The effects of midazolam administered postoperatively on emergence agitation in pediatric strabismus surgery / 대한마취과학회지

BACKGROUND: The present study tested the effect of midazolam administration after sevoflurane anesthesia against emergence agitation in children in the recovery phase. METHODS: A total of 60 children presenting for ophthalmic surgery under sevoflurane anesthesia were randomly placed in four groups from Group I to Group IV. Before the end of the surgery, we injected normal saline 2 ml in Group I and Group IV. We administered a 2-ml mixture of midazolam 0.025 mg/kg and midazolam 0.050 mg/kg to Group II and Group III respectively. Among the patients with agitation scores 4 or 5 in the peostanesthesia care unit (PACU), Group IV patients were intravenously given a 1-ml mixture of midazolam 0.025 mg/kg and normal saline up to 3 times. Agitation parameters, anesthesia recovery times, and the total administration amounts of midazolam were measured. RESULTS: Extubation time was significantly longer and maximum agitation scores higher in Group III than in Group I. The rate of the length of the period when the agitation score was 4 or 5 out of the length of stay in the PACU was significantly lower in Group II, Group III, and Group IV than in Group I. The length of stay in the PACU was significantly longer in Group III, and Group IV than in Group I. CONCLUSIONS: For pediatric patients under sevoflurane anesthesia, postoperative midazolam administration slightly prolonged the length of stay in the PACU. But it effectively reduced emergence agitation without any side effects.

Effects of Volume of the Anesthetic Solution and Patient Position / 대한마취과학회지

Factors which may influence the extent of spinal anesthesia include gravity, baricity, volume, doee and concentration of the injected local anesthetic solution, and patient position. We have often experienced unexpected high level of spinal anesthesia and incomplete muscle relaxation when 0.1% tetracaine mixed in distilled water was injected intradurally for the perianal operation in jack-knife position as hypobaric technique. We have done this study to see whether injected volume or patient position influence the level for the perianal surgery. Fourty-eight patients were divided into two groups, group I, 0.1% tetracaine 5 ml, n=24, and group 11, 0.4% tetracaine 1.25 ml, n=24 in the jack-knife position of which cephalad downward angle was 15 degree, 18degree and 23degree. Sensory dermatomal levels of anesthesia were assesed using loss of pinprick aensation at 5 min and 30 min following completion of injection. Results are as follows: 1) Tetracaine mixtures of both groups were consistently hypobaric compared to patient CSF. 2) In both groups, there were significant differences in the sensory block level between 15degree and 18degree and 15degree and 23degree position but no difference between 18degree and 23degree position after 30 min. 3) Level of anesthesia were higher after 30 min than 5 min in the both groups. 4) The effect of volume of injected anesthetic solution could not be seen in the bath groups.

Clinical Evaluation of Anesthetic Management for CO2 Laser Surgery / 대한마취과학회지

The first laser was developed by Maiman in 1960 using a ruby crystal as an active medium. The word laser is an acronym for Light Amplification by Stimulated Emission of Radiation and this light beam can be focused to a small spot, resulting in precisely controlled coagulation, incision, or vaporization of tissue. The two types of lasers commonly used for airway surgery are the carbon dioxide laser and the neodymium-yttrium-aluminum-garnet (Nd YAG) laser. The light of the former will easily vaporize tissue and can be used to make a precise incision with minimal damage to adjacent tissue and the light of the latter can be conducted through fiberoptic instruments and permits successful endoscopic resection of untreatable recurrent or persistent malignant diseases of the major airways. Airway and endotracheal tube fire are the most feared hazard during laser surgery of the airway. The risk of fire depends on the nature of the tube material, the gaseous milieu, the beam wattage, and its mode of operation. The surgeon should use the laser intermittently at moderate wattage (15W) in a pulsed mode to prevent excessive heat field buildup and tissue dessication. For safe anesthetic management, nitrous oxide should be avoided, and a mixture of oxygen (25%) and air should be used or helium, which is a known flammability quencher may be used during airway laser surgery at a 60 percent He 40 percent 0, mix. Due to the increase in CO2laser treatments, we reviewed the clinical records of 150 patients in whom CO2laser surgery was performed and the anesthetic management was evaluated from April 1987 to December 1988. 1) A total of 150 patients were evaluated, including 81 males and 69 females ranging in age from 10 months to 74 years and averaging 41 years. 2) The operations performed were vocal nodule (26.0%), vocal polyp (16.0%), laryngeal papilloma (16.0%), etc. 3) The methods for keeping the airway open during general anesthesia were orotracheal intubation (67.5%) and intubation through the tracheostomy stoma (32.5%). 4) The main anesthetic agents were halothane, enflurane, and fentanyl. The anesthesia and surgery lasted 60.9+-24.0minutes and 44.5+-28.5 minutes on average respectively. 5) Laryngoscopic laser surgery was carried out in 127 patients (84.7%), bronchoscopic surgery in 14 patients (9.3%) and surgery using a handpiece in only 8 patients (6.0%). 6) Complications were found in 3 cases, including endotracheal cuff ignition and pneumomedias-timum.

Clinical Evaluation of Anesthetic Management for CO2 Laser Surgery / 대한마취과학회지

The first laser was developed by Maiman in 1960 using a ruby crystal as an active medium. The word laser is an acronym for Light Amplification by Stimulated Emission of Radiation and this light beam can be focused to a small spot, resulting in precisely controlled coagulation, incision, or vaporization of tissue. The two types of lasers commonly used for airway surgery are the carbon dioxide laser and the neodymium-yttrium-aluminum-garnet (Nd YAG) laser. The light of the former will easily vaporize tissue and can be used to make a precise incision with minimal damage to adjacent tissue and the light of the latter can be conducted through fiberoptic instruments and permits successful endoscopic resection of untreatable recurrent or persistent malignant diseases of the major airways. Airway and endotracheal tube fire are the most feared hazard during laser surgery of the airway. The risk of fire depends on the nature of the tube material, the gaseous milieu, the beam wattage, and its mode of operation. The surgeon should use the laser intermittently at moderate wattage (15W) in a pulsed mode to prevent excessive heat field buildup and tissue dessication. For safe anesthetic management, nitrous oxide should be avoided, and a mixture of oxygen (25%) and air should be used or helium, which is a known flammability quencher may be used during airway laser surgery at a 60 percent He 40 percent 0, mix. Due to the increase in CO2laser treatments, we reviewed the clinical records of 150 patients in whom CO2laser surgery was performed and the anesthetic management was evaluated from April 1987 to December 1988. 1) A total of 150 patients were evaluated, including 81 males and 69 females ranging in age from 10 months to 74 years and averaging 41 years. 2) The operations performed were vocal nodule (26.0%), vocal polyp (16.0%), laryngeal papilloma (16.0%), etc. 3) The methods for keeping the airway open during general anesthesia were orotracheal intubation (67.5%) and intubation through the tracheostomy stoma (32.5%). 4) The main anesthetic agents were halothane, enflurane, and fentanyl. The anesthesia and surgery lasted 60.9+-24.0minutes and 44.5+-28.5 minutes on average respectively. 5) Laryngoscopic laser surgery was carried out in 127 patients (84.7%), bronchoscopic surgery in 14 patients (9.3%) and surgery using a handpiece in only 8 patients (6.0%). 6) Complications were found in 3 cases, including endotracheal cuff ignition and pneumomedias-timum.