Maternal and Neonatal Effects of Thiopental Sodium-Enflurane-N2O and Propofol-N2O Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: In anesthesia for cesarean section, thiopental sodium is regarded as the standard induction agent. Propofol, 2,6 di-isopropyl phenol, is a relatively new intravenous anesthetic agent and has been used for induction and maintenance of general anesthesia or total intravenous anesthesia. Propofol has properties which suggest that it might be useful alternative to thiopental. METHODS: Forty patients (ASA physical status 1,2) scheduled for cesarean section were randomized to either propofol (n=20) or thiopental group (n=20). In thiopental group anesthesia was induced with thiopental 4-5 mg/kg intravenously and maintained by inhalation of enflurane and nitrous oxide. In propofol group anesthesia was induced with propofol 2 mg/kg intravenously and maintained by continuous infusion of propofol 6-10 mg/kg/hr and inhalation of nitrous oxide. RESULTS: Systolic and mean arterial pressure were increased significantly in both groups at 1 min after intubation, but degree of increase were less in propofol group. There was no significant difference in diastolic pressure in both groups. Heart rate was increased significantly in both groups at afterinduction, but degree of increase were less in propofol group. The Apgar scores of the neonates and blood gas analyses of umbilical vein were not significantly different in both groups. Maternal recovery from anesthesia was quicker in propofol group. CONCLUSIONS: A propofol infusion coupled with nitrous oxide was proved to be clinically satisfactory anesthesia for cesarean section with no adverse effect on both mother and fetus. Conclusively, propofol would be an excellant alternative to thiopental sodium and inhalation anesthetic in general anesthesia for cesarean section.

The Cardiovascular Effects of Rapid Sequence Induction and Slow Induction in Normotensive Patients / 대한마취과학회지

The circulatory stimulation accompanying laryngoscopy and tracheal intubation and its attendant potential hazards are well recognized. This study was perfomed to compare cardiovascular effects of rapid sequence induction with slow induction during induction of anesthesia and following tracheal intubation with laryngoscope. Eighty six adult patients ASA class I or II, ages 20-55, with no previous history of hypertension and pulmonary diseases that undergoing elective surgery requiring intubation, were admitted to the study. These patients were randomly divided into four groups. Group 1. Rapid sequence induction (n=20) Group 2. Slow induction for 7min. (n=20) Group 3. Slow induction for 10min. (n=21) Group 4. Slow induction for 15min. (n=25) Anesthesia was induced with lidocaine 1.5mg/kg and thiopental sodium 5mg/kg i.v. in a rapid sequence induction in group 1. Tracheal intubation with laryngoscope was facilitated with succinylcholine chloride 1mg/kg iv. Thereafter 50% nitrous oxide in oxygen, 2.0 vol% enflurane, and vecuronium bromide 0.1mg/kg was administered. Group 2, 3, 4 patients received thiopental sodium 5mg/kg iv, vecuronium bromide 0.1mg/kg iv, 2.0 vol% enflurane and 5096 nitrous oxide in oxygen with mask ventilation for 7 min, 10 min and 15 min before intubation with laryngoscope, respectively. After tracheal intubation inhalation of the anesthetic gases were administered. Blood pressure and heart rate measurements and electrocardiography were obtained throughout the study period. Slow induction (Group 2, 3, 4) significantly blunted the increase in heart rate and blood pressure caused by laryngoscopy and endotracheal intubation than rapid sequence induction (group 1). Less unwanted effects were observed in group 2 and 3. Therefore, the author suggests that 7-10 minute of slow induction with volatile anesthetics following thiopental sodium injection is more effective in attenuating cardiovascular responses to tracheal intubation and laryngoscopy.