Résumé
BACKGREOUND: Tetracaine has been the most commonly used spinal anesthetic agent. Recently bupivacaine has been found to be a useful agent, and has been reported not to cause neurologic complications as well as being a better quality anesthetic. The purpose of this study was to compare the anesthetic effects of bupivacaine with that of tetracaine. METHODS: Forty patients undergoing lower abdomen and lower limb operation were randomly allocated to two groups. Group I (n=20) received 15mg, 0.5% tetracaine in 10% dextrose, while Group II (n=20) received 15mg, 0.5% bupivacaine in 8% dextrose. After intrathecal injection of the agent at the level of L3-4 intervertebral space, the changes in sensory and motor block, blood pressure and heart rate were measured in two groups. RESULTS: The onset time of sensory block was more rapid in Group I than in Group II. Two segment regression time of sensory block was significantly longer in Group II than in Group I (p<0.05). The time for maximum motor block was shorter in group I than in Group II (p<0.05), but the duration of decreased motor block was significantly longer in Group I. The change of systolic blood pressure in Group II was less than the change in Group I. CONCLUSIONS: Bupivacaine has a longer sensory block duration, a weaker, shorter motor block duration and yields a less change in systolic blood pressure than tetracaine in spinal anesthesia.
Sujets)
Humains , Abdomen , Rachianesthésie , Anesthésiques , Pression sanguine , Bupivacaïne , Glucose , Rythme cardiaque , Injections rachidiennes , Membre inférieur , TétracaïneRésumé
Currently, the incidence of massive transfusions during operation has been increasing because the more complicated and invasive operations than before can be done due to enhanced technololgy in both anesthesia and surgery. In spite of marked improvement in immunology and transfusion technique, massive transfusions are associated with several problems usually not seen in normal transfusion practice. In order to evaluate the effect of massive transfusion on the serum sodium, potassium levels and platelet count in the blood during general anesthesia, we have retrospectively examined these values before and after massive transfusion in 62 patients who received at least one blood volume at Kosin Medical Center from January 1985 through May 1989. Statistical significance was assessed by using Student's t-test. The results obtained were summarized as follows; 1) The average volume of transfusion was 5432 ml (13.4 units). 2) The total number of massive transfusions was 62 (0.47%), excluding cases with renal failure or open heart surgery, out of 13,213 anesthetic patients 3) The hightest incidence of age distribution was from 50 to 59 years. 4) There were 2 fatalities (3.2%) that seemed to be due primarily to the transfused blood itself. 5) The decrease in the serum sodium concentration after transfusion was not statistically significant (p>0.05). 6) There was a statistically significant decrease in serum potassium concentration after transfusion (p0.05) after massive transfusion between the shock and non-shock groups. Since massive transfusion can be associated with the decrease in the serum potassium and platelet count, these patients blood levels should be monitored during and after maseive transfusion for proper management.
Sujets)
Humains , Répartition par âge , Allergie et immunologie , Anesthésie , Anesthésie générale , Plaquettes , Transfusion sanguine , Volume sanguin , Incidence , Numération des plaquettes , Potassium , Insuffisance rénale , Études rétrospectives , Choc , Sodium , Chirurgie thoraciqueRésumé
Two cases of anesthetic experience for excision of pheochromocytoma were presented, one was diagnosed by abdominal computed tomography and urinary VMA level checked after cardiac arrest during previous anesthetic induction for gastric polypectomy at private clinic. The other case was diagnosed by upper GI series and abdominal sonography. Anesthesia was managed with glycopyrrolate and meperidine for premedication, thiopental for induction, isoflurane-nitrous oxide-oxygen for maintenance, pancuronium and vecuronium for muscle relaxation, and nitroprusside for controlling severe hypertensive episode. We experienced marked fluctuation of blood pressure during anesthetic course. Severe hypotension followed removal of tumor, which was corrected by rapid transfusion and infusion of crystalloids. Postanesthetic recovery and course were uneventful.
Sujets)
Anesthésie , Pression sanguine , Glycopyrronium , Arrêt cardiaque , Hypotension artérielle , Isoflurane , Péthidine , Relâchement musculaire , Nitroprussiate , Pancuronium , Phéochromocytome , Prémédication , Thiopental , VécuroniumRésumé
Two cases of anesthetic experience for excision of pheochromocytoma were presented, one was diagnosed by abdominal computed tomography and urinary VMA level checked after cardiac arrest during previous anesthetic induction for gastric polypectomy at private clinic. The other case was diagnosed by upper GI series and abdominal sonography. Anesthesia was managed with glycopyrrolate and meperidine for premedication, thiopental for induction, isoflurane-nitrous oxide-oxygen for maintenance, pancuronium and vecuronium for muscle relaxation, and nitroprusside for controlling severe hypertensive episode. We experienced marked fluctuation of blood pressure during anesthetic course. Severe hypotension followed removal of tumor, which was corrected by rapid transfusion and infusion of crystalloids. Postanesthetic recovery and course were uneventful.