Comparative Evaluation of Femoral Nerve Block & Intravenous Fentanly for Positioning During Spinal Anesthesia in Surgery of Femur Fractures

Introduction: Femur fractures configure an important publichealth issue and are associated with high mortality taxes andlose of functionality. Study aimed to compare the analgesiceffects of FNB with intravenous (IV) fentanyl prior topositioning for spinal block in patients with fractured femur.Material and Methods: Sixty patients scheduled for fracturedfemur surgery under spinal block. They were grouped as FNBgroup (n=30) and a fentanyl group (n=30). A spinal block wasperformed. Pain scores 15 minutes after analgesia and duringpositioning were recorded. A numeric rating pain scale (0 =no pain, 10 = maximal pain) was used. Additional fentanylrequirement during positioning and satisfaction with patientposition maintained for spinal block (yes = satisfactory, no =not satisfactory) were also recorded.Results: Base line values for Heart Rate (HR), Mean ArterialPressure (MAP) and type of surgery were comparable inboth the groups. We found an insignificant difference in HR(P>0.001) among the groups and a significantly lower MAPin FENT group (P = 0.0090). SpO2 was significantly lower inFENT group (P < 0.001).Conclusion: Femoral nerve block lowers pain and the needfor supplementary analgesia requirement

Inhibitory Effects of Propofol Mixed with Lidocaine on Fentanyl Induced Cough Reflex / 대한마취과학회지

BACKGROUND: Propofol and lidocaine have been purported to attenuate bronchoconstriction induced by fentanyl administration during induction of anesthesia. The purpose of the present study was to study the synergic bronchodilation effect of propofol mixed with lidocaine. METHODS: Two hundred and thirty four patients were randomly allocated to five groups: Group 1 (n = 60, normal saline 0.25 ml/kg followed by fentanyl 3ng/kg), Group 2 (n = 30, propofol 2 mg/kg mixed with normal saline 0.05 ml/kg followed by normal saline 0.06 ml/kg), Group 3 (n = 50, propofol 2 mg/kg mixed with normal saline 0.05 ml/kg followed by fentanyl 3ng/kg), Group 4 (n = 33, propofol 2 mg/kg mixed with lidocaine 1 mg/kg followed by normal saline 0.06 ml/kg) and Group 5 (n = 61, propofol 2 mg/kg mixed with lidocaine 1 mg/kg followed by fentanyl 3ng/kg). All patients were injected with fentanyl or normal saline two minutes after administration of propofol premixed with lidocaine or normal saline, respectively. We checked the cough reflex, injection pain, oxygen desaturation and chest wall rigidity. RESULTS: There was a significant difference in the incidence of cough reflex between group 1 and 3 or 5. The incidience of group 5 was significantly lower than in group 3. CONCLUSIONS: This study suggests that a propofol-lidocaine mixture should be considered when patients require bronchodilation during induction of anesthesia.

A Comparative Study of Propofol-Fentanyl and Propofol-Ketamine Anesthesia for Spine Surgery under Somato-Sensory Evoked Potential Monitoring / 대한마취과학회지

BACKGROUND: Somato-sensory evoked potential (SSEP) monitoring has been used to help minimize neurologic morbidity during spinal surgery. However, SSEP is affected by anesthetics, technical errors and physiologic aspects. We reviewed 50 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. METHODS: Fifty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl (Group I, P-F) or ketamine (Group II, P-K), and monitored by SSEP. We checked the changes of blood pressure and heart rates during the operation, recorded latency and amplitude of SSEP in the pre-induction, post-induction, during screw insertion and post-distraction periods. Also, we checked the number transfers to the ICU and application of a ventilator. RESULTS: Systolic and diastolic blood pressure were increased significantly in the propofol-ketamine group (P < 0.05), but there was no difference in heart rate between both groups. In addition there were no statistical differences in latencies and amplitudes of SSEP. The number of patients transferred to the ICU and placed on a ventilator showed no statistical difference. CONCLUSIONS: We think that the combination of propofol and fentanyl or ketamine used for total intravenous anesthesia is a very useful method in spinal surgery under SSEP monitoring.

Monitored Anesthetic Care (MAC) Using Propofol, Ketamine, Fentanyl, and Ketorolac (PKFK) for Minor Surgery / 대한마취과학회지

BACKGROUND: Even when patients agree that anesthesia is indispensable for a safe and comfortable operation, they are reluctant to experience the side effects of conventional general and regional anesthesia. We investigated whether monitored anesthetic care (MAC) using propofol, ketamine, fentanyl, and ketolorac can be substituted for conventional anesthesia in minor surgery. METHODS: One hundred forty six healthy adult patients who received minor surgery were studied. All were fasted, premedicated, and monitored according to conventional general anesthesia. Fentanyl 2 microgram/kg, propofol 1 mg/kg, ketamine 0.2 mg/kg, and ketorolac 30 mg were given intravenously and propofol was maintained at 3 4 mg/kg/h. Before local anesthetics infiltration at the incision site, ketamine 5 mg and propofol 20 mg were added intravenously. During the procedure, fentanyl 25 microgram plus propofol 20 mg were added whenever involuntary movements appeared. We observed vital signs, complications, time to eye opening to verbal command, time to regain orientation, satisfaction with anesthesia, postoperative pain scores, and analgesic consumption. RESULTS: Blood pressure and heart rate were reduced at the beginning of anesthesia, but were not clinically significant. Intraoperatively, respiratory depression (40.4%), SpO2 < 90% (25.3%) were observed, but no patients needed tracheal intubation. Postoperatively, dizziness (29.5%), pain (20.5%), and nausea (15.8%), were observed. The time to eye opening and to regaining of orientation were 57.3+/-119.4 sec, and 8.0+/-4.7 min respectively. Satisfaction with anesthesia was remarkable; surgeon (76.7%), patients (91.8%). Postoperative pain scores were low; 59.6% of patients did not need analgesics for the first 24 h. CONCLSIONS: If careful monitoring and instantaneous management for respiratory depression by anesthesiologist is provided, MAC using PKFK is an excellent and readily applicable method for minor surgery.

Adequate Target Concentration of Propofol and Fentanyl for Total Intravenous Anesthesia by Target-controlled Infusion during Cesarean Section / 대한마취과학회지

BACKGROUND: Propofol has been used for the induction and maintenance of obstetric anesthesia for its potential benefit of rapid recovery and less post-anesthetic complications. In order to determine the safe application of target-controlled infusion of propofol and fentanyl during Cesarean section under general anesthesia, we have investigated the adequate target concentrations of each drug using the bispectral index and hemodynamic parameters. METHODS: Ninety-two pregnant women who received Cesarean section under general anesthesia were enrolled in this study. After preoxygenation, anesthesia was induced with thiopental 4 mg/kg and succinylcholine 1 mg/kg, and intubation was done. Vecuronium 0.1mg/kg I.V. was applied for muscle relaxation, and mechanical ventilation was maintained with N2O/O2 (2 L/2 L)-enflurane. EtCO2 was maintained between 30 35 mmHg. After delivery of the fetus, propofol and fentanyl was infused by a computer-assisted continuous infusion system with air/O2 (2 L/2 L). The bispectral index was monitored perioperatively. This study proceeded in three stages. In the first stage, thirty women were studied for titration of the target effect-site concentration of propofol that could maintain a bispectral index between 40 60 while maintaining the target concentration of fentanyl at 1.5 ng/ml. In the second stage, forty-two women were randomly assigned into the four different groups (F25, F50, F75, F100) at target fentanyl concentrations of fentanyl of 0.25, 0.50, 0.75 and 1.0 ng/ml for each group respectively. The adequate target concentration of fentanyl was titrated. In the third stage, twenty women were studied for assessment of the adequacy of target concentrations of propofol and fentanyl prospectively. RESULTS: The target effect-site concentrations (Ce, 95% confidence interval) that could maintain 50% and 95% of patients hemodynamically stable with the bispectral index within 40-60 were 2.41 (2.27-2.55) microgram/ml and 3.15 (2.95-3.50) microgram/ml for propofol, 0.32 (0.13-0.46) ng/ml and 0.84 (0.66-1.29) ng/ml for fentanyl. The pre-anesthetic bispectral index was 97.1+/-1.2 and it decreased maximally to 39.5+/-6.47 after thiopental injection and increased maximally to 83.6+/-6.3 before delivery and it was 80.6+/-6.9 for eye-open to verbal command during recovery. CONCLUSIONS: The adequate target effect-site concentrations of propofol and fentanyl for the maintenance of total intravenous anesthesia during Cesarean section were determined and these concentrations were validated prospectively.

Oculocardiac Reflex and Postoperative Recovery in Pediatric Strabismus Surgery: A Randomized Trial Comparing Four Anesthetic Techniques / 대한마취과학회지

BACKGROUND: Oculocardiac reflex (OCR) and postoperative nausea/vomiting are major complications of pediatric strabismus surgery. The aim of the study was to assess, in children undergoing strabismus surgery, the incidence of OCR and postoperative emesis with a inhalational and a intravenous technique. METHODS: 44 healthy children undergoing elective strabismus surgery as inpatients were randomly allocated to four anesthetic techniques: (1) induction with propofol, maintenance with propofol infusion and 50% N2O-O2 (propofol-N2O); (2) induction with propofol and fentanyl 1 microgram/kg bolus, maintenance with propofol infusion and 50% air-O2 (propofol-fentnyl-air); (3) induction with thiopental, maintenance with enflurane and 50% N2O-O2 (enflurane-N2O); (4) induction with thiopental and fentanyl 1 microgram/kg, maintenance with enflurane and 50% air-O2 (enflurane-fentanyl-air). RESULTS: The incidence of an OCR significantly increased in the propofol-fentanyl-air group as compared to the enflurane-N2O or enflurane-fentanyl-air groups. Times to extubation were shorter in the propofol- N2O group than in the propofol-fentanyl-air or enflurane-fentanyl-air groups. Alertness scores were lower in the propofol-N2O group than in the enflurane-N2O or enflurane-fentanyl-air groups. Postanesthetic recovery scores and nausea/vomiting during the 24 hr after the operation did not show any differences among the groups. CONCLUSIONS: We concluded that children undergoing strabismus surgery anesthetized with propofolfentanyl-air had more episodes of OCR, propofol-N2O had shorter times to extubation and higher alertness scores, and the addition of N2O or fentanyl to anesthetic regimen was not associated with nausea and vomiting.

Inhibitory Effects of Cough Reflex Induced from Fentanyl According to the Dose of Propofol / 대한마취과학회지

BACKGROUND: Bronchodilation effect of propofol was known that it could prevent bronchoconstriction induced by fentanyl administration. The aim of this study was to investigate the dosage of propofol that inhibited cough reflex induced from fentanyl. METHODS: One hundred twenty patients were randomly allocated to four groups: Group 1 (n=30, fentanyl 3 microgram/kg), Group 2 (n=30, propofol 0.5 mg/kg, fentanyl 3 microgram/kg), Group 3 (n=30, propofol 1 mg/kg, fentanyl 3 microgram/kg), Group 4 (n=30, propofol 2 mg/kg, fentanyl 3 microgram/kg). Patients in Group 1 were injected fentanyl within a second. Other patients groups were injected fentanyl two minutes after administration of propofol dosage, respectively. We checked cough response, oxygen desaturation and chest wall rigidity. RESULTS: There was no significant difference in the incidence of cough response between Group 1 and 2. But, the incidence of Group 3 and 4 was significantly lower than in Group 1 and 2. CONCLUSIONS: Propofol of clinical doses for anesthetic induction inhibit cough reflex induced from fentanyl.

Anesthetic Management for Awake Craniotomy with Scalp Nerve Block and Propofol/Fentanyl Infusion / 대한마취과학회지

BACKGROUND: If epileptogenic foci are close to eloquent areas of the brain, awakening is needed for functional mapping during seizure surgery. In these cases adequate analgesia and sedation are needed. However sufficient dosage of intravenous anesthetics leads to many side effects. The authors used propofol and fentanyl infusion combined with scalp nerve block to reduce the severity of side effects from overdose of anesthetics. METHODS: The subjects were adult patients who would undergo awake craniotomy. After administering fentanyl 50~100 mcg intravenously, scalp nerve block was done to supraorbital, supratrochlear, auriculotemporal and lesser and greater occipital nerves of the surgical side with 0.25% bupivacaine containing 1 : 200,000 epinephrine. The anterior temporal region was infiltrated with the same local anesthetics. Oxygen was given by nasal cannula. During operation fentanyl was infused. Propofol was infused except during the awake period. Invasive arterial blood pressure, end-tidal CO2 and respiratory rate were monitored throughout the operation and arterial blood gas analysis was done intermittently. RESULTS: During total anesthesia time (410.3 39.9 min) propofol 16.2 6.3 mg/kg and fentanyl 11.9 3.7 mcg/kg were administered. The results of scalp nerve block were satisfactory. Brain swelling and transient decrease in respiratory rate were noticed in six patients and oxygen desaturation to 94% in one patient. All the patients were cooperative and the above problems were solved by reducing drug infusion rates. CONCLUSIONS: Propofol and fentanyl infusion with scalp nerve block may be an adequate method of anesthetic management for awake craniotomy.

The Application of Total Intravenous Anesthesia & Propofol-N2O Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: According to the increasing rate of cesarean section, the efforts of seeking safer and more satisfactory obstetric anesthesia techniques have been continued. Propofol, 2,6 di-isopropyl phenol, is a relatively new intravenous anesthetic agent and has been used for induction and maintenance for total intravenous anesthesia (TIVA). Authors examined the anesthetic technique using following anesthetics combinations; N2O-propofol, fentanyl-propofol, ketamine-propofol and made comparison of these ones for intraoperative hemodynamic stability, maternal and fetal safety. METHODS: Sixty patients (ASA physical status 1 or 2) scheduled for cesarean section were randomly allocated into three groups, group N (propofol-N2O, n=20), group F (propofol-fentanyl, n=20), group K (propofol-ketamine, n=20). We checked the changes of blood pressure and heart rates during operation, anesthetic induction time, neonatal status (Apgar score, umbilical vein blood gas analysis), presence of intraoperative awareness and recovery time. RESULTS: No significant differences in intraoperative hemodynamic changes, induction time and baby status. Total propofol dosages were greater in group N than group K (p<0.05) and maternal recovery time was prolonged in group K than group N or F (p<0.05). CONCLUSIONS: Anesthetic management using propofol-N2O or propofol-fentanyl or propofol-ketamine for cesarean section would provide satisfactory anesthesia without significant adverse effects to both mother and fetus.

A Small Dose of Fentanyl Used Prior to 3 Minutes before Intubation Can Reduce the Incidence of Hypertension and Tachycardia / 대한마취과학회지

BACKGROUND: Tracheal intubation can cause sympathetic stimulation such as hypertension and tachycardia. Many drug are used for reducing the incidence of hypertension and tachycardia induced by intubation. Among these drugs, fentanyl can be used with good result. The purpose of this study was to find the appropriate fentanyl injection time before intubation when a small dose (3 microgram/kg) was used. METHODS: We studied 82 ASA class 1 2 patients, scheduled for gynecological elective surgery, randomized into 5 groups. Group 1 received no fentanyl before intubation, and groups 2, 3, 4 and 5 received 3 microgram/kg fentanyl at 7 min, 5 min, 3 min and 1 min before intubation, respectively. The blood pressure and heart rate were checked at preinduction and post-intubation periods for 5 minutes. RESULTS: The increase of the heart rate was significantly lower in groups 2 and 3 than in group 5 just after intubation. Furthermore the increase of the mean blood pressure was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. The incidence of tachycardia and hypertension was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. CONCLUSIONS: When a small dose of fentanyl was used to blunt the intubation induced sympathetic stimulation, the appropriate time was prior to 3 minutes before intubation.

A Case of Total Intravenous Anesthesia Using a Propofol-Fentanyl Computer Asssisted Continuous Infusion: A case report / 대한마취과학회지

The technique of computer-assisted continuous infusion (CACI) has revolutionised the administration of drugs by intravenous infusion. A stable blood concentration is achieved rapidly with CACI, allowing the anesthesiologist to monitor therapeutic effect and titrate drug concentrations accordingly. Propofol and opioids can be administered by CACI for the induction and maintenance of anesthesia in adult patients. Also, the ability to maintain a constant blood concentration of drugs is also extremely important for studying the pharmacodynamic interactions of drugs, and research in the area has increased with advent of CACI. We experienced a case of total intravenous anesthesia which was totally conducted by CACI, using a Master TCI for propofol and Stelpump program for fentanyl infusion.

Low-dose Ketamine or Fentanyl as Analgesic Adjuvants for Intravenous Anesthesia with Propofol / 대한마취과학회지

BACKGROUND: This prospective study of 40 patients who underwent diagnostic laparoscopy at outpaient surgery center was performed to assess the use of ketamine as a analgesic adjuvant during intravenous anesthesia with propofol compared with the combination of propofol-fentanyl. METHOD: Anesthesia was induced with propofol (2 mg/kg) and either fentanyl (1 microgram/kg) or ketamine (0.2 mg/kg). Anesthesia was maintained with propofol 200 microgramkg-1min-1 during the first 5 min, followed by 180 microgram/kg 1min 1 for 5 min and then 160 microgram/kg-1min-1 after 10 min. The patient's lungs were mask ventilated with 50% N2O-O2. Increments of propofol were given during anesthesia if analgesia was judged to be inadequate. RESULT: Stable arterial pressure and heart rate were seen in the patients of both groups, except for a temporary increase of heart rate after induction of anesthesia in ketamine group. There were no significant differences between ketamine and fentanyl groups in total dose of propofol, response time, recovery time or VAS at 30 min after operation. Patients who received propofol-ketamine demonstrated a longer discharge time than the patients received propofol-fentanyl. There were higher incidences of dizziness and 1 patient showed emergence delirium in patients given propofol-ketamine, other side effects were similar. CONCLUSION: We concluded that low-dose ketamine with propofol can replace propofol-fentanyl for intravenous outpatient anesthesia.

Low-dose Ketamine or Fentanyl as Analgesic Adjuvants for Intravenous Anesthesia with Propofol / 대한마취과학회지

BACKGROUND: This prospective study of 40 patients who underwent diagnostic laparoscopy at outpaient surgery center was performed to assess the use of ketamine as a analgesic adjuvant during intravenous anesthesia with propofol compared with the combination of propofol-fentanyl. METHOD: Anesthesia was induced with propofol (2 mg/kg) and either fentanyl (1 microgram/kg) or ketamine (0.2 mg/kg). Anesthesia was maintained with propofol 200 microgramkg-1min-1 during the first 5 min, followed by 180 microgram/kg 1min 1 for 5 min and then 160 microgram/kg-1min-1 after 10 min. The patient's lungs were mask ventilated with 50% N2O-O2. Increments of propofol were given during anesthesia if analgesia was judged to be inadequate. RESULT: Stable arterial pressure and heart rate were seen in the patients of both groups, except for a temporary increase of heart rate after induction of anesthesia in ketamine group. There were no significant differences between ketamine and fentanyl groups in total dose of propofol, response time, recovery time or VAS at 30 min after operation. Patients who received propofol-ketamine demonstrated a longer discharge time than the patients received propofol-fentanyl. There were higher incidences of dizziness and 1 patient showed emergence delirium in patients given propofol-ketamine, other side effects were similar. CONCLUSION: We concluded that low-dose ketamine with propofol can replace propofol-fentanyl for intravenous outpatient anesthesia.

Effects of Propofol-Fentanyl and Propofol-Ketorolac Anesthesia on Postoperative Nausea and Vomiting after Strabismus Surgery in Children / 대한마취과학회지

BACKGROUND: Strabismus surgery is associated with a high incidence of postoperative nausea and vomiting. Propofol is an anesthetic which has an antiemetic effect. A randomized study was done to compare the efficacy of propofol-fentanyl and propofol-ketorolac anesthesia for strabismus surgery in children. METHODS: Eighty-five children, ASA physical status I or II, for strabismus surgery, were studied. Patients were randomly assigned to one of two groups by picking the envelop. Preanesthetic medication was not given. Fentanyl group received fentanyl 1.5 microgram/kg i.v. and ketorolac group received ketorolac 1 mg/kg, 2 minutes before induction. Atropine was given after that. Anesthesia was induced with propofol 2.4 mg/kg and vecuronium 1 mg/kg and intubation was performed. Anesthesia was maintained with a three-stage infusion technique of propofol (12 mg/kg/hr for 1st 10 minutes, 9 mg/kg/hr for 2nd 10 minutes and 6 mg/kg/hr was followed) with oxygen and nitrous oxide. Ketorolac was injected intramuscularly for preemptive analgesia immediate after induction. The incidence of nausea and vomiting was evaluated for postoperative 48 hours. And also, intraoperative oculocardiac reflex was monitored to compare the difference between two groups. RESULTS: During postoperative 48 hours, fentanyl group and ketorolac group had a similar low incidence of nausea and vomiting (4.2% and 7.0%). There is no significant difference of intraoperative oculocardiac reflex between two groups (45.2% and 30.2%). CONCLUSIONS: Propofol administered to induce and maintain anesthesia with a three-stage infusion technique is equally effective in preventing postoperative nausea and vomiting in propofol-fentanyl and propofol-ketorolac anesthesia for strabismus surgery in children.

Pupil Changes during Hypothermic Cardiopulmonary Bypass Under Fentanyl Anesthesia / 대한마취과학회지

BACKGROUND: Central nervous system dysfunction continues to be a major cause of morbidity after aorta and cardiac surgery under cardiopulmonary bypass (CPB). Pupillary reflexes are important component of the neurologic examination. The purpose of this study was to evaluate how the pupil reacts during hypothermic CPB under fentanyl anesthesia and its relation with postoperative neurologic deficits. METHODS: Fourteen patients undergoing ascending aortic dissection or aneurysm repair surgery under profound hypothermic CPB and circulatory arrest were enrolled. Pupil size and light reflex were evaluated at varying stages of CPB and temperatures. Temperatures were measured at different sites of perfusate, nasopharynx and rectum. Postoperatively neurologic assessments were performed to compare with the pupillary signs. RESULTS: Anesthetic induction with fentanyl decreased pupil size to pinpoint. Pupil dilated progressively under hypothermic CPB reaching fully dilated size at profound hypothermia. Rewarming returned the pupil to original size. Nasopharyngeal temperature correlated well with pupil size during cooling and rewarming. Light reflex was absent at any stage or temperature after anesthetic induction. Seven patients showed insignificant anisocoria and two died of other causes than neurologic deficit. One patient who was not in the anisocoria group exhibited delirium. CONCLUSIONS: Profound hypothermic CPB under fentanyl anesthesia dilates the pupil to a maximum size without light reflex overwhelming narcotic effect. Fully dilated pupil does not denote neurologic damage.

Is the Administration of Fentanyl Useful for Hemodynamic Stability during Propofol Induction Using Target Controlled Infusion(TCI) Mode? / 대한마취과학회지

BACKGROUND: Because the propofol TCI software commands the syringe pump to deliver a rapid infusion at a rate of 1200 ml/hr until the pharmacokinetic model predicts that the selected target concentration has been reached, the hemodynamic changes are predicted. To this change, several methods could be considered and the fentanyl injection is one of them. METHODS: Sixty adult patients scheduled for orthopedic surgery were randomly alldegrees Cated into four groups according to amount of fentanyl injected during induction period(group 1: no fentanyl, group 2: 0.75 microgram/kg, group 3: 1.5 microgram/kg, group 4: 3.0 microgram/kg). Target plasma concentration of propofol was selected as 4.0 microgram/ml and this concentration was achieved using modification of Prys-Roberts method. We evaluated the hemodynamic effect of various doses of fentanyl that injected at Vdpeak effect time and determined the optimal dose of fentanyl during propofol induction using TCI mode. RESULTS: Induction dose(range: 1.25~1.31 mg/kg) of propofol and induction time(range: 46~76 sec) showed no difference among groups. Use of fentanyl was effective for blood pressure stability immediately after intubation, but not effective before and 3 min following intubation. The higher the dosage of fentanyl, the more stable the heart rate. CONCLUSION: It suggest that use of fentanyl for the prevention of abrupt hemodynamic change during propofol induction using target controlled infusion mode is not necessary.

Intravenous Fentanyl Dose for Control of Postinguinal Herniorrhaphy Pain in Children / 대한마취과학회지

BACKGROUND: Postoperative pain control in children is a difficult problem for management. Fentanyl is one of the most commonly used narcotics in infants and children due to its rapid onset and brief duration. Infants older than 3 months had a lower incidence of apnea than adults given fentanyl; however, the dosage of fentanyl varies a great deal depending on the purpose and plan for the postoperative management. This study is designed to evaluate the effective dose of intraoperative intravenous fentanyl for pain control following inguinal herniorrhaphy in pediatric patients. METHODS: Sixty children for inguinal herniorrhaphy under general anesthesia were divided into four groups. Group I received no analgesics as a control. Group II, III and IV received intravenous fentanyl 0.5 microgram/kg, 1 microgram/kg and 1.5 microgram/kg respectively. Fentanyl was injected intravenously at the beginning of fascia closure. Extubation time and the degree of pain was evaluated. RESULTS: Our result showed that group III and IV had a lower pain score than that of the control group during the first 30 min in the recovery room (p<0.05), but no significant differences were found between the group III and group IV. The time interval from fascia closure to extubation was prolonged in the group II, III and IV compared to the control group (p<0.05). But no significant differences were found between the three groups. CONCLUSION: We suggest that intravenous administration of fentanyl 1 microgram/kg at the closure of fascia would be an easy, simple and effective means for relieving postinguinal herniorrhaphy pain in recovery room.

Effect of Sufentanil and Fentanyl on Heart Rate and Blood Pressure Changes during Induction of Anesthesia / 대한마취과학회지

BACKGREOUND: The hemodynamic responses to laryngoscopy and endotracheal intubation, tachycardia and arterial hypertension, are well known and should be minimized. The purpose of this study is comparison of effects of low-dose sufentanil and fentanyl on the changes of blood pressure and heart rate due to laryngoscopy and endotracheal intubation. METHODS: The cardiovascular responses were measured and compared in 60 patients, between 20~65 years old, ASA class I or II, undergoing elective operation pretreated with normal saline (n=20, control group), fentanyl 3 microgram/kg (n=20, fentanyl group), and sufentanil 0.6 microgram/kg (n=20, sufentanil group), respectively. Anesthesia was induced intravenously with pentothal sodium 4~5 mg/kg and endotracheal intubation was conducted after injection of succinylcholine 1 mg/kg. The changes of systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, heart rate, and SpO2 (saturation of arterial oxygen) were measured at postsedation with pentothal sodium, 30 seconds, 1 minute, and 3 minutes following intubation. The variables of each group were compared with preinduction baseline values and fentanyl and sufentanil groups were compared with control group. Data were analyzed for statistical significance using repeated measures of ANOVA (analysis of variance). P<0.05 was considered statistically significant. RESULTS: The systolic and mean arterial pressures at 30 seconds and 1 minute and diastolic arterial pressure at 30 seconds after laryngoscopy and intubation in sufentanil group were significantly lower than values of control group (p<0.01). The heart rates at 30 seconds and 1 minute were significantly attenuated compared with control group (p<0.05). The blood pressures and heart rates of fentanyl group at 30 seconds after intubation were significantly attenuated compared with control group (p<0.05). CONCLUSIONS: The results suggest that pretreatment of fentanyl 3 microgram/kg and sufentanil 0.6 microgram/kg is effective to prevent the elevation of blood pressures and heart rates, and sufentanil 0.6 microgram/kg is more effective than fentanyl 3 microgram/kg to attenuate the hemodynamic changes due to laryngoscopy and intubation.

Effects of Acute Myocardial Ischemia on Regional Function of the Remote Nonischemic Myocardium in Dogs / 대한마취과학회지

INTRODUCTION: During an acute myocardial ischemia, maintenance of overall ventricular function may depend on remote nonischemic myocardium. Whereas fentanyl has minimal hemodynamic effects, volatile anesthetics, including halothane and isoflurane cause negative inotropic and lusitropic effects in normal myocardium. This investigation examined the effects of volatile anesthetics in comparision with fentanyl on compensatory responses to brief left anterior descending coronary artery (LAD) occlusion in remote normal myocardium (left circumflex coronary artery (LCX) supply) in an open-chest canine model. METHODS: Thirty-six mongrel dogs, acutely instrumented for measurement of pressure (left ventricle (LV) and aorta), flows (pulmonary trunk and LCX) and dimensions in ischemic and non-ischemic myocardium, were subjected to a 10-min LAD occlusion during fentanyl (n=10), halothane (n=13), or isoflurane (n=13) anesthesia. Regional contractile function was assessed using percent systolic shortening (%SS) and the preload recruitable stroke work slope (Mw). Diastolic function was evaluated using a regional time constant for intramyocardial pressure decline of LV (IMPtau), peak lengthening rate (dL/dtmax) and a regional chamber stiffness constant (Kp). RESULTS: Acute LAD occlusion caused immediate deterioration of anterior wall function similarly without changes in cardiac index, mean arterial pressure and dP/dtmax in all three groups. LV end-diastolic pressure (LVEDP), LVPtau, and heart rate increased and dP/dtmin decreased to the same extent with regional myocardial ischemia in all groups. During fentanyl anesthesia, acute myocardial ischemia was associated with an increase in %SS (26%) and Mw (48%) in LCX area without changes in IMPtau and dL/dtmax. With halothane or isoflurane anesthesia, %SS, Mw and IMPtau showed similar changes as those in fentanyl in response to LAD occlusion. However, dL/dtmax was increased (47 and 45% in the halothane and isoflurane groups, respectively) and Kp was increased (34 and 33% in the halothane and isoflurane groups, respectively) less compared to fentanyl (78%). Enhanced function in LCX zone was associated with a comparable increase (21~28% from baseline) in LCX flow in all groups. CONCLUSION: Enhanced regional contractility following acute coronary occlusion in nonischemic myocardium during fentanyl anesthesia is well-preserved with volatile anesthetics in an open-chest canine model. In addition, diastolic functions are also enhanced rather than depressed during anesthesia with volatile anesthetics. Halothane and isoflurane, however, do not differ in the compensatory responses to acute regional ischemia.

A Comparision of Hemodynamic Changes of Total Intravenous Anesthesia (TIVA) and Isoflurane for Tonsillectomy in Children / 대한마취과학회지

BACKGROUND: In anesthesia for tonsillectomy in children, deep general anesthesia, rapid recovery to consciousness and the return of protective airway reflexes are desirable. This study was designed to estimate the efficacy of TIVA with propofol and fentanyl compared with isoflurane-N2O. METHODS: Forty pediatric patients in ASA class I for tonsillectomy were allocated randomly to either TIVA with propofol and fentanyl (n=20, T) or isoflurane-N2O (n=20, I) group. Anesthesia was induced with propofol 1 mg/kg, fentanyl 3 microgram/kg IV and was maintained by continuous infusion of propofol 6~10 mg/kg/hr, fentanyl 6~10 microgram/kg/hr in T group and was induced with thiopental 5 mg/kg IV and maintained by inhalation of 1.2~2.5 vol% isoflurane in I group. The changes of hemodynamics, recovery time and complications were evaluated. RESULTS: Systolic and diastolic pressure were increased in I group than T group at 1 min after intubation (p<0.05). Heart rate was increased in I group than T group at 1 min after intubation, 1 min and 5 min after incision, changing tube, end of operation and 5 min after end of operation (p<0.05). The recovery time was shorter in T group than I group (p<0.05). Pain on injection was more frequent in T group than I group (p<0.05), and excitatory effect during emergence was more frequent in I group than T group (p<0.05). CONCLUSIONS: TIVA with fentanyl and propofol is better than isoflurane-N2O for anesthesia of tonsillectomy in children in view of small hemodynamic change, early and gentle recovery pattern and side effects.