Effect of Nalbuphine on Isoflurane MAC / 대한마취과학회지

BACKGROUND: The present study was performed to elicit what effect nalbuphine would have on isoflurane MAC (minimum alveolar concentration) in the patients undergoing lower abdominal surgery. METHODS: Sixty-two women were randomly allocated to one of five study groups to receive an intravenous injection of no nalbuphine (group I), 0.25 mg/kg (group II), 0.5 mg/kg (group III), 1.0 mg/kg (group IV), 1.5 mg/kg (group V). Anesthesia and tracheal intubation were induced with propofol 2 mg/kg, succinylcholine 1 mg/kg. Patients were inhaled at a preset end-tidal concentration of isoflurane, which was maintained for 20 min. Response to skin incision, movement or no movement, was determined 30 minutes after nalbuphine injection. The isoflurane concentration of the next patient in the same group moved up or down in steps of 0.1~0.3%, according to the previous patient's response. MAC was determined using the "up-down" method and logistic regression. RESULTS: The MAC's of isoflurane were 1.09 vol% end-tidal in the control group, 0.89 vol% in group II, 0.65 vol% in group III, 0.55 vol% in group IV, and 0.51 vol% in group V. CONCLUSIONS: It would be suggested that nalbuphine dose-dependently reduce the isoflurane MAC, and have ceiling effect on the reduction of isoflurane MAC.

Anesthetic Management for Simultaneous Cesarean Section and Aneurysmal Clipping of the Pregnant with Ruptured Cerebral Aneurysm / 대한마취과학회지

Aneurysmal subarachnoid hemorrhage in a pregnant woman is a rare catastrophic situation that places both the mother and fetus at high risk. When this situation arises, numerous relevant issues must be individualized in the effort to reduce hazards threatening both the mother and fetus. A 29 year old woman who was 39 weeks pregnant presented with a subarachnoid hemorrhage, secondary to a ruptured left ophthalmic artery aneurysm. Following initial full recovery, the simultaneous sequence of cesarean section followed by aneurysmal clipping was electively underwent. Successful maternal and perinatal outcome was achieved. The anesthetic management of the case is described and discussed.