Cauda Equina Syndrome following Epidural Anesthesia / 대한마취과학회지

Neurologic complications associated with epidural anesthesia are rare. We describe a case of a cauda equina syndrome after continuous epidural anesthesia and analgesia for cesarean section. An epidural infusion of 0.15% bupivacaine was done at 2 mL/hr by two-day infusor. She developed lower extremities, buttocks and perineal sensory loss, bladder and bowel dysfunction after removal of epidural catheter. Improvement continued through the hospitalization with almost retum to normal bladder function before discharge about 1 month after the injury, but fecal incontinence and perineal sensory loss still remained. Although the mechanism causing such neural injuries are not fully known, it may be suspected that neurotoxicity is dose-dependent and related to the duration of drug exposure.

Cauda Equina Syndrome following Epidural Anesthesia / 대한마취과학회지

Neurologic complications associated with epidural anesthesia are rare. We describe a case of a cauda equina syndrome after continuous epidural anesthesia and analgesia for cesarean section. An epidural infusion of 0.15% bupivacaine was done at 2 mL/hr by two-day infusor. She developed lower extremities, buttocks and perineal sensory loss, bladder and bowel dysfunction after removal of epidural catheter. Improvement continued through the hospitalization with almost retum to normal bladder function before discharge about 1 month after the injury, but fecal incontinence and perineal sensory loss still remained. Although the mechanism causing such neural injuries are not fully known, it may be suspected that neurotoxicity is dose-dependent and related to the duration of drug exposure.

The Time of Neostigmine Antagonism for the Rapid Recovery of Profound Muscle Relaxation in Rabbits / 대한마취과학회지

BACKGROUND: A question was whether it was preferable to give the reversal agent when profound block was present or wait for some spontaneous recovery before antagonizing the block. This study has been conducted to evaluate the reversal effects of neostigmine with divided doses in the rabbits after pancuronium when profound relaxation(PTC=O) or the first twitch of TOF stimulation was appeared (TOF,T1) was confirmed. METHODS: Rabbits(n=60) were randomly allocated to 5 groups. After pancuronium 0.2 mg/kg intravenously, spontaneous recovery was evaluated in group 1. When the profound relaxation(PTC=O) was confirmed at 5 min. after pancuronium, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 2. At that time, neostigmine 10 ug/kg with atropine 4 ug/kg were injected and after 3 min. neostigmine 40 ug/kg with atropine 16 ug/kg were injected in group 3. When TOF, Tl was confirmed, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 4. At that time, neostigmine and atropine were injected in group 5 as the same way of group 3. RESULTS: The mean time from injection of pancuronium to 95% recovery was 98.9 min. in group 1, 60.3 min. in group 2, 50.9 min. in group 3, 71.0 min. in group 4 and 67.1 min. in group 5. The recovery index was significantly reduced when neostigmine was injected at TOF,T1(p<0.05). The recovery time after neostigmine with divided doses was reduced, but there was no significant difference. CONCLUSIONS: The results of present study suggested that total recovery time was reduced when neostigmine was injected earlier with divided doses than single dose unrelated to profound relaxation.

Pulmonary Aspiration and Local Anesthetic Systemic Toxicity following Epidural Anesthesia / 대한마취과학회지

Aspiration can generate postoperative pulmonary morbidity of varing severity, depending on the type and volume of the aspirate. Epidural anesthesia can lead to local anesthetic systemic toxicity with mental change, followed by respiratory depression and abdominal and intercostal muscle weakness depressing the ability of the patient to cough and clear the airway. The authors experienced a case of pulmonary aspiration with systemic toxicity after epidural anesthesia for cesarean section. The chest X-ray showed alveolar consolidation at left lower lung field and arterial blood gases showed that PaO2 decreased. The exact causes of mental change and respiratory depression were unknown, but we suspected it lidocaine induced systemic toxicity due to vascular absorption, When airway reflexes are ineffective during face mask ventilation of the lungs, aspiration of clear oral secretions can generate small airway obstruction.

The Effects of General and Epidural Anesthesia for Cesarean Section on Newborn Apgar Scores / 대한마취과학회지

This study was undertaken to evaluate the effects of general and epidural anesthesia for cesarean section on newborn Apgar scores prospectively. Forty patutients for elective cesarean section were divided into two groups. One group(I) of parturients was anesthetized with general anesthesia. The other group(II) was anesthetized with epidural anesthesia. Then, Apgar scores of group I were compared with that of group II. The results were as follows: 1) For elective cesarean section under general anesthesia, prolongation of induction-delivery time wasnt related to lowering of Apgar scores because all of that intervals were below 10 minutes. 2) For elective cesarean section under epidural anesthesia, there was no more neonatal depression accompanied by prolongation of local anesthetic injection-delivery time. 3) General anesthesia rather than epidural anesthesia had a low Apgar score. Therefore, we wish to recommand epidural rather than general anesthesia when prolongation of induction-delivery time such as repeat-cesarean section and/or lowering of Apgar score such as premature will be expected.