The Effect of High FiO2 Plus Liberal Intraoperative Fluid on the Early PONV and Pain in Patients undergoing Intra-abdominal Surgery / 대한마취과학회지

BACKGROUND: The previous studies on the influence of perioperative supplemental oxygen or generous fluid on postoperative nausea and vomiting (PONV) were inconsistent. We hypothesized in this trial that together with supplemental intraoperative oxygen and liberal fluid therapy would decrease PONV and pain. METHODS: Two hundred ASA 1 or 2 patients undergoing laparotomy and laparoscopic abdominal or gynecological surgery were randomly assigned to one of 4 groups: intraoperative FiO2 0.3 and crystalloid 6 ml/kg/h; FiO2 0.3 and 18 ml/kg/h; FiO2 0.8 and 6 ml/kg/h; FiO2 0.8 and 18 ml/kg/h. The incidence of PONV, nausea and pain scores, and amount of rescue antiemetic and analgesic drugs were studied. RESULTS: Overall incidence of PONV was 38%, 50%, 48%, 44% for group 1, 2, 3, and 4, respectively. There were no statistically significant differences among the 4 groups in the incidence of PONV, degree of nausea and pain, and the amount of antiemetics and analgesics in 2, 6, and 24 h postoperatively. The number of laparotomy and laparoscopy, and gender ratio were similar among the groups. CONCLUSIONS: We could not demonstrate an advantage of combination of intraoperative supplementary oxygen and liberal fluid in reducing PONV, pain, and amount of antiemetics and analgesics after intra-abdominal surgery.

The Effect of Perioperative Analgesic Methods on the Postoperative Changes of White Blood Cells in Patients Undergoing Knee Replacement Surgery / 대한마취과학회지

BACKGROUND: Postoperative pain is a major contributing factor to immune dysfunction related to changes of peripheral neutrophils, lymphocytes and monocytes. The aim of this study is to compare alterations in peripheral white blood cells perioperatively in patients under intravenous patient controlled analgesia (IVPCA) with intra-articular patient controlled analgesia (IAPCA) after general or spinal anesthesia, or epidural patient controlled analgesia (EPCA) after combined spinal epidural anesthesia for knee replacement surgery. METHODS: Thirty-three patients with IVPCA and IAPCA after general anesthesia (group 1), 33 patients with IVPCA and IAPCA after spinal anesthesia (group 2), and 34 patients with EPCA after combined spinal epidural anesthesia (group 3) were reviewed. The number of peripheral neutrophils, lymphocytes and monocytes were counted preoperatively, immediate postoperatively, on the first, third and fifth postoperative day. RESULTS: There were significant increases in neutrophils, decreases in lymphocytes, and increases in monocytes postoperatively in all the groups. However, there were no differences among the groups in three subtypes of white blood cells, except significantly low value of monocytes in the group 1 compared to that of group 2 immediate postoperatively. CONCLUSIONS: The technique of anesthesia and postoperative pain control did not influence to the changes of subtypes of circulating white blood cells in patients underwent knee replacement surgery.