Effects of Epidural Ketamine for Postoperative Pain Management / 대한마취과학회지

BACKGROUND: Ketamine hydrochloride, NMDA receptor antagonist is a potent analgesic and anesthetic. Other analgesics, like opioid, have been shown to effectively relieve postoperative pain when infused into epidural space, but effects of ketamine hydrochloride infused into epidrual space for postoperative pain control is still controversial, and therefore the present study was undertaken. METHODS: Ninety adult patients (ASA I or II) scheduled for upper abdominal and chest surgery were randomized into ketamine and fentanyl groups. For all patients, informed consent was obtained preoperatively. Anesthesia was induced with thiopental sodium/succinylcholine and maintained with nitrous oxide/oxygen/enflurane. Skeletal muscle relaxation was maintained with vecuronium. Epidural catheterization was done after operation. Ketamine group received epidural bolus of 0.1% bupivacaine 10 ml followed by continuous epidural infusion of 0.1% bupivacaine 100 ml containing ketamine 200 mg. Fentanyl group received epidural bolus of 0.1% bupivacaine 10 ml containing fentanyl 100 microgram followed by continuous epidural infusion of 0.1% bupivacaine 100 ml containing fentanyl 600 microgram. Continuous infusion rate was 2 ml/hr in both groups. Analgesic effects were assessed using VAS (visual analogue score), PHS (Prince Henry score) and PRS (pain relief score). Side effects and number of patients using additional analgesics were evaluated. RESULTS: Analgesic effects were significant in both group after drug administration. But fentanyl group had greater analgesic effects than ketamine group. Fentanyl group experienced side effects such as pruritus (27 cases), nausea and vomiting (9 cases). Ketamine group had side effects such as nausea and vomiting (13 cases). Number of patients using additional analgesics were seven and twenty-four in the fentanyl and ketamine groups, respectively. CONCLUSIONS: We conclued continuous epidural infusion of ketamine had fewer analgesics effect at early state of postoperative pain than fentanyl.

Airway Obstruction with Armored Tracheostomy Tube by Swelling of Inner Layer: A case report / 대한구급학회지

One of the reasons for insertion of endotracheal tube is to provide a patent airway. Unfortunately, the tube itself may become the cause of airway obstruction. Especially, armored tube is known to be most effective in maintenance of airway patency. However, airway obstruction has been reported by a varity of causes even though armored tube was used. We experienced airway obstruction with armored tracheostomy tube by swelling of inner layer near the cuff. The tube was reused one and had been disinfected with ethylene oxide. Therefore, to prevent complication such as airway obstruction by use of armored tubes, it is desirable to avoid reusal of armored tube and to examine the lumen as well as cuff before intubation when reused.