The Clinical Assessment of the Efficacy and Safety of the Intubating Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: The intubating laryngeal mask airway (ILMA) was introduced recently as an effective ventilatory device and intubation guide. The following study was designed to assess not only efficacy but also safety of the ILMA. METHODS: Sixty adult patients who were randomly assigned in 3 groups (Group 1, 2, 3), ASA class 1 or 2, undergoing elective surgery were induced with intravenous injection of fentanyl, thiopental sodium, vecuronium, lidocaine and inhalation of O2, N2O, enflurane. In Group 1 (n=20), the patients were intubated with Macintosh curved blade and endotracheal tube. In Group 2 (n=20), blind tracheal intubation using an ILMA was attempted. In Group 3 (n=20), we applicated the ILMA to a fiberoptic bronchoscope-aided tracheal intubation. Then we decided success rates for blind and fiberoptic-guided passage of an endotracheal tube via the ILMA. We measured systolic, diastolic arterial pressure and heart rate before administration of induction agent, 1 and 5 minutes after induction, just after intubation, 1, 2, 3 and 5 minutes after endotracheal intubation. RESULTS: The success rates for blind (Group 2) and fiberoptic-guided (Group 3) passage of an endotracheal tube via the ILMA were 70% and 100% respectively. There were no statistically significance in the systolic, diastolic arterial pressure and heart rate when compared to value of any other groups at any time but higher in all groups when compared to preinduction value of each group just after intubation. CONCLUSIONS: Though the ILMA may be an effective intubation guide, it doesn't blunt hemodynamic changes effectively than standard laryngoscopic intubation.

Comparison of Midazolam-Ketamine with Midazolam for Sedation during Retrobulbar Block in Cataract Surgery / 대한마취과학회지

BACKGROUND: Many ophthalmic procedures can be performed using a retrobulbar regional anesthetic technique. However, retrobulbar block is painful and most of patients express anxiety about the procedure. In addition, several life-threatening complications may occur. We compared the effects of midazolam and midazolam-ketamine as a sedative during retrobulbar block in cataract surgery. METHODS: Thirty patients undergoing cataract surgery were randomly allocated into two groups, group I (n=15) was received midazolam and group II (n=15), midazolam-ketamine. Mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) were compared before administration of drugs and 1, 2, 3, 4, 5, 10, 20, and 30 min after administration of drugs. Patients' movement requiring restraint were also checked. In the recovery room, postoperative nausea and vomiting, recall, delirium and/or hallucinations, and ocular complications were recorded. RESULTS: There were no significant differences in MAP and SpO2 between groups but heart rates were significantly increased at 1, 2, 3, 4, and 5 min than baseline in group II. Movement score was significantly lower in Group II than in Group I during the block (p<0.05). Recall during performance of the nerve block occured more often in Group I than in Group II (p<0.05). CONCLUSION: Low-dose midazolam-ketamine sedation sequence was superior to a midazolam technique regarding patients' movement and recall.

Caudal Epidural Morphine for Postoperative Analgesia in Children / 대한마취과학회지

BACKGROUND: The use of caudal morphine for postoperative analgesia has been increased in popularity since 1981. The purpose of this study was to compare the effect of analgesia and incidence of side effects of a mepivacaine-morphine mixture with mepivacaine alone. METHODS: Forty patients were randomly divided into two groups. In group 1, caudal block was performed with 1% mepivacaine 1 ml/kg alone. In group 2, caudal block was performed with 1% mepivacaine 1ml/kg-morphine 0.03 mg/kg mixture. Postoperative five-point pain scores and side effects were measured. RESULTS: There were no significant differences in sedation dose, incidence of side effects and supplemental analgesics. Pain scores were significantly lower at postoperative 2 and 3 hours in mepivacaine-morphine mixture group. CONCLUSIONS: Caudal epidural mepivacaine-morphine (0.03 mg/kg) mixture is effective in children for control of postoperative pain without significant side effects.

Heart Failure and Pulmonary Edema in Patient with Graves` Disease during Cesarian Section / 대한마취과학회지

We report a case of heart failure and pulmonary edema in patient with Graves disease during recovery from general anesthesia for cesarean section. A 34-year-old multigrivida, at 35 weeks gestation underwent emergency cesarian section for preterm labor, twin pregnancy and polyhydramnios. She has been treated with Graves' disease for 5 years. After premedication with propranolol and glycopyrrolate, anesthesia was induced with thiopenthal and maintained with O2 -N2 O-enflurane. At the end of skin closure, heart failure and pulmonary edema were developed. On auscultation, systolic murmur was audible at the left sternal border and immediate echocardiography revealed mitral valve prolapse accompanied with mitral regurgitation. After proper treatment, she was discharged without complication at 14 days after surgery.

Heart Failure and Pulmonary Edema in Patient with Graves` Disease during Cesarian Section / 대한마취과학회지

We report a case of heart failure and pulmonary edema in patient with Graves disease during recovery from general anesthesia for cesarean section. A 34-year-old multigrivida, at 35 weeks gestation underwent emergency cesarian section for preterm labor, twin pregnancy and polyhydramnios. She has been treated with Graves' disease for 5 years. After premedication with propranolol and glycopyrrolate, anesthesia was induced with thiopenthal and maintained with O2 -N2 O-enflurane. At the end of skin closure, heart failure and pulmonary edema were developed. On auscultation, systolic murmur was audible at the left sternal border and immediate echocardiography revealed mitral valve prolapse accompanied with mitral regurgitation. After proper treatment, she was discharged without complication at 14 days after surgery.

Comparison of Response between the Ulnar , Facial , Peroneal and Tibial Nerve after Administration of Vecuronium / 대한마취과학회지

Since as neuromuscular blocking agents are usually used during general anesthesia, monitoring of muscle relaxation is integra1 part of the management of patients and the ulnar nerve is allowed commonly to evaluate of neuromuscu1ar blockade. But our study was designed to monitor neuromuscular blockade-induced Vecuronium blocakade in 40 ASA 1-2 adult pateints in various nerves other than ulnar nerve with the single twitch(T1) and post-tetanic count(PTC) methods. All patients were premedicated with glycopyrrolate 0.2 mg and hydroxizine 1 mg/kg Ihour before induction, and were inducted with thiopental sodium 5 mg/kg and maintained with nitrous oxide(50%) and enflurane(1-2%). The patients were randomly divided to 4 groups, the ulnar nerve group was monitored at the adductor pollicis muscle, the facial nerve group was monitored at the orbicularis oculi muscle, the peroneal nerve group was monitored at the extensor digitorum brevis muscle, and the tibial nerve group was monitored at the flexor hallucis brevis muscle. After administration of vecuronium bromide 0.1 mg/kg, the onset time, duration of action and recovery time were compared between 4 group by INNERVATOR(Fisher & Paykel Co). The results obtained were as follow; 1) At the onset time, the facial nerve group was significant shorter than the ulnar nerve group, but the tibial and peroneal nerve group was significant prolonged. 2) The action duration from disappearance of single twitch to first appearance of PTC was significant prolonged in the peroneal nerve group than the ulnar nerve group but no significance was observed in the facial and tibial nerve gruop. 3) The recovery time from disappearance of single twitch to first appearance of single twitch was significant prolonged in the peroneal nerve group than the ulnar nerve group but no significance was observed in the facial and tibial nerve group.

Comparison of Response between the Ulnar , Facial , Peroneal and Tibial Nerve after Administration of Vecuronium / 대한마취과학회지

Since as neuromuscular blocking agents are usually used during general anesthesia, monitoring of muscle relaxation is integra1 part of the management of patients and the ulnar nerve is allowed commonly to evaluate of neuromuscu1ar blockade. But our study was designed to monitor neuromuscular blockade-induced Vecuronium blocakade in 40 ASA 1-2 adult pateints in various nerves other than ulnar nerve with the single twitch(T1) and post-tetanic count(PTC) methods. All patients were premedicated with glycopyrrolate 0.2 mg and hydroxizine 1 mg/kg Ihour before induction, and were inducted with thiopental sodium 5 mg/kg and maintained with nitrous oxide(50%) and enflurane(1-2%). The patients were randomly divided to 4 groups, the ulnar nerve group was monitored at the adductor pollicis muscle, the facial nerve group was monitored at the orbicularis oculi muscle, the peroneal nerve group was monitored at the extensor digitorum brevis muscle, and the tibial nerve group was monitored at the flexor hallucis brevis muscle. After administration of vecuronium bromide 0.1 mg/kg, the onset time, duration of action and recovery time were compared between 4 group by INNERVATOR(Fisher & Paykel Co). The results obtained were as follow; 1) At the onset time, the facial nerve group was significant shorter than the ulnar nerve group, but the tibial and peroneal nerve group was significant prolonged. 2) The action duration from disappearance of single twitch to first appearance of PTC was significant prolonged in the peroneal nerve group than the ulnar nerve group but no significance was observed in the facial and tibial nerve gruop. 3) The recovery time from disappearance of single twitch to first appearance of single twitch was significant prolonged in the peroneal nerve group than the ulnar nerve group but no significance was observed in the facial and tibial nerve group.

The Clinical Comparative Stndy on Liver Function with Enflurane and Halothane Anesthetics / 대한마취과학회지

Halothane was introduced in 1956. It has been used worldwidely as a relatively safe inhalation anesthetic but it is generally accepted that it can cause decrease of liver function. But the causative factor has not yet been pinpointed. Enflurane also seems to decrease liver function but the exact cause is not yet known. In order to study the effects of enflurane and halothane on liver function, we used 10 cases of spinal anesthesia as a control group, and 20 cases each of enflurane and halothane anesthesia respectively as experimental group. We then checked serum GOT, GPT, total bilirubin, alkaline phosphatase, and eosinophil count in peripheral venous blood before oeration and 6 days after operation and looked for the existence of high fever of more than 39 degrees C 3 days postoperatively. The results are as follows: 1) We found statistical significant change of serum GOT, GPT, total billirubin alkaline phosphatase and eosinophil count in spinal, enflurane, or halothane anesthesia beofre and after operation. There was no statistically significance between the control and experimental groups. 2) No patient developed high fever of more than 39 degrees C until 3 days after anesthesia in any group. 3) No significant change of mean arterial blood pressure was observed before and during anesthesia in each group. In this study no definite conclusion that enflurane and halothane might have affected the liver function.