Superior Cervical Sympathetic Ganglion Block may not Influence Early Brain Damage Induced by Permanent Focal Cerebral Ischemia in Rats / 대한통증학회지

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglion (SCG). The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats subjected to permanent focal cerebral ischemia. METHODS: Thirty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (control, lidocaine and ropivacaine). A brain injury was induced in all rats by middle cerebral artery occlusion with a nylon thread. The animals of the local anesthetic group received 30 microl of 2% lidocaine or 0.75% ropivacaine in the SCG. Neurologic scores were assessed 24 hours after brain injury. Brain samples were then collected. The infarct and edema ratios were measured by 2.3.5-triphenyltetrazolium chloride staining. RESULTS: There were no differences in the death rates, neurologic scores, or infarction and edema ratios between the three groups. CONCLUSIONS: These findings suggest that superior cervical sympathetic ganglion block may not influence the brain damage induced by permanent focal cerebral ischemia in rats.

The Experience of One Day Surgery in Pediatric Patients

One day surgery in children has been practiced for last 10 years in this institution. This study is to examine its safety and effectiveness for patients younger than 15 years old treated at the Department of Pediatric Surgery, Asan Medical Center, from September. 1996 to December, 2005. A total of 3,709 patients, 37 % of the total pediatric operations, are included in this retrospective study. The most prevalent ages were between 1 and 3 years olds (1,199 patients). Twenty patients were younger than 6 months, and they all had one day surgery safely. Operations were herniorrhaphy in 3,126 patients,followed by excisional biopsy, chemoport removal, and OK 432 injection. There were 12 cases (0.32 %) of unplanned admissions, 7 occurred within 6 months of one day surgery. Perioperative fever was the most common cause of admission in 4 cases. The related conditions of unplanned admission were bleeding in 2 cases and radical surgery in 2. One day surgery in this institution was easily accessible and safe. This is to the result of appropriate selection of patients, cooperation with anesthesiologists, adequate control of postoperative pain, and home care programs.

Effects of Bupivacaine on Strips of Rat Thoracic Aortic Rings / 대한마취과학회지

BACKGROUND: Local anesthetics depress smooth muscle contractions in the intact bowel and in strips of isolated intestine, and also relax bronchial smooth muscle. Following systemic absorption, local anesthetics act on the cardiovascular system. Their primary site of action is the myocardium, where decreases in electrical excitability, conduction rates, and contraction force occur. In addition, most local anesthetics cause arteriolar dilation. METHODS: The ability of bupivacaine to elicit a direct relaxant effect on vascular smooth muscle was studied using isolated rat thoracic aortic rings contracted by phenylephrine (PE). Each thoracic aorta ring was suspended on wire supports in a 20 ml tissue bath under 2 g of resting tension. All tissues were bathed in Tris Tyrode solution at 37 degrees C and 100% oxygen was supplied. RESULTS: 1. Bupivacaine (10(-5) M) inhibited PE induced contractions of aortic rings significantly (P < 0.05). 2. Relaxation of aortic rings by bupivacaine (10(-5) M) was reversed by L-NAME pretreatment. 3. Relaxation of aortic rings by bupivacaine (10(-5) M) was not recovered by methylene blue. 4. Indomethacine enhanced the contraction of aortic rings by bupivacaine (10(-5) M). 5. Bupivacaine (10(-5) M) inhibited both the influx of extracellular Ca+2 and intracellular Ca+2 release. 6. Relaxation of aortic rings by bupivacaine 10(-5) M was recovered by tetraethylammonium. CONCLUSIONS: From the results obtained, it is concluded that the relaxation effects of bupivacaine are related with endothelium dependent, and that cyclooxygenase and not guanylate cyclase participates in this relaxation. Bupivacaine inhibited both intracellular calcium release and extracelluar calcium influx. In addition, the potassium channel was also found to be related to this relaxation effect.

Fat Myringoplasty Trimmed with CO2 Laser / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fat myringoplasty is a simple and safe method for repairing tympanic membrane perforation. The purpose of this study was to investigate the effect of fat myringoplasty accompanied by CO2 laser treatment for the trimming of perforation. MATERIALS AND METHOD: Twenty-one patients diagnosed with the following tympanic membrane perforations were used: 1) Traumatic perforation, 2) Chronic otitis media without active inflammation, 3) Re-perforation after middle ear surgery. The procedure was performed at OPD under local anesthesia while operating a microscope that was adapted to the CO2 laser. RESULTS: The overall success rate was 81 percent (17/21). CONCLUSION: Fat myringoplasty can be recommended for repairing tympanic membrane perforation in traumatic, chronic otitis media and re-perforation after middle ear surgery. Fat myringoplasty was simple and effective on only small perforations (

Management of Persistent or Recurrent Otorrhea after Open Cavity Tympano-Mastoidectomy: Laser Application / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Persistent and recurrent otorrhea following open cavity tympano-mastoidectomy can be a serious problem for the patient and the otologic surgeon. Frequent post-operative otorrhea hallmarks surgical failure. Medical treatment may often yield resolution, but a significant number of patients would still require re-operation. So we applied CO2 laser cauterization to draining cavity. The objective of the present study was to introduce the CO2 laser cauterization on draining cavity, and to describe the clinical course of the laser treatment. MATERIALS AND METHOD: Twenty-one cases of post-operative persistent or recurrent otorrhea were diagnosed at our hospital from January 1999 to December 2000. Fifteen cases were selected in this study. The selection criteria included chronic ear patient, open cavity tympano-mastoidectomy, absent residual or recurrent cholesteatoma. The minimum duration of follow up was 6 months. All cases were locally anesthetized with 10% xylocaine. The CO2 laser was Shaplan 100 which was connected to a microscope. The interval of CO2 laser cauterization was one week. RESULTS: All of 15 cases were cured completely. There was no recurrence during the follow up period. The locations of granulation tissues were tegmen (10 cases), mastoid tip (6 cases), retro-facial or facial ridge (4 cases), and sino-dural angle (4 cases). The mechanical causes of retention of debris in open cavity procedures included insufficient meatoplasty (3 cases) and high facial ridge (2 cases). The times of CO2 laser coagulation ranged from 2 to 5. CONCLUSION: Based on our research on the effect of CO2 laser among patients with draining cavity, we concluded that : 1) CO2 laser cauterization was an efficient method for the management of draining cavity, 2) CO2 laser cauterization has benefits which reduced the frequency of OPD visits and 3) CO2 laser cauterization provided a delicate, selective removal of granulation tissues.

Effects of Laser Myringotomy on the Treatment of Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otitis media, with effusion has been known to require long term medical treatment. When medical treatment fails, myringotomy with or without ventilation tube insertion needs to be performed, but the duration of middle ear ventilation with myringotomy is very limited. The insertion of ventilation tubes may also cause some complications, and may require general anesthesia when performing at a young age. The purpose of this report is to see if myringotomy using CO laser can be used as an effective tool in the treatment of otitis media with effusion. MATERIALS AND METHODS: We retrospectively studied 66 ears of patients who went through myringotomy using CO laser between March, 1998 and May, 1999. We analyzed myringotomy size, patency time, recurrence and cost effectiveness. RESULTS: The average size of myringotorny was 2.1 mm in diameter. It remained patent for as long as 1.9 weeks in average. All myringotomy sites were healed without persistent perforations. Average recurrence rate and time were 27% and 3.2months, respectively. The medical treatment is expensive and needs more frequent follow-ups, but laser treatment is cheaper and requires less frequent follow-ups. CONCLUSIONS: CO laser myringotomy is a safe and cost effective procedure which can be done easily at the office in most of the cases.

The Mechanism of Action of Intrathecal Morphine in Neuropathic Pain Induced by Nerve Ligation: The Effect of Naloxone / 대한마취과학회지

BACKGROUND: Although the efficacy of morphine in the neuropathic pain state is somewhat controversial, spinally administered morphine reversed the tactile allodynia in our previous animal study. Using a von Frey filament test, we examined the mechanism of action of intrathecal morphine by administration of the opioid receptor antagonist naloxone in a rat model of neuropathic pain induced by nerve ligation injury. METHODS: Male Sprague Dawley rats were prepared with tight ligation of the left lumbar 5th and 6th spinal nerves and a chronic lumbar intrathecal catheter. Intrathecal doses (0.3 and 1 microgram) of morphine were administered to attenuate the allodynic state. Naloxone was administered intrathecally (10 microgram) or intraperitoneally (30 and 150 microgram) in order to investigate the reversal of the antiallodynic effect of morphine. Allodynic thresholds for left hindpaw withdrawal to the von Frey hairs test were assessed and converted to %MPE. RESULTS: A reduced effect of tactile allodynia by intrathecal morphine was produced. Naloxone 10 microgram (IT) and 150 microgram (IP), but not naloxone 30 microgram (IP), reversed the antiallodynic effect of intrathecal morphine (P < 0.05). CONCLUSIONS: The results suggest that the mechanism of tactile antiallodynia induced by intrathecal morphine may include the opioid receptor system at the spinal and supraspinal level in a rat model of nerve ligation injury.

Noninvasive Regional Cerebral Oxygenation Monitoring in Patients with Moyamoya Disease / 대한마취과학회지

Moyamoya disease is a rare progressive occlusive disease in the internal carotid arteries, along with the presence of an abnormal capillary network of vessels at the base of the brain. In moyamoya disease, the manitaining of cerebral perfusion and cerebral oxygen saturation are required to reduce complications of this disease including cerebral ischemia and cerebral hemorrhage. The authors measured regional oxygen saturation (rSO2) nonivasively by INVOS 5100 (Somanetics, USA) in patients with moyamoya disease who were scheduled for an encephalo-duro-arterio-myo synangiosis (EDAMS) operation. We therefore report our findings that deep breathing decreased rSO2 and oxygen, elevated blood pressure, and that the cerebral vasodilating drug increased rSO2.

Adult T cell leukemia/lymphoma with lymphopenia in a Korean

We experienced a case of adult T cell leukemia/lymphoma (ATLL) in a 48-year-old Korean female, who has never been abroad since birth and no history of blood transfusion. The patient had hypercalcemia and multiple lymphadenopathy. Histopathologic study of left cervical lymph node (LN) and bone marrow (BM) revealed that infiltrates of malignant lymphoid cells were composed of small, medium and large cells with pleomorphic nuclei. Smears of peripheral blood (PB) showed lymphopenia (16%) with the appearance of a few atypical lymphoid cells (less than 2%), but not the typical clover leaf cells seen in ATLL. Immunophenotypic study of LN and BM revealed T cell phenotype. PB showed increased CD4+ T cell (T(H), CD3/CD4+, 57%) and decreased CD8+ T cell counts (T(S), CD3/CD8+, 6.7%). The sera of the patient and her family were reactive for HTLV-I antibody. The specific sequences of pol, env, and tax of HTLV-I DNA were detected in the lymphoma cells and peripheral blood mononuclear cells (PBMC) using polymerase chain reaction. Ultrastructural examination of PBMC confirmed numerous type c virus particles in extracellular space. This case was an acute type of ATLL without overt leukemic features in PB. Despite chemotherapy and intensive conservative treatment, she died 3 months after admission.

The Efficacy of Electroencephalography and Somatosensory Evoked Potential Monitoring for Detecting Cerebral Ischemia during Carotid Endarterectomy under Regional Anesthesia / 대한마취과학회지

BACKGROUND: Carotid endarterectomy has been proven to be beneficial for the prevention of strokes in both symptomatic and asymptomatic patients with significant carotid stenosis. Even if there is no consensus as to the most appropriate monitoring method for detecting cerebral ischemia during carotid endarterectomy, electroencephalography (EEG) and/or somatosensory evoked potential (SSEP) has been extensively used to evaluate cerebral functions. We estimated the efficacy of EEG and SSEP for detecting cerebral ischemia during carotid endarterectomy in conscious patients. METHODS: One or both of 16-channel EEG and SSEP monitoring were performed in 103 patients scheduled for carotid endarterectomy under cervical plexus block. We estimated the sensitivity and specificity of EEG and SSEP for detecting cerebral ischemia expressed by altered consciousness and shunt insertion. RESULTS: During carotid clamp in 74 cases studied, significant EEG changes were noted in 5 of the 16 patients who had cerebral ischemia, however 11 patients had no EEG changes despite cerebral ischemia. During carotid clamp in 84 cases studied, significant SSEP changes were noted in 7 of the 19 patients who had cerebral ischemia, however 12 patients had no SSEP changes despite cerebral ischemia. The sensitivity and specificity for detecting cerebral ischemia were 31% and 86% for EEG and 37% and 95% for SSEP, respectively. CONCLUSIONS: We conclude that EEG and SSEP monitoring during carotid endarterectmy under regional anesthesia is not a sensitive method for detecting cerebral ischemia.

Enflurane Anesthesia Augments the Peripheral Venous Pressure Changes during Non-invasive Blood Pressure Measurement / 대한마취과학회지

BACKGROUND: Venous regurgitation into the infusion line and subsequent occlusion frequently occurs during blood pressure (BP) measurement. The purpose of this study was to obtain the pattern and the actual range of peripheral venous pressure (PVP) change during NIBP measurement before and during enflurane anesthesia. METHODS: Adult size NIBP cuff was placed on the same arm on which IV infusion set was placed. PVP waveforms during BP measurement were recorded from 6 subjects. PVPs were measured before induction and at 30 min after induction of enflurane anesthesia (n=19). As the PVP waveform during NIBP measurement was biphasic in shape, values of baseline PVP (BEFORE), first peak (PEAK1), notch between two peaks (NOTCH), second peak (PEAK2) were measured. Timed control data were obtained from six volunteers. RESULTS: PEAK2 was always higher than PEAK1. Range of peak PVP was 12-130 mmHg (57.6 2.5 mmHg, mean S.E.) and PVP change was augmented during enflurane anesthesia (p<0.05). Enflurane anesthesia accentuated correlationship between mean arterial pressure and PVP. CONCLUSION: Our observation showed that peak PVP occurred during deflation phase and its range of variation was substantial. Changes in the pattern and the autoregulation of PVP by enflurane needs further investigation.

Interaction between Neostigmine and Morphine in the Neuropathic Pain Model / 대한마취과학회지

BACKGROUND: Spinally administered neostigmine, but not morphine, has been well known to reverse the mechanical allodynia in human and animal studies. The efficacy of morphine in neuropathic pain state is somewhat controversial. Using an isobolographic analysis, we examine the spinal interaction between neostigmine and morphine in a rat model of neuropathic pain. METHODS: Male Sprague Dawley rats were prepared with tight ligation of left lumbar 5th and 6th spinal nerves and chronic lumbar intrathecal catheter. Intrathecal dose response curves were established for the antiallodynic effect of neostigmine (0.3, 1.0, 3.0, and 10 microgram) and morphine (0.3, 1.0, 3.0, and 10 microgram) alone to obtain the ED50 for each agent. ED50 fractions (1/2, 1/4, 1/8, and 1/16) of drug combination of neostigmine-morphine were administered. Allodynic thresholds for left hindpaw withdrawal to von Frey hairs application were assessed and converted to %MPE. The ED50 of neostigmine-morphine combinations was established and isobolographic analysis of the drug interaction was carried out. RESULTS: Intrathecal neostigmine and morphine alone produced dose-dependent reductions of tactile allodynia. ED50 values are 0.43 microgram (0.21~0.86 microgram) for neostigmine and 0.39 microgram (0.07~2.01 microgram) for morphine. The log dose responses were plotted from the peak effect of %MPE in each group of neostigmine and morphine. The experimental ED50 1.34E-2 microgram (2.1E-4-0.85 microgram) for neostigmine and morphine combination was found to be significantly below the theoretical additive ED50 value 0.41 microgram (P<0.05). CONCLUSION: The results suggest that intrathecal neostigmine and morphine alone produce a dose dependent antagonism on touch evoked allodynia and intrathecal neostigmine is synergistic at the spinal level when combined with intrathecal morphine in a rat model of neuropathy.

Effect of Preinduction Amino Acid Infusion on Body Core Temperature / 대한마취과학회지

BACKGROUND: It is well known that administration of nutrients, especially protein and amino acids mixtures, stimulates energy expenditure in the unanesthetized patients. Also, there were reports that the mechanisms for nutrient-induced thermogenesis are not impaired during general anaesthesia. The enhanced amino acid-induced thermogenesis would counteract the anaesthesia-induced reduction in metabolism and prevent the development of hypothermia. The present study was designed to see if completing the amino acid infusion before induction of anaesthesia would induce heat production, which would promote energy expenditure and thereby counteract the development of anaesthesia-induced hypothermia. METHODS: Body temperatures and arterial blood gases were measured in 48 patients during perioperative period. 24 patients had an amino acid mixture of 227 cal infused over 2 hours before anesthesia and 24 control patients received Hartman's solution. RESULTS: Amino acid infusion attenuated the development of hypothermia during the period from 60 min to 105 min after induction of anaesthesia compared to control group, however, did not prevent overall hypothermia throughout the study period. CONCLUSION: This result may indicate amino acid infusion before anesthesia can be an adjuvant to prevent intraoperative hypothermia.

The Effect of Adrenaline on the Blockade of Compound Action Potential by Local Anesthetics in Rat Sciatic Nerves / 대한마취과학회지

BACKGROUND: Adrenaline has often been used to prolong the local anesthetic effect during surgical procedures. As a possible explanation for this, a local vasoconstriction caused by adrenaline has been proposed. However, in a recent study, clonidine, an alpha2 adrenergic receptor agonist, was reported to block the conduction of mammalian nerves in vitro. Thus, there is a possibility that adrenaline may block nerve conduction by acting on the adrenergic receptor. The present study is performed to see : (1) If adrenaline directly affects nerve conduction ; (2) If adrenaline affects conduction blockade caused by local anesthetic. METHODS: Recordings of compound action potentials (CAPs) of A- and C-components were obtained from isolated sciatic nerves of adult male Sprague-Dawley rats. Dose-response curves of lidocaine and adrenaline regarding depression of CAPs were determined. Effects of adrenaline on the lidocaine-induced nerve block was assessed by comparing the effect of lidocaine (3.5x 10 5) with a lidocaine-epinephrine mixture (Lido-Epi, 3.5 x10 5 lidocaine with 1:100,000 epinephrine). RESULTS: Adrenaline, near the clinical concentrations, had no effect on the size of either A- or C-component of CAPs. The ED50 of lidocaine was 3.5x 10 5. Lidocaine depressed A-CAP 45.9+/- 7.0 when compared with baseline value, and the Lido-Epi solution depressed A-CAP to 41.7+/- 5.0 (P > 0.05). Lidocaine depressed C-CAP 59.8 +/- 3.4 when compared with the baseline value, and the Lido-Epi solution depressed C-CAP to 60.5 8.1 (P > 0.05). Consequently, adrenaline did not augment lidocaine induced nerve blockade. CONCLUSION: This study confirmed that adrenaline applied to the peripheral nerve has no effect either on nerve conduction itself or on conduction block produced by lidocaine.

An Analysis of the Clinical Status of the Brain Death Donors / 대한마취과학회지

BACKGROUND: Since the first successful kidney transplantation from a brain death donor (BDD) was done in 1979, organ transplantations from BDD have steadily increased. The number of BDDs have been increasing year by year. The purpose of this study is to analyze clinical status of organ donor from BDDs. METHODS: We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. RESULTS: The male to female ratio was 3 : 1, and the age distribution was the highest in twenties. The distribution of cause of brain death was the highest in motor vehicle accidents. The distribution of acquired organ was the highest in kidney, heart, liver in order. The distribution of days stayed in ICU before organ donation was the highest in 2 days. The choice of agent for inotropic support of the myocardium is dobutamine. The donors have been transfused with packed red blood cell (PRBC) to maintain the hematocrit between 25~35%. Two units of PRBC should be readily available at all times for transfusion. The failure of organ donation was mainly very poor organ condition. CONCLUSIONS: We wish that these results were made use of bases of status of organ donation from BDDs.

Anesthetic Management of Carotid Endarterectomy under Cervical Plexus Block / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine the possibility and safety of performing carotid endarterectomy under cervical plexus block. METHODS: Carotid endarterectomy was performed in 30 cases with deep and superficial cervical plexus block, to monitor the patient for cerebral ischemia in the awake state. The toy horn was placed in the contralateral hand in each case and was activated by the patient on command and patients had counted ten repeatedly during carotid clamping. Patients who had not been experienced in the change of mental status or motor response had been operated without a shunt. RESULTS: Cerebral ischemia requiring shunt was observed in one case (3.3%). There were no permanent neurologic deficit and major cardiovascular complication and mortality. CONCLUSIONS: Carotid endarterectomy under cervical plexus block allows direct and precise observation of the patient's central nervous system function during the operation.

Angiographic Analysis of Cerebral Aneurysm

PURPOSE: To analyze the angiographic findings of cerebral aneurysms and to compare them with previousdomestic and foreign reports. MATERIAL AND METHODS: Three hundred and seventeen patients underwent DSA(digitalsubtraction angiography) and the results were retrospectively, reviewed. Among 278 patients, 356 cerebralaneurysms were detected. Patient's age and sex ratio were analysed, as well as the location, size and multiplicityof the aneurysms. RESULT: The most prevalent age group was 40 to 60 years (n=211, 76%), and the male to femaleratio was 1:1.5. Aneurysms were located in the anterior (n=324, 91%) or posterior circulation(n=32, 9%). In theformer, the most common locations were the anterior communicating artery (n=98, 28%), middle cerebral artery (MCA)bifurcation(n=65, 18%) and the posterior communicating artery (n=32, 9%), while in the pasterior circulation, themost common location was the basilar tip(n=11, 3%). One hundred and eighty-eight cerebral aneurysms(53%) were 3-6mm in size, and 75(21%) were 6-10mm. The size of nine aneurysms (3%) was more than 25mm. Multiple aneurysms(n=149)occurred in 65 patients(23%) ; the most common age group was 40 to 60 (74%) and the male to female ratio was 1:4.The most common number of multiple aneurysms were two (77%) and the common locations were the posteriorcommunicating artery (21%), MCA bifurcation (18%) and anterior communicating artery (13%). CONCLUSION: Weanalyzed a large series in a single center and therefore expect that our data will be helpful for the analysis ofaneurysms in the cerebral circulation and for comparison with domestic and foreign studies.

Analysis of Angiographic Findings in Arteriovenous Malformations (AVM) of Brain According to PresentingClinical Manifestations

PURPOSE: To evaluate the different angio-architectures of brain arteriovenour malformatigns (AVMs) accordingto the presence of non-hemorrhagic symptoms or intracerebral (ICH) and/or intraventricular hemorrhage(IVH). MATERIALS AND METHODS: The results of complete cerebral angiography obtained in 215 patients with AVM between1989 and 1994 were retrospectively reviewed. The M:F ratio was 136:78 and their mean age was 29 (ranged 4 - 66)years. On the based of clincal presentation, CT and/or MR images, they were divided into hemorrhagic andnon-hemorrhagic groups. Angiograms were analyzed by two radiologists for the size and location of nidus; thenumber of feeding arteries and the extent of aneurysm, stenosis, dural supply, and angiomatous change; the numberof draining veins and the extent of deep or superficial drainage, stenosis, ectasia, kinking, and stasis. Thestandard chi-square test was used for statistical analysis. RESULTS: Hemorrhage was noted in 140 patients(65%),and no hemorrhage in 75(35%). Hemorrhage was more common in AVM with deep-seated and callosal locations, a nidusof less than 2cm, single feeder and single venous drainage, and deep venous drainage only (p < 0.05 - 0.001).Non-hemorrhagic presentations were more common in AVM with cortical and subcortical location, a nidus of more than5cm, angiomatous change, dural supply, both superficial and deep venous drainage, kinking, and stasis (p <0.05-0.001). CONCLUSION: The angio-architechture of AVM with hemorrhage correlated with clinical symptomaticpresentation. Analysis of the patterns of angioarchitectureis useful for prognosis and in deeiding the direetionof freatment.

Effects of Ketamine and Clonidine for Caudal Analgesia Produced by Bupivacaine in Pediatric Ambulatory Surgery / 대한마취과학회지

BACKGROUND: Caudal block has proved to be a satisfactory method of providing perioperative analgesia for pediatric surgery in inguinal and perineal areas. This study was designed to evaluate the effects of ketamine or clonidine as an adjunctive of caudal block produced by bupivacaine. METHODS: One hundred ninety five children aged 1~10 years, undergoing surgery in inguinal and perineal areas as ambulatory cases, were randomly allocated to one of four groups after the induction of general anesthesia; 0.25 % bupivacaine 1 ml/kg(group B), 0.25 % bupivacaine 1 ml/kg with ketamine 0.5 mg/kg(group K), 0.25 % bupivacaine 1 ml/kg with clonidine 1 microgram/kg(group C), and local infiltration group(group L). Postoperative pain was assessed using an objective pain scale and the incidence of side effects, such as urinary retention and nausea/vomiting was observed after surgery. RESULTS: In the group B and L, OPS score was higher and analgesics were more frequently administered than group K and C at the recovery room and at home after discharge(p<0.05). There was no difference between the groups in the incidence of nausea and vomiting but urinary retention at the recovery room was more frequent in group C than other groups(p<0.05). CONCLUSIONS: Caudal block provided more effective postoperative analgesia than local infiltration. In caudal block, the addition of ketamine or clonidine prolongs the duration of postoperative analgesia without significant increase in side effects.

Intraoperative Normovolemic Hemodilution in Patients Undergonig Posterolateral Spinal Fusion: Safety and Efficacy / 대한마취과학회지

BACKGROUND: The implementation of intraoperative normovolemic hemodilution is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential complications. The goal of this study was to evaluate the safety and efficacy of moderate intraoperative normovolemic hemodilution. METHODS: Fifteen patients scheduled for posterolateral spinal fusion underwent intraoperative normovolemic hemodilution with 10% pentastarch to a target hematocrit level of 25% (hemodilution group). All units of blood procured by hemodilution and additional allogeneic blood was transfused in the perioperative period to maintain the hematocrit level of>25%. We investigated the effect of hemodilution on whole blood coagulation as measured by the thromboelastography and, evaluated its efficacy of decreasing the need for allogeneic blood transfusion as compared to the nonhemodilution group, retrospectively. RESULTS: Hemodilution with pentastarch caused a decrease in response and coagulation time (p<0.01) but did not influence on the alpha angle and maximum amplitude on thromboelstogram. Amount of transfusion of allogeneic blood was 4.1 1.7 units for the hemodilution group and 5.0 1.5 units for the nonhemodilution group. Net red blood cell volume ""saved"" from hemodilution was about 120 ml. CONCLUSION: Moderate intraoperative normovolemic hemodilution with pentastarch does not affect the coagulability of whole blood. But its efficacy of decreasing the need for allogeneic blood transfusion is minimal.