Use of Nerve Stimulator for the Obturator Nerve Block / 대한마취과학회지

BACKGROUND: The obturator nerve passes in close proximity to the inferolateral bladder wall. Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective to stop adductor spasm during spinal anesthesia. The use of nerve stimulator for the obturator nerve block is simple and well described. We investigated the dosage of local anesthetics and the depth of skin to nerve in obturator nerve block using nerve stimulator. METHODS: We performed obturator nerve block in 87 cases by use of spinal needle and nerve stimulator, and measured the intensity of stimulation, the dosage of local anesthetics and the depth of the skin to the obturator nerve. RESULTS: The overall success rate of obturator nerve block was 95.4%. Body Mass Index (BMI) was positively correlated with the depth of skin to the obturator nerve. However, no correlation was found between BMI and the intensity of stimulation. The dosage of local anesthetics was 198.6 +/- 7.3 mg of lidocaine. The depth of the skin to nerve was 60 +/- 12 mm in men, 54 +/- 11 mm in women. CONCLUSIONS: Use of nerve stimulator for obturator nerve block is accurate, and safe. BMI was positively correlated with the depth of the obturator nerve.

Fluid Management in Kidney Transplantation: Central Venous Pressure Guided vs Esophageal Doppler Monitoring / 대한마취과학회지

BACKGROUND: Maximizing renal blood flow during reperfusion of the transplanted kidney could be the key factor to prevent acute tubular necrosis (ATN). To achieve such a goal, augmentation of circulating blood volume is necessary. We evaluated stroke volume monitored or CVP guided volume expansion method and, which method would be better for the outcome. METHODS: Forty three patients (Group I) of 79 patients received maximum hydration guided by CVP maintaining 12-15 mmHg, other 36 patients (Group II) received fluid to achieve maximum SV using esophageal doppler monitor. All patients received albumin (maximal dose < 1 g/kg), mannitol (20%, 200 ml), and furosemide (40 mg) before renal artery reperfusion. Postoperative tests for evaluation of renal function, incidence of ATN and morbidity and hospital stay in patient were investigated. RESULTS: Amount of fluid infused were 3,891 +/- 1,145 ml in Group I and 2,981 +/- 936.4 ml in Group II. Incidence of ATN (Group I; 9.3% and Group II; 8.3%), tests for renal function were not statistically significant in both Group, but two patients in Group I was administered in intensive care unit (ICU). CONCLUSIONS: Lesser fluid was administered in the Group used with SV augmentation than conventional CVP guided group and there was no difference in the incidence of ATN between two group. In kidney transplantation, esophageal doppler monitoring may be better in fluid management than CVP monitoring.