A Comparison of the Effects of Ondansetron and Granisetron on the Prevention of Postoperative Nausea and Vomiting after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the effects of ondansetron and granisetron on the prevention of postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: In a randomized placebo-controlled study, 200 gynecologic patients were divided into 5 groups. Each patient received one of 5 medications: placebo (saline 3 ml), ondansetron 4 mg (O4), ondansetron 8 mg (O8), granisetron 1.5 mg (G1.5) and granisetron 3 mg (G3). They were administered intravenously immediately before the induction of anesthesia. A standardized inhalation anesthesia and a postoperative intravenous patient-controlled analgesia were applied. Twenty four hours after anesthesia, the incidence and severity of PONV and other adverse effects were assessed. RESULTS: The incidence of PONV was 88%, 83%, 75%, 70% and 60% in the placebo, O4, O8, G1.5 and G3 groups, respectively, which showed significantly lower value in the G3 group than in the placebo and O4 groups (P< 0.05). The severity of PONV was also significantly lower in the G3 group than in the placebo group (P < 0.05). CONCLUSIONS: In this study, granisetron 3 mg showed a better prophylactic effect in the mitigation of PONV in gynecologic patients then a placebo or ondansetron 4 mg.

Anesthetic Management during Laparoscopic Cystectomy in a Third Trimester Pregnancy: A case report / 대한마취과학회지

Pregnancy, especially in the third trimester, has been considered a contraindication of laparoscopic procedure because the effect of CO2 pneumoperitoneum on the fetus and uterine blood flow was unclear. However, the benefits of laparoscopic surgery such as less stress response and shorter hospital stay are postulated. Laparoscopic surgery may be beneficial in pregnant patients compared to open laparotomy, and the safety of laparoscopic operations in pregnant women is under investigation. The careful anesthetic management and close monitoring of patient and fetus will be helpful in making laparoscopic surgery safer in pregnant patients. We report the anesthetic management for laparoscopic surgery in a third trimester pregnant patient with torsion of an ovarian cyst. We monitored the intestinal mucosal CO2 using Tonocap, because we considered it could represent the uterine perfusion and intestinal CO2 status. Although the arterial and intestinal mucosal CO2 tension increased gradually during the operation, hypercapnia was not remarkable. The respiratory and monitored parameters were stable during the laparoscopic procedure. The patient has maintained uneventful pregnancy and delivered a healthy baby at 41 weeks of gestation.

Preemptive Analgesia of Butorphanol for Hysterectomy / 대한마취과학회지

BACKGROUND: It is necessary to reduce hyperexcitable sensations induced by painful stimulus by preventing central sensitization, so called preemptive analgesia. We observed the effect of butorphanol on postoperative pain after hysterectomy so as to direct analgesic action based on elucidation of the preemptive effect. METHODS: We selected thirty-six patients undergoing elective total abdominal hysterectomy, ASA Physical Status I or II, and employed a double-blind cross-over design. Patients were randomly allocated to one of both groups, receiving intravenous butorphanol 2 mg, either preincisionally or postoperatively. Anesthesia was induced with thiopental and maintained with isoflurane. Patients received meperidine on request for postoperative pain. Patients checked the VAS of spontaneous incisional pain and movement-associated pain by themselves.The time of first demand for postoperative meperidine and the amount of postoperative meperidine for the first 6 hours and 6 to 48 hours were recorded. RESULTS: At 5 hours after surgery, the postoperative VAS score of the preincisional group was lower than that of the postoperative group, and at 24 hours after surgery, the former was also lower than the latter. The first time of demand for postoperative meperidine was earlier in the postoperative group than in the preincisional group. The amount of meperidine for the postoperative first 6 hours was less in the preincisional group than in the postoperative group. CONCLUSIONS: Preincisional intravenous butorphanol reduced the intensity of spontaneous incisional pain and movement-associated pain, regarded as a preemptive effect of butorpahnol, in the early postoperative period.

The Effects of Trendelenburg Position and Intraabdominal CO2 Gas Insufflation on Cardiopulmonary System during Pelviscopic Surgery under General Anesthesia / 대한마취과학회지

BACKGROUND: Pelviscopic techniques have rapidly increased in therapeutic procedures as well as diagnostic procedures because of the many benefits associated with much smaller incisions than traditional open techniques. But the deliberate pneumoperitoneum with carbon dioxide during pelviscopic surgery may cause some problems-hypercarbia, pneumomentum, subcutaneous or mediastinal emphysema, pneumothorax, hypoxemia, hypotension, cardiovascular collapse and cardiac dysrhythmia. METHOD: We observed the changes of blood pressure (systolic, mean, diastolic), pulse rate, PaCO2, PaO2, peak inspiratory airway pressure and expired tidal volume at 10 minute after induction of general anesthesia (control value), 30 minutes and 60 minutes after insufflation of CO2 and Trendelenburg position. RESULTS: The blood pressure, PaCO2 and peak inspiratory airway pressure were increased significantly than control values (p<0.05). The changes of pulse rate and expired tidal volume were not statistically significant in comparison to control values. The PaO2 was decreased significantly (p<0.05). CONCLUSION: To minimize the risk of CO2 retension and unstability of cardiovascular system during pelviscopy under the Trendelenburg position, we must monitor the vital signs and the arterial blood gas status continuously and carefully.

Do Metoclopramide with Dexamethasone Act Synergistically in Control of Postoperative Nausea and Vomiting? / 대한마취과학회지

BACKGROUND: Better effect of antiemetic drugs can be obtained by combination of multiple antiemetic drugs that have different mechanisms of action. However, if the combined drugs have similar mechanisms of action, the incidence of side effects may be increase. This study was conducted to evaluate the ability of using combination therapy consisting of metoclopramide and dexamethasone in control of postoperative nausea and vomiting. METHODS: Sixty adult female patients undergoing major gynecological operation under the general anesthesia were randomly divided into two groups according to administered drugs. The patients received a single IV dose of metoclopramide (10 mg, Group I) or metoclopramide plus dexamethasone (10 mg 8 mg, Group II) when as operator sutured the skin wound. The incidences of nausea and vomiting were assessed during the first 12, 24, and 48 hours after recovery from anesthesia. RESULTS: There were no prominent incidences of postoperative nausea and vomiting between two groups within postoperative 12 hours. But there were significantly increased incidences of nausea and vomiting in Group I (26.7%, 13.3%) compared to Group II ( 8.0%, 3.2%) during postoperative 24 hours and 48 hours. CONCLUSIONS: Combination therapy of metoclopramide with dexamethasone seemes to have no synergic effect in control of postoperative nausea and vomiting.