The Effect of Preemptive Analgesia with Morphine, Ketorolac, Droperidol / 대한마취과학회지

BACKGROUND: Several reports have suggested that preoperative nociceptive block with opioids and nonsteroidal antiinflammatory drugs (NSAIDs) may reduce postoperative pain. This study evaluated the effects of preemptive analgesia, the analgesic efficacy and safety of intravenous opioids and NSAIDs during the first 48 hours after lower abdominal surgery. METHODS: The 40 patients were randomized to either preemptive group or postincisional group. All subjects received IV bolus of 2 mg of morphine followed by continuous IV mixture (morphine 30 mg + ketorolac 90 mg + droperidol 2 mg in 90 ml of normal saline) via Baxter 2-Day Infusor(R). Evaluations included supplementary analgesics, analgesic pain assessment (visual analogue scale, VAS), time of first analgesic request, patient comfort (comfort scale), and side effects. RESULTS: There were no differences in number of patient requiring supplemental analgesic (3/20 vs 5/20), the time of first analgesic request (42.2 hours vs 37.5 hours), pain scores measured at each time, and patient comfort between two groups. There were minor complications such as nausea and somnolence in both groups, but no patients needed any treatment. CONCLUSIONS: Preemptive or postincisional morphine-ketorolac-droperidol infusion was equally effective for postoperative analgesia after lower abdominal surgery with minor complications. Further evaluation may be needed to determine whether preemptive analgesia has any advantages over postincisional analgesia.

Early Detection of Anesthesia Machine Malfunction with Capnography during General Endotrachial Anesthesia / 대한마취과학회지

BACKGROUND: Mechanisms of secondary injury (post-ischemic injury) in the central nervous system have cently reported in a vast of amount of experiments. Among many factors which give rise to post-ischemic neuronal damage, glial deterioration probably mediated by calcium paradox, could be another of the aggravating deleterious factars to the already ischemic neurophil. METHODS: Here we have designed experiment to investigate calcium paradox in astroglial cell line, humsn asttocytoma U1242MG. Intracellular calcium alterations in experimental cells were monitored by using calcium indicating dye fura-2 and epifluorescent photometry system. RESULTS: Intracellular free calcium changes during reperfusion phase after exposure to low calcium led to a prampt increase in intracellular calcium level after 10 and 30 minutes. The way of calcium entry during the reperfusion phase was mediated by the revase mode of Na+/Ca(2+) exchanger. Cells that had a reduction of reperfusate calcium to 10 uM increased cell viability. Also we observed an inverse relationship between major enzymatic activity in the astrocytoma cells (i.e., glutamine synthetase activity) and the duration of reperfusion in the the same protocols. CONCLUSIONS: A relatively small amount of intracellular calcium increase by the reverse mode of Na+/Ca(2+) exchanger during the reperfusion period is related to a limitation of enzyme activity and viability 24 hours later.

Analgesic Effect with Epidural Bupivacaine and Verapamil in Lower Abdominal Surgery / 대한마취과학회지

BACKGROUND: Activation of N-methyl-D-aspartic acid (NMDA) receptors leads to Ca++ entry into the cell and initiates a series of central sensitization such as wind up and longterm potentiation in the spinal cord. Therefore, it can be postulated that the central sensitization would be prevented by blocking Ca++ entry with verapamil. In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to verify whether preoperative epidural anesthesia can preempt postoperative pain and to investigate the possible role of calcium channel blocker, verapamil, in the central sensitization. METHODS: Sixty patients (ASA class I-II) scheduled for lower abdominal surgery were randomly assigned to one of three groups of equal size. Group 1 (PR) is preincisional epidural bupivacaine group. Group 2 (PO) is postincisional epidural bupivacaine group. Group 3 (PRV) is preincisional epidural bupivacaine and verapamil group. Visual analogue pain and mood scores, Prince Henry Scores, sedation scores, cumulative PCA (patient controlled analgesia) morphine consumptions, and the incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. RESULTS: Cumulative PCA morphine consumptions in PRV group was significantly lower than in PR and PO group at 24, 48 hours after surgery. The incidence of side effects had no difference among three groups. CONCLUSIONS: Preoperative epidural anesthesia with 10ml of bupivacaine would be insufficient to preempt postoperative pain in lower abdominal surgery. However, addition of verapamil to preoperative epidural bupivacaine would decrease postoperative pain possibly by preventing the establishment of central sensitization.

What is the Cause of Low End: Tidal CO2 Tension During General Endotracheal Anesthesia? / 대한마취과학회지

BACKGROUND: We have previously demonstrated the isoflurane and halothane may be detrimental to in vitro fertilization of mouse oocytes in high concentrations. The aim of this study is to compare the toxic effects of volatile anesthetics on mouse embryos using in vitro growth model of two cell mouse embryos. METHODS: Mouse two-cell embryos exposed to three volatile anesthetics, enflurane(0.5 mM; 1.5 mM), isoflurane(0.26 mM; 0.78 mM) and halothane(0.24 mM; 0.72 mM). Mouse two-cell embryos unexposed to any drugs were included as controls. RESULTS: The percentages of two-cell mouse embryos developed over morula stages on the third day after exposure of high concentrations of isoflurane and halothane decreased significantly compared with controls. The rates of embryos arrested at 2-8 cell stage in these groups were significantly higher than that of controls. There were no significant differences in these rates between enflurane group, isofiurane and halothane group of lower concentrations and controls. The hatching and/or hatched blastocysts development were significantly lower in isoflurane and halothane group than in controls. No significant differences in the hatching rate of blastocyst developed were observed among groups. CONCLUSIONS: Our data show that isoflurane and halothane in high concentrations have harm effects of the in vitro growth of two cell mouse embryos.

What is the Cause of Low End: Tidal CO2 Tension During General Endotracheal Anesthesia? / 대한마취과학회지

BACKGROUND: We have previously demonstrated the isoflurane and halothane may be detrimental to in vitro fertilization of mouse oocytes in high concentrations. The aim of this study is to compare the toxic effects of volatile anesthetics on mouse embryos using in vitro growth model of two cell mouse embryos. METHODS: Mouse two-cell embryos exposed to three volatile anesthetics, enflurane(0.5 mM; 1.5 mM), isoflurane(0.26 mM; 0.78 mM) and halothane(0.24 mM; 0.72 mM). Mouse two-cell embryos unexposed to any drugs were included as controls. RESULTS: The percentages of two-cell mouse embryos developed over morula stages on the third day after exposure of high concentrations of isoflurane and halothane decreased significantly compared with controls. The rates of embryos arrested at 2-8 cell stage in these groups were significantly higher than that of controls. There were no significant differences in these rates between enflurane group, isofiurane and halothane group of lower concentrations and controls. The hatching and/or hatched blastocysts development were significantly lower in isoflurane and halothane group than in controls. No significant differences in the hatching rate of blastocyst developed were observed among groups. CONCLUSIONS: Our data show that isoflurane and halothane in high concentrations have harm effects of the in vitro growth of two cell mouse embryos.

Analgesic Effect of Epidural Morphine and Incisional Site Infiltration with Bupivacaine in the Lower Abdominal Surgery / 대한마취과학회지

IIn a randomized double-blind study, postoperative pain was assessed in 60 patients undergoing gynecologic surgery with three types of anesthesia; inhalation anesthesia only (enflurane-N2O-O2-vecuronium)(G); inhalation anesthesia with local infiltration (infiltration of the abdominal wall with 40 ml 0.25% bupivacaine along the line of the proposed incision)(GI); and inhalation anesthesia with epidural analgesia (morphine 2 mg mixed with 10 ml 0.125% bupivacaine)(GE). The severity of constant incisional pain, movement-associated incisional pain, and pain upon pressure applied to the surgical wound using 5 pounds of weight was assessed with a visual analogue scale at 2, 6, 12, 24, and 48 hours after surgery. The duration of analgesia (time from the end of the surgery to the first request for analgesic) was 7.9+/-3.1 hours in group G, 22.8+/-4.8 hours in group GI, and 33.1+/-3.9 hours in group GE, with statistically significant differences between group G and other two groups. Forced vital capacity (FVC), peak expiratory flow, and forced expiratory volume in 1 second (FEV1) were measured with the patients in a semisitting position. In all groups, there were no differences in above parameters, These results indicate that postoperative pain after lower aMominal surgery would be managed satisfactorily with infiltration of local anesthetic as well as epidural analgesia.