RESUMEN
BACKGROUND: Whether monitored anesthetic care (MAC) under total intravenous anesthesia can substitute for spinal anesthesia in knee arthroscopic surgery in regard to frequency of postoperative complications, degree of postoperative pain and degree of the satisfaction of patients and operator was investigated. METHODS: Sixty healthy patients were allocated randomly into a spinal group (n = 30) who received spinal anesthesia and an MAC group (n = 30) who received TIVA for anesthesia for arthroscopic surgery. All patients were NPO for 8 hours before surgery were premedicated and monitored with an EKG, noninvasive blood pressure and pulse oximeter. Heavy 0.5% bupivacaine, 10 - 12 mg, was used for spinal anesthesia and fentanyl 2ng/kg, propofol 1 mg/kg, ketamine 0.3 mg/ kg, and ketorolac 30 mg were given intravenously for induction and propofol was maintained at 3 - 4 mg/kg/h for TIVA. Local anesthetics infiltration was done at the arthroscopic portal site and fentanyl 25ng and propofol 20 mg were added intermittently. Postoperative complication (nausea, vomitting, back pain, dizziness, pain or voiding difficulty) and satisfaction of the patients and surgeon were investigated by VAS and 5 grade methods, respectively. RESULTS: The frequency and degree of back pain, pain at the operative site and voiding difficulty occured less and the VAS was decreased in the MAC group while in the recovery room, 6 hours and the day after the operation. The grade of satisfaction of the patients and that of the surgeon were also high in the MAC group. CONCLUSIONS: These results show that, if careful airway management is provided, MAC under TIVA is a more useful anesthetic method than spinal anesthesia in an arthroscopy.
Asunto(s)
Humanos , Manejo de la Vía Aérea , Anestesia , Anestesia Intravenosa , Anestesia Raquidea , Anestésicos Locales , Artroscopía , Dolor de Espalda , Presión Sanguínea , Bupivacaína , Mareo , Electrocardiografía , Fentanilo , Ketamina , Ketorolaco , Rodilla , Dolor Postoperatorio , Complicaciones Posoperatorias , Propofol , Sala de RecuperaciónRESUMEN
BACKGROUND: Amrinone is a nonglycosidic noncatecholamine with both vasodilator and positive inotropic effects that has not been evaluated widely in pediatric patients with intracardiac left to right shunts. The present study was performed to evaluate the hemodynamic effects of amrinone in infants and children with intracardiac left to right shunts. METHODS: Twenty patients (aged 2 months to 24 months) who underwent open heart surgery to correct one or more intracardiac left to right shunts were evaluated. Before cardiopulmonary bypass, a 22 gauge angiocatheter was placed at the main pulmonary artery by surgeons to measure pulmonary arterial pressure. Patients with a mean pulmonary arterial pressure or = 25 mmHg were assigned to Group B (n = 10). Mean systemic arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), central venous pressure (CVP) and heart rate (HR) were measured before loading of amrinone (3 mg/kg), 5 minutes, and 15 minutes after continuous infusion of amrinone (10 microgram/kg). The mean pulmonary arterial pressure to mean systemic arterial pressure ratio (MPAP/MAP) and rates of changes of mean arterial pressure (delta MAP) and mean pulmonary arterial pressure (delta MPAP) were calculated. RESULTS: Amrinone reduced MAP, MPAP, CVP and increased HR. MPAP/MAP increased in Group A but decreased in Group B (P < 0.05). In Group A, delta MAP was significantly greater than that of Group B (P < 0.005). In Group B, delta MPAP was significantly greater than that of Group A (P < 0.005). CONCLUSION: In infants with intracardiac left to right shunts, amrinone reduces MAP, MPAP, CVP and increases HR. Amrinone appears to have a potent vasodilating effect on the pulmonary artery in infants with pulmonary hypertension. However, more hemodynamic measurements such as cardiac output, vascular resistance and doppler echocardiographic study are necessary to evaluate the hemodynamic effects of amrinone precisely.
Asunto(s)
Niño , Humanos , Lactante , Amrinona , Presión Arterial , Gasto Cardíaco , Puente Cardiopulmonar , Presión Venosa Central , Ecocardiografía , Frecuencia Cardíaca , Hemodinámica , Hipertensión Pulmonar , Arteria Pulmonar , Cirugía Torácica , Resistencia VascularRESUMEN
To observe the anesthetic characteristics of two different speeds of injection using 0.5% plain bupivacaine during spinal anesthesia, 40 patients undergoing lower extremity surgery were allocated randomly into two groups. In one group, 3 ml of 0.596 plain bupivacaine was administered into the subarachnoid space using 25 gauge Quincke spinal needle to the patients with a lateral horizontal position at duration of 10 seconds. In the other group, the duration was 180 seconds. There were no statistically significant differences between two groups in maximal level and its onset time of sensory blockade, hemodynamic changes, onset time to grade 3 Bromage motor blockade. We concluded that the speed of injection does not affect the anesthetic characteristics of spinal anesthesia using 0.5% plain bupivacaine.