Aspiration pneumonitis after a 10-hour fast in a patient who had undergone subtotal gastrectomy: A case report / 대한마취과학회지

A patient who had previously undergone a subtotal gastrectomy was scheduled for removal of a brain tumor under general anesthesia. Anesthesia was induced with lidocaine and propofol with rocuronium for neuromuscular blockade. She had fasted for 10 hours, but after mask ventilation, she aspirated gastric juice and materials. The oral cavity was suctioned promptly and the trachea was intubated. Intraoperative high FiO2 and dopamine were administrated to maintain the oxygen saturation and blood pressure. She received postoperative ventilatory care in the intensive care unit for 2 weeks. An upper gastrointestinal series and fiber endoscopy were performed but she had no obstruction and reflux esophagitis except delayed passage of the contrast media. She had no risk factors for pulmonary aspiration. As in this case, patients with previous gastrointestinal surgery should be considered preoperative workup for GI motility or pathology, and adequate premedication.

The EC50 of Propofol for Loss of Response to Command during Remifentanil/Propofol Anesthesia / 대한마취과학회지

BACKGROUND: Propofol sedation using target-controlled infusion (TCI) system can be used in MAC (Monitored Anesthesia Care).Remifentanil is an ultra-short-acting opioid that is advantageous in combination with propofol due to its rapid onset and offset times and analgesic effect.The present study sought to identify the EC50 of propofol for 'loss of response to command' when administered alone or with 2 or 3 ng/ml remifentanil using TCI. METHODS: Seventy patients were randomly allocated to one of three treatment groups:Group 1 = propofol only (n = 20), Group 2 = propofol plus 2 ng/ml remifentanil (n = 25) and Group 3 = propofol plus 3 ng/ml remifentanil (n = 25).The EC50 was determined by calculating the mean of the midpoint dose of all independent pairs of patients who manifested crossover from 'response to command' to 'loss of response to command'. RESULTS: The EC50 of propofol was found to be 3.41 +/- 0.25microgram/ml in Group 1, 2.04 +/- 0.22microgram/ml in Group 2, and 1.98 +/- 0.15microgram/ml in Group 3.Statistical analysis showed the EC50 for Group 1 was higher than those for Groups 2 and 3, and that the EC50 of latter groups were similar. CONCLUSIONS: Using the modified Dixon's up and down method, the present study estimated the EC50 of propofol for 'loss of response to command' when remifentanil was infused in analgesic doses using TCI.Those concentrations can safely and effectively generate sedation and analgesia without clinically significant side effects in MAC.