The Effects of Ketorolac on T Cell Subsets in Patients Undergoing a Gastrectomy / 대한마취과학회지

BACKGROUND: Perioperative procedures like surgery, anesthesia, pain control etc. induce immunosuppression and this immunosuppression can be the cause of postoperative infection or micrometastasis. PGE2 is the major cytokine related to immunosuppression especially in tissue trauma. NSAIDs blocked the cyclo-oxygenase pathway and then reduced PGE2 production. Therefore, we studied immunologic changes during a gastrectomy, and the effects of ketorolac administration. We used T cell subsets as immunologic indicator. METHODS: Forty patients scheduled for a gastrectomy due to stomach cancer were randomly allocated to the control group or the ketorolac group. The ketorolac group received 60 mg ketorolac before anesthesia and then 30 mg 6 hours later. Blood sampling was done before anesthesia, 2 hours and 24 hours after anesthesia. T cell subsets were studied by a monoclonal antibody technique. We also observed postoperative demerol consumption, side effects, infection, and discharge date. A Student's t-test, Mann- Whitney Rank Sum Test, and Chi-square were used for between groups comparisons, and a repeated measured ANOVA and then multiple comparison by the Tukey or Dunnett test for within-group comparison. RESULTS: T4 was decreased to 89.3%, 81% at 2 hours, and 24 hours in the control group but increased to 128.4%, 104.6% in the ketorolac group. T8 was not different between or within-groups. The T4/T8 ratio was decreased to 83.5%, 84.9% at 2 hours, and 24 hours in the control group but increased to 117.7%, 107.2% in the ketorolac group. 24 hour demerol consumption was higher in the control group than in the ketorolac group. Duration of infection and hospitalization were prolonged in the control group by 1 and 2 days each. CONCLUSIONS: Ketorolac increased the T4/T8 ratio and reduced demerol consumption, infection, and hosipitalization. Therefore ketorolac could help reverse immunosuppression during the perioperative period especially in immunocompromised patients.

The Effect of Famotidine on Lowering Gastric Acidity in Gastric Carcinoma Patients / 대한마취과학회지

BACKGROUND: To identify the gastric pH of gastric carcinoma patients after more than 8 hours of fasting and ascertain the antisecretory effects of H2-receptor antagonists, the gastric volume and pH of 41 gastric carcinoma patients was checked immediately after the induction of inhalational general anesthesia (endotracheal intubation). METHODS: The patients were divided randomly into two groups: the control received IV normal saline as a placebo and the famotidine group received IV famotidine as a premedicant 1 to 2 hours before the induction of anesthesia. Immediately after the induction of anesthesia, the gastric contents were aspirated blindly with a 60 ml syringe. Fisher's exact test was used to compare the percentage of patients 'at risk' between the two groups in relation to their pH and volumes. RESULTS: The percentage of patients 'at risk' (volume > 0.4 ml/kg and pH < 2.5) of acid aspiration pneumonitis in the control and famotidine groups was 8.7% and 5.6%, respectively, which was 30 77% lower than for patients with no premedication, as observed in other studies. In the present study, the difference in percentage of patients 'at risk' between the two groups was not statistically significant. CONCLUSIONS: The gastric carcinoma patients exhibited a higher gastric pH when fasting and a lower risk of acid aspiration pneumonitis relative to their gastric contents. The effect of famotidine on lowering gastric acidity and volume in gastric carcinoma patients was rather weak. Accordingly, the routine use of H2-receptor antagonists to decrease gastric secretion in gastric carcinoma patients should be reevaluated.

Effect of Preemptive vs Postoperative Continuous Epidural Analgesia on Postoperative Pain after Radical Gastrectomy / 대한마취과학회지

BACKGROUND: Recent evidence suggest that noxious surgical trauma may induce prolonged changes in central neural function that later contribute postoperative pain. So, postoperative pain may be eliminated or reduced if surgical afferent barrages are prevented with local anesthetics or opioid before they reach to the CNS. We studied the preemptive analgesic effect of continuous epidural analgesia under general anesthesia after radical gastrectomy. METHODS: Forty four patients scheduled for radical gastrectomy were investigated. After general anesthesia induction, patients of preemptive group (n=25) were given 40 ml of 0.125% bupivacaine, 0.1 mg/kg of morphine and 75 microgram of clonidine epidurally as a bolus and followed by 10 ml/hour of 0.125% bupivacaine and 0.2 mg/hour of morphine continuously for 10 hours. Patients of non-preemptive group (n=19) were given the same drugs according to the same way after finishing the operations. The effect of preemptive analgesia was assessed by visual analogue pain scale (VAPS) score, and evaluated the time to first analgesic request, and total amount of used analgesics. Side effects were recorded. RESULTS: Postoperative VAPS scores were not different between two groups. Time to first analgesic request were significantly more prolonged and total amount of used analgesics were significantly less in preemptive group than in non-preemptive group. The incidence of side effects except respiratory depression were similar between two groups. CONCLUSIONS: We concluded that despite preemptive analgesic effect was seen in preemptive group, but it was not prominent. Further studies are needed to prove more prominent preemptive effect in major abdominal operation.