The Effect of Midazolam, Fentanyl and a Small Dose of Etomidate for Prevention of Myoclonus during Induction of Anesthesia with Etomidate / 대한마취과학회지

BACKGROUND: The hypothesis that subcortical disinhibition is the reason for etomidate-induced myoclonus suggest that drugs acting on the subcortical area may reduce myoclonus. To verify the hypothesis, premedication with placebo, etomidate of a small dosage, midazolam and fentanyl were compared. METHODS: Sixty ASA physical status I or II patients undergoing elective surgery were allocated into four groups. All groups were induced with etomidate 0.3 mg/kg and vercuronium 0.1 mg/kg and maintained with 50% N2O and 1.5-2% enflurane. Group I (n = 15) received normal saline 3 ml 5 minutes before the etomidate 0.3 mg/kg administration, group II (n = 15) received 0.05 mg/kg etomidate 50 seconds before the etomidate 0.3 mg/kg administration, group III received midazolam 0.05 mg/kg 5 minutes before the etomidate 0.3 mg/kg and group IV received 2 microgram/kg fentanyl 5 minutes before the etomidate 0.3 mg/kg. In all patients, the grade, starting time, maintenance time of myoclonus and vital signs were checked and compared between the four groups. RESULTS: In group IV, myoclonus did not develope except in one patient and there were no differences in the incidence of myoclonus between the others. All premedicating drugs do not affect vital signs. CONCLUSIONS: We find that fentanyl reduces the incidence of etomidate-induced myoclonus but midazolam and a small dose of etomidate are not effective.

Effect of supplemental intravenous anesthesia in plastic surgery under local anesthesia

When operations in the field of plastic surgery are performed under local anesthesia, the degree of pain suffering the patients becomes different depending on the kind, dosage effective duration of anesthetic agent and the technique of the operator. Patients suffer from pain physically and psychologically when skin infiltration is carried out. Recently, out-patient surgery has increased in number, so the necessity of more complete analgesia for the patient undergoing surgery is required. Patients were operated under the local infiltrative anesthesia, and the supplemental intravenous anesthesia to kill pain. Patients were randomly divided into four groups differing in combinations of intravenous anesthetic agents, such as ketamine, midazolam, fentanyl that have potent analgesic sedative and amnesic effects. By random allocation patients received ketamine and midazolam(Group I), ketamine and fentanyl(Group II), midazolam and fentany l (Group III), ketamine, fentanyl arts midazolam(Group IV). The purpose of this study is to focus on the results obtained in four groups for finding out a more safe and less complicated combination of intravenous anesthetic agents and for standardization of dosage. In conclusion the group I (ketamine and midazolam) showed better results than other groups for the following reasons; no significant change in vital signs, no hypoxia no complication such as nausea, headache unpleasant dream, and hallucination, potent analgesia effects, amnesia. We have found this combination to be a highly satisfactory anesthesia and analgesia technique for outpatient plastic surgery from the standpoints of the surgeon and the patient.

Effect of supplemental intravenous anesthesia in plastic surgery under local anesthesia

When operations in the field of plastic surgery are performed under local anesthesia, the degree of pain suffering the patients becomes different depending on the kind, dosage effective duration of anesthetic agent and the technique of the operator. Patients suffer from pain physically and psychologically when skin infiltration is carried out. Recently, out-patient surgery has increased in number, so the necessity of more complete analgesia for the patient undergoing surgery is required. Patients were operated under the local infiltrative anesthesia, and the supplemental intravenous anesthesia to kill pain. Patients were randomly divided into four groups differing in combinations of intravenous anesthetic agents, such as ketamine, midazolam, fentanyl that have potent analgesic sedative and amnesic effects. By random allocation patients received ketamine and midazolam(Group I), ketamine and fentanyl(Group II), midazolam and fentany l (Group III), ketamine, fentanyl arts midazolam(Group IV). The purpose of this study is to focus on the results obtained in four groups for finding out a more safe and less complicated combination of intravenous anesthetic agents and for standardization of dosage. In conclusion the group I (ketamine and midazolam) showed better results than other groups for the following reasons; no significant change in vital signs, no hypoxia no complication such as nausea, headache unpleasant dream, and hallucination, potent analgesia effects, amnesia. We have found this combination to be a highly satisfactory anesthesia and analgesia technique for outpatient plastic surgery from the standpoints of the surgeon and the patient.

Effects of intravenous anesthetics on the phagocytosis of human neutrophils / 中华麻醉学杂志

The effects of intravenous anesthetics on phagocytosis of human neutrophils were observed in vitro. 1?10~6/ml of neutrophils, isolated from heparinized venous blood of healthy human,was mixed at equivalent volume with normal saline (as control), four different concentrations (clinical doses) of droperidoI, midazolam, fentanyl,etomidate or sodium hydroxybutyrate respectively. All mixtures were incubated in each of four 24-pore culture plates. The equivalent volumes of staphylococci 6～9?10~9/ml were added to these mixtures, 10 mins, 30 mins, 2hs or 24hs after incubation individually. The successive incubations lasted 45 mins,and the neutrophil phagoeytosis rate (NPR) was calculated. The results showed that NPR was correlated negatively with the concentration of each anesthetic mentioned above. but was related to its acting-duration. It is demonstrated that these intravenous anesthetics may reduce the phagoeytosis of neutrophils in a dose-related way,therefore we suggest that antibiotics or antineoplastics should be used in combination with these anesthetics during operation.