Drip infusion method as a useful indicator for identification of the epidural space / 대한마취과학회지

BACKGROUND: Cervical epidural anesthesia (CEA) is used for pain control and surgical procedures of the head and neck or upper arm areas. However, the failure rate of CEA is reported to be high, is the failure rate being quite higher than other sites, because of the anatomical differences of the cervical spine. We hypothesized that the loss of resistance (LOR) method combined with the drip infusion method for confirmation of the cervical epidural space can reduce the failure rate. This study investigated the usefulness of the drip infusion method. METHODS: One hundred chronic renal failure patients undergoing arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. In the cervical epidural puncture, we identified the cervical epidural space using a combination of the LOR method with the drip infusion method. After confirmation of the epidural space with LOR method, we decided it was the true epidural space when fluid dripping to the space was present. Otherwise, if fluid dripping was not present, we designated it was pseudo LOR, and we found the true epidural space using the drip infusion method only. RESULTS: In all cases, the combined LOR with drip infusion method, identify the epidural space. CONCLUSIONS: Combined LOR with drip infusion method is an efficacious method for the confirmation of the cervical epidural space.

Comparison of Methods to Confirm the Cervical Epidural Space

BACKGROUND: The loss of resistance (LOR) method is most commonly used to identify the epidural space. This method is thought to rely on the penetration of the ligamentum flavum. Unfortunately the exact morphology of the ligamentum flavum is variable at different vertebral levels. Especially, it has been pointed out that the lower cervical ligamentum flavum may be discontinuous in the midline in up to 50% of patients. Thus, the LOR method may be inaccurate to confirm the cervical epidural space. The aim of this study is to determine which method is the safest and most exact for confirming the cervical epidural space. METHODS: 100 adult, chronic renal failure patients who were undergoing an arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. During the cervical epidural puncture, we identified the cervical epidural space by subjectively feeling the resistance with using a finger just through the ligamentum flavum, and we also used the drip infusion method, the loss of resistance method using air, and the hanging drop method. By using 5 grades, we classified the extent of whether or not the techniques were effective. RESULTS: Using the drip infusion method, we identify the epidural space in all the patients as +/++ grade. The catheter insertion method was also successful in identifying those epidural spaces over a +/- grade. The pseudo LOR was over micro grade in 47 patients. CONCLUSIONS: The combined LOR/hanging drop with drip infusion method is useful for confirming the cervical epidural space.

The hemodynamic changes by different end-tidal CO2 under anesthesia using sevoflurane-N2O / 대한마취과학회지

BACKGROUND: Hypercapnia augments cardiac output and can initiate a sympathetically mediated release of catecholamines to increase cardiac output. Many studies of hemodynamic changes by hypercapnia under general anesthesia with inhalation anesthetics besides sevoflurane. This study examined the hemodynamic changes by increasing end-tidal carbon dioxide (EtCO2) under sevoflurane-N2O anesthesia. METHODS: Twenty patients were enrolled in the study. We studied stable, mechanically ventilated patients under general anesthesia maintained with O2 2 L/min - N2O 2 L/min - sevoflurane (1.5-2.5 vol%). Hypercapnia were obtained by reducing tidal volume and respiratory rate. EtCO2 was adjusted to 30, 40, 50 mmHg with each concentration maintained for 15 min. Global hemodynamic variables were monitored with a pulmonary artery catheter. RESULTS: There were no changes in mean arterial pressure or heart rate by hypercapnia. Acute moderate hypercapnia increased cardiac output (4.9 +/- 1.7, 5.5 +/- 1.7, 6.2 +/- 2.1 L/min; P 0.05). CONCLUSIONS: When we changed patient EtCO2 to 30, 40, and 50 mmHg, there were no changes in mean arterial blood pressure and heart rate, but systemic vascular resistance decreased, and cardiac output, cardiac index and mean pulmonary arterial pressure increased significantly.

The influence of head rotation on the anatomical relationship of the right internal jugular vein and the carotid artery / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the effect of head rotation on the anatomical relationship of the right internal jugular vein (RIJV) and the carotid artery (CA) with using ultrasound images in Korean patients. METHODS: We investigated 117 patients (age range: 16-87 years old) who were placed in the supine position, but not in the Trendelenburg position. An ultrasound probe was placed on the right neck at the apex of the triangle formed by the head of the sternocleidomastoid muscle and the clavicle, and it was directed toward the ipsilateral nipple at a 30 degree angle to the coronal plane. For each head rotation (0, 30, 60 degrees), we measured the horizontal diameter of the RIJV and CA, and the percentage of overlap of the CA and the RIJV with using an ultrasound system. RESULTS: The mean RIJV diameter was 18.4 +/- 4.3 mm and the mean CA diameter was 7.5 +/- 1.2 mm at the neutral head position. Following head rotation, the percentage overlap of the CA and RIJV increased significantly (0degrees: 32.7%, 30degrees: 45.4%, 60degrees: 57.0%) (P < 0.05). The percentage overlap of the CA and RIJV in the neutral head position increased more in the patients with a BMI over 25. However, age did not have any effect on the percentage of overlap. CONCLUSIONS: Head rotation toward the contralateral side increases the percentage of overlap of the CA and RIJV. To decrease the risk of CA puncture, rotate the head from the neutral position as little as possible when performing RIJV catheterization.

The influence of head rotation on the anatomical relationship of the right internal jugular vein and the carotid artery / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the effect of head rotation on the anatomical relationship of the right internal jugular vein (RIJV) and the carotid artery (CA) with using ultrasound images in Korean patients. METHODS: We investigated 117 patients (age range: 16-87 years old) who were placed in the supine position, but not in the Trendelenburg position. An ultrasound probe was placed on the right neck at the apex of the triangle formed by the head of the sternocleidomastoid muscle and the clavicle, and it was directed toward the ipsilateral nipple at a 30 degree angle to the coronal plane. For each head rotation (0, 30, 60 degrees), we measured the horizontal diameter of the RIJV and CA, and the percentage of overlap of the CA and the RIJV with using an ultrasound system. RESULTS: The mean RIJV diameter was 18.4 +/- 4.3 mm and the mean CA diameter was 7.5 +/- 1.2 mm at the neutral head position. Following head rotation, the percentage overlap of the CA and RIJV increased significantly (0degrees: 32.7%, 30degrees: 45.4%, 60degrees: 57.0%) (P < 0.05). The percentage overlap of the CA and RIJV in the neutral head position increased more in the patients with a BMI over 25. However, age did not have any effect on the percentage of overlap. CONCLUSIONS: Head rotation toward the contralateral side increases the percentage of overlap of the CA and RIJV. To decrease the risk of CA puncture, rotate the head from the neutral position as little as possible when performing RIJV catheterization.

Effect of intraoperative remifentanil infusion on postoperative urinary retention / 대한마취과학회지

BACKGROUND: Urinary retention is a common post-operative complication that has been associated with opioid therapy. In this study, we investigated whether an intraoperative remifentanil infusion increased postoperative urinary retention in patients undergoing general anesthesia. METHODS: Sixty-two healthy patients having elective minor surgery under general anesthesia were enrolled in this prospective, randomized, double-blind study. Anesthesia was maintained with either sevoflurane (S group, n = 31) alone or with sevoflurane combined with a remifentanil infusion (0.1-0.2microgram/kg/min) (RS group, n = 31). Bladder urine volume and voiding difficulty were evaluated at 2 and 6 hours after the operation. RESULTS: The incidence of urinary retention was 13% in the S group and 6% in the RS group at 2 hours after operation, which was not a significant difference. The total incidence of urinary retention was 13% in both groups at 6 hours after operation. CONCLUSIONS: Intraoperative remifentanil infusion did not increase the postoperative urinary retention.

Thrombotic obstruction of the subclavian artery associated with inadvertent arterial puncture on attempted right internal jugular vein cannulation: A case report / 대한마취과학회지

Internal jugular vein cannulation is commonly used for the anesthetic management of patients undergoing a major operation. Complications associated with internal jugular vein cannulation such as a carotid artery puncture, pneumothorax and hemothorax, have been reported; however, thrombotic complications of arteries due to accidental arterial punctures are rare. We report a case of thrombotic obstruction of the subclavian artery associated with inadvertent arterial puncture following an attempted internal jugular vein cannulation.

The Influence of a Muscle Relaxant on Bispectral Index during the Propofol Induction of Anesthesia / 대한마취과학회지

BACKGROUND: Although neuromuscular blockade can influence the bispectral index (BIS) during anesthesia, there have been contradictory reports regarding its effects. The purpose of this study was to investigate whether a muscle relaxant affected the level of BIS during propofol anesthesia. METHODS: Forty-eight healthy patients undergoing elective surgery under general anesthesia were enrolled in this prospective, randomized, double-blind study. All patients received an effect-site targeted concentration of propofol via a TCI system that was titrated until loss of consciousness occurred. The patients then received either an injection of vecuronium (relaxant group, n = 24) or normal saline as a placebo (placebo group, n = 24) at 3 minutes after loss of consciousness. The BIS and electromyogram (EMG) activity were recorded from anesthetic induction to 4 minutes after injection of the vecuronium or placebo. RESULTS: The BIS significantly decreased after injection in both groups (P < 0.05), however, the decrease in the BIS was larger in the relaxant group than in the placebo group (P < 0.05). The decrease of EMG activity was not significantly different between the two groups after administration of vecuronium or placebo. CONCLUSIONS: During propofol induction of anesthesia, a muscle relaxant decreased BIS significantly without decreasing the EMG activity.

Comparison of Cardiac Output from the Thermodilution Method versus a Transesophageal Doppler Ultrasound Monitor (Hemosonic 100(TM)) / 대한마취과학회지

BACKGOUND: The measurement of cardiac output (CO) is an important part of anesthetic practice in patients undergoing major surgery. The thermodilution method (TDM), using a pulmonary artery catheter, is still accepted as the standard procedure. However, the use of the method is associated with several limitations and severe complications. The use of a transesophageal Doppler ultrasound monitor (EDUM; Hemosonic 100(TM)) is less invasive and calculates CO from a simultaneous measurement of blood flow velocity and diameter of the descending aorta. The aim of this study was to compare the cardiac output measured by the use of the TDM and an EDUM. Methods:In 20 patients undergoing major abdominal surgery, CO and other hemodynamic profiles were measured simultaneously by the use of the TDM and an EDUM. RESULTS: The cardiac output, cardiac index, and the systemic vascular resistance monitored by both devices were highly correlated (correlation coefficients range from 0.63 to 0.88). Bland and Altman analysis showed a consistently negative mean bias for an EDUM and the TDM. This finding indicates an overestimation of the hemodynamic profile by the use of an EDUM. CONCLUSIONS: Although Bland and Altman analysis showed a significant bias, the use of an EDUM results in cardiac output, cardiac index, and total systemic vascular resistance measurements that are considerably similar to those obtained using the TDM, and a strong correlation exists for the use of the two methods.

The Influence of Remifentanil on the Bispectral Index during Intubation under TIVA using Propofol / 대한마취과학회지

BACKGOUND: The present study was undertaken to determine the effect of remifentanil on the bispectral index (BIS) during intubation under TIVA (total intravenous anesthesia) using propofol. METHODS: In this prospective, randomized, double-blind study, 80 healthy patients aged 18~60 years undergoing elective surgery were investigated. Anesthesia was induced using propofol (target effect-site concentration 4microgram/ml). After the loss of consciousness, rocuronium (0.9 mg/kg) and remifentanil was infused. The patients in the R group were infused with remifentanil using a target effect-site concentration of 4 ng/ml, and patients in the P group were infused with saline. The BIS value, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, before remifentanil infusion and before and after tracheal intubation. RESULTS: The BIS value remained constant after intubation in the two groups. The MAP and HR increased significantly after intubation in the two groups, but the degree of increase of MAP and HR was less in group R than in group P significantly. CONCLUSIONS: We suggest that the BIS value is not affected by the administration of remifentanil during intubation under TIVA using propofol.

A Clinical Measurement of the Distance from the Skin to the High Thoracic Epidural Space in Women / 대한마취과학회지

BACKGROUND: Segmental high thoracic epidural anesthesia and analgesia is now accepted as a popular technique for thoracic and breast surgeries, as well as post operative pain relief. However, a high thoracic epidural puncture is technically difficult, which can cause neurological complications. Having prior knowledge of the distance from the skin to the thoracic epidural space may be helpful for the prevention of complications during this procedure. This study was undertaken to evaluate the distance from the skin to the thoracic epidural space and the insertion angle of the Tuohy needle, as measured using a protractor, and to determine any potential relationship between a patient's height, weight and BMI (body mass index) with the calculated distance on the preoperative chest CT and the distance from the skin to the epidural space in 50 women undergoing a mastectomy. METHODS: In the sitting position, using a mid-line approach, the T4-5 epidural depth was measured in 50 mastectomy patients after the block had been successfully confirmed. The patient's age, height, weight and BMI, as well as the calculated distance on the preoperative chest CT were then checked. RESULTS: The distance from the skin to the thoracic epidural space at the T4-5 intervertebral level and insertion angle were 5.59 +/- 1.26 cm and 54.40 +/- 12.12 degrees, respectively. A significant correlation was found between the epidural depth and, the weight, BMI and calculated distance on the preoperative chest CT. CONCLUSIONS: The distance from the skin to the thoracic epidural space showed significant relationships with the weight, BMI and calculated distance on the preoperative chest CT.

Evaluation of Effect-site Concentration of Remifentanil for Blunting Hemodynamic Responses to Endotracheal Intubation during Total Intravenous Anesthesia using Propofol / 대한마취과학회지

BACKGROUND: The present study was undertaken to determine the effect-site concentration of remifentanil for blunting hemodynamic responses to tracheal intubation during total intravenous anesthesia (TIVA) using propofol. METHODS: In this prospective, randomized, double-blind study, a total of 126 patients, aged 18-60 (ASA I or II), having undergone elective surgery under TIVA using propofol were investigated. Anesthesia was induced using propofol (target effect-site concentration 4microgram/ml) and rocuronium (0.9 mg/kg). Remifentanil was infused at target effect-site concentrations of 0, 2, 4, 6 ng/ml: groups R1, R2, R3 and R4, respectively. The systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and heart rate (HR) were measured pre-induction, and before and after tracheal intubation. RESULTS: After intubation, the SAP, DAP and HR increased significantly (P < 0.05) in all groups compared to the pre-intubation values. Compared with pre-induction values, the SAP and DAP in groups R1 and R2 increased significantly after intubation (P < 0.05), but those in group R3 remained constant until 1 min after intubation. The SAP and DAP in group 4 however, decreased significantly (P < 0.05) for 3 min after intubation. The HR increased significantly after intubation in groups R1, R2 and R3 compared to the values before intubation (P < 0.05), but that in group R4 being remained constant. CONCLUSIONS: We suggest that the optimal target effect-site concentrations of remifentanil for blunting hemodynamic responses to tracheal intubation were 4 or 6 ng/ml during TIVA using propofol.

The Interaction between Intrathecal NMDA Receptor Antagonist and 5-HT3 Receptor Agonist in the Rat Formalin Test / 대한마취과학회지

BACKGROUND: A single agent administered is not effective enough to block nociception. Combination of agents acting through different mechanisms may be one of the best ways for better analgesic methods. The purpose of this study was to investigate the spinally mediated analgesic interaction between 5-HT3 receptor agonist (m-CPBG) and NMDA receptor antagonist (MK801) in the rat formalin test. METHODS: A polyethylene catheter was inserted in the atlanto-occipital membrane to the thoracolumbar level of the spinal cord. On postoperative 7 day, the normal saline (n = 6), m-CPBG (10, 30, 100microgram: n = 18) and MK801 (0.1, 1, 10microgram: n = 18) were injected intrathecally before subcutaneous injection of 5% formalin. The combinations of each 1/2ED50 + 1/2ED50, 1/4ED50 + 1/4ED50, 1/8ED50 + 1/8ED50 were tested and the ED50 of the combination was determined. The experimental ED50 values were compared with the theoretical additive values. RESULTS: m-CPBG dose-dependently decreased the number of flinches in both phase 1 and 2. MK801 dose-dependently reduced the number of flinches in phase 2, but not in phase 1. The combination of m-CPBG and MK801 produced dose-dependent decreases of flinches on both phase 1 and 2. ED50 values (2.75microng for m-CPBG and 0.076microgram for MK801) of phase 2 in the combination were significantly less than the calculated additive values (20.0microgram for m-CPBG and 0.55microgram for MK801)(P<0.01). CONCLUSIONS: Intrathecally administered m-CPBG and MK801 had synergistic analgesic effects on formalin-induced hyperalgesia as well as antinociceptive effects in phase 1 on the rat formalin test.

Effects of Continuous Epidural Infusion after Thoracic Epidural Anesthesia for Mastectomy on Postoperative Pain, Nausea and Vomiting / 대한마취과학회지

BACKGROUND: Breast cancer is the most common cause of tumors in Korean women. Until recently, oncologic breast surgery was performed by using general inhalation anesthesia. However, this anesthetic method is associated with incomplete postoperative pain control and significantly more postoperative nausea and vomiting (PONV). Therefore, this study examinated the value of thoracic epidural anesthesia (TEA) for a mastectomy, and evaluated the effects of a continuous epidural infusion on postoperative pain control and the PONV, which is known to be a better method than general anesthesia with intravenous patient controlled analgesia (IV PCA). METHODS: Sixty five patients scheduled for a mastectomy were randomly assigned and divided into two groups. The GA group underwent general anesthesia using O2-N2O-sevoflurane with IV PCA. The TEA group was injected with 20 ml of 0.375% ropivacaine with fentanyl 50microgram at T4-5. After surgery the visual analogue scale (VAS) score of postoperative pain and nausea was checked. RESULTS: The postoperative pain intensity was significantly (P < 0.05) lower in the TEA group at the postoperative period and during 6 hours compared with the GA group. Postoperative nausea intensity was significantly (P < 0.05) lower in the TEA group during 6 hours. CONCLUSIONS: These results suggest that TEA is a method suitable of regional anesthesia for a mastectomy and a continuous epidural catheter infusion is more effective on postoperative pain control than general anesthesia with IV PCA. In addition, it is a good method for decreasing the PONV to a similar level as IV PCA with antiemetics.

The Cardiovascular Effects of Thoracic Epidural Injection of Ropivacaine during Sevoflurane General Anesthesia / 대한마취과학회지

BACKGROUND: Thoracic epidural anesthesia (TEA) combined with general anesthesia is commonly used in major upper abdominal surgery. The advantages of this method is the suppression of the perioperative stress response, the improvement in endocardial perfusion, and the reduction of myocardial oxygen consumption, postoperative morbidity and mortality. In particular, this method reduces the level of postoperative ileus and intestinal anastomosis leakage during gastrointestinal surgery. However, there is the possibility of severe cardiovascular depression using this combination method. This study evaluates the cardiovascular effects of extensive TEA combined with sevoflurane general anesthesia. METHODS: Fifty patients scheduled subtotal gastrectomy were enrolled in this study. After administering a bolus injection of 20 ml of 0.375% ropivacaine through an epidural catheter during sevoflurane general anesthesia, mean arterial pressure, heart rate, stroke volume, cardiac output, and systemic vascular resistance measured by Hemosonic (HemoSonic(TM) 100, Arrow, USA) every 5 minutes over a 30-minute period after the injection. RESULTS: All the data showed a significant decrease from 5 minutes after the epidural bolus injection except for the stroke volume, but that was not important clinically. CONCLUSIONS: A thoracic epidural injection of 20 ml of 0.375% ropivacaine can be used safely during sevoflurane anesthesia without severe cardiovascular complications during upper abdominal surgery.

The Effects of the Preoperative Education about Analgesics and Patient-Controlled Analgesia (PCA) on the Consumption of Analgesics after Operation / 대한마취과학회지

BACKGROUND: The purpose of this study is to evaluate the patients' general perception about the analgesics and the effects of the preoperative education about analgesics and patient-controlled analgesia (PCA). METHODS: One hundred patients scheduled for elective gastrectomy were randomly allocated into two groups. In control group (n = 50), patients were given conventional preanesthetic visit with questionnaire survey on PCA one day before operation. In study group (n = 50), patients were sufficiently explained about postoperative analgesia and PCA by anesthesiologist and given precise explanation sheet about PCA. Total amounts of drug used in PCA as well as rescue analgesics, the pain scores, and side effects were compared. RESULTS: 62.2% of patients had much information from various sources that analgesics effects positively in the recovery phase, but actually 73.7% of patients considered that analgesics do not seem to have any influence on the recovery after operation. There was no difference between the amounts of total PCA used, rescue analgesics, and the pain scores. However, the educated patients complained less dizziness at postoperative days (POD) one. Also, the number of patients excluded from study due to the PCA discontinuation secondary to related side effects was less in educated patients (P = 0.025). CONCLUSIONS: Preoperative education about analgesics and PCA failed to demonstrate significant decrease in the amount of analgesics and of pain scores. However, it lowered the incidence of PCA discontinuation due to side effects.

Effects of Vancomycin on the Neuromuscular Blockade of Vecuronium, Rocuronium and Atracurium in Rat Phrenic Nerve-Hemidiaphragm Preparation / 대한마취과학회지

BACKGROUND: Vancomycin is frequently used as a prophylactic antibiotic in patients undergoing cardiac and orthopedic surgical procedures. However, the interactions of vancomycin with non-depolarizing muscle relaxant have not yet been reported on. Therefore, we studied the effects of vancomycin on the neuromuscular block of vecuronium, rocuronium and atracurium in vitro. METHODS: Square wave, 0.1 Hz supramaximal stimuli were applied to the phrenic nerve-hemidiaphragm preparation of the rat and the twitch height response was recorded. We measured cumulative concentration response curves of vecuronium, rocuronium or atracurium, respectively, and also those of the rats that were pretreated with vancomycin (20 microgram/ml). The EC50 and EC95 of these muscle relaxants alone and those of the rats pretreated with vancomycin were calculated with using an inhibitory sigmoid Emax model. RESULTS: Vancomycin alone did not depress the twitch height. The pretreated vancomycin (20 microgram/ml) did not affect the EC50 and EC95 of vecuronium or rocuronium, but it significantly reduced the EC50 and EC95 of atracurium (P < 0.05). CONCLUSIONS: Vancomycin itself does not have neuromuscular blocking properties. Vancomycin does not affect the neuromuscular blockade induced by vecuronium or rocuronium, but it significantly enhances the neuromuscular blockade induced by atracurium.

The Prophylactic Antiemetic Effects of Combination of Ondansetron with Dexamethasone after Strabismus Surgery in Children / 대한마취과학회지

BACKGROUND: Postoperative vomiting (POV) is a common complication after pediatric strabismus surgery. The aim of this study was to evaluate the prophylactic antiemetic effects of a combination of ondansetron with dexamethasone after strabismus surgery in children. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, 126 healthy children, aged 3-10 years, who underwent strabismus surgery under general anesthesia using sevoflurane were examined. The patients were divided randomly into three groups: Patients who received 100microgram/kg ondansetron with 100 microgram/kg dexamethasone (OD group, n = 42); 100microgram/kg ondansetron (O group, n = 42); and saline as placebo (P group, n = 42) after the induction of anesthesia. The incidence of vomiting, the patient's distress due to vomiting, the need for rescue antiemetics and parental satisfaction during the first 24 h after surgery were evaluated. RESULTS: The incidence of vomiting in group OD (5%) and group O (17%) during the first 24 h after surgery were significantly lower than in group P (40%) (P < 0.001, P < 0.05, respectively). The level of distress of the patients in group OD during the first 6 h after surgery was significantly lower than in group P (P < 0.05). The parents in group OD were more satisfied than those in group P (P < 0.05). However, the incidence of vomiting, patient's distress, need for rescue antiemetics, and parental satisfaction were comparable between groups OD and group D. CONCLUSIONS: A combination of ondansetron with dexamethasone and ondansetron alone were equally effective in preventing vomiting after strabismus surgery in children. However the combination of ondansetron with dexamerhasone, but not ondamsetrone alone, is more effective in reducing the level of patient's distress and incresing the level of parental satisfaction than the placebo.

Thoracic Epidural Anesthesia for Mastectomy / 대한마취과학회지

BACKGROUND: Segmental thoracic epidural anesthesia (sTEA) is commonly used for postoperative pain control in chest or upper abdominal surgery. But it is not commonly used for the purpose of pure regional anesthesia. Therefore we investigated the usefulness of sTEA for mastectomy and evaluated the effects of sTEA on respiration and hemodynamics. METHODS: Twenty patients scheduled for mastectomy were randomly assigned. Under sitting position, epidural catheter was inserted at T3-4 or T4-5. 20 ml of 0.375% ropivacaine with fentanyl 50 microg was injected to maintain anesthesia. The targeted sensory anesthetic dermatomal levels were determined by pinprick and measured at 5 min intervals for the first 15 min after injection of the drugs. If sensory block was not adequate, subsequent 5 ml doses of ropivacaine was injected. Supplemental oxygen (3-6 L/min) was administered through a face mask. After dermatomal level was checked, propofol infusion for sedation was started. Arterial blood sampling was taken for ABGA. RESULTS: Average sensory anesthetic dermatomal levels is C5.5 +/- 1.9 - T8.9 +/- 2.7. During surgery, hypotension was noted in 25% of patients. It was treated with ephedrine 6 mg i.v. Average PaCO2 is 47.9 +/- 7.7 mmHg. CONCLUSIONS: Above results suggest that sTEA is suitable for mastectomy as a method of regional anesthesia.

Ondansetron Reduces Postoperative Nausea and Vomiting after a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: The aim of the study was to evaluate the prophylactic effect of ondansetron on the postoperative nausea and vomiting (PONV) after a laparoscopic cholecystectomy (LC). METHODS: In this prospective, randomized, double-blind, placebo-controlled study, 77 healthy female patients, who underwent a LC under general anesthesia using sevoflurane were investigated. Patients were randomly divided into two groups; the ondansetron group (n = 39) was administered 4 mg ondansetron, and the placebo group (n = 38) 2 ml of normal saline before the end of surgery. The incidence and severity of PONV, and the need for rescue antiemetics during the first 6 h and 24 h after surgery were evaluated. RESULTS: The incidence of nausea in the ondansetron was significantly lower than in the placebo group during the 0-6 h (early nausea, P<0.05), but not in the 6-24 h (late nausea) postoperative period. However, the total incidence of nausea over the whole 24 h postoperative period was significantly lower in the ondansetron (36%) than in the placebo group (61%)(P<0.05), due to the low incidence of early nausea in the former. The incidence of vomiting was significantly lower in the ondansetron than in the placebo group during the 0-6 h and 6-24 h postoperative period. Therefore the total incidence of vomiting was significantly lower in the ondansetron (5%) than in the placebo group (46%)(P<0.001) over the whole 24 h postoperative period. The severity of nausea was also significantly lower in the ondansetron than in the placebo group. CONCLUSIONS: Ondansetron significantly reduces the PONV in female patients undergoing a LC during the first 24 h after surgery, and has a greater anti-vomiting than anti-nausea effect.