Comparative Study of 0.5% Hyperbaric Bupivacaine and 0.5% Hyperbaric Tetracaine in Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Marcaine is a recently introduced hyperbaric bupivacaine. The aim of this study was to compare the difference in hemodynamic change and sensory or motor block between 0.5% hyperbaric bupivacaine and 0.5% hyperbaric tetracaine in spinal anesthesia. METHODS: Thirty patients belonging to ASA classes I and II were divided into either a tetracaine (Group I) or bupivacaine (Group II). All patients received an infusion of lactated Ringer's solution (1,000 ml). We standardized techniques and injected equal doses (12 mg) in equal volume (2.4 ml) intrathecally for spinal anesthesia. After intrathecal injection of the agents, we measured the blood pressure, heart rate, change of sensory block level according to pinprick test and motor block by the modified Bromage score until fixation was achived. RESULTS: The onset time of sensory block was more rapid in Group I than in Group II. There was no difference in the level of sensory block between Group I and Group II. The time for maximum motor block was significantly shorter in Group I than in Group II (p < 0.05). The change in systolic and mean blood pressure in Group II was less than the change in Group I. CONCLUSIONS: Bupivacaine has a longer sensory block duration, a weaker intensity and shorter duration of motor block and yields less change in blood pressure than tetracaine in spinal anesthesia. Therefore, we concluded that spinal anesthesia with hyperbaric bupivacaine may be used more safely in comparision with hyperbaric tetracaine in hemodynamically troublesome cases.

Taylor's Approach Reduces the Incidence of Postdural Puncture Headache in Spinal Anesthesia / 대한마취과학회지

BACKGROUND: The development of postdural puncture headache is related to a patient's age, size, pregnancy, sex, type of dural puncture needle and direction of the needle bevel. We studied the effect of the needle size and type of dural puncture on postdural puncture headache after spinal anesthesia in the 40 patients. METHODS: Forty patients, belonging to ASA classes 1 and 2, were divided into 2 groups, one using the lumbar paramedian approach (n = 20, Group 1) on L4-5 interspinous space with a 24 G spinal needle and the the other using Taylor's approach (n = 20, Group 2) through S2 foramen with a 22G spinal needle. All patients received an infusion of lactated Ringer's solution (1,000 ml). After spinal anesthesia, we measured the incidence, onset, duration and severity of postdural puncture headache in the 40 patients. RESULTS: The incidence of postdural puncture headache is lower in Group 2 (0%) than in Group 1 (15%). The onset of postdural puncture headache occured within 24 hours in 100% of the patients in Group 1 and the duration of postdural puncture headache occured within 48 hours in 66.7% of the patients in Group 1. The severity of postdural puncture headache was mild and moderate in 3 cases of all the 3 cases with postdural puncture headache of Group 1. The location of postdural puncture headache was frontal in 2 cases and occipital in 1 case. CONCLUSIONS: The incidence of postdural puncture headache is zero in Taylor's approach group in 20 patients. Therefore we think that spinal anesthesia using Taylor's approach is safer than spinal anesthesia with the lumar approach for postdural puncture headache.

Analysis of Preoperative Echocardiography in 381 Geriatric Patients / 대한마취과학회지

BACKGROUND: In geriatric patients, cardiovascular disease is common and a main cause of perioperative morbidity and mortality. Therefore preoperative evaluation of cardiac function is important. The purpose of this study is to evaluate preoperative echocardiography in geriatric patients for understanding aging heart changes and proper selection of patients. METHODS: In the 381 geriatric patients, authors evaluated chamber size, wall thickness, wall motion, valve abnormalities and ejection fraction. In addition, in patients who had left ventricular dysfunction (ejection fraction < OR = 55%), authors evaluated past medical histories and electrocardiographic (ECG) findings. RESULTS: Left atrial enlargement was present in 16%, left ventricular enlargement in 3%, right ventricular enlargement in 6%, ascending aorta dilatation in 13% and left ventricular hypertrophy (LVH) in 28%. Aortic regurgitation (AR) was present in 44%, mitral regurgitation (MR) in 42%, aortic valve calcification in 21% and hypokinesia of the left ventricular wall in 4%. Left ventricular dysfunction was present in 18 patients and their past medical histories showed hypertension in 39%, myocardial ischemia in 33%, congestive heart failure in 28% and diabetus mellitus in 28%. Also their ECG findings showed LVH in 45%, atrial fibrillation in 30% and ventricular premature contraction in 15%. Among the 18 patients with left ventricular dysfunction, 16 patients (89%) had dyspnea or heart disease histories such as myocardial ischemia, myocardial infarction, congestive heart failure, premature ventricular contraction and atrial fibrillation. CONCLUSIONS: 16% of the patients showed a normal echocardiograpy. Abnormal findings of the echocardiography were, in order of frequency, AR (44%), MR (42%) and LVH (28%). Dyspnea or cardiac disease histories were present in 89% of the left ventricular dysfunction patients.