Tracheal laceration detected by high end-tidal CO2 during endoscopic thyroidectomy / 대한마취과학회지

Endoscopic thyroidectomy is frequently used for cosmetic reasons, such as reducing cervical scarring. Subcutaneous gas insufflation with CO2 is needed to maintain the surgical space, and optimal surgical techniques and careful attention are required when conducting this procedure due to the limited space available for the endoscopic instruments. We report here a case of a tracheal laceration with a tear in the cuff of a reinforced tube, which was detected by an abrupt increase in end-tidal CO2 to 90 mmHg. Reintubation was achieved using a tube exchanger and the patient was effectively ventilated without complications.

Efficacy and Safety of Positive Pressure Ventilation through Laryngeal Mask Airway during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: We evaluated the efficacy and safety of positive pressure ventilation (PPV) with a laryngeal mask airway (LMA), compared with an endotracheal tube (ETT) during a laparoscopic cholecystectomy. METHODS: Sixty six, ASA I II adults scheduled for an elective laparoscopic cholecystectomy were randomly assigned to LMA or ETT. Anesthesia was induced with fentanyl 2ng/kg, lidocaine 0.5 mg/kg and propofol 2 mg/kg and maintained with a continuous infusion of propofol 6 - 12 mg/kg/h in 67% N2O, atracurium and fentanyl. An ETT or LMA was placed with atracurium 0.5 mg/kg. Respiratory and hemodynamic parameters were measured before and after intraabdominal CO2 insufflation. The surgeon assessed the degree of change in gastric distension under laparoscope. RESULTS: Oxygen saturation, end-tidal CO2, peak inspiratory pressure, expiratory tidal volume and compliance of the respiratory system didn't differ between both groups. Blood pressure and heart rate were lower in the LMA group than in the ETT group only at 5 min after induction (P < 0.05). The maintenance dose of propofol, fentanyl and atracurium were similar in both groups. Degree of change in gastric distension were similar in both groups. The LMA resulted in less coughing after removal than did the ETT (P < 0.05). CONCLUSIONS: PPV with LMA permits adequate pulmonary ventilation and hemodynamic stability during laparoscopic cholecystectomy. Gastric distension occurs with similar frequency in LMA or ETT.

Comparison of the Antiemetic Efficacy of Droperidol, Granisetron, and Propofol after Epidural Morphine / 대한마취과학회지

BACKGROUND: We compared the antiemetic efficacy of droperidol, granisetron, and propofol in postoperative nausea and vomiting (PONV) in the patients who received epidural anesthesia with bupivacaine and morphine. METHODS: Among one hundred and sixty one ASA physical status I or II patients who received an abdominal hysterectomy under epidural anesthesia, sixty patients who showed PONV and thereby received antiemetics were randomly assigned into 3 groups: droperidol 0.75 mg (droperidol group: n = 20), granisetron 1.0 mg (granisetron group: n = 20) or propofol 20 mg (propofol group: n = 20) by an intravenous injection. Antiemetics were injected according to the patient request up to 3 times of initial dose. Nausea, vomiting, sedation, anxiety, and discomfort were assessed and the time interval between each antiemetic administration was recorded by a blind observer for 30 min after the injection of antiemetics. RESULTS: Success rates in PONV control for 30 min after the 1st antiemetic administration were 90%, 95%, and 85% in the droperidol, granisetron, and propofol group, respectively. The propofol group experienced a higher relapse incidence (90%) than other groups (droperidol: 35%, granisetron: 25%)(P<0.05). The granisetron group showed a longer time interval between the 1st and 2nd antiemetic administration (616 +/- 501 min: P<0.05) than other groups. No patients in the granisetron and propofol groups showed any anxiety and discomfort, however six patients in the droperidol group showed some anxiety and discomfort. CONCLUSIONS: All antiemetics were effective to control the PONV, but droperidol caused some anxiety and discomfort and propofol showed higher relapse incidence.

Comparison of Postoperative Complications, Postoperative Pain and Satisfaction between Spinal Anesthesia and Monitored Anesthetic Care under Total Intravenous Anesthesia for an Arthroscopy / 대한마취과학회지

BACKGROUND: Whether monitored anesthetic care (MAC) under total intravenous anesthesia can substitute for spinal anesthesia in knee arthroscopic surgery in regard to frequency of postoperative complications, degree of postoperative pain and degree of the satisfaction of patients and operator was investigated. METHODS: Sixty healthy patients were allocated randomly into a spinal group (n = 30) who received spinal anesthesia and an MAC group (n = 30) who received TIVA for anesthesia for arthroscopic surgery. All patients were NPO for 8 hours before surgery were premedicated and monitored with an EKG, noninvasive blood pressure and pulse oximeter. Heavy 0.5% bupivacaine, 10 - 12 mg, was used for spinal anesthesia and fentanyl 2ng/kg, propofol 1 mg/kg, ketamine 0.3 mg/ kg, and ketorolac 30 mg were given intravenously for induction and propofol was maintained at 3 - 4 mg/kg/h for TIVA. Local anesthetics infiltration was done at the arthroscopic portal site and fentanyl 25ng and propofol 20 mg were added intermittently. Postoperative complication (nausea, vomitting, back pain, dizziness, pain or voiding difficulty) and satisfaction of the patients and surgeon were investigated by VAS and 5 grade methods, respectively. RESULTS: The frequency and degree of back pain, pain at the operative site and voiding difficulty occured less and the VAS was decreased in the MAC group while in the recovery room, 6 hours and the day after the operation. The grade of satisfaction of the patients and that of the surgeon were also high in the MAC group. CONCLUSIONS: These results show that, if careful airway management is provided, MAC under TIVA is a more useful anesthetic method than spinal anesthesia in an arthroscopy.

Preliminary Study for Sentinel Lymph Node Biopsy with 99MTc Tin-Colloid in Patients with Gastric Cancer

PURPOSE: The sentinel lymph node (SLN) is defined as the first draining node from the primary lesion and it would be the first site of metastasis. The objective of this study was to determine the feasibility of an SLN biopsy in patients with gastric cancer for the assessment of the lymph node status. METHODS: From November 2001 through to March 2002, SLN biopsies were performed in fourteen consecutive patients whose preoperative imaging studies showed T2 or T1 and no lymph node metastases. Three hours prior to each operation, a 99mTc tin-colloid (2.0 ml, 1.0 mCi) was injected via endoscopy into the patient's gastric submucosa. Subsequently a lymphoscintigraphy was performed serially using a dual head gamma camera. After a SLN biopsy had been performed using the gamma probe (NEO2000TM Gamma Detection System, Neoprobe CO, 1999, USA), all the patients underwent a radical gastrectomy (D2+alpha). The SLN was cut into three pieces for a frozen sample, H&E and immunohistochemistry (IHC) staining. RESULTS: The location of all the SLNs was in the perigastric area. No skip metastases were found. SLNs were identified in 12 of the 14 patients (success rate, 85.7%). Of these 12 patients, 6 had lymph node metastases in SLNs or Non-SLNs, or both; 3 in both SLNs and non-SLNs; 2 in SLNs alone; and 1 in non-SLNs alone. The sensitivity of the SLN status in the diagnoses of the lymph node status of the patient was 82.2% (5/6) and the specificity was 100.0% (6/6). The diagnostic accuracy according to SLN status was 91.7% (11 of 12). CONCLUSION: SLN biopsies using a radioisotope in patients with gastric cancer are a technically feasible and accurate technique; they are a minimally invasive approach in the assessment of the node status of patients with gastric cancer.

Study on the Degree of Oxygen Saturation during Upper Gastrointestinal Endoscopy Using Propofol/Fentanyl with Oxygenation / 대한소화기내시경학회지

BACKGROUND/AIMS: Propofol is usually used for anesthesia in the case of day surgery. We studied the effects of propofol plus fentanyl for sedation and the effect of oxygenation during gastroscopy. METHODS: 154 patients who asked conscious sedation during gastroscopy were randomly divided into three groups. The first group (PF-O group, 50 patients) and the second group (PF group, 48 patients) were received an initial bolus dose of propofol (40 mg) plus fentanyl (50 microgram) intravenously, followed by additional doses of propofol at one minute interval until conscious sedation. PF-O group was received preoxygenation (3 L/min) via nasal canula, and PF group was not. The third group (56 patients) received an initial bolus dose of midazolam (3 mg) intravenously, followed by additional doses of midazolam at two minutes interval (M group). RESULTS: In PF-O group, time to achieve sedation, regain orientation, and recover walking ability were 118.0 85.2 sec, 67.5 91.2 sec and 11.1 5.3 min. Gag reflex during the procedure was absent or nearly absent in 96% of patients. Despite the changes of blood pressure and heart rate compared to the values taken prior to the procedures were observed, all values were not clinically significant. In PF-O group, transient oxygen desaturation (SaO2<90%) was observed in four (8.0%) patients. CONCLUSIONS: Propofol plus fentanyl with oxygenation seems to be more acceptable and suitable method for sedation during outpatient gastroscopic examination.

Laparoscopic Surgery for Gastric and Duodenal Disease

PURPOSE: The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic surgery in the treatment of gastric and duodenal diseases. METHODS: 27 patients who suffered from various gastroduodenal diseases were operated on between Feb. 1996 and July 1997. Operating times, procedures associated with pathologic diagnosis, bleeding during operation, mean starting times of oral intake, postoperative hospital stays, and complications were examined using the operating records and the medical charts. RESULTS: The procedures and the associated pathologic conditions were a feeding jejunostomy (gastric cancer peritonei), 12 wedge resections (1 duodenal diverticulum, 1 Brunner's gland hyperplasia, 2 gastric polyps, 6 gastrointestinal stromal tumors, and 2 early gastric carcinomas, 3 gastrojejunostomies (unresectable gastric cancers), 10 subtotal gastrectomies (9 complicated peptic ulcers and early gastric cancer), and a radical (D1 alpha) subtotal gastrectomy. The average operating times were 85 minutes in the feeding jejunostomy, 132 minutes in the wedge resections, 95 minutes in the gastro jejunostomies, 208 minutes in the subtotal gastrectomies (Billroth-I: 160 min; Billroth-II: 262 min.), and 300 minutes in the radical operation. The mean intraoperative bleeding was 80-800 cc. The mean start ing time of solid oral intake and postopeative hospital stay were shorter than in open surgery (oral intake: 1-5 day; hospital stay: 6-9 days). There were six postoperative complications. One patient died due to a cerebral infarction during the operation. one wound infection, one stump leakage, one pulmonary edema, and two cases of postoperative bleeding occurred, but they were treated conventionally without reoperation. CONCLUSION: Minimally invasive surgery appears to be an invaluable tool for treating gastroduodenal diseases. Furthermore, it is a valid option in experienced hands and in selected cases of gastric cancer, allowing patients to benefit from a less cumbersome hospital stay and from more satisfaction.

Laparoscopic Surgery for Gastric and Duodenal Disease

PURPOSE: The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic surgery in the treatment of gastric and duodenal diseases. METHODS: 27 patients who suffered from various gastroduodenal diseases were operated on between Feb. 1996 and July 1997. Operating times, procedures associated with pathologic diagnosis, bleeding during operation, mean starting times of oral intake, postoperative hospital stays, and complications were examined using the operating records and the medical charts. RESULTS: The procedures and the associated pathologic conditions were a feeding jejunostomy (gastric cancer peritonei), 12 wedge resections (1 duodenal diverticulum, 1 Brunner's gland hyperplasia, 2 gastric polyps, 6 gastrointestinal stromal tumors, and 2 early gastric carcinomas, 3 gastrojejunostomies (unresectable gastric cancers), 10 subtotal gastrectomies (9 complicated peptic ulcers and early gastric cancer), and a radical (D1 alpha) subtotal gastrectomy. The average operating times were 85 minutes in the feeding jejunostomy, 132 minutes in the wedge resections, 95 minutes in the gastro jejunostomies, 208 minutes in the subtotal gastrectomies (Billroth-I: 160 min; Billroth-II: 262 min.), and 300 minutes in the radical operation. The mean intraoperative bleeding was 80-800 cc. The mean start ing time of solid oral intake and postopeative hospital stay were shorter than in open surgery (oral intake: 1-5 day; hospital stay: 6-9 days). There were six postoperative complications. One patient died due to a cerebral infarction during the operation. one wound infection, one stump leakage, one pulmonary edema, and two cases of postoperative bleeding occurred, but they were treated conventionally without reoperation. CONCLUSION: Minimally invasive surgery appears to be an invaluable tool for treating gastroduodenal diseases. Furthermore, it is a valid option in experienced hands and in selected cases of gastric cancer, allowing patients to benefit from a less cumbersome hospital stay and from more satisfaction.

Monitored Anesthetic Care (MAC) Using Propofol, Ketamine, Fentanyl, and Ketorolac (PKFK) for Minor Surgery / 대한마취과학회지

BACKGROUND: Even when patients agree that anesthesia is indispensable for a safe and comfortable operation, they are reluctant to experience the side effects of conventional general and regional anesthesia. We investigated whether monitored anesthetic care (MAC) using propofol, ketamine, fentanyl, and ketolorac can be substituted for conventional anesthesia in minor surgery. METHODS: One hundred forty six healthy adult patients who received minor surgery were studied. All were fasted, premedicated, and monitored according to conventional general anesthesia. Fentanyl 2 microgram/kg, propofol 1 mg/kg, ketamine 0.2 mg/kg, and ketorolac 30 mg were given intravenously and propofol was maintained at 3 4 mg/kg/h. Before local anesthetics infiltration at the incision site, ketamine 5 mg and propofol 20 mg were added intravenously. During the procedure, fentanyl 25 microgram plus propofol 20 mg were added whenever involuntary movements appeared. We observed vital signs, complications, time to eye opening to verbal command, time to regain orientation, satisfaction with anesthesia, postoperative pain scores, and analgesic consumption. RESULTS: Blood pressure and heart rate were reduced at the beginning of anesthesia, but were not clinically significant. Intraoperatively, respiratory depression (40.4%), SpO2 < 90% (25.3%) were observed, but no patients needed tracheal intubation. Postoperatively, dizziness (29.5%), pain (20.5%), and nausea (15.8%), were observed. The time to eye opening and to regaining of orientation were 57.3+/-119.4 sec, and 8.0+/-4.7 min respectively. Satisfaction with anesthesia was remarkable; surgeon (76.7%), patients (91.8%). Postoperative pain scores were low; 59.6% of patients did not need analgesics for the first 24 h. CONCLSIONS: If careful monitoring and instantaneous management for respiratory depression by anesthesiologist is provided, MAC using PKFK is an excellent and readily applicable method for minor surgery.

Comparision of Amount and Cost in Terms of Homologous Blood Transfusion between Comprehensive Blood Conservation Therapy and Conservative Method in Open Heart and Major Aortic Operations / 대한마취과학회지

BACKGROUND: To reduce the amount of homologous transfusion with its inherent problems of transmission of viral hepatitis, acquired immune deficiency syndrome and others, many institutions use comprehensive blood conservation methods (CBCM) in open heart and major aortic operations. The purpose of this study is to compare the amount and cost of homologous transfusion and the efficacy of coagulation between patients with or without CBCM adoption. METHODS: We prospectively assessed available CBCM of our institution in 20 patients, comparing the requirements of blood products, their cost and the efficacy of blood coagulation with those of another 20 patients similar in age, types of operation, operation difficulty and duration of bypass time retrospectively. RESULT: Fewer whole blood and platelet concentrates were transfused in patients with CBCM (p<0.05). There are no significant differences in the amount of used packed red blood cell and fresh frozen plasma between two groups. Partial thromboplastin time is significantly short in patient with CBCM (p<0.05). The prevalence of complications and mean extra-financial cost for using cellsaver, platelete pheresis and homologous blood products are low in patients with CBCM. CONCLUSIONS: The CBCM requires additional cost won but CBCM reduces the requirements of homologous blood effectively.

Correlation between the Change of Mean Arterial Pressure and the Change of Percutaneous Oxygen Saturation in Patients with Tetralogy of Fallot / 대한마취과학회지

BACKGROUND: Hypoxia often occurs during anesthesia of patients with tetralogy of Fallot (TOF). The factors that determine pulmonary circulation and oxygenation in patient with TOF are the degree of obstruction of right ventricular outflow tract (RVOT), right ventricular filling pressure, systemic vascular resistance, loss of negative pleural cavity pressure by thoracotomy, change of pulmonary vascular resistance due to positive pressure ventilation and degree of arteriopulmonary collateral connection. Hence pulse oximetry is a noninvasive technique for measuring arterial O2 saturation continuously, this study examined the correlation between the change of percutaneous arterial oxygen saturation (delta SpO2) and the change of mean arterial pressure (delta MAP) using pulse oximetry in these patients. METHODS: Twenty pediatric patients undergoing modified Blalock-Taussig shunt or total corrective operation were prospectively investigated. Immediately after induction, baseline values of MAP and SpO2 were determined and if there were some changes in SpO2 from baseline during operation, MAP on that value of SpO2 were collected. If SpO2 reduced, patients were treated with infusion of fresh frozen plasma or pentastach (2-10 ml/kg), injection of phenylephrine (10 microgram/kg) or esmolol (0.5 mg/kg). RESULTS: Intravascular volume loading only was executed in 4 patients, intravascular volume loading and phenylephrine administration was executed in 11 patients, and intravascular volume loading, phenylephrine and beta-blocker administration was executed in 5 patients. There were no significant correlation between delta MAP and delta SpO2 from linear correlation and regression analysis (r=0.23, p<0.05). CONCLUSIONS: Because delta SpO2 were not closely related with delta MAP and above mentioned factors could act closely among each others, meticulous anesthetic management is necessary during palliative or total corrective operation in patients with TOF.

Effect of Preemptive vs Postoperative Continuous Epidural Analgesia on Postoperative Pain after Radical Gastrectomy / 대한마취과학회지

BACKGROUND: Recent evidence suggest that noxious surgical trauma may induce prolonged changes in central neural function that later contribute postoperative pain. So, postoperative pain may be eliminated or reduced if surgical afferent barrages are prevented with local anesthetics or opioid before they reach to the CNS. We studied the preemptive analgesic effect of continuous epidural analgesia under general anesthesia after radical gastrectomy. METHODS: Forty four patients scheduled for radical gastrectomy were investigated. After general anesthesia induction, patients of preemptive group (n=25) were given 40 ml of 0.125% bupivacaine, 0.1 mg/kg of morphine and 75 microgram of clonidine epidurally as a bolus and followed by 10 ml/hour of 0.125% bupivacaine and 0.2 mg/hour of morphine continuously for 10 hours. Patients of non-preemptive group (n=19) were given the same drugs according to the same way after finishing the operations. The effect of preemptive analgesia was assessed by visual analogue pain scale (VAPS) score, and evaluated the time to first analgesic request, and total amount of used analgesics. Side effects were recorded. RESULTS: Postoperative VAPS scores were not different between two groups. Time to first analgesic request were significantly more prolonged and total amount of used analgesics were significantly less in preemptive group than in non-preemptive group. The incidence of side effects except respiratory depression were similar between two groups. CONCLUSIONS: We concluded that despite preemptive analgesic effect was seen in preemptive group, but it was not prominent. Further studies are needed to prove more prominent preemptive effect in major abdominal operation.

The Effects of Intraperitoneal Local Anesthetics on the Postoperative Pain Relief in Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Although pain after cholecystectomy was reduced significantly since the advent of laparoscopic surgery, many patients still complain of moderate pain after the surgery. Recently intraperitoneal instillation of local anesthetics is known as safe, simple, and effective method of treatment for pain after laparoscopic cholecystectomy. METHODS: Three groups are randomized; group I (normal saline 80 ml), group II (0.5% lidocaine 80 ml+1:400,000 epinephrine) and group III (0.125% bupivacaine 80 ml+1:400,000 epinephrine). Local anesthetics are instilled via subdiaphragmatic trocar hole just after creation of carboperitoneum. Visual analogue scale (VAS), total used analgesics amount, time to first analgesics request, time to out of first flatus and complications are compared. Lidocaine blood concentrations are checked in five cases of the patients after lidocaine instillation. RESULTS: The VAS was insignificant among groups except 3 hr, 6 hr postoperatively. Time to first analgesics request are prolonged in lidocaine and bupivacaine group. Used analgesics amount are significantly less in lidocaine group than control group. Time to out of first flatus was significantly shorter in bupivacaine group. No significant complications were noted. The blood concentration of lidocaine were variable and the highest concentration in five of one case was 1.8 microgram/ml. CONCLUSIONS: Although intraperitoneal instillation of local anesthetics is simple, safe method for controlling pain after laparoscopic cholecystectomy, it is not so much effective because of dilution with irrigating saline and suctioning intraoperatively and postoperative scavenging by evacuator.

Changes of Blood Glucose and Insulin under Different Fentanyl Dosage in Neonates and Infants Undergoing Open Heart Surgery / 대한마취과학회지

Background: Hyperglycemia during cardiopulmonary bypass may increase the incidence and severity of neurologic deficits that may result from cerebral ischemia. Moderate hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery despite measures such as eliminating dextrose from the CPB clear pump priming solution and from the intra-operative iv fluids. To ameliorate the hormonal and hemodynamic stress responses during cardiac surgery in neonates, infants and children, high dose fentanyl anesthesia is widely used. The authors wished to determine prospectively whether fentanyl dosage is associated with reduced blood glucose or not in pediatric patients undergoing cardiac surgery. METHODS: Twenty four pediatric patients undergoing cardiac surgery were allocated randomly into 3 groups who received 25 g/kg fentanyl, 50 g/kg fentanyl or 75 g/kg fentanyl before CPB. The changes of plasma glucose and insulin levels were observed after sternotomy, on bypass, 30 min after bypass, off bypass, and the end of the operation. RESULTS: Blood glucose levels were not increased after sternotomy, but significantly increased at bypass to the end of the operation in all fentanyl dosage groups. Plasma insulin level increased, but statistically not significant. Different fentanyl dosage (25~75 g/kg) is not associated with differences in blood glucose level. CONCLUSION: At a dosage of 25~75 g/kg fentanyl anesthesia during pediatric open heart surgery were associated with no differences and below 250 mg/dl of blood glucose level and no significant changes in insulin level.

Incidence of Sore Throat after Tracheal Intubation and Postoperative / 대한마취과학회지

BACKGROUND: Sore throat is one of the most common complications of intubation. There are many factors that affect the incidence of sore throat and the succinylcholine-induced myalgia. Our study is to reveal the influences of these factors on the postoperative sore throat and the succinylcholine-induced myalgia. METHODS: One thousand and seven patients in ASA class I or II undergoing elective surgery under general anesthesia were studied, except patients undergoing brain surgery, open heart surgery, operation in oro-, naso-pharynx and larynx, and uncooperated psychiatric. We checked age, sex, patient controlled analgesia and nasogastric tube, size and kind of tube, operation position, duration of intubation and anesthetic agent. At 24~38 hours after operation, the patients were questioned about pre- and postoperative sore throat, or myalgia. RESULTS: Sore throat after endotracheal intubation developed more frequently in woman (32.8%) than man (25.9%). The older the patients, the lower the incidence of sore throat (p<0.05). The longer the anesthesia duration, the lower the incidence of sore throat (p<0.05). Succinylcholine, patient controlled analgesia, nasogastric tube, endotracheal tube, operation position, maintenance anesthetic agents and the amount of smoking did not affect the incidence of sore throat. The incidence of succinylcholine-induced myalgia was lower in elderly or patients who were administered nondepolarizing muscle relaxant. CONCLUSIONS: The incidences of sore throat and myalgia were 29% and 15%, respectively. There were significant differences in incidence of sore throat and myalgia depending on the gender, age, duration of operation, but the controllable factors which reduce the incidence of sore throat were not found. Nondepolarizing muscle relaxants could reduce the occurrence of postoperative myalgia.

Spinal Anesthesia with 0.5% Plain Bupivacaine: Effects of Patient's Posture and the Temperature of Bupivacaine / 대한마취과학회지

BACKGROUND: Many factors determine the distribution of local anesthetics in the subarachnoid space. These major factors are dosage of local anesthetics, baricity of local anesthetics, position of patient, contour of vertebral column. The temperature of local anesthetics alters the baricity of local anesthetics. At 20oC, the density of 0.5% plain bupivacaine is 1.0003 and generally act as isobaric solution in the CSF. As its temperature lowers, its baricity increases. METHODS: Forty patients (A.S.A I and II) scheduled for lower extremity operation under spinal anesthesia were randomized into four groups; group I (37oC 0.5% bupivacaine, sitting position), group II (37oC 0.5% bupivacaine, 15o head-down position), group III (4oC 0.5% bupivacaine, sitting position), group IV (4oC 0.5% bupivacaine, 15o head-down position). The patients were placed in the sitting position (Group I, III) or lateral decubitus (Group II, IV) and dural puncture was performed at the L3-4 interspace using a midline approach (25-gauge Quincke spinal needle). A free flow of clear cerebrospinal fluid was obtained before administration of drug (37oC 0.5% bupivacaine in Group I, II and 4oC 0.5% bupivacaine in Group III, IV). Patients remained in the sitting position or 15o head-down position for 3 minutes after injection. Patients in each group received a solution that had been previously equilibrated in a stove to 37oC and in a refrigerator to 4oC for more than 1 day. Syringes used to administer the bupivacaine solution were also equilibrated to 37oC and 4oC, respectively. We checked sensory block level using pin-prick test at every 5 minutes. RESULTS: There was statistic significance in sensory block level between Group I, IV and Group II, III. The maximum sensory block level and the time to maximum cephalad spread of analgesia was the T4 level and 9.6 minutes in Group I, the T5 level and 13.5 minutes in Group IV compared to the T9 level and 21 minutes in Group II, the T10 level and 18 minutes in Group III. CONCLUSIONS: The temperature of 0.5% plain bupivacaine affects sensory block level and time to block. It is concluded that the temperature of the injected solution plays an important role in the sensory spread of 0.5% plain bupivacaine.

Effects of Isoflurane on Hypoxic Pulmonary Vasocontriction in Human during One Lung Ventilation / 대한마취과학회지

BACKGROUND: AMBU bag is a useful equipment in the cardiopulmonary resuscitation(CPR) and respiratory therapy. The volume delivered during ventilation with AMBU bag may be influenced by many factors. METHOD: We evaluated the effects of ventilation method(one-hand, open-palm, two-hand) and resuscitator's sex on volume in 30 intubated patients under general anesthesia with inhalational anesthetics and muscle relaxants. RESULTS: Mean tidal volume was significantly greater with two-hand method than one-hand and open-palm method in both sex. PaO2 was significantly decreased in all ventilation methods. PaCO2 was also decreased and pH was increased in all methods. CONCLUSION: The results suggest that all ventilation methods with AMBU bag in intubated patients may suitable in the CPR. If airway management by intubation is impossible and mask ventilation, two-hand method may be effective in both resuscitator but open-palm method may not suitable to female resuscitator.

Effects of Isoflurane on Hypoxic Pulmonary Vasocontriction in Human during One Lung Ventilation / 대한마취과학회지

BACKGROUND: AMBU bag is a useful equipment in the cardiopulmonary resuscitation(CPR) and respiratory therapy. The volume delivered during ventilation with AMBU bag may be influenced by many factors. METHOD: We evaluated the effects of ventilation method(one-hand, open-palm, two-hand) and resuscitator's sex on volume in 30 intubated patients under general anesthesia with inhalational anesthetics and muscle relaxants. RESULTS: Mean tidal volume was significantly greater with two-hand method than one-hand and open-palm method in both sex. PaO2 was significantly decreased in all ventilation methods. PaCO2 was also decreased and pH was increased in all methods. CONCLUSION: The results suggest that all ventilation methods with AMBU bag in intubated patients may suitable in the CPR. If airway management by intubation is impossible and mask ventilation, two-hand method may be effective in both resuscitator but open-palm method may not suitable to female resuscitator.

The Effect of Intravenous Clonidine Pretreatment on Blood Pressure and Heart Rate during General Anesthesia / 대한마취과학회지

Laryngoscopy and endotracheal intubation are potent stimuli that can induce increased sympathetic activity, tachycardia and hypertension. The authors studied the effects of intravenous clonidine pretreatment, a centrally acting a2-adrenoceptor agonist, on hemodynamic responses to laryngoscopy and tracheal intubation, and on anesthetic requirements during operation. Forty ASA I -II patients undergoing elective minor general surgery were allocated randomly to receive either 5ug/kg clonidine or 3 ml of 0.9% normal saline as control intravenously 10 minutes before induction of anesthesia. The results obtained were as follows. Compared to baseline values, blood pressure and heart rate at 1 minute after intubation were significantly increased in control group, but significantly decreased in clonidine group. They were maintained at lower values throughout the whole duration of operation in clonidine group than in control group. More doses of fentanyl were needed in the control group but not in the clonidine group during operation, and because of bradycardia and hypotension, atropine or ephedrine was needed in the clonidine group. In conclusion, the elevation of blood pressure and heart rate accompanying tracheal intubation were preventable with less requirement of supplemental fentanyl, but bradycardia and hypotention were infrequently seen as a side effects, when 5ug/kg intravenous injection of clonidine 10 minutes before induction.

Spinal Anesthesia for Pediatric Surgery / 대한마취과학회지

Spinal anesthesia has been safely and reliably performed in minor pediatric surgery. Preterm infants are more likely to develop respiratory or cardiovascular complications after general anesthesia than full tern infants. This regional anesthesia may offer special advantages for surgical procedures such as inguinal hernia repair in former premature infants with a history of apnea and bradycardia of prematurity. Spinal anesthesia was done in sixty seven infants and children under 15 years of age, who were to undergo minor abdominal and lower extremity orthopedic procedure. In all cases 0.25 mg/kg of 0.5% hyberbaric tetracaine was injected into subarachnoid space. Age-related 4 groups (0~1, 1~6, 6~12, 12~15 years-old) were divided. The depth of lumbar puncture, sensory block, hemodynamic changes, status of sedation, duration of anesthesia, complication following spinal anesthesia were observed. The results were as follows; 1) Lumbar puncture was successed in 66 cases(98.5%), but failed in 1 case(1.5%). 2) The highest correlation in depth of lumbar puncture was with body-surface area(y=1.19+2.06x, r=0.956, p<0.001). 3) The mean height of sensory block in all age-related groups was similar between T(5) to T(6) skin dermatome. 4) Chidren less than 6 years of age showed a little changes in blood pressure and heart rate following spinal anesthesia. But children more than 6 years of age had widely varible decreases in blood pressure and heart rate, and recieved ephedrine(4 cases) or atropine(2 cases). 6) 55 cases(82.1%) required sedation with midazolam or propofol, 8 cases(10.6%) required general anesthesia to complete operative procedure. 7) The time needed to regain motor funtion increased with age (y=1.04+/-O.llx, r=0.952, p<0.001). 8) Preoperative complications were bloody tap (5 cases), hypotension (14 cases), bradycardia (6 cases), nausea or vomiting (4 cases), insufficient analgesia (2 cases), and failed tap (1 case). Postoperative complication was nonspecific postdural puncture headache (1 case). From the above results, it was suggested that spinal anesthesia without use of potent inhalational anesthetics in minor pediatric surgery is one of useful method under meticulous monitoring and observation.