Hemodynamic Responses of Pretreatments Designed to Reduce Withdrawal Movements Following Rocuronium Injection: A Comparison of Alfentanil with Lidocaine / 대한마취과학회지

BACKGROUND: This study was conducted to compare the efficacy of intravenous alfentanil and lidocaine as a pretreatment for the prevention of withdrawal movements following a rocuronium injection and hemodynamic change following tracheal intubation. METHODS: This study evaluated 180 patients that were divided into the following 3 pretreatment groups: group C: normal saline, group L: lidocaine 1 mg/kg, group A: alfentanil 10microgram/kg. Anesthesia was induced using 5 mg/kg thiopental sodium, after which the test drug was injected. Rocuronium (1 mg/kg) was then administered 1 minute after the test drug was injected over 5 seconds and the response was characterized as one of the following: no movement, movement limited to the wrist, to the elbow or to the shoulder. Intubation was performed 1 minute later. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were then recorded at each of the following points: T1: preinduction, T2: immediately prior to rocuronium injection, T3: immediately after rocuronium injection, T4: immediately prior to intubation, T5: immediately after intubation, T6: 1 minute after intubation, T7: 5 minutes after intubation. RESULTS: The incidence of withdrawal movement was significantly lower in group A than groups C and L (P < 0.05). In addition, SBP, DBP and HR following intubation were significantly lower in group A than group C and group L (P < 0.05). CONCLUSIONS: Pretreatment with 10microgram/kg of alfentanil effectively reduced the incidence of withdrawal movement in response of rocuronium injection and caused minimal hemodynamic changes following intubation.

Cardiac Tamponade Occurred during Subclavian Venous Catheterization / 대한마취과학회지

There have been numerous reports of complications associated with central venous catheterization. These are pneumothorax, hemothorax, nerve injury, and so on. These complications can occur more frequently with the subclavian approach than with the internal jugular approach in inexperienced hands. We report a rare complication, cardiac tamponade, which occurred during subclavian venous catheterization. A 44 year-old woman was scheduled for left pneumonectomy due to a tuberculosis destroyed lung. The first trial of subclavian venous catheterization was failed because of the arterial puncture. The internal jugular vein was cannulated successfully. Just after catheterization, sudden hypotension and tachycardia developed and persisted with vasopressors. An emergent left thoracotomy and pericardiostomy to evacuate massive hematoma confirmed the diagnosis, cardiac tamponade. This case suggests that central catheterization should be done carefully and it is better to avoid using the subclavian vein when there is radiological evidence of abnormal cardiac anatomy or great vessels due to a destroyed lung.