Preventive effect of ramosetron on patient-controlled analgesia-related nausea and vomiting after laparoscopic hysterectomy / 대한산부인과내시경학회지

OBJECTIVE: Patient-controlled-analgesia (PCA) using intravenous (IV) opioids is recognized a safe and effective method for pain control. However, postoperative analgesia with opioids is associated with a high incidence of postoperative nausea and vomiting (PONV) exceeding 30%. The 5-hydroxytryptamine receptor 3 (5-HT3) antagonists alleviate nausea and vomiting. This study aims to compare the effectiveness of ramosetron and ondansetron in preventing PONV following laparoscopic hysterectomy for benign uterine diseases under general anesthesia. METHODS: The medical records of 1483 patients who underwent laparoscopic hysterectomy between January 2005 and May 2009 were reviewed. Of the 1483 patients, 1184 patients who received IVPCA with ramosetron 0.3 mg (n=761) or ondansetron 8 mg (n=423) were analyzed. Fentanyl-based IVPCA was administered for 48 hours after surgery. The overall incidence of postoperative nausea and vomiting, bowel ileus, Levin tube insertion for severe bowel ileus, additional usage of pain killers and discontinuation of the IVPCA infusion with PCA-related severe nausea and vomiting were assessed for 48 hours after surgery. The amount of time until bowel gas passage resumption after surgery was measured. RESULTS: There was a significant difference between the two groups regarding the duration until post-operative bowel gas passage resumption (1.78+/-0.79 days in the ramosetron group, and 2.23+/-0.83 days in the ondansetron group; p=0.005); however, there were no significant differences found in other aspects. CONCLUSION: Ramosetron is superior to ondansetron in terms of faster recovery in bowel mobility, with similar effects in preventing the incidence of PONV.

IgA and Differentiation-associated Transcription Factors in Chronic Otitis Media with Effusion

OBJECTIVES: Inadequate antibody responses to pathogens may lead to the recurrence of otitis media with effusion (OME). Although B-cell production by antibodies is controlled by transcription factors, the status of these factors has not been assessed in patients with OME. METHODS: Expression of immunoglobulin was measured by enzyme-linked immunosorbent assay. Expression of transcription factors Bcl-6, Blimp-1, Pax-5, and XBP-1 was assessed by RT-PCR in the middle-ear fluid of 29 children with >4 OME episodes in 12 months or >3 episodes in 6 months (the OME-prone group) and in 32 children with 0.05). CONCLUSION: Lower concentrations of IgA, Blimp-1 and XBP-1 in middle ear fluid of patients with OME may be related to OME recurrence and chronicity.

Comparison of Posterior Pharyngeal Airway Space at Sitting and Supine Positions in the PACU after Uvulopalatopharyngoplasty in Patients with Obstructive Sleep Apnea Syndrome / 대한마취과학회지

BACKGROUND: Uvulopalatopharyngoplasty (UPPP) is one of the most common treatments for patients with obstructive sleep apnea syndrome (OSAS) who suffer from repetitive apnea and oxygen desaturation during sleep. It is important to properly manage the patient's airway in the PACU after surgery in order to prevent potential airway-related postoperative complications. METHODS: 20 patient cases of ASA I or II who were over 20 years old and had undergone UPPP under general anesthesia were reviewed. In PACU, Posterior pharyngeal airway space (PAS) was measured on a lateral cranial radiograph at both supine and sitting positions and the blood pressure and oxygen saturation were measured. RESULTS: PAS significantly increased in the sitting position (avg. 11.7 mm in supine, 15.7 mm in sitting, P < 0.05) but there was no influence on the blood pressure or oxygen saturation. CONCLUSIONS: PAS is associated with the patency of the airway and the increase of PAS in patients in the sitting position while in the PACU is helpful to airway management following UPPP.

The Effects of Continuous Nicardipine Infusion on Blood Pressure and Heart Rate during Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Laryngoscopy and tracheal intubation often induced an undesirable increase in blood pressure and heart rate. We evaluated the preventing effect of nicardipine infusion on the increase of the blood pressure (BP) and heart rate (HR) following a direct laryngoscopy and tracheal intubation. METHODS: Sixty, ASA physical status 1-2, adult patients were selected with informed consent, and randomly allocated into two groups; control group (n = 30) and nicardipine group (n = 30). In the control group, 1.8 ml/kg/h of normal saline was infused, and in the nicardipine group, 5microgram/kg/min of nicardipine was infused continuously from 2 minutes before intubation to 3 minutes after intubation. BP and HR were measured by non-invasive method after arrival at the operating room, before tracheal intubation, shortly after tracheal intubation, and 1, 3, 5, and 10 minutes following intubation. Data were analyzed by repeated measure of ANOVA and t-test. RESULTS: Systolic and diastolic BP were significantly lower in the nicardipine group than in the control group (P < 0.05). HR showed significantly higher value in the nicardipine group (P < 0.05). CONCLUSIONS: The continuous infusion of nicardipine (5microgram/kg/min) was effectively attenuating an increase of BP during tracheal intubation. But the increase in HR is not blunted by nicardipine infusion and there is a significant increase in HR. Although rate-pressure product (RPP) does not increase, the use of nicardipine for blunting hemodynamic responses should be considered carefully in patients with ischemic heart disease.

Comparison of Blood Pressure and Heart Rate in Pediatric Tonsillectomy under Propofol-Remifentanil Anesthesia and Desflurane-N2O Anesthesia

BACKGROUND: Remifentanil is an ultra-short-acting mu opioid receptor agonist. However, there are few reports of its use in children. Therefore, this study compared propofol-remifentanil anesthesia (PR) with a desflurane-N2O anesthesia (D) in children. METHODS: One hundred children (5-12 years), who were scheduled for a tonsillectomy, were randomly assigned to either Group PR (n=50) or Group D (n=50). After inducing anesthesia with propofol and rocuronium, group PR was maintained with an infusion of propofol and remifentanil. Group D was maintained with desflurane. At the end of surgery all the anesthetics were terminated without tapering. The systolic and diastolic blood pressure, and heart rate were measured upon arrival at the operation room, after induction, after intubation, at the beginning of the operation, 5, 10, 20 minutes after beginning of surgery and the end of anesthesia. RESULTS: There was a significantly lower heart rate in group PR than in group D but there was no significant difference in blood pressure between the two groups. CONCLUSIONS: In children, propofol-remifentanil anesthesia is a well-tolerated method of anesthesia, with a lower heart rate compared with desflurane-N2O based anesthesia.

Comparison of Effectiveness of Stellate Ganglion Block between Chronic Tension Headache and Chronic Migraine Patients / 대한마취과학회지

BACKGROUND: The treatment for chronic headache is not simple because of the complexity of its cause and etiology. A stellate ganglion block (SGB) is normally used to treat chronic headache. This study compared the effectiveness of SGB in treating tension headache and migraine patients by evaluating its effect on pain alleviation and improving the quality of life after an 8 week treatment duration. METHODS: Forty-six patients, who experienced headache for more than 4 hours a day and more than 15 days a month and were diagnosed with chronic headache, were enrolled in this study. The patients were classified into two groups, the migraine group (MG, n = 26) and the tension headache group (TG, n = 20). The patients were treated with SGB only and the degree of pain was evaluated after 4 and 8 weeks of treatment, and 4 weeks after the end of treatment. The treatment was applied twice a week during 8 weeks. The effects of these treatments in the two groups were analyzed using Visual Analogue Scale (VAS) pain scores and Brief Pain Inventory (BPI). RESULTS: The VAS and BPI after 8 weeks of treatment showed significant differences compared with those of MG and TG before treatment, and there were no differences between the two groups. The VAS and BPI of the two groups, 4 weeks after the end of treatment, showed statistically significant improvement compared with those before treatment. CONCLUSIONS: The above results suggested that SGB might be an useful modality for the alleviating the pain and improving the quality of life in TG and MG patients.

Prediction of Difficulty in Endotracheal Intubation in Patients with Obstructive Sleep Apnea: Comparison of Modified Mallampati Test and Upper Lip Bite Test / 대한마취과학회지

BACKGROUND: Patients with obstructive sleep apnea (OSA) may exhibit difficult endotracheal intubation and mask ventilation because of anatomical abnormalities of their upper airway. Many anesthesiologists try to predict difficult endotracheal intubation using simple bedside screening tests. Among these tests, modified Mallampati test (MMT) is the most popular one, but a newer method, called upper lip bite test (ULBT) has been investigated. We compared the clinical accuracy of modified Mallampati test and upper lip bite test for patients with OSA. METHODS: 65 patients with OSA were included in the study. Preoperatively, anestheiologist not involved in endotracheal intubation evaluated patient's airway with MMT and ULBT. Another anesthesiologist assessed the direct laryngoscopic grade. Using Fisher's exact test, we analyzed the correlation of MMT and ULBT with direct laryngoscopic grade and calculated the sensitivity, specificity, positive predictive value and negative predictive value. Furthermore, AUC of ROC (area under a receiver operating characteristic) curve were used to estimate the predictive accuracy of each tests. RESULTS: MMT grade III, IV and ULBT class III was significantly correlated with Cormack-Lehane grade III, IV (P < 0.05). The ULBT showed higher specificity and positive predictive value, but sensitivity and negative predictive value were higher in MMT. AUC of ROC curve was poor for MMT (0.656) and ULBT (0.617). CONCLUSIONS: These results suggest that MMT and ULBT has a poor diagnostic accuracy for predicting difficult intubation in OSA patients as a single bedside screening test.

Atelectasis after the Induction of Anesthesia in a Healthy Child: A case report / 대한마취과학회지

Atelectasis or lung collapse is a relatively common complication following surgery in anesthetized patient with respiratory tract symptoms, but may rarely occur in normal healthy patients. Children differ from adult in terms of neck and airway anatomy and physiology. Thus, we should pay more attention to pediatric patients with respiratory tract symptoms. This report describes a healthy pediatric patient with no respiratory symptoms who developed left upper lobar collapse just after the induction of general anesthesia.

The Heart Rate Response to Intravenous Atropine during Propofol or Enflurane Anesthesia / 대한마취과학회지

BACKGROUND: Propofol increases the risk of bradycardia compared with other anesthetics. This paper reports the heart rate response to intravenous atropine during propofol and enflurane anesthesia. METHODS: Sixty patients undergoing a transabdominal hysterectomy under general anesthesia were randomly assigned to two groups: the propofol group and the enflurane group. All the patients received midazolam 2 mg intramuscularly and were then anesthetized with propofol or enflurane. The blood pressure and heart rate were taken at 1 min intervals for 10 min after a bolus injection of atropine 5microgram/kg. RESULTS: In the enflurane group, the systolic blood pressure and heart rate were increased significantly at 1, 2 and 3 min after the atropine injection (P<0.05). When the two groups were compared, the heart rate in the enflurane group was significantly higher at 1, 2 and 3 min after atropine injection than in the propofol group (P<0.05). CONCLUSIONS: The heart rate response to intravenous atropine during propofol anesthesia is attenuated compared with enflurane anesthesia.

Cuff Volume of Laryngeal Mask Airway ProSealTM in Korean Adults / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine the cuff volume of the laryngeal mask airway ProSeal(TM)(PLMA (TM)) in Korean adults, which was measured at an intracuff pressure of 60 cmH2O. METHODS: A size 3 PLMATM was used for females (n = 57) and a size 4 PLMATM for males (n = 45). Anesthesia was induced with thiopental and rocuronium and maintained with sevoflurane, nitrous oxide and oxygen. After 5 minutes of conventional mask ventilation, the PLMATM was inserted using an the index finger in one motion. Increments of air up to a final intracuff pressure of 60 cmH2O were introduced and the patency of the airway was confirmed. Following successful placement during ventilation, the intracuff pressure was maintained at 60 cmH2O during anesthesia. The volume of air required to inflate the cuff to this pressure was measured, first after successful insertion of the mask (CV ins), and then 10 minutes before the end of anesthesia (CV end). Each patient was asked whether they had a sore throat, just before leaving the postanesthesia care unit (PACU) and again 24h after surgery. Data is presented as means standard error of mean (SEM). Statistical analysis was performed by bivariate correlation analysis, and by the paired t-test. Significance was accepted when P < 0.05. RESULTS: CV ins was 15-26 ml (22.8+/-0.3 ml)(female), 23-45 ml (33.6+/-0.6 ml)(male) and CV end was 17-27 ml (23.2+/-0.3 ml)(female), 22 45 ml (33.8+/-0.7 ml)(male). There were no significant correlation between BMI (body mass index), thyromental distance, sternomental distance and cuff volume (CV ins). In males, there was no significant difference between CV ins and CV end, but, in females, there was a significant difference between CV ins and CV end (CV ins < CV end)(P < 0.05). Incidences of postoperative sore throat just before leaving the PACU were 22.8% in females, 15.6% in males, and 24 hrs after surgery, these were 7% in females, 4.4% in males. CONCLUSIONS: We conclude that CV ins in both male and female was widely variable and that there is no correlation between anatomical variation and inflated cuff volume. Moreover, we could not prevent postopertative sore throat by changing cuff volume at an intracuff pressure of 60 cmH2O. Especially in Korean females, the cuff volume required to inflate the cuff to 60 cmH2O increased with anesthesia.

The Effect of Enflurane, Isoflurane and Propofol on Hepatic Function in Tympanomastoidectomy / 대한마취과학회지

BACKGROUND: Isoflurane and propofol are known to have a low potential for hepatotoxicity. However, no study has compared the effects on hepatic function after of enflurane, isoflurane or propofol in tympanomatoidectomy. Anesthetic techniques should permit the maintenance of low blood pressure during operation for a bloodless surgical field. Because of a long operation time and low blood pressure, the liver may be damaged. The purpose of this study was to evaluate the effects of isoflurane and propofol on liver function by comparing them with enflurane in patients who had been received tympanomatoidectomy. METHODS: Eighty-seven patients with normal liver function were studied following tympanomastiodectomy. The patients were randomly assigned to Group E (n = 28), who received enflurane, Group I (n = 30), who received isoflurane or Group P (n = 29), who received propofol. The plasma concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were measured on the day before the operation, and 1, 2 and 3 days after the operation. RESULTS: one and two days after the operation, all groups showed a significant increase in AST (P < 0.05), but this recovered to the baseline level at 3 days postoperatively, and there was no difference among the three groups. ALT and ALP were not changed until 3 days postoperatively in all groups, and there were no difference between the three groups. CONCLUSIONS: We conclude that there are no significant difference in terms of postoperative hepatic function after tympanomatoidectomy between the three groups.

Recovery Profile after Desflurane-N2O Versus Isoflurane-N2O in Pediatric Tonsillectomy Patients / 대한마취과학회지

BACKGROUND: This study was doned to evaluate the rate of awakening after desflurane or isoflurane anesthesia in pediatric tonsillectomy patients. METHODS: Sixty patients, aged 5 10 years undergoing a tonsillectomy with or without an adenoidectomy were randomly assigned to receive either desflurane-N2O (group D) or isoflurane-N2O (group I). A recovery profile was assessed by a 3 point scale for the first 0, 15 and 30 min in the recovery room. RESULTS: It was statistically significant that group D had a shorter extubation time and eye opening time and a less apprehensive score than group I at 0, 15 and 30 min. CONCLUSIONS: We conclude that desflurane-N2O may offer clinical advantages over isoflurane when used for maintenance of anesthesia during a pediatric tonsillectomy.

Comparison of the Effects of Propofol and Isoflurane Anesthesia on Respiratory Gas Exchange during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Introduction of a pneumoperitoneum using CO2 is accompanied by significant alterations in respiratory function and pulmonary gas exchange during laparoscopic cholecystectomy. Previous studies have shown differing results concerning pulmonary gas exchange: a significant decrease of PaO2 was induced with isoflurane. In contrast, no significant changes were observed with propofol. The purpose of the present study was to compare the effects of propofol vs isoflurane on pulmonary gas exchange during general anesthesia for laparoscopic cholecystectomy. METHODS: Forty patients were divided randomly between isoflurane and propofol groups. After induction of anesthesia, ventilation was controlled and intra-abdominal pressure was maintained automatically at 12 mmHg by a CO2 insufflator. After the measuring of baseline values of blood pressure, heart rate, PaO2, PaCO2 and PetCO2 before CO2 insufflation, measurements were also made immediately, 30min after CO2 insufflation and 5 min after CO2 exsufflation. RESULTS: In the isoflurane group, PaCO2, PetCO2, PaO2, and P(a-et)CO2 changed significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). In the propofol group, PaCO2 and PetCO2 increased significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05), but PaO2 and P(a-et)CO2 remained constant. When the two groups were compared, there were significant differences in PaO2, PaCO2, PetCO2 and P(a-et)CO2 at 30min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). CONCLUSIONS: These results indicate that during laparoscopic cholecystectomy the PaO2 was significantly lower and PaCO2 and P(a-et)CO2 were significantly higher in the isoflurane group compared with the propofol group.

Propofol and Thiopental-Enflurane: A Comparison of Anesthesia for Laryngomicrosurgery / 대한마취과학회지

BACKGROUND: Laryngomicrosurgery has some special characteristics. It is stressful due to intubation and direct laryngoscopy during a short operation time. Therefore both adequate anesthesia and quick recovery for the slience therapy after the operation are needed. This study compared the cardiovascular responses and recovery pattern between propofol and Thiopental-Enflurane anesthesia. METHODS: Sixty outpatients of ASA class 1 or 2 for microlaryngoscopy were randomly assigned to receive either anesthesia with propofol (Group P, n = 30) and thiopental-enflurane (Group E, n = 30). Group P was induced with propofol 2 mg/kg and succinylcholine 1 mg/kg and maintained with vecuronium 0.04 mg/kg, propofol 10 - 6 mg/kg/h, and N2:O2/3 L/min:2 L/min. Group E was induced with thiopental 5 mg/kg and succinylcholine 1 mg/kg and maintained with vecuronium 0.04 mg/kg, enflurane 1 3 vol%, and N2O:O2/3 L/min:2 L/min. Ketorolac (30 mg) and hydrocortisone (100 mg) were added for postoperative pain in both groups. The changes in blood pressure and heart rate, pre and post induction, were compared in both groups. In addition, we compared energence time and the state of recovery (Steward's score) 5 minutes and 15 minutes after extubation and the frequencies of other complications. RESULTS: No significant differences in age, wt, sex and anesthesia time of the two groups were observed. Mean arterial pressures were significantly different after anesthesia and after intubation between the two groups. However the heart rates were not different among the groups. The extubation time was significantly shorter in Group P. The recovery score at 5 min and 15 min after extubation was significantly higher in Group P. CONCLUSIONS: We conclude that propofol with nitrous oxide may be useful in laryngeal microsurgery, especially, when silence therapy is needed.

Role of Fiberoptic Bronchoscopy in Conjunction with the Use of a Single Lumen Tube with Bronchial Blocker for Thoracic Anesthesia / 대한마취과학회지

BACKGROUND: Fiberoptic bronchoscopy has been recommended to verify the position of single lumen tubes with bronchial blockers (Univent(R) tube), but this remains controversial. The authors studied the role of a bronchoscopy for placing and monitoring bronchial blockers (BB) after blind intubation and after positioning the patient. METHODS: One hundred patients having thoracic surgery requiring a Univent tube insertion were prospectively studied. After "blind" tracheal intubations with Univent tubes, BB were advanced in the left-side mainstem bronchus for 60 patients and the right-side for 40 patients. A bronchoscopy was performed after conventional clinical verification of correct placement and after patient positioning for a thoracotomy. A BB was considered malpositioned when it had to be moved < 0.5 cm to correct its position. RESULTS: After "blind" BB intubation, clinical evidence of malpositioning was found in 5 patients. This was confirmed by fiberoptic assessment. In 95 patients in whom placement was judged correct by clinical assessment, malpositioning was detected by bronchoscopy in 39 cases. After patient positioning, BB were found to be displaced in 29 patients. Right-side BB were significantly more likely to be malpositioned than were left-side BB. CONCLUSIONS: After blind intubation and patient positioning, more than one third of BB required repositioning. A routine bronchoscopy is therefore recommended after intubation and after patient positioning.

Incidence of Pulmonary Aspiration in Patients with Tracheostomy / 대한구급학회지

BACKGOUND: Patients with tracheostomy tubes have altered glottic closure in deglutition that may result in aspiration and may cause dangerous pulmonary complication including bronchopneumonia and atelectasis. The incidence of pulmonary aspiration in patients with tracheosomy may be high but difficult to determine because investigators often apply different criteria. The present study was prepared to document the incidence of aspiration in patients with tracheostomy using a simple dye-marker test. METHODS: Thirty six surgical and medical patients (14 male and 22 female) in ICU with tracheostomy tube (high volume, low pressure cuffed tube) were included in this study. Mental status (presence of response to verbal command), the presence of nasogastric tube and the presence of ventilatory support were recorded in each patients to evaluate the effect of these factors on the incidence of aspiration. 1% solution of methylene blue dye was applied on the both side of posterior tongue and then any evidence of the blue dye-marker obtained microscopically on secretion through the tracheostomy tube at every 2 hours during 72 hours was considered the positive evidence of aspiration. RESULTS: Aspiration was detected by a positive methylene blue dye test in 11 of the 36 patients (30.5%) and average length of time before blue dye was obtained on tracheal secretion was 8.2 7.3 hours.The presence of response to verbal command, nasogastric tube and ventilatory support had no apparent effect on the incidence of aspiration. CONCLUSIONS: This observation suggests that a simple test using dye-maker is helpful to detect aspiration in patients with tracheostomy. Tracheostomy should be done under discreet decision because the high incidence of aspiration in trcheostomized patients.

Effects of Blood-Brain Barrier Disruption on Cerebral Oxygen Balance / 대한구급학회지

BACKGOUND: Disruption of the blood-brain barrier (BBB) can alter the internal milieu and may increase the release of excitatory amino acid neurotransmitters or catecholamines, which may affect metabolic rate or coupling. This study was performed to evaluate whether disruption of BBB by unilateral intracarotid injection of hyperosmolar mannitol would alter oxygen supply/consumption balance in the ipsilateral cortex. METHODS: Rats were anesthetized with 1.4% isoflurane using mechanical ventilation via tracheostomy. 25% mannitol was administered at a rate of 0.25 mlxkg-1s-1 for 30 s through unilateral internal carotid artery. The BBB transfer coefficient (Ki) of 14C-alpha-aminoisobutyric acid was measured in one group (N=7) after administering mannitol. Regional cerebral blood flow (rCBF), regional arterial and venous O2 saturation and O2 consumption were measured in another group using a 14C-iodoantipyrine and microspectrophotometry (N=7). RESULTS: Vital signs were similar before and after administering mannitol. Ki was significantly higher in the ipsilateral cortex (IC) than in the contralateral cortex (CC), (22.3+/-8.4 vs 4.4+/-1.1 microliterxg-1min-1). rCBF was similar between IC (105+/-21 mlxg-1min-1) and the CC (93+/-20). Venous O2 saturation was lower in the IC (43+/-7%) than in the CC (55+/-4). O2 consumption was higher in the IC (9.6+/-3.0 mlx100 g-1min-1) than in the CC (6.7+/-1.5). CONCLUSIONS: Our data suggested that increasing permeability of the BBB increased cerebral O2 consumption and deteriorated cerebral oxygen balance.

Anesthesia for Renal Transplantation in Children: 4 cases / 대한마취과학회지

Despite significant advances in dialysis technology, kidney transplantation is accepted today as the optimal available treatment for end-stage renal disease (ESRD) in children and adolescents. Children undergoing renal transplantation pose many challenges to the anesthesiologist because ESRD has such adversely affects on the entire vital organ system as hypotension, hypovolemia, acidosis, atelectasis and pulmonary edema. Most importantly, hypotension and hypovolemia as results of large kidney transplantation should be corrected for normal renal function. In addition, ESRD alters the effects of various drugs used in anesthetic practice. We experienced 4 cases of general anesthesia for renal transplantation in children. Careful preoperative evaluation and preparation of the patients, as well as a knowledge of altered dry responses are essential in planning and managing anesthesia.

The Effect of Lidocaine, Verapamil and Lidocaine-Verapamil Combination on Blood Pressure and Heart Rate following Tracheal Extubation / 대한마취과학회지

BACKGROUND: Tracheal extubation, as well as intubation, causes hypertension and tachycardia. The aim of this study was to compare the effect of verapamil, lidocaine to lidocaine-verapamil combination in attenuating the cardiovascular changes following tracheal extubation and emergence from anesthesia. METHODS: Eighty patients (ASA physical status 1) were randomly assigned to one of four groups (n=20 each) ; saline (control), 1 mg/kg lidocaine, 0.05 mg/kg verapamil and lidocaine-verapamil combination. These medication were given intravenously 2 min before tracheal extubation. Changes in blood pressure and heart rate were measured following tracheal extubation. RESULTS: Lidocaine, verapamil and their combination all attenuated the changes of heart rate and blood pressure. The inhibitory effect on changes of heart rate and blood pressure were miximum in group of the combination of lidocaine and verapamil. CONCLUSION: We conclude that the verapamil 0.05 mg/kg and lidocaine 1 mg/kg given iv concomitantly 2 min before tracheal extubation is a more effective prophylaxis than verapamil or lidocaine for attenuating the cardiovascular changes associated with tracheal extubation.

Comparison of Diclofenac or Fentanyl for Pain Following Tonsillectomy / 대한마취과학회지

BACKGROUND: This study was designed to compare intramuscular diclofenac with intravenous fentanyl in the prevention of pain after tonsillectomy and adenoidectomy for day-surgery. METHODS: We studied 60 patients, aged 3-13 years, undergoing tonsillectomy with or without adenoidectomy. Patients were randomly assigned to receive placebo injecton (Group 1), intramuscular diclofenac 1 mg/kg (Group 2) or intravenous fentanyl 1 microgram/kg (Group 3) after induction of anesthesia. Pain was evaluated by using an observer pain score for the first 30 min, 60 min and 4 hrs postoperatively. RESULTS: It is statistically significant that group 2 and group 3 had lesser pain than group 1 at 30 min and 60 min. But there is no difference among any groups at 4 hr postoperatively. CONCLUSIONS: We conclude that diclofenac may have advantages compared to fentanyl in safety and convenience for the treatment of pain after tonsillectomy in children.