Effects of sevoflurane and propofol on wound healing in rats: comparison of blood flow and wound size / 대한마취과학회지

BACKGROUND: As the wound healing is a multi-factorial process, the anesthetic agent and the duration of its exposure may influence the healing process after surgery. This study investigated the effect of anesthetic agents and duration of its exposure on the wound healing process after operation. METHODS: Total 32 rats weighing 200-300 g were randomly allocated to one of eight groups according to the exposure time (1, 2, 4, 8 hours) of sevoflurane or propofol (n = 4 each). After wounding under the each anesthetic, anesthesia was maintained for 1, 2, 4 and 8 hours in each group. We compared the skin blood flow around the wound and the wound size at baseline, 3 days, and 7 days postoperatively. RESULTS: In sevoflurane group, short exposure group (1, 2 hours) showed higher wound blood flow than long exposure (4, 8 hours) at 3 days after wounding (P < 0.05), but not at 7 days after wounding. For the wound size, there was no difference at 3 days after wounding in sevoflurane group, but 8 hours exposure group had the largest wound at 7 days after wounding. In propofol group, wound blood flow showed no difference at 3 days after wounding, but that of 4, 8 hours exposure group was higher than 2 hours exposure group at 7 days after wounding. There was no difference in wound size in propofol group. CONCLUSIONS: This study implicates that sevoflurane might influence the wound healing process more prominently than propofol according to the duration of exposure time.

Effect of remifentanil on postoperative pain in gynecologic surgery with sevoflurane anesthesia / 대한마취과학회지

BACKGROUND: Rapid development of acute opioid tolerance and hyperalgesia is well established in animal studies and is more likely to occur with large doses of short-acting drugs. Several experimental and clinical studies of varied design that have been conducted in humans comparing remifentanil with other routinely used anesthetics or placebo preparations have produced conflicting results. The aim of this study was to investigate whether remifentanil had any impact on postoperative pain after gynecologic surgery. METHODS: Sixty patients undergoing gynecological surgery were randomly allocated into three groups (each n=20): N group with normal saline, L group with target-controlled infusion (TCI) of 1 ng/ml remifentanil, and H group with TCI of 3 ng/ml remifentanil. All patients were anesthetized with sevoflurane to maintain mean arterial pressure within 20% of basal values. Thirty minutes before the end of surgery, patients received morphine sulfate through a patient-controlled infusion device. Pain scores, sedation scores, and analgesic requirements were recorded for 48 hours postoperatively. RESULTS: The mean remifentanil infusion dose of the H group was significantly higher than that of the L group. The VAS scores of the L and H groups were significantly higher than those of the N group only at the postanesthetic care unit and not at the ward. CONCLUSIONS: Intraoperative use of remifentanil with sevoflurane may be related to increased postoperative pain during early postanesthetic period. Provision for effective preventive and therapeutic management strategies in case of intraoperative remifentanil use may be reasonable.