Vital Capacity Induction with Sevoflurane in Children Results in Less Incidence of Withdrawal after Rocuronium than Tidal Volume Induction / 대한마취과학회지

BACKGROUND: The Vital capacity technique is known to have some advantages over the tidal volume technique during inhalation induction of anesthesia.The aim of this study was to compare the incidence of withdrawal movement associated with the intravenous administration of rocuronium 0.3 mg/kg in children during inhalation induction with sevoflurane using the tidal volume and vital capacity techniques. METHODS: We randomly assigned 130 patients (aged 5-12 years) to either tidal volume (group T) or vital capacity (group V) groups for inhalation induction with sevoflurane.Rocuronium 0.3 mg/kg was administrated after loss of the eyelash reflex.The time to loss of the eyelash reflex was recorded and adverse events during induction were documented.The patient's response to rocuronium injection was graded using a four-point scale. RESULTS: No significant differences were observed between the groups with respect to age, weight, and gender.The time to loss of the eyelash reflex was more rapid in group V than in group T (P < 0.05).Excitatory movement developed more frequently in group T, and no significant differences were found in the incidence of other adverse events between the groups.The incidence of withdrawal movement associated with the injection of rocuronium was significantly lower in group V compared to group T (30 vs. 60%; P < 0.05). CONCLUSIONS: Inhalation induction with sevoflurane using the vital capacity technique decreased the incidence of withdrawal movement during the injection of rocuronium compared to the tidal volume technique.

The Efficacy and Incidence of Side Effects in Patient Controlled Analgesia Using Hydromorphone / 대한마취과학회지

BACKGROUND: Hydromorphone, a derivative of morphine, has the same actions and uses as morphine, has about eight times more potency on a milligram basis. Hydromorphone is used for the relief of moderate to severe pain. There has been no report in Korea on patient controlled analgesia (PCA) using hydromorphone. Here, the efficacy and incidence of side effects of PCA, with hydromorphone, were investigated. METHODS: 68 patients scheduled for spinal, urological, gynecological and general surgery were enrolled. Patients received standardized general anesthesia, with the PCA initiated at the end of surgery. Parameters for PCA were a 0.1 mg bolus and 0.05 mg/hr infusion of hydromorphone, with a 10 min lockout interval. A verbal rating scale (1: none, 2: very mild, 3: mild, 4: moderate, 5: severe) of pain, nausea (mild, moderate, severe), vomiting, dizziness and somnolence were assessed at 6, 12, 24 hr postoperatively. The amount of hydromorphone used and the requirements for symptomatic relief were also recorded. RESULTS: The mean pain scores were 3.5+/-0.8, 2.9+/-0.8 and 2.5+/-0.7, and the amounts of hydromorphone delivered were 1.0+/-0.1, 1.8+/-1.0 and 2.7+/-1.3 mg, 6, 12 and 24 hr postoperatively, respectively. The incidence of nausea, vomiting, dizziness and somnolence were 17.6, 4.4, 8.8 and 1.5%, respectively. CONCLUSIONS: Intravenous PCA, with hydromorphone, was effective in controlling postoperative pain, with fewer eide effects than morphine, as reported in the literature.