Posterior Reversible Encephalopathy Syndrome after Cesarean Section under Spinal Anesthesia: A case report / 대한마취과학회지

A posterior reversible encephalopathy syndrome (PRES) is characterized as headache, altered mental function, seizure, and visual disturbances resulted from vasogenic edema in the brain. A 29-year-old normotensive parturient developed a postural headache two days after the cesarean section under spinal anesthesia. The headache was initially misdiagnosed as a postdural puncture headache (PDPH). The patient experienced generalized seizures four days after delivery. Her blood pressure increased to 170/100 mmHg with mild proteinuria. She developed homonymous hemianopsia two days after the seizures. MRI revealed high signal intensity areas in the posterior temporal, frontal, occipital and parietal white matter. Presuming a diagnosis of PRES, the patient was treated with magnesium sulfate, sodium valproate, and carbohydrate solutions. She was discharged without headache or neurologic deficit on postoperative day 13. When patients present a headache with focal neurological deficits or visual disturbances, the anesthesiologist must consider the possibility of PRES and aggressively treat based on the clinical presentation.

The effects of epidural analgesia on labor progress and perinatal outcomes / 대한산부인과학회지

OBJECTIVE: We evaluated the effects of epidural analgesia on labor progress and perinatal outcomes in nulliparous women. METHODS: Between June 2004 and December 2004, we included total one hundred and thirty-two normal near term nulliparous women in early spontaneous labor or rupture of membranes for a prospective analysis. Patients were divided into those who received epidural analgesia (study group n=66) and those who did not (control group n=66). In order to evaluate the effects of epidural analgesia on labor progress, we compared the duration of active phase of labor and second stage of labor, cervical dilatation on admission, Bishop score and labor interval between the groups. We also compared perinatal outcomes between the two groups. RESULTS: The duration of active phase of labor was 4.7+/-2.0 hours in the study group and 3.6+/-1.9 hours in the control group showing a statistically significant prolongation in the duration of active phase of labor and significant slowing in the rate of cervical dilatation (p<0.05). The second stage of labor was also prolonged slightly in the study group (65.1+/-39.0 minutes) compared to the control group (54.1+/-33.5 minutes) but no statistical significance was noted. There was no significant difference in perinatal outcomes. CONCLUSION: Epidural analgesia may prolong active phase of labor. Therefore, we should always consider the effect of epidural analgesia before we decide to perform cesarean section.

Hemodynamic Effects of Intravenous Bolus Dosing of Nicardipine on Pneumoperitoneum during Laparoscopically-Assisted Vaginal Hysterectomy (LAVH) / 대한마취과학회지

BACKGROUND: Pneumoperitoneum and a head-down tilt during a laparoscopically-assisted vaginal hysterectomy (LAVH) decrease the cardiac index with a concurrent increase in blood pressure. This study investigated the effects of bolus nicardipine on the changes in the hemodynamics. METHODS: The patients scheduled for LAVH were randomly assigned to 1 of 3 treatment groups: control (n = 40) receiving normal saline; NIC 15 (n = 40) and NIC 30 (n = 40) groups receiving intravenous nicardipine 15 microgram/kg, 30 microgram/kg, respectively 1min before pneumoperitoneum. The hemodynamic parameters (mean blood pressure [MBP], cardiac index [CI], and heart rate [HR]) were measured before inducing anesthesia (INI, only the MBP and HR [the CI was not measured]), immediately after tracheal intubation (INT), prior to the skin incision (BF), and 2, 5, 10, 20, and 30 min after pneumoperitoneum (P2, P5, P10, P20, P30) by noninvasive cardiac output measurements. A p value 20%. In the control group, the CI had decreased at P2, P5 in comparison with BF. An increase of CI was observed at P5 in the NIC 15 group and at P2, 5, and 10 in the NIC 30 group compared with the control group. CONCLUSIONS: Intravenous bolus dosing of 30 microgram/kg nicardipine at 1 min before pneumoperitoneum during LAVH can reduce the decrease in CI after pneumoperitoneum and Trendelenburg position in LAVH but the blood pressure needs to be monitored carefully.

Preoperative Anxiety and Propofol Requirement in Conscious Sedation for Ovum Retrieval

The purpose of the present study was to evaluate the correlation among the trial number of in vitro fertilization (IVF), preoperative anxiety, and propofol requirement for conscious sedation. One hundred and twenty six Korean women undergoing oocyte retrieval were enrolled. The target-controlled infusion by the anesthesiologist was conducted with initial target propofol concentration of 2.5 microgram/mL, which was manipulated until the sedation score 3 and desired clinical end point were achieved. A weak correlation was observed between visual analogue scale (VAS) anxiety and the dose of propofol required for the induction of conscious sedation (r=0.22, p=0.0192). A weak correlation was also found between VAS anxiety and the sedation time needed to reach the proper conscious sedation level for the procedure (r=0.181, p=0.0484). Multiple regression analysis showed that VAS anxiety, preoperative baseline prolactin level, and cortisol level had statistically significant effects on the propofol induction dose for target controlled conscious sedation. We concluded that the induction dose and time requirements for propofol in anesthesiologist- controlled conscious sedation be modified based on the preoperative anxiety level and the baseline blood concentration of stress hormone, cortisol and prolactin.