Effect of beach chair position on bispectral index values during arthroscopic shoulder surgery / 대한마취과학회지

BACKGROUND: Bispectral index (BIS) monitoring reduces the cases of intraoperative awareness. Several factors can alter BIS readings without affecting the depth of anesthesia. We conducted a study to assess the impact of beach chair position (sitting position) on BIS readings. METHODS: General anesthesia was administered to 30 patients undergoing arthroscopic shoulder surgery. Patients were kept in neutral position (supine) for 10 minutes and BIS readings, mean arterial blood pressure, heart rate, end-tidal carbon dioxide, and end-tidal sevoflurane were recorded. Patients were then shifted to beach chair position. After 15 minutes, data were recorded. RESULTS: A significant decrease in BIS values (P < 0.01) associated with a position change from neutral position to beach chair position was evident. CONCLUSIONS: BIS values are significantly decreased in the beach chair position compared with the neutral position and might affect interpretation of the depth of anesthesia.

Effects of esomeprazole premedication on gastric pH during laparoscopic surgery / 대한마취과학회지

BACKGROUND: The use of CO2 for pneumoperitoneum during laparoscopic surgery provokes a decrement in the gastric pH. Since the incidence rate of PONV increases after laparoscopic surgery, the possibility of lung aspiration of gastric juice with a low pH during a postanesthetic emergence may increase and this could be fatal for the patient. We conducted this study to determine the effects of esomeprazole premedication on inhibiting the decrement of the gastric pH during laparoscopic surgery. METHODS: 40 adult patients with no underlying diseases were chosen and 20 patients each were grouped as C (the control group) and E (the esomeprazole group). In both group, 0.2 mg glycopyrrolate was given intramuscularly 30 minutes prior to the surgery. In group E, esomeprazole was given orally 2 hours prior to the surgery. The pH, PaCO2, and PETCO2 were measured via pH probe, an ABGA and an capnogram at preinsufflation and 15, 30 and 60 minutes after the CO2 insufflation and right before CO2 exhaustion (predeflation). RESULTS: Comparing the measurements of the gastric pH between group E and group C, all the results showed a significant increase in group E (P < 0.05). The difference of the PaCO2 and PETCO2 in the two groups was not significance. CONCLUSIONS: In contrast to the decrease in the gastric pH as the PaCO2 and PETCO2 increased in group C, the gastric pH in group E remained high until the end of the surgery despite the increase in the PaCO2 and PETCO2. Esomeprazole premedication seem to have an effect for inhibiting the gastric pH decrement regardless of the increase in the PaCO2 and PETCO2 during laparoscopic surgery.

The Optimal Anti-emetic Dose of Ramosetron for Prevention of Postoperative Nausea and Vomiting Following Gynecolgic Surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most frequent and distressing side effects of surgery, and approximately 50-70% of patients who undergo gynecologic surgery suffer from PONV. In this study, we evaluated the effects of various doses of ramosetron on postoperative nausea and vomiting following gynecologic surgery. METHODS: This study evaluated a randomized placebo-controlled study comprised of 200 patients who underwent gynecologic surgery under general anesthesia. The patients were divided into the following 4 groups; placebo group (saline 4 ml), R15 group (ramosetron 0.15 mg), R30 group (ramosetron 0.3 mg) and R45 group (ramosetron 0.45 mg). Each patient was administered the study drug intravenously at the completion of the operation and the presence and severity of PONV were then evaluated 24 and 48 hours after the operation. RESULTS: The incidence of PONV during the first 24 hours following surgery was lower in patients in the R30 group (44%) than in patients in the placebo group (68%)(P < 0.05). In addition, the incidence of PONV 24 to 48 hours after the operation was lower in patients in the R30 group (12%) and the R45 group (14%) than in patients in the placebo group (44%)(P < 0.05) Moreover, common side effects of 5-HT3 receptor antagonist such as headache, dizziness, and constipation did not develop in any of the groups. CONCLUSIONS: The results of this study indicate that 0.3 mg of ramosetron is the most effective dose for preventing PONV during to the first 48 hours following gynecologic surgery.

Comparison of Posterior Pharyngeal Airway Space at Sitting and Supine Positions in the PACU after Uvulopalatopharyngoplasty in Patients with Obstructive Sleep Apnea Syndrome / 대한마취과학회지

BACKGROUND: Uvulopalatopharyngoplasty (UPPP) is one of the most common treatments for patients with obstructive sleep apnea syndrome (OSAS) who suffer from repetitive apnea and oxygen desaturation during sleep. It is important to properly manage the patient's airway in the PACU after surgery in order to prevent potential airway-related postoperative complications. METHODS: 20 patient cases of ASA I or II who were over 20 years old and had undergone UPPP under general anesthesia were reviewed. In PACU, Posterior pharyngeal airway space (PAS) was measured on a lateral cranial radiograph at both supine and sitting positions and the blood pressure and oxygen saturation were measured. RESULTS: PAS significantly increased in the sitting position (avg. 11.7 mm in supine, 15.7 mm in sitting, P < 0.05) but there was no influence on the blood pressure or oxygen saturation. CONCLUSIONS: PAS is associated with the patency of the airway and the increase of PAS in patients in the sitting position while in the PACU is helpful to airway management following UPPP.

Changes in blood pressure, heart rate and regional cerebral oxygen saturation during the sitting position for shoulder arthroscopic surgery / 대한마취과학회지

BACKGROUND: The sitting position for shoulder arthroscopic surgery can cause critical hypotension, a reduction in cerebral blood flow and possible cerebral ischemia due to decreased venous return.The aim of this study was to determine the effects of a positional change to the sitting position on the mean arterial pressure (MAP), heart rate (HR) and regional cerebral oxygen saturation (rSO2) through ECG, invasive blood pressure monitoring and near-infrared spectrometry. METHODS: Thirty five patients of ASA class I or II undergoing shoulder surgery were chosen randomly.General anesthesia was administered with sevoflurane and a mixed gas of medical air and oxygen.The MAP, HR, rSO2 and rate of change in the rSO2 on the left and right side were measured at the following times:after induction when the MAP and HR were stabilized (baseline), 1, 3, 5, 10, 15 and 20 min after placing the patient in the sitting position. RESULTS: The MAP decreased significantly at 5, 10, 15 and 20 min after placing the patient in the sitting position.The HR increased significantly at 1 min and 3 min after placing the patient in the sitting position, and decreased significantly at 15 min and 20 min after placing the patient in the sitting position.The rSO2 showed a significant decrease at 5, 10, 15 and 20 min on the left side and at 10 min, 15 min and 20 min on the right side. CONCLUSIONS: The MAP and rSO2 significantly decreased after placing the patient in the sitting position but there were no neurological complications.However, close monitoring of the MAP and rSO2 is required in elderly patients or patients with cerebrovascular disease is recommended while the patient is in the sitting position in order to avoid neurological complications.

The Effects of Continuous Nicardipine Infusion on Blood Pressure and Heart Rate during Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Laryngoscopy and tracheal intubation often induced an undesirable increase in blood pressure and heart rate. We evaluated the preventing effect of nicardipine infusion on the increase of the blood pressure (BP) and heart rate (HR) following a direct laryngoscopy and tracheal intubation. METHODS: Sixty, ASA physical status 1-2, adult patients were selected with informed consent, and randomly allocated into two groups; control group (n = 30) and nicardipine group (n = 30). In the control group, 1.8 ml/kg/h of normal saline was infused, and in the nicardipine group, 5microgram/kg/min of nicardipine was infused continuously from 2 minutes before intubation to 3 minutes after intubation. BP and HR were measured by non-invasive method after arrival at the operating room, before tracheal intubation, shortly after tracheal intubation, and 1, 3, 5, and 10 minutes following intubation. Data were analyzed by repeated measure of ANOVA and t-test. RESULTS: Systolic and diastolic BP were significantly lower in the nicardipine group than in the control group (P < 0.05). HR showed significantly higher value in the nicardipine group (P < 0.05). CONCLUSIONS: The continuous infusion of nicardipine (5microgram/kg/min) was effectively attenuating an increase of BP during tracheal intubation. But the increase in HR is not blunted by nicardipine infusion and there is a significant increase in HR. Although rate-pressure product (RPP) does not increase, the use of nicardipine for blunting hemodynamic responses should be considered carefully in patients with ischemic heart disease.

Measurement of Hemodynamic Changes Caused by Administration of Atracurium Besylate after Pretreatment with Anti-histamine Agent / 대한마취과학회지

BACKGROUND: Hemodynamic changes through the histamine-induced release of atracurium are relatively common, but can be particularly dangerous in hemodynamically unstable patients. This study evaluated the effectiveness of a pretreatment with an anti-histamine agent before the administration of atracurium in the prevention of histamine-induced hemodynamic changes. METHODS: Forty-eight ASA class I and II patients were assigned to four groups. Groups 1 and 2 were assigned to receive atracurium through a bolus 0.5 mg/kg. Groups 3 and 4 were assigned to receive atracurium through a bolus 1.0 mg/kg. Group 1 and 3 were pretreated with pheniramine (H1-blocker) and ranitidine (H2-blocker) intravenously before the induction of general anesthesia. After induction, HemosonicTM 100 was installed and the following hemodynamic parameters were measured: systemic vascular resistance (SVR), cardiac index (CI), heart rate (HR) and blood pressure (BP) immediately before, 1, 2, 3, 5 and 10 min after the rapid administration of the atracurium bolus before the skin incision. RESULTS: Groups 1 and 3 showed more stable hemodynamics than groups 2 and 4. Group 2 showed more significant changes in the SVR, CI, BP, HR than group 1 (P< 0.05). Group 4 showed more significant changes in the SVR, CI, BP, HR than group 3, and some cases were significant hemodynamically (P< 0.05). Group 4 showed more significant changes in the SVR, CI, BP, HR than group 2 (P <0.05). CONCLUSIONS: Pretreatment with an anti-histamine drug prior to the administration of atracurium can be effective in attenuating the hemodynamic responses.

The Effect of Distal Tourniquet in the Axillary Brachial Plexus Block / 대한마취과학회지

BACKGROUND: We investigated the effect of distal tourniquet to the proximal spread of local anesthetics in the axillary brachial plexus block. METHODS: In this prospective, randomized, controlled trial, 60 patients undergoing elective surgery were divided into two equal groups; Group I (2% mepivacaine 20 ml plus 1% lidocaine 20 ml with 250 mmHg of distal tourniquet) and Group II (2% mepivacaine 20 ml plus 1% lidocaine 20 ml alone). Patients were left for 30 minutes after an axillary brachial plexus block with paresthesia and single injection technique. Sensory blockades were evaluated by pin prick test at each nerve dermatome. RESULTS: There was no significant difference of sensory blockade in radial nerve, but there were significant differences of sensory blockade in ulnar, median, musculocutaneous, medial antebrachial cutaneous, and axillary nerves (P < 0.05). CONCLUSIONS: Our findings suggest that the quality and effect of axillary brachial plexus block in group with distal tourniquet is better than the control group.

The Effect of Obesity on Awareness in General Anesthesia with Propofol / 대한마취과학회지

BACKGROUND: Recently obesity population is epidemically rapidly increasing. But, in the anesthetic field the study for obesity patients is not good enough. So, we designed the study to see the effect of obesity on awareness in general anesthesia with propofol. METHODS: The 52 subjects were between 20 to 60 years old and ASA physical status 1, 2 undergoing general anesthesia for elective surgery. According to asia pacific obesity criteria, we divided the patients into the obesity group (BMI > or = 25) and the non-obesity group (BMI < 25). Propofol was infused using TCI for induction and maintenance. BIS was used for monitoring the depth of anesthesia. During operation, we tried to keep BIS between 40-49 by manipulate the target concentration of TCI. After the operation, without stimulating patients, we measured the time (T-BIS(5070)) from the BIS passes 50 then goes to 70. We compare the T-BIS(5070) between the obesity and the non-obesity group. RESULTS: The obesity and the non-obesity group do not show significant difference in age, sex, height, body temperature, anesthesia time, and total used propofol amounts. BMI in obesity group was 27.3 +/- 1.9 kg/m(2) and in non-obesity group was 22.2 +/- 1.8 kg/m(2). T-BIS(5070), the awareness time was significantly different between the obesity group (170.3 +/- 54.8 sec) and the non-obesity group (212.7 +/- 81.8 sec). CONCLUSIONS: Our data suggest that in general anesthesia with propofol the obesity group's awareness time is shorter compared with the non-obesity group and the effects may come from the uniqueness of the propofol's pharmacokinetics and the obesity patient's physical characteristics.

Effects of Lidocaine Spray or Lidocaine IV on Endotracheal Intubation during Sevoflurane Inhalation Induction without Muscle Relaxants / 대한마취과학회지

BACKGROUND: This study was designed to assess tracheal intubation without muscle relaxants, especially using 8 vol% sevoflurane. The study was designed to compare heart rate and blood pressure changes induced by a 10% lidocaine spray with that of 1% lidocaine IV and a control. METHODS: Sixty patients, ASA I or II, undergoing various surgical procedures, were randomly assigned into three anesthetic pretreatment groups: Group I received routine vital capacity rapid induction with sevoflurane; Group II, inhalation induction with a 10% lidocaine spray 5 minutes before intubation; and Group III, inhalation induction with 1% lidocaine IV injection 2 minute before intubation. Intubating conditions were assessed as acceptable or unacceptable on the basis of a scoring system that depended on the ease of laryngoscopy, vocal cord position, and coughing after endotracheal tube insertion. Heart rate and blood pressure changes in each group were assessed before and after intubation. RESULTS: The overall assessments of the intubating conditions were acceptable in 90%, 95%, and in 95% of patients in groups I, II, and III, respectively. Statistically, supplementing with a lidocaine intravenous injection or a pharyngolaryngeal lidocaine spray did not improve intubating conditions. Moreover, no differences in coughing after intubation, and no improvement in heart rate or in blood pressure changes were observed among the three groups. CONCLUSIONS: Sevoflurane inhalation induction without muscle relaxants offers satisfactory intubation, and heart rate and blood pressure changes without the use of lidocaine IV injection, or lidocaine spray.

Anesthetic Management of Patients during Carotid Balloon Angioplasty and Stenting: A case report / 대한마취과학회지

Carotid balloon angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy for the management of carotid artery stenosis, especially in high risk patients or poor candidates for standard carotid endarterectomy. We conducted anesthetic management in patients receiving carotid balloon angioplasty and stenting. General anesthesia was performed in 2 cases and anesthesia care was monitored in 5 cases to ensure hemodynamic stability. No severe complications such as major stroke occurred during the procedures. One case with monitored anesthesia care showed a rapid decrease in arterial pressure and transient bradycardia during balloon inflation, but these immediately resolved.

Generalized Convulsion and Delayed Emergence following Microvascular Decompression Surgery under General Anesthesia: A case report / 대한마취과학회지

Trigeminal neuralgia and hemifacial spasm are thought to be caused by cross-compression of a cranial nerve by a vascular structure. Microvascular decompression (MVD), a surgical treatment of these conditions, has a high success rate and low recurrence rate. In our hospital, we have a case of 64 year-old, male patient, who has shown postoperative events, such as delayed emergence, postoperative convulsion, left facial palsy, and dizziness after MVD surgery for left hemifacial spasm. We're going to report this case and consider about possible causes.

The Hemodynamic Changes and Stress Hormone Responses to Mild Intraoperative Hypothermia during Intravenous Anesthesia (in Neurosurgical Patients) / 대한마취과학회지

BACKGROUND: It is not clear whether mild hypothermia (34 degrees C) enhances stress hormonal responses during surgery under general intravenous anesthesia. The purpose of this study was determine how mild hypothermia affects hemodymic and stress hormonal responses introperatively and during extubation in patients undergoing cerebral aneurysm surgery under general intravenous anesthesia. METHODS: Anesthesia was induced intravenously with thiopental sodium 5 mg/kg, succinylcholine 1 mg/kg, and maintained with 50% O2, 50% N2O, and propofol using a target controlled system; Diprifusor(R) (3-5 microgram/ml) and muscle relaxation were administered with intravenous vecuronium intermittently. For the normothermia and the hypothermia groups, body temperatures were maintained at 36.9+/-0.3degrees C and 34.2+/-0.2 degrees C, respectively, up to the recovery room. Hemodynamic changes were recorded continuously. Arterial blood gas analysis, glucose, hemoglobin, stress hormones comprising epinephrine, norepinephrine, ADH, ACTH and cortisol were measured at whilst awake, intraoperatively, and just after extubation. RESULTS: Hemodynamic changes from the awake control state to postextubation were not significantly different between the normothermia and hypothermia groups. In the control awake state, all five hormonal concentrations were similar in the two groups. Intraoperatively and during extubation, all hormonal concentrations tended to be lower in the hypothermia group than in the normothermia group, except epinephrine during extubation. During the same period, all except ACTH decreased sufficiently to reach statistical significance (P < 0.05) versus the awake control state. But no significant differents were found between the two groups. CONCLUSIONS: Our data suggest that intraoperative mild hypothermia dose not significantly affect hemodynamic changes or the plasma concentrations of stress hormones.

Effects of Gallamine, Vecuronium and Rocuronium on Oculocardiac Reflex, Blood Pressure and Heart Rate in Pediatric Strabismus Surgery / 대한마취과학회지

BACKGROUND: Intraoperative oculocardiac reflex (OCR) is a common problem of pediatric strabismus surgery and potentially fatal as it can cause cardiac arrest. The goal of this study was to assess the effects of gallamine, vecuronium and rocuronium on the oculocardiac reflex, blood pressure and heart rate in pediatric strabismus surgery. METHODS: Ninety healthy children undergoing strabismus surgery were randomly assigned to three groups; gallamine, vecuronium or rocuronium group. All children were under general anesthesia induced with thiopental sodium and received gallamine 3 mg/kg, vecuronium 0.1 mg/kg, or rocuronium 0.8 mg/kg as a muscle relaxant, and were maintained with sevoflurane in 50% nitrous oxide. Systolic blood pressure, diastolic blood pressure, and heart rate were measured before anesthesia, before the operation, before traction and after traction of the ocular muscle. The OCR was defined as a 20% or greater decrease in heart rate from before traction of the ocular muscle. RESULTS: Compared with three groups, there were decreased incidences of OCR and increased heart rate at before the operation, before traction and after traction in the gallamine group (P<0.05). Systolic blood pressure and diastolic blood pressure were no differences occurred among three groups. CONCLUSIONS: We found that the gallamine group results in decreased incidences of OCR and increased heart rate were comparable with three groups.

Role of Fiberoptic Bronchoscopy in Conjunction with the Use of a Single Lumen Tube with Bronchial Blocker for Thoracic Anesthesia / 대한마취과학회지

BACKGROUND: Fiberoptic bronchoscopy has been recommended to verify the position of single lumen tubes with bronchial blockers (Univent(R) tube), but this remains controversial. The authors studied the role of a bronchoscopy for placing and monitoring bronchial blockers (BB) after blind intubation and after positioning the patient. METHODS: One hundred patients having thoracic surgery requiring a Univent tube insertion were prospectively studied. After "blind" tracheal intubations with Univent tubes, BB were advanced in the left-side mainstem bronchus for 60 patients and the right-side for 40 patients. A bronchoscopy was performed after conventional clinical verification of correct placement and after patient positioning for a thoracotomy. A BB was considered malpositioned when it had to be moved < 0.5 cm to correct its position. RESULTS: After "blind" BB intubation, clinical evidence of malpositioning was found in 5 patients. This was confirmed by fiberoptic assessment. In 95 patients in whom placement was judged correct by clinical assessment, malpositioning was detected by bronchoscopy in 39 cases. After patient positioning, BB were found to be displaced in 29 patients. Right-side BB were significantly more likely to be malpositioned than were left-side BB. CONCLUSIONS: After blind intubation and patient positioning, more than one third of BB required repositioning. A routine bronchoscopy is therefore recommended after intubation and after patient positioning.

Comparison of the Effects of Propofol and Isoflurane Anesthesia on Respiratory Gas Exchange during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Introduction of a pneumoperitoneum using CO2 is accompanied by significant alterations in respiratory function and pulmonary gas exchange during laparoscopic cholecystectomy. Previous studies have shown differing results concerning pulmonary gas exchange: a significant decrease of PaO2 was induced with isoflurane. In contrast, no significant changes were observed with propofol. The purpose of the present study was to compare the effects of propofol vs isoflurane on pulmonary gas exchange during general anesthesia for laparoscopic cholecystectomy. METHODS: Forty patients were divided randomly between isoflurane and propofol groups. After induction of anesthesia, ventilation was controlled and intra-abdominal pressure was maintained automatically at 12 mmHg by a CO2 insufflator. After the measuring of baseline values of blood pressure, heart rate, PaO2, PaCO2 and PetCO2 before CO2 insufflation, measurements were also made immediately, 30min after CO2 insufflation and 5 min after CO2 exsufflation. RESULTS: In the isoflurane group, PaCO2, PetCO2, PaO2, and P(a-et)CO2 changed significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). In the propofol group, PaCO2 and PetCO2 increased significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05), but PaO2 and P(a-et)CO2 remained constant. When the two groups were compared, there were significant differences in PaO2, PaCO2, PetCO2 and P(a-et)CO2 at 30min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). CONCLUSIONS: These results indicate that during laparoscopic cholecystectomy the PaO2 was significantly lower and PaCO2 and P(a-et)CO2 were significantly higher in the isoflurane group compared with the propofol group.

The Effect of Clonidine Pretreatment on Cardiovascular Response and Seizure Duration according to Electroconvulsive Therapy / 대한마취과학회지

BACKGROUND: Elecroconvulsive therapy (ECT) is frequently associated with cardiovascular complications such as hypertension and tachycardia. The aim of this study was to evaluate whether clonidine given as an oral preanesthetic medication would influence the hemodynamic stress response, peripheral oxygen saturation and seizure duration which follows ECT. METHODS: Twenty-two ASA physical status I, II patients with major depressive disorders were included in a crossover study design and assigned randomly to either a control group who received placebo, or a clonidine group who received oral clonidine of 3 microgram/kg 90 min before preparation of ECT. All patients received glycopyrrolate 0.2 mg intramuscularly 60 min before anesthetic induction. Electrocardiography, pulse oximetry, and blood pressure monitors were applied to all patients. Patients were pre-oxygenated with 100% O2. Patients received thiopental 2.5 mg/kg and succinylcholine 0.5 mg/kg for anesthetic induction. Noninvasive mean arterial blood pressure (MAP), heart rate, and oxygen saturation were recorded just before test drug administration, immediately before ECT, and each minute for five minutes after ECT. The times from ECT stimulus to the cessation of clonic-tonic motor activity in the "isolated" arm were noted. RESULTS: There was a significant decrease in MAP (P = 0.007) through the peri-ECT period in groups with oral clonidine pretreatment (3 microgram/kg) relative to the control group. There were no significant differences in heart rate and peripheral oxygen saturation values between two groups. The duration of motor seizure activity was similar between the clonidine pretreatment and placebo groups. CONCLUSIONS: We conclude that oral clonidine 3 microgram/kg as a pretreatment medication is effective in attenuating the MAP increase in routine ECT.

Comparison of Diclofenac or Fentanyl for Pain Following Tonsillectomy / 대한마취과학회지

BACKGROUND: This study was designed to compare intramuscular diclofenac with intravenous fentanyl in the prevention of pain after tonsillectomy and adenoidectomy for day-surgery. METHODS: We studied 60 patients, aged 3-13 years, undergoing tonsillectomy with or without adenoidectomy. Patients were randomly assigned to receive placebo injecton (Group 1), intramuscular diclofenac 1 mg/kg (Group 2) or intravenous fentanyl 1 microgram/kg (Group 3) after induction of anesthesia. Pain was evaluated by using an observer pain score for the first 30 min, 60 min and 4 hrs postoperatively. RESULTS: It is statistically significant that group 2 and group 3 had lesser pain than group 1 at 30 min and 60 min. But there is no difference among any groups at 4 hr postoperatively. CONCLUSIONS: We conclude that diclofenac may have advantages compared to fentanyl in safety and convenience for the treatment of pain after tonsillectomy in children.

The Influences of the Bispectral Index and Hemodynamics during Induction of Anesthesia with Propofol and/or Midazolam / 대한마취과학회지

BACKGROUND: The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. In this study, we measured BIS, blood pressure (BP) and heart rate (HR) during induction of anesthesia (IA) with propofol, with and without midazolam pretreatment. METHODS: A study design was used in 20 ASA physical status 1 and 2 patients aged from 18 to 60 years undergoing short (2 h) operation times. In the control group (group 1, n = 10), propofol 12 mg/kg/h was infused continuously after propofol 2 mg/kg as an intravenous bolus for IA preceded by normal saline. In group 2 (n = 10), propofol 12 mg/kg/h was infused continuously after half-strength propofol 1 mg/kg as an intravenous bolus for IA preceded by 0.1 mg/kg midazolam 2 min before. Patients received intravenous propofol for IA over 40 seconds. During the infusion, vecuronium (0.15 mg/kg) was given 3 5 min before intubation. The assistant and controlled ventilation were maintained with 100% oxygen over 5 min, and continued until BIS decreased to 40 and intubation was called for. The BIS, BP and HR were measured 2 min after midazolam or normal saline infusion, 3 5 min after propofol with vecuronium and 1, 3 and 5 min after endotracheal intubation. RESULTS: The midazolam pretreatment produced transient decreases in systolic BP and the BIS. During IA with propofol, BP decreased 20% in both groups. BIS decreased significantly 5 min after endotracheal intubation. CONCLUSIONS: Midazolam pretreatment attenuated the cardiovascular response to intubation, so BIS is considered a good monitor as a predictor of hypnotic state during intravenous anesthesia.

Anesthetic Management for a Patient with Total Body Cerebral Palsy: A case report / 대한마취과학회지

Some of cerebral palsy patients are accompanied by mental retardation, convulsion, scoliosis and thoracic deformity. We experienced general anesthesia of a 22-year-old male with cerebral palsy accompanied by high degree mental retardation and scoliosis for dental caries therapy. We performed anesthetic management of this patient without any occurrence of anesthesia-related complications, though we had some difficulties in anesthetic induction and postural maintenance during the process. We recognized that considerable attention is needed for the patients with cerebral palsy to avoid undesirable anesthetic complications, especially ventilatory failure and neurologic sequelae.