Comparison of Esmolol and Thoracic Epidural Block in Induced Hypotension / 대한마취과학회지

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility. For induced hypotension, many methods have been used. Recently esmolol is favored in induced hypotension because of its short action and easy controlability, but thoracic epidural block is seldom used in induced hypotension. So we compared the effect of esmolol and thoracic epidural block in induced hypotension. METHOD: Patients scheduled for spinal posterior fusion under general anesthesia were randomly divided into two groups. In thoracic epidural group (Group I, 20 patients), 8~10 ml of 2% lidocaine was injected into the epidural catheter located in T6-7 interspace in a bolus. In esmolol group (Group II, 20 patients), 0.5 mg/kg of esmolol received as loading dose and 50~150 microgram/kg/min infused continuously. We measured mean arterial pressure, central venous pressure, heart rate, amounts of administrated fluids, urine output and VAS score. RESULT: There were no statistically significant differences between the two groups in amounts of bleeding, administered fluid, urine output. The elapsed time to reach the state of induced hypotension (MAP 55~65 mmHg) is 15.1 2.4 min after lidocaine injection in Group I and 6.1 2.7 min after esmolol injection in Group II (p<0.05). There were statistically significant differences between two groups in mean arterial pressure in 10 min after the injection (p<0.05). But there was apparent difference in VAS score in postoperative 1 hrs, 2 hrs and 6 hrs (p<0.05). CONCLUSION: Thoracic epidural block is another method for induced hypotension. And postoperative pain control can be easily achieved by injection through epidural catheter.

Comparison of Post-operative Liver Function after Induced Hypotention between Thoracic Epidural Bldegrees Ckade and Esmolol / 대한마취과학회지

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provies better visibility. May methods have been used for induced hypotension. Recently Esmolol is favored in induced hypotension because of its short action of sympathetic beta-1 receptor antagonist and easy to control. Thoracic epidural bldegrees Ck can provide cadiovascular stability in induced hypotension. The purpose of the study is to compare postoperative liver function after induced hypotension between thoracic epidural bldegrees Ckade and esmolol combined with general anesthesia with isoflulane. METHOD: Fourty patients scheduled for spinal posterior fusion under general anesthesia were randomly divided into two groups. In thoracic epidural bldegrees Ckade group(Group I, 20 patients), 8~10 ml of 2% liddegrees Caine was injected into the epidural catheter ldegrees Cated in T6~7 interspace in a bolus. In Esmolol group(Group II, 20 patients) received 0.5 mg/kg as loading dose and 50~150 microgram/kg/min continuously. We measured preoperative and postoperative 1, 3, 5, 7 day's serum glutamic-oxaloacetic transaminase(SGOT), serum glutamic-pyruvate transaminase(SGPT) and alkaline phosphatase(ALP). RESULT: In the thoracic epidural bldegrees Ckade group, there was statistically significant increase of SGOT level above normal range on postoperative 1 day, which decreased on postoperative 3 and 5 day(p<0.05). But it was within normal range on postoperative 7 day. SGPT was increased within normal range. Similarly, in the esmolol group, there was statistically significant increase of SGOT level above normal range on postoperative 1 day, which decreased on postoperative 3 and 5 day(p<0.05). But it was within normal range on postoperative 7 day. SGPT was increased within normal range. The level of ALP was increased within normal range in both groups. There was no statistically significant difference in liver function between two groups. CONCLUSION: We consider that postoperative liver function is little influenced with induced hypotension by thoracic epidural bldegrees Ckade and esmolol combined with general anesthesia with isoflurane.