Attenuation of pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum in laparoscopic cholecystectomy / 영남의대학술지

BACKGROUND: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient's hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. METHODS: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. RESULTS: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). CONCLUSION: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient's hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.

Risk Factors of Acute Renal Failure after Colorectal Surgery / 영남의대학술지

BACKGROUND: Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. MATERIALS AND METHODS: Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. RESULTS: The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). CONCLUSION: Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.

Subcutaneous Emphysema and Inflammation of the Neck after Tracheal Puncture by an Intubating Stylet / 영남의대학술지

Laryngo-tracheal perforation caused by the use of a stylet during tracheal intubation is a rare complication. We present a case of subcutaneous emphysema and connective tissue inflammation after tracheal intubation. The patient was a 41-year-old male undergoing general anesthesia for an appendectomy. The intubation was difficult during laryngoscopy (Cormack-Lehane Grade III). An assistant provided an endotracheal tube with a stylet inside while the laryngoscope was in place. During intubation, a short, dull sound was heard with a sudden loss of resistance after the distal tip of the endotracheal tube passed the rima glottis. A sonogram and computerized tomography revealed subcutaneous emphysema from the neck to the upper mediastinum and fluid collection between the trachea and the thyroid. This lesion appeared to have been caused by the protruded, loose stylet. Anesthesiologists should be aware of the damage a loose stylet protruding beyond the tip of the endotracheal tube can cause.

Investigation of the Influence of Low Birth Weight on the Severity of Asthma in Prealdolescent Children and Aldolescence / 소아알레르기및호흡기학회지

PURPOSE: Over the past several decades, the survival rates of low birth weight(LBW; birth weight <2,500 g) infants have been improving. Many of these infants have had bronchial asthma(BA) at childhood and aldolescence. The aim of this study is to investigate whether LBW influenced the severity of BA in prealdolescent children and aldolescence by a retrospective case control study. METHODS: 15 LBW children(1,500 g

A Comparison of the Recovery Characteristics of Propofol and Sevoflurane Anesthesia under Bispectral Index System Monitoring / 대한마취과학회지

BACKGROUND: This prospective, double-blind randomized study was performed to compare the characteristics of recovery after general anesthesia induced by target-controlled propofol and sevoflurane. METHODS: Sixty, ASA class 1 or 2 female patients scheduled for an elective total abdominal hysterectomy were randomly allocated to two groups of 30; i.e. Propofol or Sevoflurane groups. General anesthesia was induced using propofol plus a fentanyl bolus (1 microgram/kg), and maintained with 66% nitrous oxide and either propofol infusion or sevoflurane inhalation. Anesthetic depth was controlled under bispectral index (BIS) monitoring: propofol and sevoflurane concentrations were adjusted to achieve target BIS values, and were between 40-60 during surgery and 60-70 during the final 15-20 minutes. The two anesthetic agents were discontinued following subcutaneous layer closure. After skin closure, the patients were ventilated manually with 100% oxygen until extubation. Patients were evaluated in terms of level of consciousness and side effects at the end of anesthesia and at 5, 15, 30 and 120 min after anesthesia. RESULTS: There were no significant differences in recovery times. The incidences of side effects were similar in the two groups, though the incidence of postoperative nausea was higher in the sevoflurane group. CONCLUSIONS: These results suggest that sevoflurane inhalation anesthesia has an emergence similar to that of propofol, except for a higher incidence of postoperative nausea.

Effects of ProSeal Laryngeal Mask Airway on Intraoperative Ventilation and Blood Pressure, and Postoperative Sore Throat in Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the effects of a ProSeal laryngeal mask airway (PLMA) on intraoperative ventilation and blood pressure, and postoperative sore throat in laparoscopic cholecystectomy (LC). METHODS: Sixty, ASA 1 or 2 adults scheduled for elective LC were randomly allocated into two groups; i.e., endotracheal tube (ETT) or PLMA groups. General anesthesia was administered in the usual fashion. Blood pressure and heart rate were measured before and after the induction of anesthesia. Blood pressure, heart rate, peak inspiratory pressure (PIP) and end-tidal CO2 (ETCO2) also were measured before and after intraabdominal CO2 insufflation (pneumoperitoneum) at 5 minutes intervals over 30 minutes. Sore throat, nausea and vomiting were evaluated at 6 and 24 hours postoperatively. RESULTS: Blood pressure and heart rate were higher in the ETT group than in the PLMA group after induction (P < 0.05), however, no differences were observed during pneumoperitoneum. Following the induction of pneumoperitoneum, ETCO2 increased significantly, but without the group differences. PIP was less increased in the PLMA group. No significant differences were observed in incidences of postoperative sore throat, nausea or vomiting in the two groups. CONCLUSIONS: We conclude that PLMA is a useful alternative to ETT in LC. Furthermore, PLMA seems to be more useful for hypertensive patients.

Decrease in Pulse Oximeter Readings Following Injection of Isosulfan Blue Dye / 한국유방암학회지

PURPOSE: A sentinel lymph node mapping with blue dye has been well accepted as a common procedure in breast cancer surgery. However, it is well known that blue dye absorbed into the circulation may interfere pulse oximetery reading. The aim of this study was to evaluate the change of pulse oximetery reading by isosulfan blue dye injection during sentinel lymph node mapping. METHODS: Thirteen breast cancer patients with normal preoperative cardiopulmonary functions were studied. Four ml of isosulfan blue dye was injected subdermally when the patient became stable after induction of general anesthesia. The pulse oximetery was monitored continuously. Multiple arterial blood gas analyses (ABGA) were performed before dye injection and 10, 30, 40 minutes after dye injection. The results of oxygen saturturation by oximetery (SpO2) and the results of arterial oxygen tension (SaO2) and arterial oxygen saturation (SaO2) by ABGA were compared. RESULTS: The value of both SaO2 and PaO2 measured by ABGA has not been altered by isosulfan dye injection. However SpO2 decreased by isosulfan dye injection. SpO2 decrease started 8.2+/-1.5 (2~0) minutes after dye injection and returned to preinjection level by 85.7+/-5.6 (60~126) minutes after injection. The lowest vaule of SpO2 was 95.6+/-1.2% (93~97). Mean duration of SpO2 decrease was 77.5+/-6.2 (40~117) minutes. The duration of SpO2 decrease was longer in the aged patients, but it was not statistically significant (p=0.3). There was no siginificant difference in duration of SpO2 decrease according to injection site, operation method, and body mass index (BMI). CONCLUSION: .Isosulfan dye injection using for sentinel lymph node mapping causes no change in true ABGA results but causes a mild reversible decrease in SpO2, It is important to look for other causes when SpO2 decrease is significant and persistent.

The Clinical Features and Charateristics of anal Cancer Arising from Chronic Fistula-in-ano

PURPOSE: The incidence of unhealed chronic fistula is about 7% and the cancer can occur in the longstanding unhealed fistula. The most of the cancer is mucinous adenocarcinoma. The report is diverse about treatment, adjuvant chemotherapy and prognosis. The purpose of this study is review of the clinical characteristics and survival of the anal cancer arising from chronic fistula-in-ano. METHODS: The number of patients was 10. The diagnosis is made under pathological examination at the Kanbuk Samsung Hospital from 1983 to 2000. The retrograde study was done with patients' records and telephone questionnaire. The survival rate was calculated with Kaplan-Meier method. RESULTS: All patients were male. The patients had symptoms of anal discharge and anal swelling suggesting the anal fistula. The patients had history of anal surgery. The external openings were multiple. Seven patients had mucinous adenocarcinoma. The prognosis was poor. Among 8 patients' follow-up data, except one patient, 7 patients died within 43 months. CONCLUSIONS: The anal cancer can occur in longstanding unhealed fistula. In our series, all patients were male, and they had multiple opening fistula. The patient who had small size tumor have only survived. Through meticulous exploring and deep biopsy of the fistula, early detection is best method to treat the anal cancer arising from chronic fistula-in-ano.

The Effects of Intraperitoneal Instillation of Lidocaine before Pneumoperitoneum on Postoperative Pain Score and Intraoperative Changes of Blood Pressure in Patients with a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the effects of pre-emptive subdiaphragmatic instillation of lidocaine before pneumoperitoneum on postoperative pain following a laparoscopic cholecystectomy (LC) and also to evaluate it's effect on the changes of blood pressure during an operation. METHODS: Thirty-three relatively healthy patients for an LC were allocated into the two groups. after the induction of general anesthesia with sodium thiopental, vecuronium, nitrous oxide and enflurane (1-2 vol%), 0.2% lidocaine 200 ml was subdiaphragmatically instilled 10 min before pneumoperitoneum in the lidocaine group (n = 15), and normal saline in the control group (n = 18). The changes of the systolic and mean arterial pressure (SAP and MAP), postoperative pain score, and the number of analgesics used during the postoperative 24 h were compared between two groups. RESULTS: The pain scores at postoperative 1, 3, 6, 12, 18 and 24 h and the number of analgesics used were significantly low in the lidocaine group compared to the control group (P<0.01). The elevations of SAP and MAP during pneumoperitoneum were significantly attenuated in the lidocaine group (P<0.01). CONCLUSIONS: This data suggests that subdiaphragmatic instillation of lidocaine before pneumoperitoneum is effective in the control of postoperative pain following an LC and also effective to attenuate the elevation of blood pressure during pneumoperitoneum. However, further study is needed to evaluate the safety of these methods before recommendation of routine use.

There is Some Differences in the Changes of Liver Enzyme Levels among the Type of Surgery under Enflurane Inhalation Anesthesia / 대한마취과학회지

BACKGROUND: There are many factors which cause postoperative hepatic dysfunction. Anesthetic agents are not the most common factor and there aremany other factors such as preoperative condition of the patients, site and duration of the operation, operation per se and so on. The purposeof this study is to evaluate postoperative liver function with respect to different types of surgery. METHOD: Fourty three patients were classified into three groups; 11 patients for tympanoplasty with mastoidectomy (Group 1), 16 patients for total abdominal hysterectomy (Group 2), 15 patients for subtotal gastrectomy (Group 3). All patients were anesthesized with about 2 vol% of enflurane combined with 50% nitrous oxide. Serum glutamic oxalacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase (ALP) were measured before anesthesia, 1, 3 and 7 days after surgery in all group, respectively. RESULT: In Group 1 and 2, postoperative SGOT and SGPT levels were maintained with preoperative level during the 7days, but in Group 3, those levels were increased in the 1st day but below upper limit (p<0.05) and decreased thereafter. Alkaline phosphatase level was maintained within the normal range for all the group during the 7 days. CONCLUSION: We consider that postoperative liver functioin may be influenced by different types of surgery, and also may be influenced by anesthetic time.

Varicose Veins that Well Treated by Sclerosing Agents in Lower Extremity

In the early period (B'C) the definition of the primary varicose vein in lower extremity was dilate, tortuous and elongated vein. It has been known that the varicose vein in lower extremity is more involved in western people than orintal. However nowadays this disease is also well involved in oriental because of incresed economic level and well equipped culture. BACKGROUNDS: We has been tried the clinical reserch because of good result & possibility of therapy by only sclerotheray in well defined selected indication of primary varicose vein. MATERIAL AND METHOD: We reviewed primary varicose vein involved in lower extremity of 23cases that was well treated by sclerosing agents to Dept of Surg, Kangbuk Samsung Hosp, SungKyunKwan University College of Medicine, From January 1996 To December 1997. RESULTS: 1. The distribution of the age were the first in 5th decade (39.1%), followed by 6th decade, 4th decade. The ratio of sex were more prevalent in female than male (6.7:1). The median age was 47.3 years-old. 2. Sx & sign were showed cosmetic problem (82.6%) in most patients, followed by heaviness (47.8%), numbness (39.1%), pain (21.7%). 3. The duration of illness were over 10years in 17cases (73.9%). 4. The size of varicose vein were type II in 16case (69.6%), follwed by type I (21.7%), type III (8.7%) according to the classification by Dr. Weiss. 5. The frequency of injection were 1st injection in 12cases (52.2%), 2nd-4th injection (26.1%), over 5th injection (21.7%). 6. Post injection complication were pigmentation in 1case and thrombosis in 1case. 7. The predisposing factors were corelated with pregnancy in most patients, others were long standing position, familiar tendency, trauma. CONCLUSION: Double therapy (operation and sclerotherapy) has been tried in primary varicose vein, however if we are well select indication of therpy, sclerotherapy is also choice of treatment in the primary varicose vein.

Effects of Intercostal Nerve Block Combined with IV-PCA on Pain and Inspiratory Capacity after Thoracotomy / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the effects of intercostal nerve block added in intravenous patient-controlled analgesia (IV-PCA; PCA) on pain, pulmonary function and the movement of the ipsilateral arm after a thoracotomy. METHODS: Forty five patients undergoing elective thoracotomy were randomly allocated into one of three groups. The groups were divided as follows: PCA, ICB-PCA (PCA and intercostal nerve blocks by direct injection of 5 ml of 0.2% bupivacaine into the intercostal spaces of two upper and two lower segments around the surgical incision) and IM groups. For the PCA, the patients that received PCA, were administered IV bolus of 0.1 mg/kg of nalbuphine followed by PCA with 0.1% nalbuphine (basal rate 0.5 ml/hr, bolus dose 1 mg and lockout interval 8 minutes). In each group, VAS score, the inspiratory capacity and the movement of the ipsilateral arm were checked postoperatively at 6, 24, 48 and 72 hours. RESULTS: Inspiratory capacity was decreased less in ICB-PCA group (P<0.05) at 6 hour, but after 24 hour, there were no differences between the groups. The analgesic effect was significantly better in ICB-PCA group as compared to the PCA or IM groups (P<0.05). Furthermore, arm motion limitation after operation was the least in ICB-PCA group (P<0.01). CONCLUSION: Intraoperative intercostal nerve blocks added in PCA has a transient improvement of pulmonary function, and also provide better analgesia and improved ipsilateral arm motion after a thoracotomy than in PCA or IM analgesia. The authors recommend adding intercostal nerve block for patients undergoing thoracotomy who receive IV-PCA.

Status of Bcl-2 expression and Its Relationship to the Other Prognostic Factors in Breast Cancer / 대한암학회지

PURPOSE: There are several well-established prognostic factors to predict the course of breast cancer. Recently, a new category of genes that control the process of programmed cell death, also called apoptosis, has been identified. It includes the bcl-2 proto-oncogene which actively blocks apoptosis. The purpose of this retrospective study is to investigate the relationship between Bcl-2 protein expression in primary breast cancers and other markers of prognostic value. MATERIALS AND METHODS: We analyzed 43 cases of invasive ductal carcinoma of breast cancer, which were consecutively operated in the period from January 1990 to December 1994. Analysis of Bcl-2 protein, ER and PgR expression was carried out using immunohistochemistry on the paraffin-embedded tissue section. The following indices were measured.; size of the tumor, number of axillary metastasis, histological grade, menopausal status, ER, PgR, and Bcl-2 status. RESULTS: Expression of the bcl-2 proto-oncogene was found in 28 cases of 43 patients (65.1%). No relationship could be observed between Bcl-2 status and tumor grade, TNM staging and menopausal status. A strong positive relationship was demonstrated between Bcl-2 immunoreactivity and ER status (P 0.001) and PgR status (P=0.014). A favorable prognostic value was demonstrated for Bcl-2 expression on overall survival (P=0.0427), but no prognostic value was demonstrated on disease-free survival (P=0.1587). CONCLUSION: Our results suggest that the Bcl-2 expression may be a favorable prognostic marker and its important role may be a modulator of response to adjuvant therapy in breast cancer.

Rectal Carcinoid

PURPOSE: This study was designed to evaluate the clinical charateristics, surgical treatment and outcome of carcinoid tumors of the rectum. METHODS: A retrospective review of the charts of all patients treated for rectal carcinoid tumors at Kangbuk Samsung Medical Center between Jan 1989 and April 1998. Thirteen patients with rectal carcinoids tumors were treated. Follow-up data, histopathological information and surgical procedures were obtained from case notes. RESULTS: There were 10 men and 3 women. The ages ranged from 28 to 60 years (mean 41.1 years for all, 43.8 years for men and 32 years for women). Eight patients (61.5%) had no symptoms. Of the five patients, four complained of rectal bleeding (30.8%), and one complained of defecational difficulty (7.7%). Size of rectal carcinoid tumor was less than 1 cm in 7 patients (53.8%), between 1 cm and 2 cm in 2 patients (15.4%), in four patients (30.8%) larger than 2 cm. Three patients were treated in Abdominoperineal resection. Two patients underwent stapled low anterior resection. The remaining 8 patients underwent conservative resection (3 colonoscopic polypectomy and electrocauterization, 2 colonoscopic snaring biopsy, 2 transanal resection and one Mason's operation). The depth of invasion was contained within sutmucosa in 3 patients. Liver metastasis was found in 2 patients. Average follow-up time was 35.6 months. Two patients died of mutiple mestastasis (liver, bone, peritoneum) 9 and 30months later. CONCLUSION: We concluded that tumors smaller than 1 cm could be managed by local treatment whereas larger than 2 cm should be managed by radical treatment.

Clinical Usefulness of Laparoscopic Appendectomy

PURPOSE: There have been numerous retrospective and uncontrolled study of laparoscopic appendectomy. Although most of these have concluded that the laparoscopic appendectomy is at least as good as open appendectomy, there has been considerable controversy as to whether laparoscopic appendectomy is superior. METHODS: We performed total 47 cases of laparoscopic appendectomy (LA) during one year from January 1997 to December 1997 and these were compared with 50 cases of open appendectomy (OA) in same period to assess the clinical usefulness. RESULTS: The sex, male to female ratio and severity of appendicitis were similar in both groups. The anesthetic time was longer in the LA group (P<0.05) but operative time was similar. Gas-passing time and diet-intake time in postoperative period were earlier in LA group (P<0.05). The LA group required less analgesics in postoperative period. In LA group, no case was converted to open appendectomy and overall complication rate was lower in LA group but this was not statistically significant. Among the postoperative complication, the wound infection rate was absolutely lower in LA group (P<0.05). The diagnostic rate for acute abdomen including acute appendicitis was superior in LA group, especially in reproductive women. The hospital stay was shorter in LA group (P<0.05) and hospital charges was not different in both group. CONCLUSION: Laparoscopic appendectomy offers considerable advantages over open appendectomy because this has ability to reduce postoperative complications and shorten recovery times and is useful for detecting the cause of acute abdomen other than acute appendicitis. So we expect this technique will be alternative operation or new standard operation in selected cases for suggestive acute appendicitis.

The Relationship of Depth of Penetration and Tumor Size to the Number of

We examined the interrelationships of depth of penetration, tumor size, and the number of positive lymph nodes in Dukes'c colorectal cancer. This report contains a retrospective study of 256 cases of colorectal cancer that underwent treatment from Jan. 1985 to Dec. 1994 at the Department of Surgery, Kangbuk Samsung Hospital. The most of the patients were on the 6th decades and male to female ratio was 1.27 : 1. By modified Astler-Coller classification, there were stage Cl 29 cases(11.3%), C2 227 cases(88.7%). Eighty patients with colon cancer(31.4%) and 176 patients with carcinoma of the rectum(68.6%) were available for analysis. Utilizing cumulative frequency distributions of tumor size, depth of invasion and the number of positive lymph nodes, comparisons were carried out among three factors. The results indicate that there was no correlation between the longest diameter of the tumor and other two factors but the number of positive lymph node was closely related to depth of invasion. In conclusion, the number of positive lymph node and depth of invasion are very important prognostic factor. But tumor size as a single factor does not correlated with prognosis in Dukes' C colorectal cancer.

Clinical Review of Early Postoperative Intestinal Obstruction after Colorectal

This study was undertaken to identify the causative factors that predispose to early postoperative intestinal obstructions after the radical resection due to colorectal cancer, and to determine their preventive operative techniques. The records of 722 patients that had undergone radical resection due to colorectal cancer at the Department of General Surgery, Kangbuk Samsung Hospital, between January 1, 1986 and December 31, 1995, were reviewed. Among them, operative treatments due to early postoperative intestinal obstructions were performed in 39 patients(5.4%). The most common cause of intestinal obstruction in early postoperative period was bowel adhesion, that was developed in 20 cases(51.3%), and next common cause was internal herniation of bowel into the space between colostomy loop and lateral peritoneal wall(3 cases, 7.7%), incarcerated herniation of small bowel into the reperitonealized pelvic cavity(3 cases, 7.7%), pelvic abscess(1 case, 2.6%), and unknown causes(9 cases, 23.1%) in descending frequency. Use of closed suction drains was responsible to development of the 3rd and 4th causes. As a result, during the radical resection due to colorectal cancer, meticulous manupulation of bowels not to injure the bowel serosa, reperitonealization of pelvic floor at narrow interval with inversion of its dissected edge, complete closure of the space between colostomy loop and lateral wall of peritoneum, and adequate alternative use of closed suction drain and natural drain according to the operative condition, should be considered. In conclusion, surgeons should pay more attention to the operating procedures to lower the incidence of early postoperative intestinal obstruction.

The Appropriate Inflow Rates of Fresh Anesthetic Gas in the Pediatric General Anesthesia with Mapleson D - circuit / 대한마취과학회지

BACKGROUND: During pediatric general anesthesia with Mapleson D-circuit, we used large amount of FGF(fresh gas flow) for avoidance of rebreathing of expired gas but low FGF are employed, the amount of anesthetic consumption and air contamination can be reduced. The aim of this study was to evaluate the fact that FGF of 220 ml/kg/min is clinically acceptable. METHODS: We selected sixty children weighing or =8 kg because of economic and ecological advantages. Also, we consider FGF can be reduced in children weighing <8 kg under accurate respiratory gas monitoring.

Comparative Effects of Continuous Epidural Morphine with Bupivacaine Mixture Infusion and Intramuscular Meperidine on Pulmonary Function after Upper Abdominal Surgery / 대한마취과학회지

BACKGROUND: Pain after upper abdominal surgery may cause shallow and rapid breathing, resulting in postoperative pulmonary complications. Intramuscular injection of narcotics may increase mortality and morbidity of pulmonary complications. Continuous epidural infusion of opioid with local anesthetic mixture may produce good analgesic action without hypoventilation and hypoxia. METHODS: Forty patients for upper abdominal surgery, chosen at random, were studied for postoperative pain relief. In grouop 1 (n=20), pain was managed by intramuscular injection with meperidine and in group 2 (n=20), it was managed by continuous thoracic epidural block with morphine and bupivacaine mixture. In both groups, pulmonary functions were assessed before operation, on the 1st postoperative day. the 2nd day and the 3rd day. RESULTS: In group 1 and 2, On the 1st postoperative day, FEV was 32.1% and 45.4% of the preoperative value, FVC was 31.9% and 42.4% and MEF was 34.4% and 46.7%, respectively(P<0.05). On the 2nd postoperative day, FEV was 38.6% and 54.8%(P<0.01), PEF was 31.7% and 42.5%, FVC was 37.1% and 49.8% and MEF was 43.2% and 59.6%(P<0.05). on the 3rd postoperative day, FEV was 46.3% and 68.7%, PEF was 38.7% and 54.4%, FVC was 43.8% and 63.1%(P<0.01) MEF was 56.1% and 69.7% of the preoperative value(P<0.05). CONCLUSIONS: As a result of pulmonary function test, we suggest that continuous epidural infusion of morphine with bupivacaine mixture will be an appropriate way of postoperative pain relief methods, with its potential effectiveness in aged, smoking, obese and debilitated patients with ventilatory dysfunction.

Effects of the Methods of General Anesthesia on the Changes of Blood Prssure and Arterial Carbon Dioxide Tension during Laparoscopic Chosecystectomy / 대한마취과학회지

Laparoscopic cholecystectomy is a relatively new non-invasive surgical procedures, enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incision and less postoperative ileus. During this procedure, the deliberate pneumoperitoneum with carbon dioxide(CO2) insufflation may cause some problems such as hypercarbia, hypertension, pneumomediastinum and other cardiovascular impairments. This study was performed to search a anesthetic method, which has least increase in blood pressure during CO2 insufflation, and to find out whether increased PaCO2 is a major causative factor in the changes of blood pressure during this period. Sixty patients of ASA class 1 or 2 were classified randomly into 3 groups. Group C(control group) was received enflurane-N2O-O2, and others were recieved enflurane-propofol(group P), or enflurane-propofol-fentanyl(group F), respectively. The blood pressure and heart rate were measured at 1 min before CO2 insufflation and 1 min, 5 min, 15 min after insufflation and 1 min before deflation, 5 min after deflation. Also PaCO2 were checked at 1 min before, and 15 min after insufflation. The results were follows ; 1) Changes of arterial pressure : The control group showed most prominent increasing in systolic and mean blood pressure during CO2 insufflation(P<0.05). Group F produced the least increase in blood pressure during CO2 insufflation, compared with group C and P(P<0.05). 2) Changes of heart rate : Although, in the preinsufflation period, heart rates in the group F were significantly lower than other groups, there were no significant changes in heart rates in each group. 3) Changes of PaCO2: There were no siginificant increases in PaCO2 in each group, and no differences between the groups. In conclusion, fentanyl and propofol added light enflurane anesthesia could be a method of the least increase in blood pressure during the laparoscopic cholecystectomy, and increased PaCO2 would not be a major causative factor in hypertension during CO2 insuftlation.