The Effects of Esmolol on cardiovascular and Centroneural System in Anesthesia with Ketamine and Midazolam for Chemical Facial Peeling / 대한마취과학회지

One of the indications of outpatient surgery is chemical peeling of the face. It usually requires deep sedation with analgesia of short duration. For this purpose we tried to use ketamine(1 mg/kg) and midazolam(0.1 mg/kg) but experienced frequent hypertension and tachycardia. We tried to use beta blocker, esmolol for the of control blood pressure and heart rate. The patients were divided into two groups. In control group, eighty-five patients were anesthetized with bolus intravenous injection of I mg/kg of ketamine and 0.1 mg/kg of midazolam. In esmolol group, eighty-three patients reed a continuous infusion of esmolol(500 mcg/kg/min for initial dose, followed by 200 mcg/kg/min for maintenance) in addition to midazolam(0.1 mg/kg) and ketamine(1 mg/kg). During operation, we observed systolic, diastolic blood pressure and peripheral oxygen saturation(SaO2). All patients were allowed to breathe spontaneously. There was no case of airway obstruction and SaO2 value was over 98% in most cases. So we investigated the effects of esmolol on blood pressure,heart rate,emergence sequelae and patients acceptance in the anesthesia with ketamine and midazolam in the patient of facial chemical peeling. The results were as follows: 1) No one could recall. 2) There were no differences on the status of mood, emotion and patient's positive acceptance between two groups 3) Blood pressure and heart rate were increased during anesthesia with midazolam and ketamine. But esmolol attenuated this response, significantly(P<0.05). We concluded that esmolol added benefits of control of blood pressure and heart rate in the anesthesia of facial chemical peeling. But the control of the high blood pressure is not so easy, so it is needed to find out the optimal dosage of esmolol for complete blocking of the sympathetic response without complications.

The Effects of Depolarizing and Nondepolarizing Muscle Relaxants on Postoperative Sore Throat , Hoarseness , and Myalgia / 대한마취과학회지

The relationship between different muscle relaxants(vecuronium, pancuronium, succinyl- choline) and postoperative sore throat, hoarseness, and myalgia was evaluated in 46 adult ASA class I women undergoing general anesthesia with endotracheal intubation. All patients were anesthetized with thiopental-N2O-O2 and enflurane. The patients were divided into 3 groups. Patients in group 1(n=15) were given vecuronium, group 2(n= 16) pancuronium, and group 3(n =15) succinylcholine. Patient interviews were conducted at 6~10 hours(h) and 24~30 h postoperatively. Evaluation for severity of sore throat, hoarseness and myalgia was accomplished by scoring according to specific criteria. In groups 1, 2, and 3, 6~10 h postoperatively, the incidence of sore throat was 40%, 50%, and 33%; hoarseness was 40%, 31% and 27%; myalgia was 13%, 6% and 20% respectively. In groups 1, 2, and 3, 24-30 h postoperatively, the incidence of sore throat was 7%, 25%, and 53%; hoarseness was 13%, 31%, and 33%; myalgia was 13%, 19%, and 33% respectively. The use of succinyleholine(Sch) resulted in higher incidence of postoperative sore throat at 24-30 h compared with 6-10 h(p<0.05). These results suggest that administration of SCh may contribute to the occurence of postoperative sore throat.