The Clinical Study of Labor Analgesia by Intrathecal Injection of Morphine, Fentanyl, and Bupivacaine / 대한마취과학회지

BACKGROUND: Intrathecal fentanyl has been known to have rapid analgesic effect for the first stage of labor, but pruritus usually occurs, and respiratory depression can happen. The addition of bupivacaine during intrathecal analgesia has been known to have synergistic action with intrathecal opioids. We observed the efficacy of the intrathecal injection of morphine, fentanyl, and bupivacaine on labor parturients. METHODS: 20 laboring patients were studied. Each patients received morphine 0.2 mg, bupivacaine 2.5 mg, and fentanyl 10 microgram intrathecally. Analgesia was assessed using visual analogue scale (VAS) score as the time elapsed from the drug administration to the delivery. Side effects such as nausea, vomiting, pruritus, urinary retention, respiratory depression, and hypotension were evaluated. RESULTS: The onset of analgesia was rapid (within 5 minutes) and VAS scores were significantly lower than pre-treatment value for 5 hours. The incidence of nausea or vomiting was 55% (11/20). Pruritus occurred 50% (10/20). The occurrence of urinary retention was 35% (7/20). Hypotension occurred 10% (2/20). No patient developed post dural-puncture headache, respiratory depression, fetal bradycardia, or motor weakness. More than 90% of the patients in this study said that they were satisfied with this analgesic procedure. CONCLUSIONS: Intrathecal injection of morphine 0.2 mg, fentanyl 10 microgram, and bupivacaine 2.5 mg provided rapid and effective analgesia in labor patients.

Efficacy of Intrathecal Fentanyl for Tourniquet Pain during Spinal Anesthesia with Hyperbaric Bupivacaine / 대한마취과학회지

BACKGROUND: Tourniquet pain is probably mediated by C-fiber. The ability of fentanyl to interrupt this nociceptive conduction was studied by administering either fentanyl or saline intrathecally along with hyperbaric bupivacaine for spinal anesthesia. METHOD: The incidence of tourniquet pain was evaluated in 60 patients having orthopedic surgery of the lower extremities during spinal anesthesia by administering either 30 mcg fentanyl (group 2) or saline (group 1) along with 0.5% hyperbaric bupivacaine 10 mg. We measured the maximal sensory spread of analgesia to pinprick, the incidence of tourniquet pain, and the sensory anesthesia to pinprick at the onset of tourniquet pain. RESULTS: The average maximal sensory spread of analgesia was the same in both groups (T9). The incidence of tourniquet pain was significantly greater in group 1 (33%) than in group 2 (10%). The sensory levels of anesthesia at the onset of tourniquet pain were not different in two groups. CONCLUSIONS: Intrathecal fentanyl was effective against tourniquet pain for 2 hours of the orthopedic surgery of the lower extremities.

The Effects of Urapidil on Changes of Arterial Blood Pressure and Heart Rate to Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Urapidil is a new antihypertensive agent known to diminish total peripheral vascular resistance by postsynaptic alpha 1-adrenergic blockade and central sympatholytic activity. The purpose of this study was to determine its effectiveness and safety in preventing hemodynamic responses to endotracheal intubation under general anesthesia. METHODS: Thirty normotensive, ASA physical status I patients for elective surgery were selected randomly. They were divided into three groups(Group 1: control group with saline, Group 2: urapidil 0.4 mg/kg, Group 3: urapidil 0.5 mg/kg, n=10 in each group). The drugs were injected 3 minutes before induction with thiopental sodium(4 mg/kg) and succinylcholine(1 mg/kg). Endotracheal intubation was performed 5 minutes after the drugs injection. After endotracheal intubation, vecuronium 0.1 mg/kg was injected and 50% nitrous oxide in oxygen and 2Vol% enflurane were inhaled. We measured the blood pressure and the heart rate with noninvasive method at one minute interval for 5 minutes. RESULTS: In group 3, no significant increase in systolic blood pressure after endotracheal intubation was noted(p<0.05). Urapidil groups showed increase in heart rate at 1, 2 minutes after urapidil injection(p<0.05) and did not blunt increase in heart rate after endotracheal intubation. The side effects of urapidil(hypotension, dizziness, headache and chest tightness) occured in a patient of group 3. CONCLUSIONS: We found that the blood pressure response was effectively controlled, but the change in heart rate was not controlled by urapidil 0.5 mg/kg injection before induction.

Recovery from Cardiac Arrested Patiens due to Intracardiac Stab Wound by Electric Defibrillator / 대한마취과학회지

Recently, there was improved cardiopulmonary resuscitation in parallel with development of electric defibrillator. This 18-year-old male arrived at our hospital emergency room in shock state about 1 hour after trauma. Cardiac arrest was occurred at operating table. Promptly, open thoracotomy was performed under endotracheal intubation. There was found left ventricular laceration about 3cm in length, therefore primary closure of lacerated ventricle was done and open cardiac message, too. But ventricular fibrillation was remained. Myocardial fibrillation was disappeared after operation of defibrillator internally at 20 W/sec and 40 W/sec for 30 minutes. Thereafter, operation was finished successfully. This patient was admitted in our hospital for 32 days and discharged.

The Effects of Premedicants for Children in Day Out Surgery / 대한마취과학회지

Preoperative sedation of children is a difficult problem for the psychic trauma consequent to anticipation of surgery may be as a great hazard to the patient as his original disease. Until now, a number of sedatives have been used commonly for adequate sedation of pediatric patients, but no method has been uriversally accepted. Comparison of the efficacy and safety of ketamine HCI(2.5mg/kg), hydroxyzine HCI(2 mg/kg) and pentazocine(1mg/kg) for preoperative mediaction was conducted in each 25 cases below 10 year old children for minor day out surgery. The obtained results were as follows; 1) Preoperative sedation effect was more better ketamine and hydroxyzine than pentazociae. 2) No clinically significant changes were observed in vital signs in hydroxyzine group. 3) Adverse reaction during induction of anesthesia was unremarkable in all groups, but bradycardia was occurred in pentasocine group. 4) Recovery time was more longer in hydroxyzine group than in the other groups.

A Clinical Study of Hyperbaric Oxygenation Therapy / 대한마취과학회지

Authors observed the 242 patients who were treated with hyperbaric oxygenation therapy from September, 1972 to May, 1978 at our department of B.N.U.H. The results were as follows. 1) Sex distribution was 106 male and 136 female, and the age group was between 10 and 39 year old, which occupied 71. l% of the total cases (172 cases). 2) With regard to distribution by month, 206 cases were in November to April, using coal briquette as the main fuel of heating systems. 3) The patients with CO intoxication were 232 cases(95. 9%) and the other 10 cases included Buergers disease, gas gangrene, sudden deafness and uncommon dermatologic disorder's such as scleroderma and pyoderma gangrenosum. 4) 188 cases(77. 7%) were treated by one time hyperbaric oxygenation therapy and 30 cases(12. 4%) twice, reflecting that most cases were able to be treated only once or twice by hyperbaric oxygenation therapy. Therapy 10 to 49 times was applied to Buerger's disease and sudden deafness, and over 50 times to 2 cases of dermatologic disorders. 5) We could not notice convulsion due to oxygen toxicity, a complication of hyperbaric oxygenation, but tinnitus and aspiration pneumonia were observed in 6 cases(2. 5%).