Comparing the Effects between a Continuous Epidural Infusion of an Opioid or an Opioid-Local Anesthetic Mixture and a Continuous IV Infusion of an Opioid after a Spinal Laminectomy / 대한마취과학회지

BACKGROUND: Postoperative pain after a spinal laminectomy has very harmful effects on human physiology, and many people are trying to control it more easily and safely. There are controversies in methods used for controlling postoperative pain after a spinal laminectomy. The purpose of this study was to examine an effective way to control postoperative pain after a spinal laminectomy. METHODS: Ninety patients (ASA I-II, aged 40 to 70) scheduled for a spinal laminectomy were divided into three groups. In group A, we administered fentanyl 1,000 microgram and morphine 5 mg (mixed in 0.9% normal saline) using the continuous epidural infuser; in group B, we administered fentanyl 500 microgram and morphine 5 mg and 0.25% bupivacaine (mixed in 0.9% normal saline) using the continuous epidural infuser; in group C, we administered fentanyl 1,500 microgram and morphine 10 mg (mixed in 0.9% normal saline) using the continuous IV infuser. We compared effects between the continuous epidural infusion and the continuous intravenous infusion by using the visual analogue scale and side effects. RESULTS: There was no significant difference between continuous epidural infusion groups. When the continuous epidural infusion groups and the continuous IV infusion group were compared, there were significant differences in 3 hr, 6 hr, and 12 hr VAS scores (P < 0.01). The incidence of side effects was very low, and there was no significant difference in side effects between the continuous epidural infusion and the continuous IV infusion groups. CONCLUSIONS: It was found that continuous epidural infusion methods were more effective than the continuous IV infusion method, but none of them showed satisfactory postoperative pain control in the early periods.

Tranexamic Acid Versus a Placebo in Decreasing Blood Loss in Patients Undergoing Spine Surgery / 대한마취과학회지

BACKGROUND: Major spine surgery can be associated with dramatic blood loss, thereby requiring a high-volume transfusion. Tranexamic acid inhibits fibrinolysis and it has been used in general surgery. The effect of tranexamic acid on blood loss and transfusion requirements during spine surgery was prospectively studied. METHODS: Twenty-two patients scheduled for orthopaedic surgery for spinal stenosis under general anesthesia were randomly selected to receive, either tranexamic acid administered as a bolus of 15 mg/kg, or the equivalent volume of saline, during the operation and postoperatively. The anesthetic and perioperative management were standardized. The total blood loss of each patient and transfusion requirements were noted. Hematocrit, PT, PTT, and platelet count measure were performed before and after surgery. RESULTS: The tranexamic acid group demonstrated a significantly less amount of blood loss (859.5 +/- 280.0 ml) compared to the placebo group (1366.0 +/- 333.7 ml). In addition the fluid and homologous transfusion requirements in the placebo group were greater than in the tranexamic acid group. CONCLSIONS: Tranexamic acid during major spine surgery significantly reduces both blood loss and consequent blood transfusion requirements.

Cardiac Arrest Due to Rebleeding after Spinal Surgery: A case report / 대한마취과학회지

It is a common knowledge to anesthesiologists that bleeding can eventually lead to shock and it is a mandatory task of anesthesiologists to monitor and prepare for postoperative bleeding. We have experienced at recovery room a case of cardiac arrest due to massive bleeding after a spinal surgery in a 62-year-old lady weighing 60 kg with no specific abnormalities in both history and physical examination. Immediate intervention with CPR, DC shock and administration of blood and fluids revived her and a subsequent surgical procedure was performed for bleeding control. The major common cause of cardiac arrest associated with operation/anesthesia are cardiovascular failure and respiratory failure. Postoperative bleeding, therefore, warrants close and careful monitoring in order that immediate and optimal care can be provided.