Bupivacaine Versus Bupivacaine-Fentanyl for Cervical Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Significant analgesic synergy is obtained when opioids are combined with dilute local anesthetics, but serious side effects of intraspinal opioid can develope. The purpose of this study was to see how much does additional fentanyl make change of hemodynamics and analgesic dermatome according to variation of local anesthetic concentration. METHODS: Thirty patients were divided into three groups who were receiving epidurally 0.33% bupivacaine 15 ml(group 1), 0.33% bupivacaine 15 ml including fentanyl 100 g(group 2), 0.25% bupivacaine 15 ml including fentanyl 100 g(group 3) at the C7-T1 interspace. We observed mean arterial blood pressure, pulse rate and arterial blood gas analysis to be changed. Evaluation of the onset and duration of analgesic action by pin prick test were taken. Also side effects and complications were checked. RESULTS: Decreases of mean arterial blood pressure was statistically significant between 10 and 120 minutes in group 1, between 10 and 50 minutes in group 2, between 10 and 40 minutes in group 3 after drug administration. Decreases of pH and increases of PaCO2 were statistically significant between 30 and 60 minutes in group 1, between 30 and 120 minutes in group 2, 3 after drug administration. In three groups, number of analgesic dermatome was maximal at 40 minutes after drug administraion. The duration of analgesia in C8 dermatome was 153 29 minutes in group 1, 168 21 minutes in group 2, 131 31 minutes in group 3. Inadvertant dural puncture was developed in one patient. Transient pruritus, nausea/vomiting and solmnolence were developed in group 2, 3. CONCLUSIONS: Three groups provided sufficient analgesia for operation. fentanyl affects on hemodynamics, ventilation but not on number of maximal analgesic dermatome. Also it produces side effects such as, mild pruritus, somnolence, nausea/vomiting.

Gas Embolism during Diagnostic Laparoscopy Combined with Hysteroscopic Procedure: A case report / 대한마취과학회지

Laparoscopy is a frequently used technique in surgery and gaining wide popularity replacing laparotomy. The advantages of laparoscopy are shorter hospital stay, faster recovery, more decreased postoperative pain and smaller scar than laparotomy. But inducing artificial pneumoperitoneum with gas causes various complications. Among them, gas embolism is a rare but fatal complication and may occur more frequently when laparoscopy is performed simultaneously with hysteroscopy. We experienced one case of gas embolism during diagnostic laparoscopy for secondary infertility and hysteroscopic resection of uterine myoma under general anesthesia. Early diagnosis and prompt treatment seem to be the keys to prevent catastrophic outcome and the anesthesiologist should know about it's patho- physiology, preventive methods, diagnosis and treatment.