A Comparison of Fentanyl, Lidocaine and Esmolol for Blunting the Hemodynamic Response during Rapid-Sequence Induction in the Hemodynamically Unstable Patients / 대한마취과학회지

BACKGROUND: Tracheal intubation is accompanied by varing degrees of sympathetic stimulation as reflected by increases in heart rate, and blood pressure and several clinical trials to reduce the effects on blood pressure and heart rate by pharmacologic agents such as and blockers, calcicum channel blockers, narcotics and lidocaine, have been reported. METHODS: To evaluate the effect of fentanyl, lidocaine, esmolol on the hemodynamic changes induced by intubation, we administered thiopental 5 mg/kg only (group 1, n=12), fentanyl 2 g/kg with thiopental 5 mg/kg (group 2, n=12), lidocaine 1 mg/kg with thiopental 5 mg/kg group 3, n=12) or esmolol 0.5 mg/kg with thiopental 5 mg/kg (group 4, n=12) for induction of anesthesia, and measured heart rate, systolic blood pressure, diastolic blood pressure, mean arteiral pressure, and rate-pressure products (RPP) before induction, after induction, after intubation and at 1, 2, 3, and 5 minutes after intubation. RESULTS: There was a significant increase in heart rate, systolic blood pressure and RPP after intubation and 1 min after intubation in all groups, but in group 2, group 3 and group 4, the cardiovascular responses were more attenuated compared to group 1. CONCLUSION: The preintubation intravenous injection of fentanyl, lidocaine and esmolol may offer important roles in the hemodynamically unstable patients because it attenuate cardiovascular responses with intubation.

Pulmonary Edema secondary to aryngospasm after Extubation / 대한마취과학회지

Pulmonary Edema is a complication of acute upper airway obstruction secondary to laryngospasm. This serious complication is treated promptly to minimize the delayed morbidity and mortality among the patients. Acute pulmonary edema followed the event in minutes to hours and required ventilatory assistance to maintain oxygenation. All patients eventually respond to fluid restriction diuretics and steroids. We present a case of pulmonary edema that occured in a 37 years old healthy adult after extubation caused by a laryngospasm.

Anesthetic Management for Coronary Artery Bypass Surgery with Coronary Artery Stenosis / 대한마취과학회지

This report is concerned with our clincal experiences of sixty one cases of anesthesia for coronary artery bypass grafting at the Dong San Medical Center during the period from Februry 1986 to September 1993. The results were as follows; 1) There were 41 men and 20 women with a mean age of 54 (25 to 79 years). 2) Among 61 cases, 17 cases (28%) were history of myocardial infarction. 3) Among 61 cases, single aortocoronary grafts were placed in 37 patients (60%), double or more grafts in 24 patients (40%). 4) The mean bypass time was 135+/-63.9 minutes and cross-clamp time was 45+/-23.5 minutes. 5) Glycopyrrolate, morphine or demerol, vistaril or lorazepam or veprin were used as premedicants. 6) 2% thiopental or 2% thiopental and fentanyl or midazolam and fentanyl were used as induction agents. 7) We have also used isoflurane and fentanyl as anesthetic agents in conjuction with nitrous oxide. 8) Succinylcholin and pancuronium or vecuronium were used for intubation. 9) Early mortality was 16.4% (10 patients) and poor ejection fraction was significantly associated with mortality rate. 10) perioperative myocardial infarction was most common complication.

Inadvertent Subdural Block Confirmed by Subduragram / 대한마취과학회지

Accidental subdural extra-arachnoid block is a rare but life-threatening complication of epidural anesthesia. The subdural area is a potential space between the dura and the subarachnoid membranes. It exists in the spinal meninges just as it does in the cranial meninges. In the past 19 years a number of clinical reports have described the unintentional catheterization to this potential space and delayed subdural migration of the epidural catheter. We had three cases of accidental subdural blocks recently. Tbis is a report concerning a case confirmed by subduragram. A healthy 44 years old woman underwent a radical hysterectomy under continuous epidural anesthesia combined with general anesthesia. Epidural catheterization was carried out smoothly and the induction of general anesthesia was uneventful. However, an unexpected hypotension was continuously noticed after the epidural injection of 2% lidocaine 20 ml. Thereafter, general anesthetic was turned off and the respiration was controlled using 100% oxygen. The patient remained unconscious with severe miosis for one and a half hours. 5 ml of a water soluble Niopam 300 was injected through the catheter postoperatively. It was later observed on the subduragram that the catheter was inadvertently misplaced in the subdural space. The anatomy and physiological changes related to subdural block are described hereafter.