The Effects of Small Intravenous Doses of Midazolam on Explicit Recall and the Bispectral Index after Fetal Expulsion in a Cesarean Section under General Anesthesia / 대한마취과학회지

BACKGROUND: Explicit recall in a cesarean section under general anaesthesia can be a terrifying experience and may cause psychological sequelae. Administering low doses of midazolam, we investigated the changes of the bispectral index (BIS) and the occurrence of explicit recall of specific events after fetal expulsion in a cesarean section under general anesthesia. METHODS: The investigation was carried out on 30 ASA 1 or 2 parturients who underwent a cesarean section under general anesthesia. Anesthesia was maintained with 50% N2O in oxygen and 0.75% of isflurane. We randomly allocated parturients into a control group (n = 10), group A (n = 10), and B (n = 10). Neither midazolam nor any other drugs except oxytocin were administered in the control group. In the group A and B, midazolam 0.02 and 0.03 mg/kg respectively, were injected immediately after umbilical cord clamping. An isolated forearm test were done to all the parturients at 5, 10, and 20 minutes after fetal expulsion. We assessed the changes of the BIS at 1, 2, 3, 4, 5, 10, 15, and 20 minutes after fetal expulsion, at discontinuance of isoflurane administration and extubation. The wav file, "clench your left or right hand" was binaurally played, simultaneously with the isolated forearm test. The wav file, "one, two, three, four, five" was also binaurally played 15 minutes after fetal expulsion. We interviewed all the parturients the next day and assessed the occurrence of explicit recall. RESULTS: The BIS values after fetal expulsion in the control group and group A was maintanied above 60 and group B, below 60 (P < 0.05). The lowest median BIS value was 54.5 in the group A, 36.4 in the group B (P < 0.05). There were two parturients in the control group and in the group A, respectively, who showed explicit recall. The results of the isolated forearm test were negative for all groups. The extubation times and PAR scores failed to show significant differences among the three groups. CONCLUSIONS: The authors confirmed the occurrence of explicit recall for specific events after fetal expulsion. The BIS values after fetal expulsion could be maintained below 60 until the end of surgery,and explicit recall could be prevented when we injected midazolam 0.03 mg/kg immediately after fetal expulsion.

Combination of Small Doses of Subarachnoid Bupivacaine/Fentanyl and Epidural Bupivacaine in Combined Spinal-Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: An intrathecal injection of a small-dose local anesthetic and an opioid using combined spinal-epidural anesthesia (CSEA) technique is a new trend in regional anesthesia for cesarean section. Prophylactic epidural injection may be useful to complete the new regimen. METHODS: Spinal anesthesia via the CSEA technique was performed with 6 mg 0.5% hyperbaric bupivacaine plus 20ng fentanyl in 75 parturients undergoing cesarean section. group S (study, n = 38) received an epidural injection of 10 ml of 0.25% bupivacaine 5 min after intrathecal injection, and was compared with group C (control, n = 37) in sensory levels and Bromage scores, incidences of side effects such as hypotentsion, pain and discomfort, nausea and vomiting, dizziness, pruritus and shivering. Recovery times from sensory and motor block and the duration of postoperative analgesia were assessed between the groups. RESULTS: Sensory block levels were higher (but remained

Epidural Anesthesia for Cesarean Section in a Parturient with Eisenmenger's Syndrome / 대한마취과학회지

Eisenmenger's syndrome is defined as pulmonary hypertension with right-to-left or bidirectional shunting of blood through an intracardiac or aorto-pulmonary commumication. It can occur with complex congenital cardiac malformations, such as septal defect and patent ductus arteriosus. Parturients with Eisenmenger's syndrome are at high risk for peripartum morbidity and mortality. We experienced a case of parturient for cesarean section with Eisenmenger's syndrome and performed epidural anesthesia with fractionated doses of 2% lidocaine and fentanyl. The sensory block reached to T10 level and blood pressure was maintained with intravenous phenylephrine. After baby out, sudden hypotension with severe bradycardia developed and arterial oxygen saturation dropped. Immediate intubation and resuscitation was done, but cardiac rhythm disturbance, hypoxemia, and acidosis did not corrected. Cardiac standstill developed and stopped resuscitation. The neonate's Apgar score was 7 and he was transferred to pediatric ICU.

Comparison of the Effects of Induction before and after Surgical Preparation on Neonatal Well-being in General Anesthesia for Elective Cesarean Section / 대한마취과학회지

BACKGROUND: Generally, in order to decrease the fetal exposure time from anesthetic drugs, anesthetic induction is conducted after the completion of surgical preparation in general anesthesia for cesarean section. However, this method, in decreasing the fetal exposure time from anesthetic drugs, has been regarded as also aggravating the feeling of anxiety and fear of the patients. The purpose of this research is to compare the result of anesthetic induction conducted before and after surgical preparation in relation to the well-being of the newborn. METHODS: Fifty healthy women scheduled for elective cesarean section, not in labor, with no signs of fetal distress were randomly divided into 2 groups. Group A (n = 25) started anesthetic induction after surgical preparation and group B (n = 25) started before surgical preparation. Induction to delivery (I-D) interval and uterine incision to delivery (U-D) interval were measured and for the evaluation of the neonatal outcome, blood gas analysis at umbilical vein and artery, 1 and 5 min Apgar scores, and neurobehavioral test at 15 min, 2 hr and 24 hr of age, respectively, were performed. RESULTS: There was a significant difference in the I-D interval (P < 0.05) but no significant difference in the U-D interval between the two groups. Blood gas analysis, acid-base status, Apgar score and neurologic and adaptive capacity score (NACS) all did not differ significantly between the two groups. CONCLUSIONS: From our results, the induction before surgical preparation did not seem to affect neonatal well-being significantly. Therefore, when patients without fetal distress are very anxious, anesthetic induction before surgical preparation would reduce the patient's anxiety and fear without neonatal depression in general anesthesia for cesarean section.

The Effects of Anesthetic Techniques and Postoperative Pain Control on the Response of the Stress and Immune System in Cesarean Section Patients / 대한마취과학회지

BACKGROUND: Surgical trauma may affect the host immune system. We have examined the time course of circulating interleukin-6 (IL-6) and cortisol in patients undergoing a cesarean section (c/s) to determine if the anesthetic techniques and postoperative pain control have an effect on the response of the stress and immune system. METHODS: Thirty healthy women undergoing c/s were randomly allocated to three groups. Group I (n = 10) was provided with general anesthesia, group II (n = 10) with epidural anesthesia and group III (n = 10) with epidural anesthesia plus continuous epidural analgesia for postoperative pain control. Blood samplings for IL-6 and cortisol were conducted 4 times in all patients: preoperation, 1 h, 3 h and 24 h after skin incision. RESULTS: The mean concentrations of IL-6 were significantly increased in all three groups at 3 h and 24 h after the skin incision, but there were no significant differences among the three groups. The mean concentrations of cortisol were significantly increased in three groups at 1 h and 3 h after the skin incision, but there were no significant differences among the three groups. CONCLSIONS: No significant differences among three groups were seen. Thus, We couldn't determine that anesthetic techniques and postoperative pain control had a significant effect on the response of the stress and immune system.

Comparision of Intrathecal 0.5% Hyperbaric and Isobaric Bupivacaine for Cesarean Section / 대한마취과학회지

BACKGROUND: Baricity differences between spinal anesthetic solutions are thought to produce differences in distribution of anesthetics within the subarachnoid space. We evaluated the influence of baricity of bupivacaine on the quality of the block and the incidence of side effects obtained following intrathecal injection of bupivacaine 8 mg with fentanyl 20 microgram. METHODS: Thirty healthy term parturients scheduled for a cesarean section under combined spinalepidural procedures were randomly allocated into Group I, hyperbaric bupivacaine (n = 15); or Group II, isobaric bupivacaine (n = 15). The dose of both groups was bupivacaine 8 mg combined with fentanyl 20 microgram. The maximum level of sensory blockade, time to reach T4 level and maximum level, time to get complete motor recovery and perioperative complications were assessed. RESULTS: Time to sensory block T4, motor block Bromage scale 3, complete resolution of motor block and sensory regression time to T10 was significantly delayed in Group II compared to Group I. Maximal block height, and time to maximal block had no significant differences between the two groups. There were no significant clinical advantages of one preparation over the other. CONCLUSIONS: The data from this study suggests that intrathecal injection of either hyperic or isobaric bupivacaine produces satisfactory anesthesia with similar side effects.

Patient Controlled Sedation Using Propofol during Regional Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: During regional anesthesia for a cesarean section, adverse effects such as nausea and/or vomiting (N&V), visceral pain and shivering are common complications. A subhypnotic dose of propofol has been known to have an antiemetic effect perioperatively. Patient controlled sedation (PCS) using propofol might be a solution for emesis and other adverse effects occurring during regional anesthesia in cesarean deliveries. METHODS: One hundred ten parturients scheduled for elective cesarean section were randomly divided into two groups: PCS-spinal (n = 55) and PCS-epidural (n = 55). Spinal anesthesia was performed with 0.5% bupivacaine 10 mg and 10 microgram of fentanyl. Epidural anesthesia was performed with 2% lidocaine 25 ml + 100 microgram of fentanyl + 0.1 mg of epinephrine + 1.5 ml of 8.4% sodium bicarbonate in the PCS-epidural group. After delivery, PCS with propofol was applied to the patients in both groups (bolus dose: 30 mg, lock-out time: 3 min, no background infusion). We investigated incidences of adverse effects such as N&V, hypotension, intraoperative visceral pain, and shivering during the operation. We also assessed sedation scores (Grade 1 - 5) in the patients of both groups. RESULTS: There was no difference in sensory levels between the groups. Although more patients in the PCS-epidural group complained of N&V (3.6%:20%, P = 0.018) and shivering (0%:14.5%, P = 0.036) in the PACU, there were no differences intraoperative adverse effects between both groups. The sedation score did not differ between the groups. CONCLUSIONS: With PCS using propofol, adverse effects during cesarean section under both regional anesthesias are negligible.

Comparison of Intrathecal Isobaric and Hyperbaric Bupivacaine during Combined Spinal Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: We aimed to compare the clinical effects of 7 mg of intrathecal isobaric and hyperbaric 0.5% bupivacaine during combined spinal epidural (CSE) anesthesia for a cesarean section. METHODS: Thirty patients scheduled for an elective cesarean section under the CSE technique were randomly divided into two groups. 0.5% hyperbaric bupivacaine (Hyperbaric group, n = 15) or 0.5% isobaric bupivacaine (Isobaric group, n = 15) was separately injected into the subarachnoid space through a 26 G Quincke needle. Immediately after fixing the epidural catheter, 2% lidocaine 4 ml and fentanyl 50 microgram were injected through the epidural catheter. We measured the level and time of maximal sensory block, hemodynamic variables and many other clinical effects according to times. RESULTS: The level of maximal sensory block and duration of sensory block were not significantly different between the two groups. The time to maximal sensory block was significantly shorter in group I. Five of group H and two of group I needed an additional injection of epidural lidocaine and two of group H and four of group I needed IV fentanyl. However, all patients had the operation in comfort. CONCLUSIONS: An intrathecal injection of 7 mg of isobaric or hyperbaric 0.5% bupivacaine both with an epidural dose of 2% lidocaine 4 ml and fentanyl 50 microgram during CSE anesthesia is suitable for an elective cesarean section.

Anesthetic Management of a Morbidly Obese Parturient for Cesarean Section / 대한마취과학회지

An obese parturient can pose considerable physiologic and technical chalenges to an anesthesiologist. The combined pulmonary changes of pregnancy and obesity commonly make for hypoventilation & hypoxemia because they have both a reduced functional residual capacity and an increased oxygen consumption. The cardiovascular system is also stressed by obesity and pregnancy; both conditions contribute to increased cardiac work. Hypotension is frequently associated with spinal anesthesia because of aortocaval compression by the enlarged uterus and sympathetic blockade. In general anesthesia, obesity is an important risk factor for difficult intubation. Pulmonary aspiration of gastric contents is another significant risk of general anesthesia. Obese parturients are at high risk for developing hypoxia during the induction of anesthesia. We successfully managed the first Cesarean section of a morbidly obese parturient (25 years old, BMI = 54.19 kg/m2) with pregnancy induced hypertension using spinal anesthesia. Then, 1 year later we also successfully managed the second Cesarean section in the same patient (26 years old, BMI = 54.95 kg/m2) using general anesthesia. We restress the importance of anesthetic management of morbidly obese parturients in this case report.

Hemodynamic Effects of Propofol Anesthesia on Cesarean Section Patients / 대한마취과학회지

BACKGROUND: It is already known that systemic vascular resistance (SVR) is decreased during pregnancy. In addition, one of the large hemodynamic changes when using propofol is also a decrease in SVR, more profoundly than is found with enflurane. It might therefore be suggested that hemodynamic changes are more prominent in cesarean section during propofol anesthesia, compared with enflurane anesthesia. This study was designed to investigate these possible changes by propofol anesthesia. METHODS: One hundred thirty six women for elective cesarean section were involved in this study. They were divided into 2 groups: group E (n = 74), anesthesia with thiopental, enflurane, and N2O, and group P (n = 62), anesthesia with propofol and N2O. All patient were given glycopyrrolate as premedicants. The hemodynamic variables (MAP, HR, CO, CI, SVR, SVRI, SI, and EF) were measured by bioimpedence at the five different time points: at preoperation, after induction, after intubation, during push abdomen, and after delivery. RESULTS: The variables of hemodynamics did not change significantly when both groups were compared, except that MAP, SVR and SVRI at after induction and HR during push and after delivery in group P were lower compared with respective variables in group E. CONCLUSION: From these results, we concluded that there were no significant changes in cardiovascular system (CVS) by propofol anesthesia, compared with enflurane anesthesia in cesarean section patients. It is therefore suggested that propofol anesthesia is safe in considering hemodynamics for cesarean section.

Effect of Propofol on Neonate in Emergency Cesarean Section / 대한마취과학회지

BACKGROUND: Many reports claim that propofol anesthesia in cesarean section is safe for neonates, but these studies concern cases of elective, or combined elective and emergency surgery. Our study was designed to investigate the effects of propofol on neonates in emergency cesarean section. METHODS: One-hundred patients for cesarean section were involved. They were divided into 2 main groups; (P) anesthesia with propofol (N = 50) and (E) enflurane (N = 50). Both P and E were subdivided into 2 groups each; (PE) propofol elective (N = 25); (EE) enflurane elective (N = 25); and 2 emergency subgroups, (PM) propofol emergency (N=25), and (EM) enflurane emergency (N = 25). Apgar score (1 min, 5 min), Neurologic Adaptive Capacity Score (NACS, 15 min, 24 hr), cord blood gas analysis (cBGA) were measured. Maternal venous and umbilical artery and venous blood concentration of propofol were measured at delivery. RESULTS: The values of the Apgar score, NACS, and cBGA of group P were not different from the corresponding values of group E. Also there were no differences between groups PM and EM, and between groups PE and EE. The blood concentration of propofol was 2.36 microgram/ml in the maternal vein, 1.13 microgram/ml in the umbilical vein, and 0.89 microgram/ml in the umbilical artery. CONCLUSIONS: From these results, it may be suggested that propofol is safe for neonates in emergency cesarean section surgery.

The Preemptive Analgesic Effect of Ketamine Used with Fentanyl in Epidural Anesthesia / 대한마취과학회지

BACKGROUND: The present study was undertaken to determine whether ketamine, used with fentanyl in epidural anesthesia, can potentiate postoperative analgesia. METHODS: Fifty patients undergoing Cesarean section were allocated randomly into two groups. Group 1 received epidural injection of 2.0% lidocaine 18-20 ml and 0.5% bupivacaine 2-5 ml with fentanyl 50 ug on 20 minutes before surgical incision, and group 2 added epidural ketamine 30 mg to group 1 at the same time. Postoperative pain relief was provided with epidural morphine 3 mg and 0.25% bupivacaine 8 ml on 40 minutes after surgical incision in both groups. Numeric rating scales for pain and mood, Prince Henry Hospital scores for pain were assessed at 2, 6, 12, 24, 48 hours after anesthesia. We measured the first request time of analgesics for postoperative pain, the dose of analgesics within postoperative 48 hours and the incidence of side effects postoperatively. RESULTS: There were no significant difference in the first request time of analgesics and use of analgesics for postoperative pain control between two groups. Pain and mood scores, and PHS score for pain in group 2 were better than those of group 1. The incidence of side effects were similar in both groups. CONCLUSIONS: The combined use of fentanyl and ketamine in epidural anesthesia provided little effect in potentiation of postoperative pain control. Further studies are needed to provide more prominent analgesic effect.

General Anesthesia for Cesarean Section in a Pregnant Woman with Eisenmenger's Syndrome / 대한마취과학회지

Eisenmenger's syndrome is the presence of high pulmonary vascular resistance associated with pulmonary hypertension at or near systemic values, with a reversed or bidirectional shunt. When patients with this syndrome become pregnant, these anatomic and physiologic changes can become additionally altered. An understanding of these changes along with anesthesia and pharmacologic interventions is necessary for the successful management of delivery and puerperium in such a disease entity associated with high maternal and fetal mortality. We report the successful anesthetic management of a pregnant patient with Eisenmenger's syndrome, whose baby was delivered by elective cesarean section under general anesthesia. Anesthesia was induced with ketamine, and maintained with ketamine, midazolam, and fentanyl. The patient was ventilated with 100% O2. Invasive hemodynamic monitoring such as systemic and pulmonary artery pressure was continued throughout delivery and puerperium in pregnant patients with this syndrome. The mother and baby were discharged home 10 days later without complication.

The Factor that Determines Mechanical Ventilation during Cesarean Section under General Anesthesia: Weight before pregnancy vs. weight during delivery / 대한마취과학회지

BACKGROUND: During general anesthesia the adult patient's tidal volume is determined by patient's weight. Therefore patients with severe ascites, huge abdominal mass or pregnancy have considerable ventilatory change during the operation because the great change in their body weight, that might cause unwanted respiratory alkalosis or acidosis. The purpose of this study is to identify the effects of such changes in ventilation between pre-delivery and post-delivery periods during the cesarean section. METHODS: Eighteen 36weeks or older pregnant patients (ASA 1), scheduled for elective cesarean section under general anesthesia, are selected for the study. PhysioFlex was used for ventilation. Pre-induction maternal gas analysis were performed in all cases. They were randomly divided into two groups according to the ventilator setting for minute ventilation, one set by pre-pregnant weight (Group 1) and the other by pregnant (term) weight (Group 2). Blood gas analysis were performed 5 minutes after induction and 20 minutes after delivery. End-tidal CO2 and inspiratory airway pressure were also measured. RESULTS: All patients show mild hyperventilation with normal acid-base status at pre-induction period. There were no significant differences in arterial PCO2 value between two groups. Group 1 shows mild metabolic acidosis compared with group 2 (by pH at 20 minutes after delivery). CONCLUSION: Term(just prior to operation) body weight rather than pre-pregnant weight is preferable for ventilator setting in the case of cesarean section under general anesthesia.

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.

General Anesthesia for Emergency Cesarean Section in a Patient with Severe Aortic Stenosis / 대한마취과학회지

A 34-year-old female underwent emergency cesarean section with general anesthesia. The patient was a para 1-0-0-1, referred at 39 weeks in labor with known severe aortic stenosis due to a bicuspid aortic valve. She has been treated with digoxin and furosemide for 5 years. At first, she tried a normal spontaneous vaginal delivery, but dyspnea was aggravated during delivery, so an emergency operation was decided. Anesthesia was induced using ketamine 80 mg, fentanyl 50 microgram and vecuronium 6 mg and maintained with 50% nitrous oxide in oxygen. After fetal delivery and infusion of oxytocin, the systolic blood pressure decreased to 60 mmHg or less, so we injected phenylephrine 100 microgram bolus. However, the blood pressure did not increase, so we injected phenylephrine continuously ( 0.5 microgram/kg/ min). One month postpartum, echocardiography was done. The left ventricle-aortic pressure gradient was 140 mmHg, so the cardiologist recommended an aortic valve replacement operation. She refused the operation and has been medicated with digoxin and furosemide up to date.

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.

Effect of Intrathecal Neostigmine on Post-Cesarean Section Analgesia / 대한마취과학회지

BACKGROUND: Intrathecal (IT) neostigmine produces analgesia in animal and human. This study was designed to evaluate the efficacy and safety of IT neostigmine for post-cesarean section analgesia. METHODS: Forty-five women undergoing cesarean section under spinal anesthesia were randomly assigned into 3 groups to receive; normal saline 0.2 ml, or neostigmine 12.5 microgram, or neostigmine 25 microgram intrathecally with 0.5% hyperbaric bupivacaine 12 mg. Degrees of sensory and motor blocks, maternal hemodynamic changes, and side effects were recorded. Apgar scores and umbilical vein blood gas analysis (UVBGA) were checked for evaluation of fetal status. Postoperative analgesia was provided by intravenous patient-controlled analgesia (PCA) using fentanyl 500 microgram and ketorolac 150 mg in 100 ml. Pain scores with 10-cm visual analogue scale (VAS), time to first PCA use, cumulative PCA consumptions, and side effects were assessed at 1, 2, 4, 8, 12, 24, and 48 hr after IT injection. RESULTS: There were no significant differences among the three groups in characteristics of spinal anesthesia, maternal blood pressure and heart rate, Apgar scores, and UVBGA data. Compared to saline group, IT neostigmine significantly prolonged time to first PCA use and decreased 24 hr- and 48 hr-PCA consumptions (P<0.05). Pain scores in neostigmine groups were significantly lower than those in saline group for first 4 hr after which there were no differences among the three groups. There were significantly higher incidences of nausea and vomiting in neostigmine groups than in saline group. CONCLUSIONS: These data indicate that IT neostigmine can be an alternative postoperative analgesic without adverse fetal effects for cesarean section. However, high incidence of nausea and vomiting seem to limit its clinical usefulness. Further studies are necessary to enhance its analgesic effects and to decrease its adverse effects.

Comparison of Epidural Anlagesia with Morphine-Bupivacaine Versus Fentanyl-Bupivacaine after Cesarean Section / 대한마취과학회지

Background: This study was aimed to compare the analgesic effect and side effects of morphine- bupivacaine mixture with those of fentanyl-bupivacaine mixture after Cesarean section. Methods: Eighty patients who were taken continuous epidural catheterization after Cesarean section were divided into two groups. In group 1 (N=40) the mixture of 1% lidocaine 10 ml and morphine 1mg was firstly injected via epidural catheter, and then two day infusor (Baxter(R)) which contained the mixture of 0.15% bupivacaine 100 ml and morphine 6mg was connected to epidural catheter. In group 2 (N=40) the mixture of 1% lidocaine 10 ml and fentanyl 100 mcg was firstly injected via epidural catheter, and then two day infusor (Baxter(R)) which contained the mixture of 0.15% bupivacaine 100 ml and fentanyl 850 mcg was connected to epidural catheter. Mean arterial pressure (MAP) and heart rate (HR) were checked preoperatively, and at post-injection 10, 20, 30 and 60 minutes. The visual analogue scale (VAS) was checked at postoperative 1/2, 1, 6, 12, 24 and 48 hours. The side effects of epidural analgesia were evaluated. Results: In group 2 MAP was significantly decreased at post-injection 20 minute. VAS was significantly increased at post-injection 1/2 and 1 hour in group 1. The most frequent side effect was pruritus in both groups. Conclusions: The first bolus injection of the mixture of 1% lidocaine 10 ml and fentanyl 100 mcg has more rapid analgegic effect than the mixture of 1% lidocaine 10 ml and morphine 2 mg, but because of shorter duration of action of fentanyl it seems to be better to increase the dosage of fentanyl or replace fentanyl by morphine for more effective epidural analgesia after Cesarean section.

The Infusion Rate of Cisatracurium and Its Spontaneous Recovery for Cesarean Section under Enflurane Anesthesia / 대한마취과학회지

BACKGROUND: Cisatracurium, one of 10 isomers of atracurium, undergoes pH and temperature-dependent Hofmann elimination in plasma and tissues. Physiologic changes may affect the pharmacodynamics of neuromuscular bldegrees Cking agent during pregnancy. So, we compared the difference in the infusion rate and its spontaneous recovery of cisatracurium between full-term pregnant and nonpregnant women. METHODS: Muscle relaxation of full-term pregnant(group I, n=10) and nonpregnant(group II, n=10) women was maintained by continuous infusion of cisatracurium to keep 1st twitch response of train-of-four(TOF) at 5~10% of control. After discontinuation of infusion, recovery index was measured without reversals using the accelerograph. RESULTS: The infusion rate of cisatracurium in group I(1.25+/-0.16 mcg/kg/min) was not significantly different from that in group II(1.31+/-0.22) and recovery indices were not different between two groups(10.7+/-2.0 vs. 11.6+/-1.9 min). CONCLUSION: The infusion rate of cisatracurium in parturients to maintain surgical relaxation is not different from that in non-parturients. For Cesarean section, the usual infusion rate of cisatracurium is recommeneded to achieve the adequate surgical relaxation.