The Effects of Midazolam and Propofol by Continuous Intravenous Infusion to provide Sedation in Patients who receive Spinal Anesthesia / 대한마취과학회지

Midazolam and propofol by continuous intravenous infusion produce excellent and easily controllable sedation as an adjunct to spinal anesthesia. The purpose of the present study is to compare the cardiovascular and respiratory effect, degree of sedation and recovery of midazolam and propofol, and then determines the mean infusion rate of both groups. Forty patients of ASA class 1 or 2 scheduled to lower extremities surgery under spinal anesthesia were classified randomly into 2 groups. Group 1 were infused with midazolam 0.1-0.2mg/kg/h and group 2 propofol 2-3mg/kg/h. The results were as follows: 1) The mean induction dose of midazolam was 0.29+/-0.03mg/kg/h and propofol was 5.56+/-0.78mg/kg/h and the mean infusion rate of midazolam was 0.09+/-0.02mg/kg/h and propofol was 2.13+/-0.41mg/kg/h, which resulted in easily controllable sedation during operation. 2) The quality of sedation was assessed as good in 19 patients but 1 patient showed excitatory movements after midazolam infusion. Good sedation was provided in 16 patients but 2 patients showed excitatory movements and 2 patients complained pain on injection after propofol infusion. 3) The mean arterial pressure was more significantly decreased in propofol than midazolam group. 4) The heart rate was more decreased than control in both groups. 5) Airway maintenance was excellent and side effects were rare. 6) Recovery, judged by ability to open the eyes and recall date of birth, was significantly more rapid after propofol than after midazolam infusion.

Effect of Lidocaine on the Prevention of Intravenous Propofol-induced Pain / 대한마취과학회지

Propofol is a rapidly acting intravenous anesthetic agent used for the induction of anesthesia, with a low incidence of side effects. But pain on injection of propofol has limited its use. The additional effect of lidocaine on painful injection of propofol was studied, during induction of general anesthesia in 75 patients in a prospective, randomized method. They were allocated randomly to three groups to receive propofol 2.0 mg/kg(group A), propofol 2.0 mg/kg with lidocaine 0.2 mg/kg(group B), propofol 2.0 mg/kg with lidocaine 0.3 mg/kg(group C). Pain score was assessed on a simple scale graded from 0 (no pain) to 3 (severe pain). Mean arterial blood pressure and heart rate were monitored at 1, 3, 5, 7 minutes after endotracheal intubation. In group B and C, significantly smaller pain score was observed. On the other hand, changes of mean arterial blood pressure and heart rate after endotracheal intubation was not significant. It is concluded that the addition of small amount of lidocaine can significantly reduce the severity of pain on injection of propofol.

Cardiovascular Changes of Midazolam for Induction of Anesthesia / 대한마취과학회지

The cardiovaseular response evoked by tracheal intubation was observed in 69 patients undergoing elective surgery in whom anesthesia was induced with group A, B and C induction agents. Sixty nine ASA class 1 or 2 surgical patients were divided into three groups. Group A: thiopental 5 mg/kg (control) Group B: thiopental 2 mg/kg with midazolam 0.1 mg/kg Group C: midazolam 0.2 mg/kg Systolic and diastolic blood pressure, mean arterial pressure, heart rate and loss of eyelid reflex were measured in each group. There was a little difference in the cardiovascular changes between group A and C. But there was not a significant difference between group A and B and also between group B and C. The measured time until loss of eyelid reflex of the group C (55+/-30 sec) was considerably longer than other groups (Group A: 10+/-3 sec, Group B: 37+/-13 sec). The incidence of venous complication in three groups was low. Pain on injection and posto- perative nausea and vomiting was noted in one patient of the group A and B respectively, but no patient in the group C. There was no significant difference in the incidence of the postoperative local venous complication. On the whole, these results suggest that the difference between midazolam and thiopental had no apparent hemodynamic change. From the above results, both midazolam alone and midazolam combined with thiopental may be useful agents for induction of anesthesia.

A Case Report of Severe Bradycardia and Mobitz Type I A-V Block after Anesthetic Induction with a Fentanyl-Propofol Sequence / 대한마취과학회지

Severe bradycardia has been associated with a number of medications used for induction of anesthesia. Fentanyl and other potent opioids are well known for their central vagotonic effect, particularly when given rapidly in high doses. Propofol administration has also been associated with bradycardia, and may even exert a central vagotonic or sympatholytic ef- fect, or both. The anesthetic induction with propofol fentanyl may be followed by severe bradycardia in patients who have not received atropine. The bradyeardia may be prevented by premedication with atropine. We report a case in which anesthesia was induced with fentanyl 3 ug/kg and propofol 2. 5mg/kg in 43 year old female patient undergoing oophorectomy. Twenty or thirty seconds after injection of propofol and fentanyl the reduction of blood pressure and severe bradycardia appeared along with premature ventricular contraction and Mobitz type I A-V block. Immediate therapy was initiated with injection of atropine 0.5mg and hyperventilation with 100% oxygen. After about one minute the vital sign of the patient returned to normal. We emphasize that anticholinergic and oxygen before induction with fentanyl propofol should be administered to prevent possible bradycardia and hypoxia.

Cardiovascular change to endotracheal intubation during anesthetic induction with midazolam-fentanyl / 대한마취과학회지

Thiopental sodium, a water-soluble barbiturate derivative with pH 10.0, reaches brain tissue in its highest concentration in about 50 seconds after intravenous injection. Blood concentration then decreases according to redistribution. Patients who are given midazolam as an induction agent are known to awake from general anesthesia relatively more slowly than those given pentothal sodium. Fentanyl, a potent analgesic, has been used in balanced anesthesia because of its minimal cardiovascular effects. In the present study, the effects of pentothal sodium, midazolam and midazolam-fentanyl on cardiovascular changes to endotracheal intubation during anesthetic induction were compared. Sixty patients of ASA class I or II scheduled to undergo elective operations were classified randomly into 3 groups. Group I and II were injected with thiopental sodium 5.0 mg/kg and midazolam 0.2 mg/kg, respectively. Group III received midazolam 0.1 mg/kg and fentanyl 2 ug/kg. The results were as follows ; 1) The onset time (time from intravenous injection to loss of eyelid reflex) of group III (137+/-10.29 seconds, p<0.05) was longer than those of group I (10+/-3.22 seconds) and group II (37+/-12.49 seconds). 2) The change of the mean arterial pressure : Group III showed minimal change (4% decrease, p<0.05) at 1 minute after endotracheal intubation as compared with group I (21% increase) and group II (6% increase). 3) The change of the heart rate ; Group III showed the least change (6% increase, p<0.05) at 1 minute after endotracheal intubation as compared with group I (18% increase) and group II (12% increase). From these results, it is suggested that the combined use of midazolam and fentanyl may cause less effect on the cardiovascular system during endotracheal intubation than midazolam or thiopental sodium alone.

Clinical Effects of Propofol According to Dosage / 대한마취과학회지

Propofol(Diprivan, England ICI) is a new intravenous anesthetic agent chemically unrelated to barbiturates or other intravenous anesthetic agents. It was found to produce rapid onset of anesthesia and early recovery similar to that Obtained with pentothal sodium. The purpose of the present study is to compare the cardiovascular and respiratory effect of propofol with the cardiovaseular and respiratery effeet of pentothal sodium. Sixty patients of ASA class l or 2 scheduled to undergo gynecological, orthopedic and abdominal procedures were classified randomly into 3 Groups. Group A were injected with pentothal sodium 5.0 mg/kg and Group B, C received propofol 2.0 mg/kg, 2.5 mg/kg respectively. The results were as follows, 1) Change of the systolic arterial pressure. Propofol 2.5 mg/kg produced the greatest decrease in systolic blood pressure when compared with other groups. 2) Change of the heart rate. Change of the heart rate was minimal after both doses of prepofol when compared with pentothal sodium. 3) Respiratory effect. Respiratory measurement in 20 unpremedicated surgical patients who received an induction dose of propofol 2.5 mg/kg showed significant respiratory depression. 4) Side effect. Excitatory effects and pain on injection were more frequent in propofol group than pentothal sodium group. Nausea, vomiting were more frequent in pentothal sodium group than propofol group.

Cardiorespiratory Changes with Benzodiazepine Derivatives during Spinal Anesthesia in Elderly Patients / 대한마취과학회지

Midazolam, a water soluble benzodiazepine, was compared with diazepam as the changes of eardiopulmonary function during sedation under the spinal anesthesia in elderly patients. The results were as follows; I) Cardiovascular effect. At the conclusion after diazepam 0.05 mg/kg(Group D) or midazolam 0.02 mg/kg(Group M) injection, systolic, diastolic pressure and heart rate were significantly decreased(P<0.05) in the both group from 3 min to 30 min, but maintained within normal range. However, it is not significant difference that each group. 2) Respiratory effect. SaO decreased significantly at 3 min. in M-group after midazolam injection but there was not significant difference from change in D-group. Respiratory rate, pH and PaCO2 were not significantly changed between D-group and M-group. However, PaO2 was significantly decreased(p<0.05) within normal range at 3 min. in M-group after midazolam IV and significant difference between both groups. From the above results, We have concluded that IV administration of small dose of diazepam or midaaolam during spinal anesthesia had a little changed in cardiopulmonary function. However, sedative effect was efficient.

Clinical effect of parasympathomimetric agent and clinical analysis in the patients with urinary retention after benign anorectal surgery

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