Comparison of Onset Time and Postoperative Analgesic Effects of Mepivacaine and Bupivacaine with Morphine on Caudal Block / 대한마취과학회지

BACKGROUND: Caudal injection of local anesthetics with morphine is the most common anesthetic technique for perianal operation and postoperative analgesia. This study was purposed to compare the onset time of caudal analgesia, postoperative analgesic effect and side effects. METHOD: Sixty healthy patients scheduled for perianal operation were divided into 2 groups randomly. Group I was given 2 mg of morphine in 20 ml of 2% mepivacaine via sacral hiatus. Group II was also given 2 mg of morphine in 20 ml of 0.5% bupivacaine caudally. We measured the onset time of caudal block, time to the first request of analgesics, the number of analgesics within 24 hours and the incidence of postoperative side effects. Analgesic effect was evaluated by visual analogue scales (VAS) at 1, 2, 6, 12 and 24 hours postoperatively. RESULT : The onset time of caudal block for operation and the first request time of analgesic for postoperative pain was significantly shorter in group I than group II. The analgesic use in the first 24 hours was significantly more in group I than group II. The side effects were similar in both groups. CONCLUSION: We concluded that the combined use of morphine and bupivacaine provided better postoperative analgesia than the combined use of morphine and mepivacaine.

Comparison of Epidural Patient-Controlled Analgesia and Intravenous Patient-Contolled Analgesia for Pain Relief after Cesarean Delivery / 대한마취과학회지

BACKGROUND: Epidural administration of local anesthetics and opiate or intravenous administration of opiate and ketorolac has proven to be effective in the treatment of postoperative pain. Studies that compare epidual morphine-bupivacaine vs intravenous nalbuphine-ketorolac administration showed conflicting results. We compared the ability and side effects of epidural (EPI-PCA) morphine-bupivacaine versus intravenous (IV-PCA) nalbuphine-ketorolac for postoperative pain relief after cesarean delivery. METHOD: Sixty healthy women were randomly assigned to receive an epidural bolus of morphine 3 mg mixed with 0.5% bupivacaine 10 ml, followed by a EPI-PCA with 0.0125% morphine and 0.125% bupivacaine (basal infusion 2 ml/hr, bolus 0.5 ml, lock-out interval 15 min) or intravenous bolus of nalbuphine 5 mg, followed by a IV-PCA with 0.05% nalbuphine and 0.15% ketorolac (basal infusion 2 ml/hr, bolus 0.5 ml, lock-out interval 30 min) for pain relief after cesarean delivery. The intensity of pain was assessed by the patient, who was unawared of the dose given, using a visual analog scale (VAS). To compare intensity of pain, VAS was used at 1, 6, 12, 24 and 40 hour after the end of surgery. RESULT : EPI-PCA group had significant lower visual analog scale (VAS) at immediate postoperative period, whereas no significant difference was observed when pain was assessed at other time sequence. Pruritus was more frequent with EPI-PCA group, although the incidence of other side effects were the same. CONCLUSION: We conclude that EPI-PCA or IV-PCA using morphine-bupivacaine or nalbuphine- ketorolac is relatively effective and safe method for the postoperative pain control. Although EPI-PCA with morphine-bupivacaine shows lower VAS at immediate postoperative period, IV-PCA with nalbuphine-ketorolac is a safe and effective alternative to EPI-PCA with morphine-bupivacaine for providing pain relief after cesarean delivery.

Inhalation Anesthesia with Isoflurane for Surgical Removal of Pheochromocytoma / 대한마취과학회지

We have experienced an anesthetic management of a 34 year old female patient with pheochromocytoma of left adrenal gland. The anesthetic management of patients presents many difficult problems, such as hypertension, arrhythmia and hypotension. The patient had been treated with phenoxybenzamine for 2 weeks preoperatively. Following induction of anesthesia with intravenous fentanyl, thiopental sodium and vecuronium, endotracheal intubation was performed. Anesthesia was maintained with nitrous oxide, oxygen and isoflurane administration. Blood pressure and pulse were controlled well with nitroprusside and isoflurane. After removal of tumor, blood pressure was controlled by Hartman's solution, packed red cell and dopamine administration. The patient tolerated well despite the episodic hemodynamic changes. Importance of preoperative preparation, sufficient sedation, smooth induction, complete analgesia, good muscle relaxation and stable cardiovascular control has been discussed.

Balanced Anesthesia in a Patient with Complete Left Bundle Branch Block: Case report / 대한마취과학회지

Local or general anesthesia is essential for safe operation. Patients in good preoperative condition are relatively to tolerable to the operation, but the patients in poor preoperative condition have the high mortality and morbidity during and after the operation. Therefore, we should choose the anesthetic agents and methods, which cause little effect to the patient's life. Among the intraventricular blocks, bundle branch is the most common type, and left bundle branch block may progress to a more serious condition of complete heart block. Optimal anesthetic management of patients with cardiovascular disease requires a thorough knowledge of normal cardiac physiology, the circulatory effects of the various anesthetic agents, and the pathophysiology and treatment of these diseases. The authors successfully performed balanced anesthesia in operation of a 63 year old female patient who showed complete left bundle branch block pattern in a preoperative electrocardiographic tracing without any subjective symptoms.

Balanced Anesthesia in a Patient with Complete Left Bundle Branch Block: Case report / 대한마취과학회지

Local or general anesthesia is essential for safe operation. Patients in good preoperative condition are relatively to tolerable to the operation, but the patients in poor preoperative condition have the high mortality and morbidity during and after the operation. Therefore, we should choose the anesthetic agents and methods, which cause little effect to the patient's life. Among the intraventricular blocks, bundle branch is the most common type, and left bundle branch block may progress to a more serious condition of complete heart block. Optimal anesthetic management of patients with cardiovascular disease requires a thorough knowledge of normal cardiac physiology, the circulatory effects of the various anesthetic agents, and the pathophysiology and treatment of these diseases. The authors successfully performed balanced anesthesia in operation of a 63 year old female patient who showed complete left bundle branch block pattern in a preoperative electrocardiographic tracing without any subjective symptoms.

Clinical Evaluation of Anesthetic Management for Pheochromocytoma Following Prazosin Pre-treament / 대한마취과학회지

Perioperative management of patients with pheochromocytoma is challenging. Accordingly, proper preoperative preparation is important. Prazosin, a selective alpha I blocker, may offer a potential advantage. This 54-year-old woman was treated with prazosin 2 mg, b.i.d. for 15 days and also with propranolol 20 mg, b.i.d. for a few days intermittently before the proposed surgery. Both symptoms and blood pressure were well controlled effectively. Induction of anesthesia was accomplished with nitrolingual spray, fentanyl 100 ug, 1% idocaine 50 mg, 2.5% thiopental sodium 200 mg, vecuronium 6 mg and 100% O2-enflurane. During the surgical and anesthetic procedure, the patient showed a reduced incidence of excessive blood-pressure variations and no arrhythmia was present except for supraventricular ectopic beats. Conclusively, we believe that careful preoperative preparation is recommended to minimize intraoperative hemodynamic dieturbances and their sequelae.