The Effects of Prophylactic Metoclopramide and Induction with Propofol on Postoperative Nausea and Vomiting / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common problems in patients undergoing a laparoscopic cholecystectomy. This study evaluated the effect of prophylactic metoclopramide (MCP) and induction with propofol on PONV. METHODS: 165 patients undergoing laparoscopic cholecystectomy were randomly divided into four groups. Groups 1 (control group) and 2 were inducted with thiopental sodium. Groups 3 (propofol group) and 4 were inducted with propofol. Prophylactic metoclopramide 10 mg i.v. was administered in Groups 2 (MCP group) and 4 (propofol + MCP group). The incidence of PONV, the need for rescue antiemetics, adverse events, and the nausea severity scores were assessed at 0 to 1 hour and at 1 to 24 hours postoperatively. RESULTS: During the first 24 hours after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 41.5%, 29.3%, 30.3% and 23.3%, respectively. There was no significant difference between the groups. During the period, 1 hour to 24 hours, after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 36.6%, 17.4%, 27.5% and 14.4%, respectively. The incidence of PONV in Group 4 was significantly lower than in Group 1 (P < 0.05). CONCLUSIONS: In patients with laparoscopic cholecystectomy, a combination of prophylactic metoclopramide administration and induction with propofol was found to reduce the incidence of PONV by about 22.6% during the period 1 hour to 24 hours after anesthesia.

Long-term Outcome of Trigeminal Nerve Block with Alcohol for the Treatment of Trigeminal Neuralgia / 대한통증학회지

BACKGROUND: Recently trigeminal nerve block with alcohol (TnbA) for the treatment of trigeminal neuralgia (TN) has come to be known as a procedure with a short-term effect and high complications. There has been none of report about long-term outcome of TnbA for TN. The objective of this prospective study for the long-term results of TnbA was to analyse the pain free duration and complication after the administration of blocks and compare them in the first block and subsequent blocks. METHODS: From March 1996 to May 2005, 304 consecutive patients with primary trigeminal neuralgia were treated with TnbA including supraorbital nerve block, infraorbital nerve block, maxillary nerve (V2) block, mandibular nerve (V3) block, and V2 and V3 at the same time and were prospectively followed up every two months for 10 years. RESULTS: The mean value of pain free duation of 1st, 2nd and 3rd TnbA were 43, 38 and 48 months, respectively using Kaplan-Meier analysis. The probability of pain recurrence in 1 and 3 years after the 1st, 2nd and 3rd blocks were 25%, 25%, 20% and 53%, 54%, 34%, respectively. The pain free durations of first and subsequent blocks were not statistically different. Complications were reported at 36 (11.8%), 5 (4.2%), and 0 in 1st, 2nd and 3rd blocks. CONCLUSIONS: TnbA showed the relatively long duration of pain free and low incidence of complications. Repeated TnbA has pain free duration as long as the 1st block and less complications as well. TnbA is a valuable treatment of TN as a percutaneous procedure.

Anaphylactic Shock by Hemocoagulase with Increased Concentration of Mast Cell Tryptase: A case report / 대한마취과학회지

Multiple agents can cause anaphylaxis in a perioperative setting. Identifying the agent responsible is essential for avoiding future adverse reactions as well as to attenuate the progression of anaphylaxis. Being able to distinguish an anaphylactic reaction from an anaphylactoid reaction would help clarify the therapeutic and medicolegal issues. Anaphylaxis generally occurs after reexposure to a specific antigen and requires the release of proinflammatory mediators from mast cells and basophils. An increased concentration of mast cell tryptase is a highly sensitive indicator of anaphylactic reactions during anesthesia. Botropase(R) is a procoagulant hemocoagulase purified from venom of Bothrops jararaca, a Brazilian viper and in wide use in patients with high risk of bleeding. We report a case of suspected anaphylaxis to Botropase(R) in a 67 years old female patient undergoing segmental resection of the liver with elevated concentration of serum mast cell tryptase.

Percutaneous Discectomy of Herniated Intervertebral Disc with a Dekompressor(R) / 대한통증학회지

BACKGROUND: Radicular pain, associated with herniated intervertebral disc, has been treated with either conservative treatments or a traditional surgical discectomy. Several modalities for minimally invasive percutaneous procedures have been developed as alternatives to a surgical discectomy. Percutaneous decompression using a Dekompressor(R) probe has been recently introduced. Herein, we report the outcome of percutaneous decompression with a Dekompressor(R) for the treatment of a herniated intervertebral disc. METHODS: Between August 2004 and April 2005, percutaneous decompression was performed using a Dekompressor(R), 1.5-mm percutaneous lumbar discectomy probe in 17 patients with a herniated lumbar intervertebral disc resistant to conservative treatments, with the results reviewed retrospectively. The procedure was performed under fluoroscopic guidance after local anesthesia. Disc access was gained with a posterolateral approach on the symptomatic side and intradiscal placement of the discectomy probe in the herniated disc confirmed from the anteroposterior and lateral views on the fluoroscopy. RESULTS: We obtained satisfactory clinical results in 14 patients with a decrease in the initial Visual analogue scale (VAS) of more than 55% and the elimination or reduction of analgesic medication, with a follow-up of 3 to 11 months. CONCLUSION: We concluded that a percutaneous discectomy with a Dekompressor(R) probe might be an effective alternative for the treatments of painful disc herniations resistant to conservative managements when performed under proper selection criteria.

The Target Plasma Concentrations of Propofol for a Rapid Loss of Responsiveness during the Induction of Anesthesia / 대한마취과학회지

BACKGROUND: Although the target plasma concentrations of propofol required for the induction of anesthesia have been studied extensively, the relationship between the duration of induction and target plasma concentration have not yet been described fully. We studied the target plasma concentration of propofol required for a rapid loss of responsiveness (LOR) during the induction of anesthesia, and the adverse effects and the incidence of induction failure, and compared this with the bolus administration of propofol. METHODS: ASA physical status I, unpremedicated, 21-40 yr, 174 female patients scheduled for minor gynecologic surgery under general anesthesia were randomly assigned to eight different groups. In groups I and II, propofol 2.0 mg/kg or 2.3 mg/kg were administrated to induce anesthesia. In the other 6 groups, target plasma concentrations were set at 5.4, 6.1, 6.8, 7.4, 8.1 and 8.8microgram/ml. Every 5 seconds the patients were asked to open their eyes. The time to LOR was measured by a blinded investigator. The target plasma concentrations of propofol for LOR within 60, 90, 120, 180 and 300 seconds were calculated by regression and probit analysis. RESULTS: The target plasma concentrations of propofol for LOR within 60, 90, 120, 180 and 300 seconds in 95% of patients were 9.5, 8.4, 8.2, 7.4 and 6.5 microgram/ml, respectively. The incidence of hypotension and bradycardia were not different between groups, but the incidence of induction failure was significantly higher in Group I (P < 0.05). CONCLUSIONS: We evaluated the use of the target-controlled infusion of propofol for LOR within 1 to 5 minutes in this prospective, randomized study and demonstrate the target plasma concentration of propofol required for the rapid LOR in 95% of healthy, unpremedicated female patients.

Unanticipated Difficult Intubation in a Patient with an Asymptomatic Epiglottic Cyst / 대한마취과학회지

Although an epiglottic cyst is often asymptomatic and harmless to the patient, discovery of a large epiglottic cyst after induction of anesthesia is a potentially life-threatening problem for the patient and provides a challenge for the anesthesiologist in airway management. We experienced a case of unanticipated difficult mask ventilation and intubation as a result of an asymptomatic epiglottic cyst. A 37-year-old woman presented for elective removal of a brain tumor. She had normal mouth opening and neck extension; no masses or distortions of the tongue or neck were observed. She was premedicated with 0.2 mg glycopyrrolate intramuscularly. Anesthesia and paralysis were induced with 250 mg thiopental, fentanyl 100ng and pipecuronium 6 mg. It was noted that ventilation of the lungs via mask was difficult. Despite insertion of an oropharyngeal airway, ventilation proved to be more difficult. Intubation was attempted. Direct laryngoscopy revealed a 2 cm cyst arising from the epiglottis. The cyst completely obscured the view of the epiglottis and larynx, preventing intubation despite multiple attempts by three anesthesiologists. We consulted an otolaryngologist and awakened the patient. During further questioning in the post anesthesia care unit she admitted to a several-years of dysphagia. Next day, she was admitted to the operation room for removal of an epiglottic cyst. She was intubated using fiberoptic bronchoscope guided awake intubation, and the remainder of anesthetia and the operation proceeded uneventfully. The pathology report confirmed the finding of a 2.5 X 1.5 X 1.5 cm epidermal cyst.