Comparative Study of 0.5% Hyperbaric Bupivacaine and 0.5% Hyperbaric Tetracaine in Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Marcaine is a recently introduced hyperbaric bupivacaine. The aim of this study was to compare the difference in hemodynamic change and sensory or motor block between 0.5% hyperbaric bupivacaine and 0.5% hyperbaric tetracaine in spinal anesthesia. METHODS: Thirty patients belonging to ASA classes I and II were divided into either a tetracaine (Group I) or bupivacaine (Group II). All patients received an infusion of lactated Ringer's solution (1,000 ml). We standardized techniques and injected equal doses (12 mg) in equal volume (2.4 ml) intrathecally for spinal anesthesia. After intrathecal injection of the agents, we measured the blood pressure, heart rate, change of sensory block level according to pinprick test and motor block by the modified Bromage score until fixation was achived. RESULTS: The onset time of sensory block was more rapid in Group I than in Group II. There was no difference in the level of sensory block between Group I and Group II. The time for maximum motor block was significantly shorter in Group I than in Group II (p < 0.05). The change in systolic and mean blood pressure in Group II was less than the change in Group I. CONCLUSIONS: Bupivacaine has a longer sensory block duration, a weaker intensity and shorter duration of motor block and yields less change in blood pressure than tetracaine in spinal anesthesia. Therefore, we concluded that spinal anesthesia with hyperbaric bupivacaine may be used more safely in comparision with hyperbaric tetracaine in hemodynamically troublesome cases.

The Incidence of Hypoxia Following the Use of Hypnotics and Analgesics during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. METHODS: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0 microgram/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injection of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after arrival in the recovery room. RESULTS: There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2 +/- 1.8%, for the second group 97.9 +/- 2.6%, and for the third group 92.4 +/- 2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group CONCLUSIONS: We concluded that oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia.

The Effect of Anal Packing on Urinary Retention after Hemorrhoidectomy under the Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Urinary retention after anorectal surgery is thought to be a mild complication but has a high incidence. Since anal pain and distention can contribute to the urethral spasm reflex which may cause urinary retention, we investigated the effect of absorbable gelatin sponge (Gelfoam(R)) used for anal packing postoperatively on urinary retention after hemorrhoidectomy under spinal anesthesia. METHODS: One hundred and nineteen ASA Physical Status I patients scheduled for hemorrhoidectomy were selected. Patients were randomly divided into Group A, postoperative anal packing free group and Group B, postoperative anal packing group and studied prospectively. Spinal anesthesia was performed with the bevel of 25 gauge Quincke needle parallel to dura fibers at lumber 3 4 intervertebral space and the injection of hyperbaric 0.5% tetracaine 6 mg (1.2 ml) to patients in sitting position. After hemorrhoidectomy, all patients were permitted to ambulate as soon as possible and urinate spontaneously. If urinary retention occurred, urinary catheterization was done temporarily. The number of patients who received urinary catheterization were recorded. Surgical technique and the total amount of intravenous fluid during the operation were controlled. RESULTS: The incidence of urinary retention in Group A (11/57, 19.3%) was similar to that in Group B (10/62, 16.1%) (P = 0.651, chi 2 = 0.205, degree of freedom = 1). CONCLUSIONS: Our study did not indicate the clue that the absence of anal packing helped to reduce the incidence of urinary retention after hemorrhoidectomy under spinal anesthesia.

Early Ambulation Reduces the Incidence of Urinary Retention after Spinal Anesthesia for Benign Anorectal Surgery / 대한마취과학회지

BACKGROUND: It has been known that bed rest after spinal anesthesia for benign anorectal surgery helps to reduce the incidence of postdural puncture headache, but the bed rest position is thought to have a negative effect on urinary retention, as a result of anxiety, anal distention, bladder distention and pain-induced reflex inhibition of the urinary bladder detrusor muscle. We investigate the effect of early ambulation after spinal anesthesia on postdural puncture headache and on urinary retention compared with bed rest for 24 hours. METHODS: One hundred and fifty-three ASA Physical Status I patients received spinal anesthesia for scheduled benign anorectal surgery. We applied hyperbaric 0.5% tetracaine 6 mg (1.2 ml) using 25 gauge Quincke needles with the cutting bevel parallel to the dural fibers at the patients' sitting position. All patients were randomly divided into an early ambulation group or bed rest group. We investigated the incidence of urinary retention and headache. The duration of operation, the perioperative intravenous fluid volume, surgical technique and postoperative pain regimen were standardized. RESULTS: The incidence of urinary retention in the early ambulation group (16/75, 21.3%) was lower than that in bed rest group (32/78, 41.0%). There was no difference in any parameters between the two groups. CONCLUSIONS: To reduce the incidence of urinary retention, early ambulation after spinal anesthesia for benign anorectal surgery is recommended over bed rest with no increase in the incidence of postdural puncture headache.

Spinal Anesthesia for Cesarean Section: A comparison of three doses of hyperbaric bupivacaine and the effects of fentanyl / 대한마취과학회지

BACKGROUND: Spinal anesthesia has several advantages in cesarean section. Those are rapid induction, complete analgesia, profound muscle relaxation, low failure rate and systemic toxicity. But the determination of anesthetic level is more difficult in spinal anesthesia than in epidural anesthesia. So we would like to determine the appropriate dosage of 0.5% hyperbaric bupivacaine and the effects of addition of intrathecal fentanyl. METHODS: Sixty full term parturiants scheduled for cesarean section were randomly received 0.5% hyperbaric bupivacaine 8, 10, 12 mg intrathecally. Analgesia, sensory and motor blockade, muscle relaxation, hypotension and side effects were assessed. We compared these results with the previous study that was done with the same dosages mixed with 10 microgram fentanyl. RESULTS: The maximum level of block was higher in 12 mg group (T2) then 8 and 10 mg group (T3). 5 parturients showed more than T1 sensory block in 12 mg group (n=20). 4 parturients did not reach T4 in 8 mg group (n=20). 7, 4 and 0 parturients complained pain during operation in each 8, 10, 12 mg group (p=0.012 between 8 and 12 mg group, p=0.062 between 10 and 12 mg group). Addition of 10 microgram fentanyl showed better analgesia and less shivering. CONCLUSION: Intrathecal 0.5% hyperbaric bupivacaine 12 mg showed complete analgesia for all parturients but the tendency of high spinal anesthesia. Analgesia was inadequate in 8 mg group. Addition of 10 microgram fentanyl showed better analgesia and less shivering.

A Sudden Cardiac Arrest during Spinal Anesthesia / 대한마취과학회지

Spinal anesthesia is a widely practiced technique for both elective and emergency procedures. It is recommended for its efficacy and safety. Hemodynamic instability and cardiac arrest have been reported in healthy patients. Sudden cardiac arrest occured during spinal anesthesia in sixteen-year old patient who had experienced three episodes of syncope associated with severe exercise or extremely psychological stress. Although the exact pathophysiology of this phenomenon is unknown, the etiology is probably multifactorial. The patient was immediately resuscitated and recovered with no adverse effects. Thus the patient who receives spinal anesthesia should be required constant monitoring and vigilance throughout all procedures.

Prevention of Nausea and Vomiting during Spinal or Epidural Anesthesia for Cesarean Section - The Efficacy of Metoclopramide and Droperidol - / 대한마취과학회지

BACKGROUND: Regional anesthesia for cesarean section is associated with a high incidence of nausea and/or vomiting (N&V) during the operation. Metoclopramide and droperidol have been known to be effective in the prevention of N&V. However, they have been reported to induce some adverse effects such as sedation. We evaluated the efficacy of metoclopramide and droperidol in the prevention of N&V in spinal and epidural anesthesia for cesarean section. METHODS: A prospective randomized double-blind study was performed on 180 parturients scheduled for elective cesarean section. They were allocated into spinal or epidural (n = 90, each) anesthesia groups and each group into either a placebo, metoclopramide, or droperidol drug group (n = 30, each). After delivery, 2 ml saline, 10 mg metoclopramide, or 0.625 mg droperidol was given to the parturients, respectively. Incidences of N&V and sedation during the operation were checked, and the other adverse effects of the anesthesias such as hypotension and visceral pain were compared among the groups. The height of sensory blockade was also checked. RESULTS: Epidural anesthesia was more related with N&V than spinal (P = 0.030). Among the groups there was a significant difference in the incidence of N&V (P = 0.002). There were fewer parturients with N&V in the droperidol group than in the placebo group during epidural anesthesia (P = 0.021). During both spinal and epidural anesthesia more parturients in the droperidol group had sedation than placebo or metoclopramide groups (P = 0.0001) and more in the metoclopramide group than in the pacebo group (P = 0.01). No differences were found in incidences of hypotension and in the height of sensory block among the groups. There were more parturients with visceral pain during epidural anesthesia (P = 0.031). CONCLUSIONS: Epidural anesthesia provoked N&V more frequently than spinal anesthesia for cesarean section. Only droperidol was effective in the prevention of N&V during epidural anesthesia, but had a more sedative effect than metoclopramide during either spinal or epidural anesthesia.

Spinal Anesthesia for Cesarean Section: A comparison of three doses of hyperbaric bupivacaine mixed with fentanyl / 대한마취과학회지

BACKGROUND: Spinal anesthesia for cesarean section is regaining popularity because it offers better intraoperative analgesia and relaxation than epidural anesthesia. Hyperbaric bupivacaine has been known to ameliorate visceral pain more than tetracaine and fentanyl seems to potentiate analgesic effect of bupivacaine. We evaluated if adding fentanyl reduce the dose of spinal hyperbaric bupivacaine. METHODS: Sixty healthy term parturients scheduled for elective cesarean section randomly received 8, 10 or 12 mg of 0.5% hyperbaric bupivacaine intrathecally, which was mixed with fentanyl 10 g. Intraoperative analgesia was checked with visual analog scale. Sensory blockade variables such as time to T4 block, maximal block height, time to maximal block height, time to and degree of motor block and muscle relaxation were assessed. We also checked side effects and times of regression to T10, complete motor recovery and start of postoperative pain. RESULTS: All patients had no intraoperative pain. The time to sensory block T4 and the level of maximum sensory block were not significantly different between three groups. Though only 70% of 8 mg group showed complete motor block, which is significantly less than 100% of 10 or 12 mg group (p=0.01), muscle relaxation was equally excellent in three groups. They showed no significant difference in side effects, but sensory and motor recovery and start of postoperative pain were faster in 8 mg group (p<0.05). CONCLUSION: After mixing with fentanyl 10 g, 10 mg or more of 0.5% hyperbaric bupivacaine was not necessary and 8 mg was enough in spinal anesthesia for cesarean section.

The Effect of Lithotomy Position on Hyperbaric Tetracaine Spinal Anesthesia / 대한마취과학회지

The effect of hyperbaric tetracaine spinal anesthesia was studied in 40 patients having genitourinary surgery in the horizontal lithotomy position. Patients were randomly assigned to one of two groups, after spinal injection, patients in one group were placed immediately in the supine and horizontal lithotomy position, and patients in the second group were placed immediatley in the supine and horizontal position for 10 minutes and then placed into the horizontal 1thotomy position. There were no statistically significant differences in anesthesia sensory level and heart rate of patients placed immediately in the horizontal lithotomy position compared to the patients kept in the supine position for the first 10 minutes after receiving the spinal anesthetic. The ranges of systolic blood pressure were all within normal limits, although systolic blood pressure showed a difference at 5,10 and 60 minute intervals after anesthesia. We conclude that immediate application of the horizontal lithotomy position can be safely practiced in the anesthesia of genitourinary surgery.

Effect of Intrathecal Morphine on Tourniquet Pain / 대한마취과학회지

In order to study the effect of spinal morphine on the tourniquet pain, 40 patients scheduled for orthopedic surgery on the lower extremity under spinal anesthesia were allocated randomly to two groups. In the experimental group, 20 patients received hyperbaric T-cain 10 mg and morphine 0.3 mg (0. 15 ml). In the control group, 20 patients received T-cain 10 mg and saline 0.15 ml. The levels of analgesia and motor block were similar in both groups. During surgery, patients in both groups did not complain of tourniquet pain, whereas one patient in the control group required general anesthesia for surgical pain although the sensory block extended to T(7). In the recovery room, when the sensory block had regressed to the Tdermatomal level, the pain response was checked on the contralateral unoperated thigh in a 60 min tourniquet pressure experiment (350 mmHg for 20 min, 0 mmHg for 20 min, 350 mmHg for 20 min). Seventeen patients in the experimental group experimenced no pain in this test, compared with four patients in the control group. From this study, it is suggested that intrathecal morphine prevents tourniquet pain and it may have some inhibitory effect on tourniquet pain transmission at the spinal cord level.