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.