The Effect of Anesthesia with Propofol-N2O on Neonate and Maternal Awareness during Cesarean Section / 대한마취과학회지

BACKGROUND: In anesthesia for cesarean section, there is an increased incidence of maternal awareness because a light plane of general anesthesia is chosen for fetal safety and rapid recovery. Propofol may be the choice if smooth induction and rapid maternal recovery are desired. Authors tried to know that propofol has properties which suggest that it might be useful alternative to thiopental and enflurane. METHODS: Forty patients in ASA class I or II scheduled for cesarean section were allocated randomly to either propofol (n=20) (P) or thiopental-enflurane (n=20) (T-E) group. Anesthesia was induced with propofol 2 mg/kg IV and maintained by continuous infusion of propofol 8 mg/kg/hr in P group and was induced with thiopental 4 mg/kg IV and maintained by inhalation of 1 vol% enflurane in T-E group. All patients received vecuronium 0.1 mg/kg and 50% N2O-O2. Blood pressure, heart rate, Apgar score, umbilical arterial blood gas analysis and the incidence of maternal awareness using the isolated forearm technique (IFT) were evaluated. RESULTS: Diastolic pressure was decreased in P group than T-E group at 10 min after delivery. Heart rate was increased in P group than T-E group at immediate after extubation (p<0.05). For apgar score, umbilical artery gas analysis and maternal awareness there were not significant differences between two groups. CONCLUSIONS: In comparison with thiopental-enflurane, propofol infusion (8 mg/kg/hr) coupled with N2O was proved to be clinically satisfactory anesthesia for cesarean section with no adverse effects on both mother and neonate.

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.

Effects of Nitric Oxide Synthase Inhibitor on Vascular Responses of Lidocaine and Bupivacaine in Endotoxemic Rats Aorta / 대한마취과학회지

BACKGROUND: Various local anesthetics have been shown to cause relaxation of isolated vascular rings contracted by phenylephrine. Recent studies reported that local anesthetics enhance nitric oxide (NO) production by human peripheral neutrophils. The author measured the effects of local anesthetics of nitrite production in LPS-treated rat aortic vascular smooth muscle cells and examined the effects of NW-nitro-L-arginine methyl ester (NAME) on vascular relaxant responses of lidocaine and bupivacaine in LPS-treated rat aortic rings. METHODS: Aortic ring preparations were obtained from LPS-treated (1.5 mg/kg, i. p. for 18hours) rat. Contractile responses of aorta to phenylephrine in dose-dependent administeration of lidocaine and bupivacaine (10(-6)M 10(-3)M) was examined. And also evaluated the effects of NAME (10(-6), 10(-5) and 10(-4)M) on relaxant responses of lidocaine and bupivacaine in LPS-treated rat aortic rings. From the cultured vascular smooth muscle cells, nitrite production of lidocaine and bupivacaine were measured by Griess reaction method. RESULTS: Lidocaine and bupivacaine enhanced the production of nitrite, the stable end product of nitric oxide, in cultured media of the vascular smooth muscle cells of the rat aorta but it didn't enhance significantly. NAME enhanced the contractile responses to lidocaine and bupivacaine in the LPS-treated rats significantly (p<0.05) but it didn't increase dose-dependently. CONCLUSION: These results show that lidocaine and bupivacaine increased NO production slightly in the LPS-treated rats and the vascular relaxant responses of local anesthetics were more enhanced because of NO production in LPS-treated rat.

Incomplete Preemptive Analgesic Effects of Tenoxicam on Continuous Intravenous Analgesia with Morphine after Cesarean Section / 대한마취과학회지

BACKGROUND: The analgesic properties of the nonsteroidal antiinflammatory drugs (NSAIDs) have been attributed to their effects on the peripheral synthesis of prostaglandins. Although the preoperative use of NSAIDs has been increasing because of concerns regarding the side effects of opioid analgesics but results of clinical preemptive analgesia studies remain inconclusive. So, we studied the efficacy of preemptive analgesic effects of tenoxicam, new NSAID, on postoperative continuous intravenous analgesia with morphine. METHODS: We studied 40 parturients, undergoing cesarean section, ASA class I or II, randomly divided into two groups. Tenoxicam group were injected tenoxicam 0.3 mg/kg and control group were injected normal saline 3 ml at ten min. before induction. For both groups morphine 0.1 mg/kg was administered as loading dose and 0.015 mg/kg/hr as maintenance dose. We examined verbal quantitative score (VQS) at postoperative 30 min, 1, 6, 12, 24 and 48 hr. Maternal satisfaction, side effects, hepatic and renal function also evaluated after pain control. RESULTS: The values of VQS showed no significant differences between two groups 30 min, 1 and 6hr after start of morphine infusion, but there was significant decrease in tenoxicam group compared to control group 12, 24 and 48 hr after start of morphine infusion (p<0.05). There was no significant difference in maternal satisfaction between two groups and also there were no significant differences in the overall incidences of side effects between two groups. CONCLUSIONS: Preoperative single injection of tenoxicam showed incomplete preemptive analgesic effects on postoperative pain control after cesarean section.

Awareness and Recall During Anesthesia with Propofol-N2O or Thiopental-Enflurane-N2O for Cesarean Section / 대한마취과학회지

BACKGROUND: Experience of awareness and recall during general anesthesia would be most distressing for patients. Especially for the cesarean section, medical team must consider both maternal awareness and fetal safety. Authors tried to know the possibility of propofol use as induction and maintenance agent of anesthesia for the cesarean section in respect of maternal awareness, recall and fetal safety. METHODS: Forty patients (ASA physical status 1, 2) were allocated randomly to either propofol (n=20) (P) or thiopental-enflurane (n=20) (T-E) group. We checked B.P, pulse rate, and the incidence of maternal awareness using the isolated forearm technique (IFT). The postoperative interview was conducted between 12~24h after operation. RESULTS: The incidence of maternal awareness signaled by flexing fingers in response to voice commands were significantly lower in the T-E group (20% after induction, no response during other times) than the P group (45% after induction, then 35%, 30%, after 5, 10 min delivery respectively). Seven patients had postoperative recall of introspective awareness in the P group but no patients in the T-E group. The 1 min Apgar score of the newborn were significantly lower in the P group than the T-E group but both groups were within normal range. CONCLUSIONS: Our date indicated that, in comparison with thiopental-enflurane, propofol infusion (6 mg/kg/h) were associated with a greater incidence of awareness during surgery and recall.

Two Cases of Fibrosing Mediastinitis Caused by Tuberculosis / 결핵

Fibrosing mediastinitis is a rare disease which is characterized by excessive fibrosis of mediastinum and symptoms caused by compression and obstruction of mediastinal structures. Afthough the pathogenesis of this disease is unknown, granulomatous infection is cinsidered to be the most common cause of this disease. Histoplasmosis is the most common etiology, especially in the endemic areas in United States. Tuberculosis is another etiology of fibrosing mediastinitis. We experienced two cases of fibrosing mediastinitis associated with tuberculous infection.