Anesthetic Management of a Morbidly Obese Parturient for Cesarean Section / 대한마취과학회지

An obese parturient can pose considerable physiologic and technical chalenges to an anesthesiologist. The combined pulmonary changes of pregnancy and obesity commonly make for hypoventilation & hypoxemia because they have both a reduced functional residual capacity and an increased oxygen consumption. The cardiovascular system is also stressed by obesity and pregnancy; both conditions contribute to increased cardiac work. Hypotension is frequently associated with spinal anesthesia because of aortocaval compression by the enlarged uterus and sympathetic blockade. In general anesthesia, obesity is an important risk factor for difficult intubation. Pulmonary aspiration of gastric contents is another significant risk of general anesthesia. Obese parturients are at high risk for developing hypoxia during the induction of anesthesia. We successfully managed the first Cesarean section of a morbidly obese parturient (25 years old, BMI = 54.19 kg/m2) with pregnancy induced hypertension using spinal anesthesia. Then, 1 year later we also successfully managed the second Cesarean section in the same patient (26 years old, BMI = 54.95 kg/m2) using general anesthesia. We restress the importance of anesthetic management of morbidly obese parturients in this case report.

Postoperative Analgesic Effect of Epidural Neostigmine Coadministered with Bupivacaine under General Anesthesia / 대한마취과학회지

BACKGROUND: Intrathecal injection of analgesic agents such as opioids, clonidine, ketamine and nalbuphine with a local anesthetic produces analgesia in patients. Recently, the analgesic effect of intrathecal neostigmine has been investigated; however, the use of epidural neostigmine has not been investigated. The purpose of this study was to define the analgesic effectiveness and the side effects of epidural neostigmine. METHODS: Forty patients undergoing a total abdominal hysterectomy were divided into 4 groups. After intramuscular 0.1 mg/kg midazolam premedication, patients were randomized to receive epidural bupivacaine with saline (control group), 1 microgram/kg epidural neostigmine (Group I), 2 microgram/kg epidural neostigmine (Group II), or 3 microgram/kg epidural neostigmine (Group III) postoperatively. The concept of the visual analog scale, which consisted of a 10-cm line with 0 equaling "no pain at all" and 10 equaling "the worst possible pain" was introduced. Pain was assessed by using the visual analog scale at 1, 3, 6, 9, 12, and 24 h postoperatively, and intramuscular 90 mg diclofenac was available at the patient's request. RESULTS: The visual analog scale score at first rescue analgesic and the incidence of adverse effects were similar among neostigmine groups. The analgesic consumption in 24 hours and the pain visual analog scale score at 3 h, 12 h, and 24 h were significantly decreased in neostigmine groups compared with control groups. CONCLUSIONS: Epidural neostigmine coadministered with bupivacaine produces a dose-independent analgesic effect compared to the control group and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.

The Influence of Anesthetic Technique on the Responses of White Blood Cells and Interleukin-6 in Patients Undergoing Low Abdominal Surgery / 대한마취과학회지

BACKGROUND: Surgical trauma and anesthesia are associated with postoperative immune suppression. Alterations in immune response have been suggested in the same surgery, according to anesthetic techniques. Therefore, this study was conducted to investigate whether regional anesthesia or premedication with clonidine change postoperative circulating neutrophils, lymphocytes and monocytes, and interleukin 6 (IL-6) responses. METHODS: Thirty patients undergoing elective low abdominal surgery were randomly divided into 3 groups: the control group and spinal group received no premedication and the clonidine group received general anesthesia with clonidine premedication. Blood samples were obtained to measure subpopulations of white blood cells (WBC) and IL-6 at pre-induction, immediately after the operation, and 24 h after incision. RESULTS: Increase in total WBC and percentage of neutrophils, decrease in percentage of lymphocytes and monocytes, and increase in IL-6 levels were significant after surgery, compared to the baseline values within the three groups. However, no significant differences of subsets of WBC and IL-6 level were seen among the groups throughout the study periods. CONCLUSIONS: Anesthetic technique did not influence the levels of circulating WBC and IL-6.

Anesthetic Considerations Concerning VSD a Patient with Eisenmenger's Syndrome: A case report / 대한마취과학회지

Eisenmenger's syndrome includes any condition in which communication between the pulmonary and systemic circulations gives rise to pulmonary vascular disease causing a right to left shunt with peripheral cynosis. The theoretical risks of anesthesia in patients with Eisenmenger's syndrome are considerable. We report on the case of a 47-year-old female patient with Eisenmenger's syndrome secondary to ventricular septal defect for transabdominal hysterectomy. Of prime concern was the maintenance of sytemic vascular resistance, and this was achieved using an infusion of phenylephrine started before the induction of anesthesia; the infusion continued after the operation. We carefully performed general anesthesia with N2O-O2-ketamine-fetanyl-enflurane. The patient was discharged for home 8 days later without complications.

Intraocular Pressure during Mechanical Ventilation with Positive End-Expiratory Pressure under General Anesthesia / 대한마취과학회지

BACKGROUND: The purpose of the present study was to determine the effect of positive end-expiratory pressure on intraocular pressure under general anesthesia. METHODS: Contact tonometer HA-1 (Kowa, Japan) was used to measure the intraocular pressures of 22 subjects at zero end-expiratory pressure and positive end-expiratory pressure of 15 cmH2O under general anesthesia. The data were statistically analyzed by paired t-test. RESULTS: There is no statistically significant difference between intraocular pressure of zero end-expiratory pressure and positive end-expiratory pressure of 15 cmH2O in a population with normal basal ocular tonometry. CONCLUSIONS: Mechanical ventilation with positive end-expiratory pressure of 15 cmH2O under general anesthesia dose not present a clinically important significant risk for intraocular pressure increase in a population with normal basal ocular tonometry.

Detection of Lumbar Disc Herniation after General Anesthesia: A case report / 대한마취과학회지

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.

Detection of Lumbar Disc Herniation after General Anesthesia: A case report / 대한마취과학회지

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.

Postoperative Sore Throat and Hoarseness : Influence of the Method of Anesthesia Induction and Time for Extubation / 대한마취과학회지

BACKGROUND: Tracheal intubation for general anesthesia often leads to trauma of the airway mucosa, resulting in postoperative sore throat and hoarseness. Numerous studies have investigated the factors as contributing causes, but the influence of method of anesthesia induction and time for extubation of the endotracheal tube has not been systematically examined. The aim of this study was to establish the effects of the methods of anesthesia induction and timing of extubation on postoperative sore throat and hoarseness. METHODS: Eighty patients with ASA physical status 1 or 2 were randomly divided into four groups. Group 1 patients (n=20) recieved succinylcholine 1.0 mg/kg for intubation and early extubated ; group 2 patients (n=20) recieved succinylcholine 1.0 mg/kg for intubation and lately extubated ; group 3 patients (n=20) recieved pancuronium 0.1 mg/kg for intubation and early extubated ; group 4 patients (n=20) recieved pancuronium 0.1 mg/kg for intubation and lately extubated. All patients were interviewed 6, 24, 48, and 72 hrs after operation by an anesthesiologist in a double-blind manner. RESULTS: The incidence of sore throat at postoperative 6 and 24 hrs were decreased in group 3 compaired with group 1, 2, and 4 (p<0.05), respectively. The severity of sore throat at postoperative 6 hrs were decreased in group 3 compared with group 1, 2 and 4 (p<0.05), and that of postoperative 24 hrs were decreased in group 3 compared with group 1 and 2 (p<0.05), respectively. The severity of hoarseness at postoperative 6 hrs were decreased in group 3 compared with group 2 (p<0.05). CONCLUSIONS: We suggest that postoperative sore throat and hoarseness may be developed more when extubation was perfomed lately than early. Therefore, early extubation provide advantage in terms of reducing sore throat and hoarseness in limited cases of anesthesia.