanyl at a basal rate of 0.3 microg/kg/h and a bolus of 0.075 microg/kg. In addition, ketorolac at a basal rate of 0.04 mg/kg/h and a bolus of 0.01 mg/kg was added to Group RK1, RK2, and F. All PCA conditions had a lock out period of 15 minutes. Pulse rate, systolic and diastolic BP, sedation score, visual analogue scale (VAS), and PONV score were recorded at 1, 3, 6, 12, and 24 hours after the operation. Total opioid use and the patients' number for rescue analgesic drug were also collected. RESULTS: The groups did not differ in PONV score and hemodynamic changes. The VAS in Group RK2 was high compared with the other groups. In addition, the sedation score was high in Group R. CONCLUSIONS: The additional ketorolac administration in remifentanil IV PCA had remifentanil sparing effects and reduced sedation among the side effects. Further studies will be needed to evaluate the precise and adequate dosage of ketorolac.

Comparison of ramosetron and ondansetron for preventing nausea and vomiting after middle ear surgery under general anesthesia with sevoflurane and remifentanil / 대한마취과학회지

BACKGROUND: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) after middle ear surgery. METHODS: Seventy patients of either sex, ASA 1-2, scheduled middle ear surgery (mastoidectomy and tympanoplasty) under general anesthesia with sevoflurane and remifentanil were included. Patients were randomly divided into two groups and received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) before the end of operation (n = 35 each). The incidence and severity of PONV, pain score (VAS), rescue antiemetic, rescue analgesic and side effects were assessed following 6 hr, 24 hr and 48 hr after surgery. RESULTS: The incidence of PONV showed no significant difference between groups at each time points after surgery. There were no difference in the severity of nausea, pain score, rescue antiemetic, analgesic drug usage and side effects between groups. CONCLUSIONS: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in patients undergoing general anesthesia for middle ear surgery.

Allergic Reaction to a Latex Face Mask for Manual Ventilatory Support : A case report

The number of latex-induced allergic reactions, including anaphylaxis, has been increasing since latex induced contact urticaria was first reported in surgical patients by Nutter in 1979. Latex allergy is frequently seen in the healthcare industry, and is associated with systemic symptoms, hand eczema, and allergic contact dermatitis. Reactions range from contact urticaria, rhinitis and conjunctivitis, angioderma or bronchospasm to the recently recognized severe anaphylactic shock with cardiovascular collapse. We encountered a 55-year-old female patient who developed a severe anaphylactic reaction after manual vetilatory support using a facemask that contained latex. A subsequent allergy workup revealed a delayed-type hypersensitivity to latex. This case highlights the need for anesthesiologists to be able to diagnose the signs and symptoms of allergic reactions in patients during the peri-anesthetic period. Two types of allergic reactions to natural rubber latex (NRL) and rubber products are now known to exist: type I (immediate-type) and type IV (delayed-type hypersensitivity [DTH]). Patients with NRL allergy should be provided with information on non-latex devices and latex avoidance in medical, dental, and occupational settings. In addition, we should pay more attention to the management of allergic reactions to latex in high risk groups.

Intravenous anesthesia using laryngeal mask airway without muscle relaxants during tracheostomy in a patient with quadriplegia: A case report / 대한마취과학회지

Quadriplegia is a serious or complete loss of motor function of all four limbs that is commonly caused by spinal cord injuries secondary to damage to the cervical spine. In this situation, there is a higher risk of pneumonia due to paralysis of the respiratory muscles. Tracheostomy is preferred over endotracheal intubation for the effective elimination of sticky bronchial secretion. The safest technique for a tracheostomy is to carry it out under general anesthesia with endotracheal intubation. However, endotracheal intubation may be difficult and cause other complications in patients with laryngotracheal stenosis caused by repeated tracheostomy and a limitation of neck movement as a result of the fixation of the cervical vertebral bodies due to the cervical spine fracture. We report a case of a tracheostomy performed sucessfully under intravenous anesthesia using a laryngeal mask airway without muscle relaxants in a patient with quadriplegia caused by a cervical spine injury.

Sevoflurane for the Management of Refractory Status Epilepticus : A case report / 대한마취과학회지

Refractory status epilepticus is defined as seizure activity that continues after treatment with conventional anticonvulsants. An 8-month-old male had an operation for repair of small bowel perforation, and he suffered a febrile seizure that developed into refractory status epilepticus. Febrile seizure is the most common etiology for children with status epilepticus. We report here on a case of a patient with refractory status epilepticus, and he was managed with sevoflurane, an inhalational anesthetic. The patient was given an inspired concentration of 0.6-2 vol% sevoflurane for 15 days. After stopping of sevoflurane inhalation, he continued to experience intermittent convulsive status epilepticus that was successfully managed with using conventional anticonvulsants.

The Incidence of Hypoxia Following the Use of Hypnotics and Analgesics during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. METHODS: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0 microgram/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injection of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after arrival in the recovery room. RESULTS: There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2 +/- 1.8%, for the second group 97.9 +/- 2.6%, and for the third group 92.4 +/- 2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group CONCLUSIONS: We concluded that oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia.

The Analgesic Effect of Ketorolac Administered in a Hemorrhoidectomy / 대한마취과학회지

BACKGROUND: Moderate to severe postoperative pain is still treated with an intermittent intramuscular injection of narcotics. Recently introduced ketorolac is a nonsteroidal anti-inflammatory drug that has analgesic property comparable to morphine and does not increase opioid-associated side effects such as respiratory depression, nausea and vomiting. We evaluate the analgesic effect of ketorolac directly injected around the anal sphincter muscle during a hemorrhoidectomy. METHODS: Forty adult patients undergoing hemorrhoidectomy were randomly assigned to one of two groups. Both groups received the operation under saddle block and by one surgeon. We administered 60 mg of ketorolac to one group (ketorolac group, n = 20) and the other group (control group, n = 20) received no pain medication intraoperatively. Postoperative visual analogue pain scores (VAS), analgesic requirements and side effects were examined and compared between two groups. RESULTS: VAS at 6 hours after surgery were significantly less (P<0.05) in the ketorolac group (3.1+/-1.5) than in the control group (6.0+/-1.2) and demerol consumption during the first 6 hours after surgery in the ketorolac group was significantly less (P<0.05) than in the control group (35 mg vs 62.5 mg). The ketorolac group also showed significantly less incidence of urinary retention than the control group (P <0.05). CONCLUSIONS: 60 mg of ketorolac administered during hemorrhoidectomy was partially effective for postoperative pain control and the incidence of urinary retention was significantly reduced.

Air Embolism during Spinal Fusion: A case report / 대한마취과학회지

Fatal air embolism can occur during a variety of surgical procedures. We experienced a case of cardiac arrest due to venous air embolism during spinal fusion. A 63-year-old woman underwent spinal fusion for compression fracture on L1 and scolio-kyphosis. Anesthetic induction and initial intraoperative course were completely uneventful until precipitous blood pressure drop occurred, and accompanied by a significant decrease in heart rate and cardiac arrest after use of bone cement. Although more common intraoperative events were presumed and treatment initiated, venous air embolism was considered the etiology of these events when whirring noise was detected by esophageal sthetoscope and a transient decrease in end-tidal carbon dioxide tension was noted by capnometer. We performed cardiac resuscitation with external cardiac compression, various cardiotonic drugs, and removal of air through the right internal jugular venous catheter, but the result was unsuccessful.

Clinicsl Evaluation of Electroconvulsive Therapy under General Anesthesia / 대한마취과학회지

This is the report of our clinical experience of 1365 cases of aneethesia for eelectroconvu lsive therapy at the Department of Anesthsiology, Maryknoll Hospital, during the period of March, 1989 to February, 1986. To prevent complications, suck as compressed fracture of the spine, and to improve doctor-patient relationship, softening electroconvulsive therapy is the preferred treatment for indicated cases.The results were as follows: 1) Diagnostic distribution of the patients treated by E.C,T. were schizophrenia 74.3%, affective disorder 15.0%, other psychosis 10.7$. 2) Average number of treatments given to a patient were average 6.7 times, for the entire group,7.8times for schizophrenia, 8.2 times for the patients with mania,5.5 times for the Patients with major depression, 5.6 times for the patients with the other psychosises. 3) Medication required was sufficient with half the dosage of uaual surgical procedu res ; ie, atropine sulfate 0.008 mg/kg, thiopental sodium 2.5 mg/kg, and succinylcholine 0.5 mg /kg. 4) Duration of apnea averaged 2 minutes 30 seconds, awakening averaged 10 minutes, and average duration per treatment was 15 min. 5) Few patients complained of discomfort or phobia, and less personnel and less effort were required. Complications and side effecta due to anesthesia were minimal.

The Oculocardiac Reflex during Strabismus Surgery in Children / 대한마취과학회지

The oculocardiac reflex is developed by surgical or nonsurgical procedures to the eyeball, induding traction on extraocular muscles, This reflex is a decrease in heart rate, although other arrhythmias, including A-V junctional rhythm, A-V block, ventricular premature beat, and cardiac arrest, have been reported. This is the report of our experience of oculocardiac reflex during strabismus surgery in children at Department of Anesthesiology, Maryknoll Hospital during the period between February, 1986 and January, 1987. The results are as follows : 1) In group l (0.02 mg/kg, atropine sulfate premedication), oculocardiac reflex was developed 15 cases of 42 cases (35.7%), and in group ll (0.01 mg/kg, glycopyuolate premedication), oculecardiac reflex was developed 17 cases of 49 cases (34.7%). Comparing group l with group ll, there were similar effect to prevention of the oculocardiac reflex (p> 0.05). 2) In each group, developing of the oculocardiac reflex following traction of medial and lateral rectus muscles were 30.0% and 26.3% in group l, and 28.2% and 28.2% in group ll respectively. This was not significant statistically. 3) The oculocardiac reflex following traction of extraocular muscles was disappeared soon after stopping surgioal manipulation. And, intravenous administration of anticholinergic or retrobulbar block were not used for prevention of the reflex.

The Oculocardiac Reflex during Strabismus Surgery in Children / 대한마취과학회지

The oculocardiac reflex is developed by surgical or nonsurgical procedures to the eyeball, induding traction on extraocular muscles, This reflex is a decrease in heart rate, although other arrhythmias, including A-V junctional rhythm, A-V block, ventricular premature beat, and cardiac arrest, have been reported. This is the report of our experience of oculocardiac reflex during strabismus surgery in children at Department of Anesthesiology, Maryknoll Hospital during the period between February, 1986 and January, 1987. The results are as follows : 1) In group l (0.02 mg/kg, atropine sulfate premedication), oculocardiac reflex was developed 15 cases of 42 cases (35.7%), and in group ll (0.01 mg/kg, glycopyuolate premedication), oculecardiac reflex was developed 17 cases of 49 cases (34.7%). Comparing group l with group ll, there were similar effect to prevention of the oculocardiac reflex (p> 0.05). 2) In each group, developing of the oculocardiac reflex following traction of medial and lateral rectus muscles were 30.0% and 26.3% in group l, and 28.2% and 28.2% in group ll respectively. This was not significant statistically. 3) The oculocardiac reflex following traction of extraocular muscles was disappeared soon after stopping surgioal manipulation. And, intravenous administration of anticholinergic or retrobulbar block were not used for prevention of the reflex.

Two Case Report on Anesthesia for Pheochromocytoma / 대한마취과학회지

The following is a report of the anesthetic experience in the surgical management of two cases of surgery for pheochromocytoma performed at Maryknoll Hospital, Busan, between the dates of June and July, 1982, The report covers the pre-surgical tests and the laboratory results on the two cases, which was similar, and the anesthetic agents halothane and enflurane, was used on the cases, respectively. During surgery using the anesthetic agent halothane, which was chosen because of the high blood pressure of the patient, and our effect to control it, we encountered dangerous arrythmia. In the case where enflurane was the anesthetic agent uaed, it was found that while the blood pressure of the patient was more difficult to control, the incidence of arrythmias was much less frequent. In one of the cases, becsuse of hemorrhage from the operative site during the immediate surgical period, re-exploration was done with adequate replacement of whole blood and catecholamines administered as needed during the anesthetic management. In comparing the two cases, the one case in which alpha-sdrenergic blockers were not administered during the pre-surgical period, when compared with the case in which the the blockers were used, showed, after removal ef the tumor, a decrease in the need for alpha-adrenergic stimulators.

A Clinical Survey of 18,413 Cases of Anesthesia / 대한마취과학회지

A total of 18,413 cases had anesthesia at Maryknoll Hospital in Pusan from January 1970 to December 1979. These data were analyzed statistically and the following results were obtained. 1) The number of general anesthesia cases steadily increased while those of local anesthesia decreased. 2) Of all departments, general surgery had the largest number of cases. 3) Sex ratio was equal when the OB-GYN cases were included. 4) The 20-30yr age group numbered nearly the total number of cases. 5) Geriatric and pediatric cases increased progressively. 6) Among anesthetic agents used, ether was used mostly, but halothane was used with increasing frequency. 7) Of the anesthetic techniques used in general anesthesia, the circle system was mostly used and the non-rebreathing system was used for all pediatric cases, which also have increased in number. 8) For induction of anesthesia, thiopental sodium was mainly used. Since 1975, pancuronium was mainly used in addition to S.C.C. fro muscle relaxation.

Management of Diskogenic Pain using Epidural Steroids / 대한마취과학회지

Ever since Mixter and Barr demonstrated the relationship between disk protrusion and radicular pain nearly 50 years ago, there has been a swing toward mechanical explanations for all problems of this type. Murphy has proposed that inflammation rather than mechanical pressure is the basis of back pain and sciatica, and that the causal irritant is likely to be a chemical product of disk degeneration. That administration of steroids reduces the inflammatory process is well known. The present study was undertaken to acess our experience in using epidural steroid injection ofr patients suffering from diskogenic low back pain. Ten patients with the clinical diagnosis of sciatica and with post larninectomy sequelae were referred to the anesthesia department of Maryknoll hospital. Our routine epidural injection of the lumbar spine(L3-4) consists of 2ml of 2% xylocaine and 120mg of methylprednisolone(Depo medrol). Following the injection of Depo Medrol patients were encouraged to ambulate actively and were asked to evaluate their subsequent pain relief. Of the 10 patients studied, all patients experience pain relief within 10 minutes of the epidural injection. A follow up study of these patients was done between 5 and 10 months after injection. The results were as follows: 1) 3 patients: Complete relief. 2) 3 patients: moderate relief. 3) 3 patients: no relief. 4) 1 patient: technical failure.

C.S.F. Pressure Changes Following Injection of Xylocaine into the Epidural Space / 대한마취과학회지

Many cases have been reported indicating that postspinal headache can be relieved immediately by an epiduralinjection of saline: also autologous blood has recently been used successfully instead of saline. C.S.F. changes in 20 cases were observed in the support of the concept; that a continuous leakage in association with hypovolemia and hypotension of C.S.F is the primary cause of postspinal headache. Subarachnoid pressure increased immediately with Xylocaine injection into lumbar epidural space. A spinal needle was inserted into the subarachnoid space at the level Ll-L2 and opening pressure of C.S.F. was read, epidural Tuohy needle was inserted at the 4~5. Twenty-five ml of Xylocaine was injected into epidural space and C.S.F. pressure changes were observed. This procedure was performed on 10 patients in lateral position and another 10 patients were tested in the sitting position. Sitting position: Condition Highest pressure change Lowest pressure change Average pressure change Average opening pressure Horizontal position: Highest pressure change Lowest pressure change Average pressure' change Average opening pressure .Pressure rise 350 mm H2O 60 mm HO 191 mm H2O 369 mm H2O .290 mm H2O 40 mm H2O 14Z mm H2O 165 mm H2O .These pressure changes responded almost simultaneously as xylocaine was injected. The immediate relief of postspinal headache by injecting fluid into epidural space is simultaneous with the increase of C.S.F. pressure. In summary, the direct cause of postspinal headache is probably hypotension of C.S.F. pressure resulting from continuous leakage from spinal tap.

Clinical Experiences of Combid Spansule as a Preanesthetie Medicant ( 2,800 Cases Report ) / 대한마취과학회지

Combid is a compound of Compaxine, which is a phenothiazine derivative, and Darbid that is a long acting anticholinergic synthetic. This medicant was originally intended for use in physical and emotional peptic ulcer cases. Because of it's pharmacological action, writers decided to consider the medicant as a preanesthetic medication. From a record of 2800 patients in the hospital for the year 1975 was administered as a premedicant at random, even though some contraindication did occur and is discussed later in this article, the following results were observed. 1. Because of the characteristics of a long acting effect of Combid Spansule, it can be administered orally with sips of water, 2~3 hours prior to operation, eliminating needless preanesthetic shots, without affecting the N.P.O. rule. 2. Sedative and antisialogue effects of the drug have been also satisfactory, therefore it is recommended to use as a premedicant especially in Korea because ether is commonly used. 3. The drug has an additional antiemetic effect to prevent vomiting from ether anesthesia. 4. Some side effects were observed such as dry mouth, tachycardia, fever and extrapyramidal action that occur from overdosage. 5. The contraindications to be considered when using Combid Spansule as a premedicant include dehydration, fever, tachycardia and parkinsonism. 6. Please note the writers do not recommend this application for short procedure such as closed reduction of Colles fracture and simple spinal anesthesia due to the long lasting drying effect.