Conventional Intermittent "Top-up" Injections of 0.25% Bupivacaine/Fentanyl vs 0.125% Bupivacaine/Fentanyl during Labor / 대한마취과학회지

BACKGROUND: Conventional intermittent "Top-up" injections (CIT) of fentanyl added to bupivacaine reduces the total amount of local anesthetic required, resulting in less motor blockade, reducing incidence of instrumental deliveries, and improving the quality of analgesia during labor. The purpose of this study was to compare the analgesic efficacy of two different solutions and side effects of them. METHODS: Fifty healthy parturients were divided into two groups: intermittent epidural injections of 0.25% bupivacaine with 0.0005% fentanyl (Group I) and 0.125% bupivacaine with 0.0005% fentanyl (5 microgram/ml) (Group II). We injected 5 ml of each solution to block T10 sensory level of the request of the parturients. Assessments included interval of epidural injection, duration of first and second stage of labor, total dose of bupivacaine, maternal blood pressure, satisfaction, fetal heart rate, and Apgar scores. RESULTS: The interval of epidural injection was 75.7+/-50.6 min in Group I, compare with 57.8+/-27.5 min in Group II (p<0.05). The total dose of bupivacaine was 45.5+/-15.3 mg in Group I, compared with 23.5+/-10.4 mg in Group II (p<0.05). There was no significant difference between the two groups in terms of duration of labor, maternal blood pressure, maternal satisfaction, fetal heart abnormality, or Apgar scores of neonates. No serious side effects were encountered in either group, although two patients in Group I experienced urinary retention. Only one patient in each group experienced nausea and vomiting. CONCLUSIONS: The injection of 0.125% bupivacaine plus fentanyl provides good analgesia during labor. We concluded that lower concentration of bupivacaine was better in consideration of adverse effects of it on fetus and mother.

A Comparison with Infusion of Single Intravenous Anesthetic with Propofol and Fentanyl in Operation of Short Duration / 대한마취과학회지

BACKGROUND: Propofol, a new intravenous anesthetic agent, is now used for brief operation and day surgery for its rapid recovery and controllability. Propofol, rapid acting sedatives hypnotics, is known to no analgesic effect. This study was taken to evaluate the analgesic effect of propofol, compared to those of fentanyl. METHODS: Forty patients (ASA physical status 1, 2) scheduled for surgery of short duration (within 1 hour) were randomly allocated into two groups. Induction of anesthesia was performed by injection of thiopental (5 mg/kg) and succinylcholine (1 mg/kg) and ventilated with O2-N2O (50%) after endotracheal intubation. Maintenance of anesthesia was performed by vecuronium (1 mg/kg) and continuous infusion of propofol (group I) or fentanyl (group II). RESULTS: There was no significant differences in systolic and diastolic blood pressure in both groups. In heart rate, there was significant difference at preincision and postincision between two groups. Time to extubation (4.5 +/- 4.6 vs 6.3 +/- 4.6 min), time to eye open (7.5 +/- 7.1 vs 6.6 +/- 5.4 min), time to complain pain after stop dropping at recovery room (30.5 +/- 8.0 vs 35.5 +/- 17.9 min), the average flow rate of drugs (6.0 +/- 2.2 mg/kg/hr vs 6.7 +/- 2.4 microgram/kg/hr) has no significant difference between two groups. CONCLUSIONS: A single continuous infusion of propofol is applied as one of general anesthesia methods with O2-N2O, muscle relaxants. Propofol has a appropriate and similar analgesic effect compared with fentanyl in operation of little hemodynamic changes and short operation, and rapid recovery compared with fentanyl.

A Comparison of Laparoscopic Cholecystectomy with Open Cholecystectomy in a Korean Hospital / 예방의학회지

Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.