Effect of intraoperative lidocaine on anesthetic consumption, and bowel function, pain intensity, analgesic consumption and hospital stay after breast surgery / 대한마취과학회지

BACKGROUND: Perioperative lidocaine infusion improves postoperative outcomes, mostly after abdominal and urologic surgeries. Knowledge of the effect of lidocaine on peripheral surgeries is limited. Presently, we investigated whether intraoperative lidocaine infusion reduced anesthetic consumption, duration of ileus, pain intensity, analgesic consumption and hospital stay after breast plastic surgeries. METHODS: Sixty female patients, aged 20-60 years, enrolled in this prospective study were randomly and equally divided to two groups. One group (n = 30) received a 1.5 mg/kg bolus of lidocaine approximately 30 min before incision followed by continuous infusion of lidocaine (1.5 mg/kg/h) until skin closure (lidocaine group). The other group (n = 30) was untreated (control group). Balanced inhalation (sevoflurane) anesthesia and multimodal postoperative analgesia were standardized. End tidal sevoflurane concentration during surgery, time to the first flatus and defecation, visual analog pain scale (0-10), analgesic consumption and associated side effects at 24, 48, and 72 h after surgery, hospital stay, and patient's general satisfaction were assessed. RESULTS: Compared to the control group, intraoperative lidocaine infusion reduced by 5% the amount of sevoflurane required at similar bispectral index (P = 0.014). However, there were no significant effects of lidocaine regarding the return of bowel function, postoperative pain intensity, analgesic sparing and side effects at all time points, hospital stay, and level of patient's satisfaction for pain control. CONCLUSIONS: Low dose intraoperative lidocaine infusion offered no beneficial effects on return of bowel function, opioid sparing, pain intensity and hospital stay after various breast plastic surgeries.

A survey of user acceptance of electronic patient anesthesia records / 대한마취과학회지

BACKGROUND: An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users' attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR). METHODS: A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administered to anesthesiologists, trainees, and nurses during February 2011 and the responses were collected anonymously during March 2011. RESULTS: A total of 28 anesthesiologists, 27 trainees, and 47 nurses responded to this survey. Most participants involved in this survey were satisfied with AIMS (96.3%, 82.2%, and 89.3% of trainees, anesthesiologists, and nurses, respectively) and preferred AIMS over handwritten anesthesia records in 96.3%, 71.4%, and 97.9% of trainees, anesthesiologists, and nurses, respectively. However, there were also criticisms of AIMS related to user-discomfort during short, simple or emergency surgeries, doubtful legal status, and inconvenient placement of the system. CONCLUSIONS: Overall, most of the anesthetic practitioners in this hospital quickly accepted and prefer AIMS over the handwritten anesthetic records in the OR.

Evaluation of dose effects of magnesium sulfate on rocuronium injection pain and hemodynamic changes by laryngoscopy and endotracheal intubation / 대한마취과학회지

BACKGROUND: Rocuronium produces injection pain in 50-80% of treated patients. Therefore, a variety of pretreatments have been attempted to reduce this issue. We evaluated the efficacy of 3 different doses of magnesium on the rocuronium injection pain and following hemodynamic changes by laryngoscopy and tracheal intubation (LTI). METHODS: Two hundreds patients, ASA I and II, undergoing general anesthesia for elective surgery were randomly divided to 4 groups: group 1, 2, 3, 4 received saline 5 ml, magnesium 5, 10 and 20 mg/kg prior to 0.6 mg/kg of rocuronium, respectively. Then, group 1 only was treated with esmolol (20 mg) before LTI. Pain intensity with rocuronium injection was assessed using a four-point scale according to patient's movement. Cardiovascular responses at baseline, after induction, 1 minutes after LTI were determined. RESULTS: Compared to saline, 10 and 20 mg/kg of magnesium significantly reduced the incidence of overall movement after rocuronium injection (34% and 36% in group 3 and 4, respectively vs. 76% in the group 1) (P < 0.0001). Generalized movement was seen in 4% of patients in groups 3 and 4, respectively. Compared to baseline values, diastolic blood pressure (DBP) immediately after LTI significantly increased within groups 1 and 2 (P < 0.001), but not within groups 3 and 4. CONCLUSIONS: Magnesium (10 and 20 mg/kg) prior to rocuronium was effective in attenuating rocuronium associated injection pain and cardiovascular changes by LTI.

Dilution and slow injection reduces the incidence of rocuronium-induced withdrawal movements in children / 대한마취과학회지

BACKGROUND: The aim of this study was to evaluate whether slow injection of diluted rocuronium could reduce rocuronium-induced withdrawal movements effectively in children. METHODS: After loss of consciousness, rocuronium 0.6 mg/kg was administered into 171 children according to the pre-assigned groups as follows: Group CF, injection of non-diluted rocuronium over 5 seconds; Group CS, injection of non-diluted rocuronium over 1 minute; Group DF, injection of diluted rocuronium (10 times) over 5 seconds; Group DS, injection of diluted rocuronium over 1 minute. An investigator who was blind to the injection techniques recorded patient movements followed by rocuronium injection. RESULTS: The incidence of withdrawal movement in Group CF was highest among the groups (all P < 0.0001). Moreover, withdrawal movement was less frequently observed in Group DS than in Groups CS and DF (P = 0.021 and P = 0.007, respectively). CONCLUSIONS: Slow injection of diluted rocuronium reduced the incidence of withdrawal movements in children.