Comparision of Hemodynamic Changes in Patients Undertaking Hysterectomies under Genernal and Epidural Anesthesia / 대한마취과학회지

BACKGROUND: The purpose of the study was to evaluate the effect of postural change on hemodynamics using thoracic eletrical bioimpedance (TEB) device during general anesthesia with enflurane-N2O-O2 and lumbar epidural anesthesia. The TEB device is safe, reliable and non-invasive way to measure hemodynmic values continuously. METHODS: General anesthesia (twenty patients) was induced by administration of pentotal sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously, and was maintained with 1 vol% of enflurane, N2O-O2 (2 l/min-2 l/min) and vecuronium 0.1 mg/kg. Epidural anesthesia (twenty patients) was performed at the level of L3-4 epidural space using 20 ml of 2% xylocaine mixed with epinephrine (5 microgram/ml). Hemodynamic changes were measured before induction, 1 and 5 minutes after intubation or epidural injection, 1, 5, 10, 20, 30 minutes after head- down tilt and 1, 5, 10 minutes after returning to the supine position. RESULTS: HR and LVSWI were minimaly affected in group E with epidural anesthesia compared to group G with general anesthesia. BP (SBP, DBP, MAP) and SVRI were remarkably increased in group G compared to group E. BP and SVRI showed rapid increse 1 minutes after head-down tilt in group G (p<0.01) and decreased gradually thereafter. SI and CI were decreased significantly in group G compared to group E (p<0.001). SI was unchanged but CI was decreasd significantly after head-down tilt in group E (p<0.05). EDI and ACI showed lower values decreased in general significantly in group G compared to group E (p<0.05). CONCLUSIONS: All hemodynamic changes were more predictable, gradual, less variable, and stable in the group with epidural anesthesia compared to the group with general anesthesia for hysterectomy.

The Effect of Posture on the Induction of Epidural Anesthesia / 대한마취과학회지

BACKGROUND: A study was done to determine if there is any difference in the quality of anesthesia and time to reach maximum anesthesia between the induction of lumbar epidural anesthesia in the sitting and supine position in young male patients undergoing appendectomy. METHODS: We randomly divided 30 patients to 2 groups. An epidural catheter was inserted at L2~3 interspace. In group 1, with the patient sitting, 3 ml of 1% lidocaine with 5mcg/ml epinephrine was injected as a test dose via the epidural catheter, and then 3 minutes later, 0.5% bupivacaine 30 ml was given through the same catheter. After maintaining sitting position for 5 minutes, the patient changed to a supine position and the quality of anesthesia was assessed at 3-minute intervals for 30 minutes. In group 2, after the epidural catheter was inserted at the sitting position, the patient changed to a supine position immediately. Remaining procedures were the same. RESULTS: The two groups showed no difference in maximum cephalad spread of anesthesia and motor block. CONCLUSIONS: The position of the patient during induction of epidural anesthesia has no effect on the cephalad sensory and motor block.

Effect of Supine or Jack-knife Position on the Arterial O2, CO2 Tension, Respiratory Rate and Oxygen Saturation Following Midazolam Sedation for Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Anorectal procedures are performed in the jack-knife position. The combined use of midazolam and spinal anesthesia is common in clinical practice. Despite the known potential for each to alter ventilation, the effect of their interaction under jack-knife position has not been examined. METHODS: In a prospective, double-blind, and randomized study, forty patients (four groups, n=10 each, saline-supine position group, saline-jack-knife position group, midazolam-supine position group and midazolam-jack-knife position group) were examined. The effect of intravenous midazolam (0.05 mg/kg) for sedation, spinal anesthesia (hyperbaric tetracaine, below T8), position (jack-knife position or supine position during operation), and their combination on mean arterial pressure, arterial oxygen saturation (SpO2), PaO2, PaCO2, respiratory rate were evaluated. Incidence of hypoxemia was measured by pulse oximetry (SpO2 less than 90% for 30 seconds or longer). RESULTS: The incidence of hypoxemia in the midazolam-supine position group was 20%. There was no patient showing hypoxemia in other groups. After spinal anesthesia, there were no significant differences of mean arterial pressure, arterial oxygen saturation, PaO2, PaCO2, respiratory rate between supine and jack-knife position. The combination of jack-knife position and midazolam caused a significant increase of PaCO2 (9% of baseline value). Cardiovascular side effects such as hypotension or other reactions such as vomiting, nausea, or confusion were not observed after midazolam. At the end of the operation, all patients were fully awake and cooperative. CONCLUSIONS: Intravenous midazolam (0.05 mg/kg) may produce hypoxemia (SpO2<90%) during spinal anesthesia in supine position. In the jack-knife position, intravenous midazolam caused increase of the arterial CO2 tension. Monitoring of arterial blood oxygen saturation is mandatory in patients with spinal anesthesia and midazolam sedation during supine position.

The Effect of Laryngeal Mask Airway on Postoperative Sore Throat in Prone Position / 대한마취과학회지

Background: Postoperative sore throat is a complaint after general anesthesia of multifactorial etiology. The laryngeal mask airway (LMA) reduces sore throat and discomfort during maintenance of the airway and make patients more comfortable. The purpose of this study was to compare effect of patient's position during operation on postoperative sore throat after the use of LMA. Methods: The fifty three patients were randomly divided into two groups. Group 1 (n=30) was underwent general anesthesia with supine position and group 2 (n=23) with prone position. After the LMA was positioned in the hypopharynx and the cuff inflated, fiberoptic laryngoscope was immediately passed down through the LMA. Number of attempts, degree of postoperative sore throat and other complications were also noted. Results: The incidence of postoperative sore throat after the use of LMA was 10% in supine position and 4% in prone position. But the difference between the groups was not statistically significant. All of the reported sore throats were rated as mild. Conclusions: Postoperative sore throat after the use of LMA is mild and the incidence is not affected by the prone position during the operation.

Hemodynamic Changes on Position Changes in Healthy Adult Measured by Bioimpedance / 대한마취과학회지

INTRODUCTION: The purpose of positioning is to allow the procedure to be performed as simply as possible and to achieve the best possible results free of complications. In a normal person, many investigators have researched the hemodynamic changes during positional adjustments. But the delicate qualitative hemodynamic changes in various positions has not been recorded very much. So we studied the qualitative hemodynamic changes in various positions with a noninvasive bioimpedance method. METHOD: Healthy adult males were studied (n=25). The protocol was that the position changed from supine to head-up, head-down, lithotomy, sitting, right-lateral, prone and Jackknife (J-K) position. Each position was sustained for three minutes. The mean arterial pressure (MAP), heart rates (HR), left cardiac work index (LCWI), systemic vascular resistance index (SVRI), cardiac index (CI), stroke index (SI) and end diastolic index (EDI) were measured with the bioimpedance method and an automated blood pressure device. Result: The contractility of heart expressed by LCWI, CI and SI decreased in head-down, sitting, right-lateral, prone and J-K positions. The preload expressed by EDI decreased in right-lateral and J-K positions. The afterload expressed by SVRI increased in sitting, prone and J-K positions, and decreased in right-lateral position. CONCLUSIONS: These results may be used as reference for anesthesiologist managing many patients of various physical status.