Postoperative Analgesia with Meperidine in Cesarean Section Patients / 대한마취과학회지

BACKGROUND: Perioperative noxious stimuli and inflammation may induce peripheral and central sensitization. Together, these changes contribute to the state of postinjury pain hypersensitivity found postoperatively. Preemptive analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurones and may therefore, reduce postoperative pain. We studied whether or not intravenous meperidine infusion before induction could affect postoperative pain and analgesic consumption when compared with intravenous meperidine infusion at peritoneum closure. METHODS: Female patients scheduled for cesarean section were randomly assigned to one of two groups for prospective study. Group I (n=10) received intravenous meperidine (0.5 mg/kg) 5 minutes before induction of anesthesia and group II (n=10) received the same treatment at peritoneal closure. Both groups had a continuous infusion of meperidine (5 mg/hr) immediately after intravenous bolus meperidine. Postoperative pain relief was provided with intravenous meperidine from a PCA system (Walkmed , Medex, USA). Postoperative visual analogue pain scores (VAS), meperidine consumption and side effects were examined and compared between the groups for two postoperative days. RESULTS: At two hours post surgery VAS at rest were below 3 in both groups and were not statistically significant. VAS on motion were slightly higher than VAS at rest in both groups and were not statistically significant. There was no significant difference in meperidine consumption. There were minor side effects such as nausea, somnolence, dizziness and pruritus, but no patients needed any treatment and all of them were satisfied. CONCLUSION: Preemptive or postincisional intravenous PCA with meperidine was equally effective for postoperative analgesia after cesarean section, with minor side effects. These results suggested that there was no reason for applying preemptive analgesia for cesarean section patients. Further studies will be needed to evaluate preemptive effects of intravenous meperidine or other analgesics in cesarean section patients.

Pressure-Controlled Ventilation with Permissive Hypercapnia in Severe Adult Respiratory Distress Syndrome / 대한마취과학회지

The clinical complex of ARDS includes hypoxemia, hypercapnia, diffuse pulmonary infiltrates on chest radiograph, and depressed pulmonary compliance. Even with improved intensive care, the onset of severe disease with ARDS is associated with high mortality rate of 55% to 85% in an adult population. The etiology of ARDS remains uncertain, although increasing experimental evidence suggests that high inflation pressures may be involved in the pulmonary injury that is associated with ARDS. The use of low volume, pressure limited mechanical ventilation with permissive hypercapnia has been proposed to reduce the mortality rates associated with severe ARDS. Pressure-controlled ventilation has been proposed to recruit closed alveolar units and improve oxygenation through changing the inspiratory flow pattern from a square wave as used with volume-controlled ventilation to a rapidly exponentially decaying curve and through maintaining airway pressure at a constant level throughout the inspiratory phase. We present the case of a severe ARDS patient in whom a specific ventilatory management strategy of low peak inflation pressures and permissive hypercapnia appears to have favorably influenced survival and warrants further clinical evaluation.

Roentgenographic Confirmation of Central Venous Catheter Tips / 대한마취과학회지

To compare the rate of success and incidence of complications associated with currently popular routes of percutaneous central venous cannulation, we studied 131 patients in whom central venous catheterization was attempted. Right or left external jugular veins were used in 67 cases, and success rate was 9796. Right internal jugular veins were used in 27 cases, and success rate was 100%. Right or left basilic veins were used in 21 cases, and success rate was 76%. Right or left subclavian veins were used in 16 cases, and 75% of success rate. Non-J-wire type catheters were utilized in 60 cases, and success rate was 88%. J-wire type catheters were used in 71 eases, and success rate was 94%. We found 2 cases of catheter curling in Non-J-wire type catheters.

(99m)Tc-MIBI SPECT Findings in Diabetics with Coronary Artery Disease

BACKGROUND: Evaluation of coronary artery disease(CAD) by radionuclide myocardial perfusion scintigraphy is safe, convenient and informative for diagnosis of CAD & assessment of functional significance of stenotic lesions. We tried to evaluate the characteristics of CAD in dibetics by intravenous dipyridamloe (99m)Tc-MIBI(methoxy isobutyl isonitrile) SPECT(Single Photon Emission Computed Tomography). METHOD: (99m)Tc-MIBI SPECT and coronary arteriography(CAG) were performed simultaneously in less than 2 week interval in 41 diabetics(diabetic group) and 103 non-diabetics(non-diabetic group) with clinical suspicion of CAD. The sensitivity and specificity of (99m)Tc-MIBI SPECT for detection of CAD were compared between two groups. The site and number of involved vessels, the extent of perfusion defect and redistribution pattern were compared between two groups. RESULT: 1) The sensitivity and specificity of (99m)Tc-MIBI SPECT for detection of CAD were 97% and 80% in diabetics, these were comparable to those in non-diabetics(97% and 78%). 2) Three vessel disease were common(p<0.01)in diabetics(SPECT 28.1%, CAG 32.3%) than in non-diabetics(SPECT 11.4%, CAG 7.5%). Distal lesions were also more common(p<0.005) in diabetics(CAG 40.3%) than in non-diabetics(CAG 15.7%). 3) On stress SPECT, the extent of perfusion defect was not different in individual vessel areas between diabetics and non-diabetics. However the perfusion defect of left ventricle as a whole was significantly higher(p<0.05) in diabetics(35.2+/-16.2%) than in non-diabetics(26.4+/-15.5%). 4) On rest SPECT, the percent redistribution was significantly lower in diabetics than in non-diabetics(left anterior descending artery area ; diabetic group 31.1+/-22.5% vs non-diabetic group ; 49+/-28.5%, p<0.05, left ventricle as a whole ; diabetic group 30.6+/-21.2% vs non-diabetic group 48.2+/-27.6%, p<0.02). CONCLUSION: Quantitative (99m)Tc-MIBI SPECT provided high sensitivity and specificity for detection of CAD in diabetics. Multiple vessel disease, distal lesion and fixed lesions were more common in diabetics than in non-diabetics, (99m)Tc-MIBI SPECT is useful noninvasive test for diagnosis of CAD & important prognostic implications.

A case of lung injury caused by ammonia-gas inhalation / 결핵

No abstract available.