Impacto de un programa de educación estructurado sobre el nivel de ansiedad preoperatoria de pacientes pediátricos y de sus padres / Impact of a structured education program on preoperative anxiety level in pediatric patients and their parents

Introducción: los pacientes pediátricos y sus padres sienten ansiedad antes de una cirugía, síntoma que afecta la inducción anestésica, el dolor y el comportamiento postoperatorio. El objetivo fue evaluar el efecto de la educación preoperatoria estructurada en el nivel de ansiedad de niños sometidos a cirugía electiva y de sus padres. Métodos: estudio prospectivo, aleatorio, doble ciego, en niños de 2-12 años, ASA I-II. Los participantes fueron aleatorizados en grupo control (información habitual) y grupo experimental (información estructurada). Se registraron variables demográficas, nivel de ansiedad en unidad preoperatoria y en pabellón en niños y padres; se evaluó el comportamiento de los niños durante la inducción anestésica. Análisis estadístico: t-test, x2; valores expresados en media y desviación estándar; significancia p ≤ 0,05. Resultados: se reclutaron 34 pacientes, 18 en grupo control y 16 en grupo experimental. Los valores ansiedad en niños pre-pabellón fueron 37,7 ± 21,4 en grupo control y 31,9 ± 11,5 en grupo experimental (p= 0,35); durante pre-inducción fue 43,2 ± 25,3 y 36 ± 15,5 respectivamente (p= 0,33). Los niveles de ansiedad en padres pre-pabellón fueron 42,5 ± 15,5 para grupo control y 37,6 ± 6,9 en grupo experimental (p= 0,25), y al retirarse del pabellón fueron de 45,1 ± 16,6 y 43,9 ± 9,8 respectivamente (p= 0,82). No hubo diferencias en el comportamiento durante la inducción anestésica entre ambos grupos (p= 0,24). Conclusiones: no fue posible demostrar efectos de información estructurada en niveles de ansiedad en niños que van a ser operados y en sus padres.

Introduction: Pediatric patients and their parents experience anxiety before surgery, a symptom that affects anesthetic induction, pain and postoperative behavior. The objective was to evaluate the effect of structured preoperative education on the anxiety level in children undergoing elective surgery and their parents. Methods: A prospective, randomized, double-blind study in children aged 2-12 years, ASA I-II. Patients were randomized into a control group (usual preoperative information) and an experimental group (structured information). Demographic variables, anxiety level in the preoperative unit and in operating room in children and parents were recorded; the behavior of children during anesthetic induction was evaluated. Statistical analysis: t-test, x2; values expressed as mean and standard deviation; significance p ≤ 0.05. Results: 34 patients were recruited, 18 in the control group and 16 in the experimental group. The anxiety levels in children in preoperative unit were 37.7 ± 21 and 31.9 ± 11.5.4 in control and experimental group, respectively (p = 0.35), and in operating room were 43.2 ± 25.3 and 36 ± 15.5 respectively (p = 0.33). Parental anxiety levels in preoperative unit were 42.5 ± 15.5 in control group and 37.6 ± 6.9 in experimental group (p = 0.25), and when they leaving operating room were 45.1 ± 16.6 and 43.9 ± 9.8 respectively (p = 0.82). There were no differences in the behavior during anesthetic induction between both groups (p = 0.24). Conclusions: It was not possible to demonstrate effects of structured information on anxiety levels in children undergoing surgery and in their parents.

Intraoperative Hypertensive Crisis in a Patient with Normotensive Primary Aldosteronism. Lessons from a Clinical Case

Primary hyperaldosteronism is the most frequent cause of secondary hypertension. However, it can also be found in apparently normotensive patients, often associated with recurrent hypokalemia and isolated hypertensive episodes. We hereby present the case of a normotensive 50-year-old female patient with a surgical left kidney mass; however, after anaesthetic induction, surgery was aborted due to a severe hypertensive crisis. She was referred to our Hypertension Outpatient Clinic to rule out pheochromocytoma/ paraganglioma. The anamnesis revealed unexplained episodes of hypokalemia. Ambulatory blood pressure monitoring showed normal mean values of blood pressure and heart rate, with an isolated hypertensive peak. Plasma glucose, ions, creatinine, lipids, metanephrines and chromogranin A were normal, but plasma aldosterone was clearly elevated with suppressed plasma renin activity and high aldosterone/renin activity ratio. Primary aldosteronism was confirmed by the captopril test. Abdominal CT was compatible with left adrenal hyperplasia. Treatment with low-dose spironolactone was well tolerated and resulted in normal blood pressure, normokalemia and unsuppressed plasma renin activity. The patient underwent successful laparoscopic removal of a renal oncocytoma. We conclude that normotensive primary aldosteronism is not harmless; it can be associated with severe hypokalemia, anxiety, depression, hypertensive crisis and cardiovascular damage. Patients can also develop resistant hypertension. Adequate treatment can decisively improve the survival and quality of life of the patients with primary aldosteronism, but a correct diagnosis is needed first. Therefore, it must be considered as a diagnostic possibility in normotensive patients with unexplained hypokalemia or isolated hypertensive episodes.

Uso do propofol na indução anestésica de emas (Rhea americana americana) / Propofol use during anesthetic induction of Rheas (Rhea americana americana)

O propofol é um anestésico injetável que promove indução e recuperação rápida, e toxicidade limitada. Apesar de suas vantagens, poucas pesquisas determinam a dose e os efeitos do propofol em emas. Objetivou-se com este estudo avaliar o uso do propofol na indução da anestesia de emas, bem como determinar a dose de indução anestésica do fármaco para a espécie. Foram utilizados 20 emas, machos jovens, os quais foram anestesiados com propofol, administrado por via intravenosa. A frequência cardíaca (FC) e respiratória (f), temperatura cloacal (TC) foram aferidas antes da administração do propofol e logo após a obtenção da anestesia. Nestes momentos, sangue venoso foi colhido para análise hemogasométrica. Para avaliação da anestesia, realizou-se pinçamento interdigital, sendo determinados, com base na resposta ao estímulo, o período de latência, período hábil e de recuperação anestésica. A dose capaz de promover anestesia nas emas foi de 5 mg.kg-1. As médias da FC, ƒ, TC basais foram 138 bpm, 35 rpm e 39,1ºC, respectivamente e, após a indução as médias foram 180 bpm, 25 rpm e 40,6ºC. A administração do propofol não resultou em alterações significativas nos valores de pressão parcial de oxigênio, excesso de base, bicarbonato, saturação de oxigênio, pH, pressão parcial de dióxido de carbono. As médias do tempo de indução, período hábil de anestesia e tempo de recuperação, em minutos, foram respectivamente 2,48; 2,98 e 7,85. A dose do propofol encontrada para emas foi compatível com as utilizadas para a indução em outras espécies de aves. O propofol, na dose de 5 mg.kg-1, mostrou-se um fármaco seguro para indução anestésica em emas, possibilitando recuperação rápida da anestesia além de promover poucas alterações cardiorrespiratórias e hemogasométricas na espécie.

Propofol is an intravenous anesthetic agent, which promotes rapid inductions and recovery as well, as limited toxicity. Despite its advantages, the dose and effects of such a drug on rheas has not been determined yet. This study aimed to evaluate the use of propofol in anesthesia induction of rheas, and to determine its dosage for the species. Twenty young male rheas were used, which were anesthetized with propofol administered intravenously. Heart rate (HR), respiratory rate (f), and cloacal temperature (TC) were measured before administration of propofol and soon after obtaining anesthesia. In those moments, venous blood was collected for hemogasimetric analysis. Interdigital pinch was held for evaluation of anesthesia, being determined, based on the response to the stimulus, the latency period as well as active period and anesthetic recovery. The dose able to induce anesthesia in rheas was 5mg.kg-1.The average HR, ƒ, TC levels were 138 bpm, 35rpm and 39.1ºC, respectively; and after inducing the averages were 180 bpm, 25rpm and 40.6ºC. Administration of propofol resulted in no significant changes in the values of oxygen partial pressure, base excess, bicarbonate, oxygen saturation, pH, and carbon dioxide partial pressure. The average induction time, active period of anesthesia and recovery time, in minutes, were respectively 2.48, 2.98 and 7.85. The dose of propofol found to rheas was compatible with those used for induction in other avian species. Propofol at a dose of 5 mg.kg-1 proved to be a safe drug for total intravenous anesthesia in rheas, enabling rapid induction and recovery from anesthesia in addition to promoting few changes in cardiorespiratory and blood gas in the species.

Concerns of the anesthesiologist: anesthetic induction in severe sepsis or septic shock patients / 대한마취과학회지

Septic patients portray instable hemodynamic states because of hypotension or cardiomyopathy, caused by vasodilation, thus, impairing global tissue perfusion and oxygenation threatening functions of critical organs. Therefore, it has become the primary concern of anesthesiologists in conducting anesthesia (induction, maintenance, recovery, and postoperative care), especially in the induction of those who are prone to fall into hemodynamic crisis, due to hemodynamic instability. The anesthesiologist must have a precise anesthetic plan based on a thorough preanesthetic evaluation because many cases are emergent. Primary circulatory status of patients, including mental status, blood pressure, urine output, and skin perfusion, are necessary, as well as more active assessment methods on intravascular volume status and cardiovascular function. Because it is difficult to accurately evaluate the intravascular volume, only by central venous pressure (CVP) measurements, the additional use of transthoracic echocardiography is recommended for the evaluation of myocardial performance and hemodynamic state. In order to hemodynamically stabilize septic patients, adequate fluid resuscitation must be given before induction. Most anesthetic induction agents cause blood pressure decline, however, it may be useful to use drugs, such as ketamine or etomidate, which carry less cardiovascular instability effects than propofol, thiopental and midazolam. However, if blood pressure is unstable, despite these efforts, vasopressors and inotropic agents must be administered to maintain adequate perfusion of organs and cellular oxygen uptake.

A randomized trial of anesthetic induction agents in patients with coronary artery disease and left ventricular dysfunction.

The deleterious effects of anesthetic agents in patients suffering from coronary artery disease are well known. The risk increases when a patient has compromised ventricular function. There is a paucity of literature regarding the choice of the suitable agent to avoid deleterious effects in such patients. The use of etomidate and propofol has been considered superior to other intravenous anesthetic agents in these groups of patients. The aim of the present study is to compare the hemodynamic effects of anesthesia induction with etomidate, thiopentone, propofol, and midazolam in patients with coronary artery disease and left ventricular dysfunction. This randomized clinical trail was conducted at the All Indian Institute of Medical Sciences, New Delhi, India. Sixty patients with coronary artery disease and left ventricular dysfunction (ejection fraction < 45%) scheduled for elective coronary artery bypass surgery participated in this study. After stabilization baseline hemodynamic data stroke volume variation and systemic vascular resistance index were recorded for all patients (Flo Trac TM sensor with Vigileo cardiac output monitor used for hemodynamic monitoring). The patients were randomly alloted to one of the four groups and the intravenous induction agent was administered for over 60 - 90 seconds (Group E - Etomidate 0.2 mg/Kg; Group M - Midazolam 0.15 mg/Kg; Group T - Thiopentone 5 mg/Kg; Group P - Propofol 1.5 mg/Kg). Hemodynamic data were recorded at one minute intervals starting from induction till seven minutes after intubation, - the end point of the present study. There was a significant decrease in the heart rate in comparison to the baseline(-7 to -15%, P = 0.001), mean arterial pressure (-27 to -32%, P = 0.001), cardiac index (-36 to -38%, P = 0.001), and stroke volume index (-27 to -34%, P = 0.001) after induction in all four groups. The hemodynamic response was similar in all the four groups. There was no significant change in central venous pressure and stroke volume variation (SVV) during induction and intubation, while the effects on the systemic vascular resistance index (SVRI) were variable. The midazolam group was the most effective in preventing intubation stress (tachycardia,hypertension). The change from baseline values in heart rate (+ 4%, P = 0.12) and mean arterial pressure (-1%, P = 0.77) after intubation were not statistically significant in the midazolam group. The etomidate group was the least effective of all the four groups in minimizing stress response, with statistically significant increase from baseline in both heart rate (P = 0.001) and mean arterial pressure (P = 0.001) at 1 minute after intubation. All the four anesthetic agents were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction despite a 30 - 40% decrease in the cardiac index. Clinician experience along with knowledge of the potential interactions (e.g., premedication, concurrent opioid use) is needed to determine hemodynamic stability during anesthetic induction in these patients with ventricular dysfunction.

Optimal dose of esmolol in combination with nicardipine to stabilize cardiovascular response during anesthetic induction in ambulatory patients

BACKGROUND: We conducted this study to determine the optimal dose of esmolol in combination with nicardipine to block undesirable cardiovascular responses effectively during endotracheal intubation in patients undergoing ambulatory surgery. METHODS: One-hundred and twenty patients were randomly allocated into one of the following 4 groups: the E0 group (no esmolol, control), the E0.25 group (esmolol 0.25 mg/kg), the E0.5 group (esmolol 0.5 mg/kg) and the E1.0 group (esmolol 1.0 mg/kg). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.9mg/kg. All the patients received 20 microgram/kg of nicardipine, and esmolol was subsequently administered according to the group. Endotracheal intubation was performed 150 seconds after inhalation of 6 vol% of desflurane. The systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure and the heart rate (HR) were measured before and immediately after intubation, and at 1, 3, 5, and 10 minutes after intubation. The rate changes were calculated using the baseline values as the standard (change rate [%] = measured value/baseline value x 100). RESULTS: There were no significant differences in SBP, DBP and MBP after intubation between the control and the experimental groups. The rate changes of HR in the experimental groups were significantly lower than those in the control group throughout the study period (P < 0.05). However, there was no difference in therate changes of HR among the experimental groups. CONCLUSIONS: The combination of nicardipine 20 microgram/kg and esmolol 0.25 mg/kg can most effectively and safely attenuate thecardiovascular responses during anesthetic induction in ambulatory patients.

Relationship between carotid intima-media thickness and hemodynamic changes during anesthetic induction / 대한마취과학회지

BACKGROUND: The carotid intima-media thickness (IMT) have been known to be related to the degree of atherosclerosis and cardiovascular risk factors. The aim of this study was to elucidate the relationship of IMT and the hemodynamic changes during anesthetic induction. METHODS: Two hundred fourteen patients scheduled for general anesthesia were studied. The blood pressures and heart rates during anesthetic induction and endotracheal intubation were measured. IMT was measured at right common carotid artery using M-mode ultrasonography after anesthesia, RESULTS: Mean IMT of the patients was 0.611 +/- 0.146 (0.34-0.96) mm. IMT was significantly related with age, systolic blood pressure, the changes of blood pressure after induction, and the changes of blood pressure after intubation. IMT was not related for basal heart rate and the changes of heart rate during anesthetic induction and intubation. CONCLUSIONS: IMT is related with the magnitude of blood pressure decreasing during anesthetic induction and increasing during intubation. The further study is needed to evaluate the relationship of IMT and hemodynamic changes during other anesthetic practice.

Comparación de dos protocolosanestésicos para ovariohisterectomíaen perras sanas / Comparision of two anesthetic protocols for ovariohisterectomy in healthy female dogs

Para determinar los cambios hemodinámicos, y fisiológicos y la recuperación en dos protocolos anestésicos, en hembras caninas sanas durante ovariohisterectomia (OVH) electiva, se utilizaron dos grupos de animales, a cada uno de los cuales se les asignó un protocolo anestésico: Grupo I (fentanil+ etomidato), grupo II (fentanil + tiopental). En ambos grupos el mantenimiento se hizo con isoflurano. Cada cinco minutos durante el procedimiento quirúrgico se midieron las siguientes variables: frecuencia cardíaca, frecuencia respiratoria, temperatura, dióxido de carbono expirado, presión arterial no invasiva, saturación de oxígeno. Las variables que presentaron significancia, desde el punto de vista estadístico, fueron: temperatura, con una media en el protocolo I de 37.7 ± 1.4, y de 38.0 ± 1.2 en el protocolo II (p<0.05); y la variable capnografía con una media para el protocolo I de 50.9 ± 19.1 (p<0.05) y en el protocolo II de 51.9 ± 7.9. Las demás variables se comportaron dentro de los parámetros normales, sin cambios significativos entre los protocolos. Durante el tiempo de recuperación se midieron las siguientes variables: tiempo de presentación del reflejo deglutorio, posición esternal, primera ingesta de líquidos y primera ingesta de alimentos. En resumen, desde el punto de vista estadístico los dos protocolos se comportaron de manera similar a pesar de las diferencias significativas de las variables temperatura y capnografía, por tanto corresponde al criterio clínico definir cuál de los dos protocolos utilizar, dependiendo de variables y circunstancias distintas a las analizadas en este estudio, como son la disponibilidad y el precio de los medicamentos, entre otros.

To determine the hemodynamic and physiologic changes and the characteristics of the recuperation phase in two anesthetic protocols to be used in healthy female dogs for elective ovariohisterectomy, two groups of animals were used in order to test two protocols: Group I was given fentanyl + ethomidato and group II fentanyl + thiopental. For maintenance isofluorane was used in both groups. The following variables were measured at five minute intervals during the surgical procedure: cardiac frequency, breathing frequency, temperature, expired carbon dioxide, non- invasive blood pressure and oxygen saturation. Statistically, temperature and capnography were the only ones yielding significant results: temperature presented an average of 37.7 ± 1.4, in protocol I and 38.0 ± 1.2 in protocol II (p<0.05); for capnography the average was of 50.9 ± 19.1 for protocol I and 51.9 ± 7.9 for protocol II (p<0.01), the other variables did not present statistical differences between the tested protocols and maintained themselves within physiological parameters. For recuperation the fallowing variables were measured: time to gag reflex, esternal position, time of liquid ingestion and time of ingestion of solids. In summary, in spite of the significant differences in temperature and capnography, the values were always within physiological parameters therefore in practical terms the protocols behaved in a similar manner. It corresponds to the clinician to define which of the two protocols is more suitable depending of variables and circumstances other than those analyzed in this study such as costs and availability.

Application of continuous infusion of remifentanil during induction of general anesthesia in elderly patients / 上海第二医科大学学报

Objective To study the application of continuous infusion of remifentanil combined with propofol with different velocity du-ring induction of general anesthesia in elderly patients. Methods Sixty elderly patients were divided into 4 groups randomly(n=15) and given remifentanil with continuous infusion rate of 0.1,0.15,0.2 and 0.3 ?g?kg-1?min-1,respectively.After given midazolam and propofol,remifentanil infusion started with different velocity.Three minutes later,vecuronium was given and intubation performed 2 min later.After that,propofol infusion rate was adjusted according to the changes of blood pressure and kept at 4 mg?kg-1?h-1 5 min before incision.Blood pressure(BP),heart rate(HR),intubation score(following Grant's method) and all side effects and adjuvant drugs used were recorded. Results Grant scores in all patients were less than 8.Atropine and ephedrine were given more in large dose groups and with decreasing of usage of propofol.HR decreased markedly in 0.3 ?g?kg-1?min-1 group after remifentanil began(P

Effect of Continuous Infusion of Remifentanil on Propofol Dose and Hemodynamics using Bispectral Index during Anesthetic Induction / 대한마취과학회지

BACKGROUND: Remifentanil combined with propofol is usually used to induce anesthesia. However, remifentanil and propofol depress the cardiovascular system. This study investigated the effects of a continuous infusion of remifentanil on the propofol dose and hemodynamics using the bispectral index (BIS) during anesthetic induction. METHODS: Sixty female ASA physical status class I or II patients, who were scheduled to undergo gynecologic surgery were randomly assigned to one of three groups (n = 20). Normal saline 20 ml/hr (Group S), remifentanil 0.25microgram/kg/min (Group 0.25), or remifentanil 0.5microgram/kg/min (Group 0.5) was infused intravenously. Propofol was administered slowly two minutes after administering remifentanil or normal saline. The heart rate, mean arterial pressure (MAP) and BIS were measured at baseline, preintubation and postintubation. RESULT: There were no significant differences in the changes in the BIS among the groups. The MAP and heart rate decreased at preintubation compared with baseline (P < 0.05). The MAP of Group 0.5 at postintubation was lower than that in the other groups (P < 0.05). The heart rate in all groups increased at postintubation compared with baseline (P < 0.05). The heart rate of Group 0.5 at postintubation was lower than that of Group S (P < 0.05). The propofol requirement for unconsciousness was lower in Groups 0.25 and 0.5 than in Group S. The propofol requirement in Groups S, 0.25 and 0.5 was 1.56+/-0.2 mg/kg, 1.07+/-0.2 mg/kg and 0.9+/-0.1 mg/kg, respectively. CONCLUSIONS: A combined injection of 0.5microgram/kg/min remifantanil with 0.9 mg/kg of propofol decreases the heart rate and MAP at preintubation without adverse effects and appropriately prevents the cardiovascular responses to tracheal intubation, and reduces the propofol dose needed for a loss of consciousness.

Effect of Continuous Infusion of Remifentanil on Propofol Dose and Hemodynamics using Bispectral Index during Anesthetic Induction / 대한마취과학회지

BACKGROUND: Remifentanil combined with propofol is usually used to induce anesthesia. However, remifentanil and propofol depress the cardiovascular system. This study investigated the effects of a continuous infusion of remifentanil on the propofol dose and hemodynamics using the bispectral index (BIS) during anesthetic induction. METHODS: Sixty female ASA physical status class I or II patients, who were scheduled to undergo gynecologic surgery were randomly assigned to one of three groups (n = 20). Normal saline 20 ml/hr (Group S), remifentanil 0.25microgram/kg/min (Group 0.25), or remifentanil 0.5microgram/kg/min (Group 0.5) was infused intravenously. Propofol was administered slowly two minutes after administering remifentanil or normal saline. The heart rate, mean arterial pressure (MAP) and BIS were measured at baseline, preintubation and postintubation. RESULT: There were no significant differences in the changes in the BIS among the groups. The MAP and heart rate decreased at preintubation compared with baseline (P < 0.05). The MAP of Group 0.5 at postintubation was lower than that in the other groups (P < 0.05). The heart rate in all groups increased at postintubation compared with baseline (P < 0.05). The heart rate of Group 0.5 at postintubation was lower than that of Group S (P < 0.05). The propofol requirement for unconsciousness was lower in Groups 0.25 and 0.5 than in Group S. The propofol requirement in Groups S, 0.25 and 0.5 was 1.56+/-0.2 mg/kg, 1.07+/-0.2 mg/kg and 0.9+/-0.1 mg/kg, respectively. CONCLUSIONS: A combined injection of 0.5microgram/kg/min remifantanil with 0.9 mg/kg of propofol decreases the heart rate and MAP at preintubation without adverse effects and appropriately prevents the cardiovascular responses to tracheal intubation, and reduces the propofol dose needed for a loss of consciousness.

The Effects of Remifentanil Pretreatment on Rocuronium Injection Pain and Cardiovascular Response during Anesthetic Induction / 대한마취과학회지

BACKGROUND: Remifentanil is an opioid agonist with rapid onset and ultra-short duration of action. Rocuronium bromide can elicit a high incidence of pain when intravenous injection. In this study, the quantitative effect of remifentanil pretreatment on the injection pain of rocuronium and cardiovascular response during anesthetic induction were evaluated. METHODS: Eighty adult female patients undergoing gynecological procedures with general anesthesia were analyzed for this study. Patients were randomly allocated to one of four groups. Patients received 2 ml of normal saline (n = 20), 2 ml (40 mg) of 2% lidocaine (n = 20), 2 ml of remifentanil 0.5 microgram/kg (n = 20) or 2 ml of remifentanil 1 microgram/kg (n = 20) 60 seconds prior to administration of rocuronium 0.7 mg/kg. Pain was assessed after rocuronium injection. Systolic and diastolic arterial blood pressure and heart rates were measured before and during anesthetic induction. RESULTS: Both remifentanil and lidocaine have the good effect in minimizing the rocuronium injection pain. But, only 1 microgram/kg of remifentanil blunts the hypertension after endotracheal intubation. CONCLUSIONS: A bolus dose (1 microgram/kg) of remifentanil may be used for minimizing the rocuronium injection pain and blunting the hypertension after endotracheal intubation.

Upper Airway Obstruction in a Child with Unrecognized Obstructive Sleep Apnea during Anesthetic Induction - A case report- / 대한마취과학회지

The definition of obstructive sleep apnea (OSA) is an absence of air flow at the mouth and nose despite respiratory movement. In these patients, OSA does not occur during the awake state due to pharyngeal dilator muscles, but occurs due to loss of muscle tone during sleep. Moreover, sleep and anesthesia are related. Anesthesia and sedatives aggravate or precipitate OSA by the inhibiting neural and muscle activity and suppressing protective arousal responses. Therefore, the identification of OSA patients at greatest risk during the perioperative period is a major concern of anesthesiologists during preoperative visits. We experienced a case of acute upper airway obstruction in a child with unrecognized obstructive sleep apnea that occurred during anesthetic induction for adenotonsillectomy.

Atelectasis after the Induction of Anesthesia in a Healthy Child: A case report / 대한마취과학회지

Atelectasis or lung collapse is a relatively common complication following surgery in anesthetized patient with respiratory tract symptoms, but may rarely occur in normal healthy patients. Children differ from adult in terms of neck and airway anatomy and physiology. Thus, we should pay more attention to pediatric patients with respiratory tract symptoms. This report describes a healthy pediatric patient with no respiratory symptoms who developed left upper lobar collapse just after the induction of general anesthesia.

Parental Response after Participation in Pediatric Anesthetic Induction / 대한마취과학회지

BACKGROUND: Potential benefits from parental presence during induction of anesthesia (PPIA) include reducing the need for preoperative sedatives and avoiding fear and anxiety that may occur on separation to the operating room (OR). In addition, the purpose of PPIA includes concern about possible adverse reactions of parents. The purpose of this study was to evaluate parental satisfaction after PPIA. METHODS: Subjects were obtained by approaching all parents of children from 1 to 7 years admitted for elective surgery. Ninety four pediatric patients were accompanied by their parents to the OR and then their anxiety level was checked. For anesthetic induction, intravenous thiopental sodium or sevoflurane with a mask was administrated. A questionnaire was given to parents after anesthesia and the operation to check the satisfaction of their presence. RESULTS: Over eighty eight percent of parents were satisfied with their presence with their children. However, there were no significant differences between parental satisfaction and the anxiety level of children, type of anesthetic induction or attempts of venipuncture. CONCLUSIONS: We concluded that the participation in induction of anesthesia in pediatrics may be effective in not only relieving anxiety of children but also increasing parental satisfaction.

Atelectasis and Ventricular Tachycardia after Induction of Anesthesia / 대한마취과학회지

A frequent dilemma facing the anesthesiologist is the patient with respiratory tract symptoms. The risks of anesthesia and surgery in these patients have not been clearly established. We present a case in which a potentially serious respiratory complication had arisen. The patient had symptoms of coughing and mucous production. She was a heavy smoker. However, there was no history of pulmonary disease. This report describes a patient who developed left upper lobar collapse after induction of general anesthesia and tachydysrhythmia resulting in ventricular tachycardia and myocardial ischemia.

Effects of Fentanyl, Midazolam, and Fentanyl-Midazolam on the Cardiovascular System and Blood Glucose during General anesthetic Induction / 대한마취과학회지

In this study, we evaluated the effects of fentanyl, midazolam, and fentanyl-midazolam on cardiovascular system and blood glucose during endotracheal intubation in forty normotensive patients scheduled for elective surgery under general anesthesia. The patients were randomly classified into four groups; Group I (control) received tracheal intubation with thiopental 5 mg/kg (n=10), group II received tracheal intubation with fentanyl 6 ug/kg followed by thiopental 2 mg/ kg (n=10), group III received tracheal intubation with midazolam 0.3 mg/kg (n=10), group IV received tracheal intubation with fentanyl 4 ug/kg followed by midazolam 1 mg/kg (n=10). The changes of systolic blood pressure, diastolic blood pressure, mean arterial blood pressurie, heart rate, and blood glucose were compared in each group. The results were as follows; 1) In group I, endotracheal intubation caused a significant rise in SBP, HR and blood glucose. 2) In group II, endotracheal intubation caused little changes in SBP, DBP,MAP and blood glucose but HR was rised. 3) In group III, endotracheal intubation caused little changes in SBP, DBP, MAP, HR and blood glucose. 4) In group IV, endotracheal intubation caused little changes in SBP, DBP, MAP, HR and blood glucose.

Cardiovascular Changes of Midazolam for Induction of Anesthesia / 대한마취과학회지

The cardiovaseular response evoked by tracheal intubation was observed in 69 patients undergoing elective surgery in whom anesthesia was induced with group A, B and C induction agents. Sixty nine ASA class 1 or 2 surgical patients were divided into three groups. Group A: thiopental 5 mg/kg (control) Group B: thiopental 2 mg/kg with midazolam 0.1 mg/kg Group C: midazolam 0.2 mg/kg Systolic and diastolic blood pressure, mean arterial pressure, heart rate and loss of eyelid reflex were measured in each group. There was a little difference in the cardiovascular changes between group A and C. But there was not a significant difference between group A and B and also between group B and C. The measured time until loss of eyelid reflex of the group C (55+/-30 sec) was considerably longer than other groups (Group A: 10+/-3 sec, Group B: 37+/-13 sec). The incidence of venous complication in three groups was low. Pain on injection and posto- perative nausea and vomiting was noted in one patient of the group A and B respectively, but no patient in the group C. There was no significant difference in the incidence of the postoperative local venous complication. On the whole, these results suggest that the difference between midazolam and thiopental had no apparent hemodynamic change. From the above results, both midazolam alone and midazolam combined with thiopental may be useful agents for induction of anesthesia.

Effects of Anesthetic Induction Methods in Open Heart Surgery on Unconsciousness and Cardiovascular Response / 대한마취과학회지

Rapid induction,complete loss of conciousness,and stability of cardiovascular system are the variables that should be considered in choosing anesthetics and method of induction for patients with cardiovascular diseases. The great attention should be given because elevation of blood pressure and tachycardia during induction of anesthesia can deteriorate patients cardiovascular system. High-dose of fentanyl was used for the induction of open heart surgery since 1978 and showed effectiveness in stabilizing cardiovascular changes. Many authors argued that fentanyl may not induce unconciousness. As endeavor to shorten the oneset time of unconsciousness, commonly used intravenous anesthetics with fentanyl were tried. Among patients scheduled for open heart surgery, 30 patients with ejection fraction higher than 0.5 were randomly selected and divided into three groups. For the induction of anesthesia, group 1 was given fentanyl alone; group 2 fentanyl with diazepam(0.1mg/kg); and group 3 fentanyl with thiopental sodium (0.2mg/kg). Loss of conciousness (oneset time of unconciousness and dosage of fentanyl) and cardiovascular responses(systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and rate pressure product) just before induction,before intubation, and immediately after intubation were compared and results were as followes. l. It took 322 seconds to induce unconciousness in group 1, 213 seconds in group 2,and 87 seconds in group 3. It was shortened significantly in group 2 and group 3 as compared to group 1 and in group 3 as compared to group 2(p<0.05). 2. Dosage of fentanyl was 30 mcg/kg in group 1, 20 mcg/kg in group 2, and 8 mcg/kg in group 3. As compared to group 1 and group 2, it was significantly decreased in group 3 (p<0.05). 3. Systolic blood pressures before tracheal intubation in gmup 2 and group 3 significantly decreased as compared to the level of preinduction(p<0.05), 4. Diastolic blood pressure before tracheal intubation in group 3 significantly decreased as compared to the level of preinduction(p<0.05). 5. Mean arterial blood pressure before tracheal intubation in group 2 and group 3 significantly decreased as compared to the level of preinduction(p<0.05). 6. There was no significant change in heart rate. 7. Rate pressure product before tracheal intubation in group 3 significantly decreased as compared to the level of preinduction and rate pressure product after tracheal intubation in group 1 significantly increased as compared to the level of preinduction(p<0.05). Considering above results, it is difficult to choose specific anesthetics and methods for the induction of open heart surgery. It depend on the patients cardiovascular function and physicians experience and their preference. Meticulous observation and continuous monitoring of cardiovascular response are very important when intravenous anesthetics are used with fentanyl.

Midazolam Compared with Thiopental as an Induction Agent / 대한마취과학회지

This study was performed to evaluate the induction time, hemodynamic responses and local venous complications after intravenous induction with midazolam, comparing with those after intravenous induction with thiopental. Sixty adult surgical patients received either 5 mg/kg thiopental sodium(group I) or 0.2 mg/kg midazolam hydrochloride(group II) as an induction agent. The results were as follows. 1) The induction time(loss of palpebral reflex) of the group II(68.2+/-21.5 sec) was significantly longer than those of group I(29.6+/-8.3 sec) 2) The magnitude of rises in the systolic blood pressure, 1 and 2 minute after intravenous administration of induction agent, of group II were significantly smaller than those of group I. 3) The magnitude of rises in the diastolic blood pressure, 2 minute after intravenous administration of induction agent,of group II were significantly smaller than those of group L 4) The magnitude of rises in the pulse rate, 1 and 2 minute after intravenous administration of induction agent, of group II was not significantly differ from those of group I. 5) In three patients of the group I complained of pain during injection, but no patients of the group II complained of pain. There was no significant difference in the incidence of the postoperative local venous complication.