Comparison of Propofol and Thiopental Anesthesia for Ambulatory Surgery / 대한마취과학회지

The purpose of the present study was to compare prapofol, newly introduced anesthetic agnet, & thiopental as to the characteristics of induction & recovery as well as the safety of both anents. Fifty patients who presented for termination of pregnancy were allocated at random to recieve either propofol 2 mg/kg IV or thiopental 4 mg/kg IV. In addition all patients recevied fentanyl, 1 ug/kg IV, one minute befor the induction. Repeated bolus doses of either propofol 20 mg or thiopental 50 mg were given, if the patient respond to surgical stimulation by moving. The result were as follows. 1) Both propofol and thiopental produced smooth and rapid induction, but caused significant respiratory depression. 2) There was more cardiovascular depression with propofol than with thiopental. 3) Postoperative recovery(time to ambulation) was faster with propofol than with thiopental (36.5+/-1.4 vs 72.9+/-5.1 min, p<0.001). 4) Propofol was associated with less side effects(Nausea, vomithing, and dizziness) than thiopental. These results suggest 1) that propofol has significant advantage over thiopental in outpatient surgery, where early ambulation and discharge is desirable, and 2) that both propofol and thiopental should be administered by expert anesthesiologist only when ventiatory assistant device with oxygen is immediately available.

The Effects of Ketamine on the Hemodynamics Decreased by Fentanyl - Deazepam / 대한마취과학회지

To investigate the effects of ketamine on the hemodynamics decreased by fentanyl-diazepam, twenty-five patients were randomly assigned to three groups. In all patients fentanyl (10 ug/kg) diazepam (0.2 mg/kg) was intravenously administered, and then patients in group 1 recevied saline only, group 2 and group 3 recevied 1 and 2 mg/kg of ketamine, respectively. Hemodynamic parameters were obtained before and 5 minutes after durg in each group. In group 1, fentanyl-diazepam produced a decrease in heart rate (HR:17%), mean arterial pressure (MAP:27%), cardiac index (CI:40%) and sroke volume index (SVI:14%), and a increase in mean pulmonary arterial pressure (MPAP:27%) and pulmonary capillary wedge preasure (PCWP;25%), but no significant change in central venous pressure (CVP) and systemic vascular resistance index (SVRI). Patients in group 2 had decreases in HR(16%), MAP(10%), CI(10%) and SVI(16%), and decrease in MPAP(21%), PAWP(21%), PCWP(26%), CVP(58%) and SVRI(24%), but theae hemodynamic changes were no significant difference compared to those of group 1 except a bit increase in CVP and SVRI. In group 3, HR(11%), MAP(11%), CI(23%), and SVI(13%) were decreased, but MPAP(14%), PCWP(14%), CVP(69%) and SVRI(26%) were increased and these values were no difference compared to those of group 2. These results demonstrated that ketamine did not significantly affect the hemodynamics decreased by fentanyl-diazepam except CVP and SVRI were increased by ketamine. Base on this study, the author suggeeted that the mechanism of cardiovascular depression caused by diazepam-fentanyl might to be the result of myocardial depression, ketamine produced its sympathomimetic actions primarily by direct stimulation of central nervous system, and ketamine might to be unuseful to improve the hemodynamics to patients with cardiovaseulsr depreseion caused by fentanyl-diazepam.

The Effects of Postural Change on Hemodynamics / 대한마취과학회지

The purpose of this study was to evaluate the effect of postural change on hemodynamics under halothane-N2O-O2 anesthesia. The authors measured heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (PVP), and cardiac index (C1) on supine position (baseline), and after a postural change to the lithotomy, head up tilt (5, 10, 15 degress) and head down tilt (5, 10, 15 degrees) positions in 10 healthy subjects. The results were as follows: 1) After a postural change to the lithotomy position, all hemodynamic variables revealed no changes. 2) After a change to the head up position, MAP, CVP, PAP, PCWP, and CI decreased significantly, while HR remained unchanged. 3) After a change to the head down position, CVP, PAP, PCWP, and CI increased and HR decreased significantly, while MAP remained unchanged. From the above results, it might be concluded that a down ward tilt of 10 degrees is most the appropriate position to restore hemodynamics in the presence of cardiovascular instability.