The Effect of the IV-PCA (Intravenous-Patient Controlled Analgesia) on the Recovery Index / 대한마취과학회지

BACKGROUND: It is well known that intravenous patient controlled analgesia (IV-PCA) is an effective method to reduce the magnitude of postoperative pain. However, we do not know the appropriate time to start the IV-PCA. To determine the appropriate time to minimalize the sympathetic stimulation and shorten the awakening time after general anesthesia, experiments to indicate whether starting an infusion of the IV-PCA before the end of an operation has a minimal hemodynamic change and similar recovery index compared with the control group were done. METHODS: Seventy-eight patients scheduled for a total abdominal hysterectomy were randomly allocated to two groups. In the IV-PCA group (n = 37), we started the infusion of the IV-PCA before the end of the operation and in the control group (n = 41) which received no IV-PCA, we did not use the IV-PCA as a postoperative pain control method. We measured heart rate, blood pressure, postanesthesia recovery score every 10 minutes for 60 minutes and awakening time at the post-anesthesia care unit. RESULTS: The postanesthesia recovery scores on arrival, 10, 20, 30, 40 and 50 minute after arrival at the post-anesthesia care unit were lower in the IV-PCA group than in the control group. In addition the awakening time after vaporizer-off and at the post-anesthesia care unit was longer in the IV-PCA group than in the control group. CONCLUSIONS: We conclude that starting the infusion of the IV-PCA before the end of the operation is not effective in early recovery and awakening.

Anesthetic Management of a Patient with Pheochromocytoma in Pregnancy / 대한마취과학회지

The anesthetic management of a patient with pheochromoctoma in pregnancy is presented. Preoperative phenoxybenzamine therapy and careful intraoperative monitoring preduced successful cesarean section and tumor reseetion in this patient. Problems that occurred during mamagement of this patient are hypoxemia(R/0 pulmonary edema) and cardiovascular flucctuation according to the operative procedure. Hypoxemia oceurred possibly due to large amount of crystalloid infusion in a short time and was solved with applying positive end expiratory pressure and using diuretics. Blood pressure was controlled effectively with sodium nitroprusside or phenylephrine infusion according to the operative procedure. Preoperative pregnancy induced liver disease in this patient was recovered after delivery.