Lumbar Root Compression Secondary to Epidural Air Retension: A case report / 대한마취과학회지

Air can be introduced into the epidural space during the loss of resistance technique used to identify needle entry into the epidural space. Complications resulting from the injection of air into the epidural space include pneumocephalus, spinal cord and nerve root compression, retroperitoneal air collection, subcutaneous emphysema, venous air embolism, and possibly, incomplete analgesia and anesthesia. We experienced a case of a large epidural collection of air following epidural anesthesia attempted one month before. The CT scan revealed epidural air extending from L1-S1 with moderate compression of nerve root at L4-5.

Comparison of Spinal and Epidural Anesthesia for Transurethral Resection of Prostate (TURP) / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine whether spinal or epidural anesthesia is more suitable in terms of sensory and motor blockade, cardiovascular stability, intraoperative blood loss, postoperative recovery and patient satisfaction in elderly patients undergoing TURP. METHODS: Fourty patients undergoing TURP were randomly allocated to either a spinal or an epidural anesthesia group. The spinal group (n = 20) received 10 12 mg of 0.5% tetracaine in 10% dextrose, while the epidural group (n = 20) received 20 25 ml of 2% lidocaine at L4-5 intervertebral space. After injection of the agent, changes in sensory and motor blockade, blood pressure and heart rate were measured in the two groups. We compared serum Hb, serum Na, foley removal, hospital stay, side effects, analgesic use, and patient satisfaction between the two groups. RESULTS: The two techniques were similar with regard to the level of blood pressure, heart rate, Hb and Na changes, foley removal and hospital stay. At 15 and 30 minutes after spinal and epidural anesthesia, the results for sensory blockade were T8 +/- 2.2 S5, T9 +/- 1.2 S5 (spinal) and T10 +/- 1.5 S3, T8 +/- 2.1 - S4 +/- 1.0 (epidural), and motor blockade was complete in the spinal group but incomplete in the epidural group. Patient satisfaction was better in the epidural group than in the spinal group, but analgesic use was more frequent in the spinal group than in the epidural group. CONCLUSIONS: Both spinal and epidural anesthesia are suitable for TURP. Spinal anesthesia was technically easier and produces a complete and more reliable block of the sacral segment, but was also an unnecessarily profound motor block of the lower extremity. Epidural anesthesia is less pronounced and gives a shorter duration of motor blockade with good patient satisfaction.

A Comparison of the Antiemetic Effect of Ondansetron and Metoclopramide on Nausea and Vomiting Associated with Epidural Buprenorphine / 대한마취과학회지

BACKGROUND: Epidural buprenorphine provides good pain relief after Cesarean section, but is often associated with nausea and vomiting. Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, is known to prevent and treat emesis after chemotherapy in cancer patients and after general anesthesia. The purpose of this study was to compare the prophylactic antiemetic effect of ondansetron and metoclopramide on nausea and vomiting after epidural buprenorphine. METHODS: Sixty women undergoing Cesarean section were studied. The patients were given subarachnoid injections of 0.5% tetracaine 9 mg and were inserted with epidural catheters for postoperative pain control. Prior to closure of the peritoneum, we injected a mixture of buprenorphine and bupivacaine through the epidural catheters and gave intravenous boluses of saline 6 ml, metoclopramide 10 mg and ondansetron 4 mg randomly. The incidence of nausea and vomiting and the degree of satisfaction were evaluated until 24 hr after the injection of epidural buprenorphine. RESULTS: The number of patients who became nauseated or vomited did not differ significantly between the ondansetron group and the metoclopramide group. Also, subjective ratings of satisfaction and incidence of other side effects did not differ significantly between the groups. CONCLUSIONS: Ondansetron, administered intravenously, prevented postoperative nausea and vomiting associated with epidural buprenorphine equally as well as metoclopramide.

Anesthetic Considerations Concerning VSD a Patient with Eisenmenger's Syndrome: A case report / 대한마취과학회지

Eisenmenger's syndrome includes any condition in which communication between the pulmonary and systemic circulations gives rise to pulmonary vascular disease causing a right to left shunt with peripheral cynosis. The theoretical risks of anesthesia in patients with Eisenmenger's syndrome are considerable. We report on the case of a 47-year-old female patient with Eisenmenger's syndrome secondary to ventricular septal defect for transabdominal hysterectomy. Of prime concern was the maintenance of sytemic vascular resistance, and this was achieved using an infusion of phenylephrine started before the induction of anesthesia; the infusion continued after the operation. We carefully performed general anesthesia with N2O-O2-ketamine-fetanyl-enflurane. The patient was discharged for home 8 days later without complications.

A Study on the Distance from Epidural Space to Subarachnoid Space in Combined Spinal-Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: Combined spinal-epidural anesthesia (CSEA) has gained an increasing interest as it combines the reliability of a spinal block and the flexibility of an epidural block. This study was designed to determine the distance from skin to epidural space (S-EP) and the distance from epidural space to subarachnoid space (E-SA) in obstetric parturient and whether weight, height, BMI (body mass index) and PI (ponderal index) might influence S-EP and E-SA. METHODS: Sixty obstetric patients undergoing elective cesarean section during CSEA in L3-4 level were partitioned into group I (with dural click), group II (no dural click) and in each group, weight (prepregnancy, pregnancy), height, BMI and PI were measured. Measurements of S-EP and E-SA were made. The Pearson correlation was used to investigate relationships between S-EP, E-SA and patient characteristics (height, weight, BMI, PI). RESULTS: S-EP was 4.39+/-0.49 cm and E-SA was 8.23+/-2.05 mm (7.99+/-2.07 mm in group I, 8.78+/-1.94 mm in group II). S-EP was related to weight, BMI and PI except height. E-SA was related to pregnancy BMI and pregnancy PI in group I. No correlation was found between E-SA and other variables in group II. CONCLUSIONS: E-SA in obstetric parturients was related to obesity and has been found to be somewhat larger and more variable due to the segmented and discontinous nature of epidural space.

The Effects of Propofol as s Sole Intravenous Anesthetics on Endourologic Transurethral Lithotripsy / 대한마취과학회지

BACKGROUND: Propofol is an intravenous anesthetic characterized by rapid induction and prompt recovery. Recently, its is used widely in clinical practice, especially when early discharge is advisable. We conducted this study for the evaluation of the effects of propofol as a sole intravenous anesthetic on the operation with minimal pain such as TUL(transurethral lithotripsy). METHODS: Patients were recruited for ASA class 1 and 2 from those who received TUL operation. Propofol was administered 2 mg/kg for induction and continuously infused at the rate of 1.2~1.4 mg/kg/hr after the loss of consciousness. With the stabilization of the vital signs, we reduced the dose of propofol to 1.0~1.2 mg/kg/hr. We checked the patients' movement, vital signs, recovery time and monitored the appearance of the symtoms such as nausea, vomiting postoperatively. RESULTS: 1) The average time of operation was 15+/-12 minutes. 2) The average recovery time was 15+/-9 minutes(range 2~30 min). 3) Blood pressure and peripheral oxygen saturation(SpO2) were declined during anesthesia, but SpO2 was normalized in the recovery room. 4) No significant complications were observed. 5) Mild movement of the patient was noticed in the begining of operation, but it did not affect the surgical procedure. CONCLUSIONS: Propofol was effective as a sole intravenous anesthetic to minimize postoperative complications such as nauea, vomiting for TUL with minimal pain.

Effect of Propofol and Thiopental on the Isolated Stunned Rat Heart / 대한마취과학회지

BACKGROUND: Propofol(2,6-diisopropyl phenol) is an intravenous anesthetic agent, which was first introduced in 1986. It has 178.27 molecular weight and 1.8 fold stronger action of induction than that of thiopental. The effect of propofol, lowering blood pressure by depressing the cardiovascular system, has been mentioned in many papers, but its effect on myocardium is still in controversy and differs according to the method and interpretation of experiments used. This animal experiment was conducted to compare the effects of propofol and thiopental on myocardial contractility and coronary flow in isolated stunned rat hearts. METHOD: The hearts were isolated from twenty-four Sprague-Dawley rats and were perfused with modified Krebs solution. After isolation, the hearts were left in stabilizing period for 30 minutes. Then, myocardial stunning was induced by global ischemia for 15 minutes. In Group I, propofol was added to modified Krebs solution, which was used to perfuse the hearts at 40, 80, 120, 160, and 200micrometer concentration. In Group II, thiopental was added to perfusate at same concentration. Between each perfusion with anesthetic-added solution, the hearts in both groups were perfused with normal Krebs solution for 30 minutes to eliminate cumulative effect of anesthetics added. Left ventricular pressure, rate of ventricular pressure generation(dP/dt), and coronary flow were measured. RESULT: In both groups, anesthetics reduced left ventricular pressure and dP/dt in a dose dependent fashion. These changes were not statistically significant between two groups. However, at the 40 and 80micrometer concentration, the increment of coronary flow by propofol was significantly larger than that by thiopental. At the 120, 160, and 200micrometer concentration of propofol, coronary flow was gradually decreased with increasing concentration, and these decrease in coronary flow were not statistically significant between two groups. CONCLUSION: The effects of propofol on myocardial function were similar to those of thiopental in isolated stunned rat hearts and the increment of coronary flow might develop the coronary stealphenomenon. So, propofol may not have the benefit compare to thiopental for cardiac function.

The Effect of Pneumonectomy on Right Ventricular Function / 대한마취과학회지

BACKGREOUND: The pneumonectomy may depress the right ventricular (RV) function transiently. The thermodilution ejection/volumetric catheter is known to be most useful method assessing the changes in RV performance during pulmonary resection. The purpose of this study was to examine the RV function during and immediately after pneumonectomy using thermodilution methods. METHODS: 16 patients undergoing pneumonectomy were studied. After induction of anesthesia, a multilumen thermodilution catheter mounted with a rapid response thermister was inserted. Using computer system, RV ejection fraction (RVEF), cardiac output, and RV end-diastolic volume (RVEDV) were measured when the patient was in lateral position (control), after one lung ventilation (OLV) and the main pulmonary artery ligated, and at the completion of resection. Arterial blood gases were analyzed and pulmonary vascular resistance (PVR) was calculated. RESULTS: Systolic pulmonary blood pressure (SPAP)(28.3 +/- 6.2 mmHg) increased compared to the control (24.6 +/- 5.9) without a significant change of PVR. No statistically significant difference was found in either RVEF or RVEDV at each times. CONCLUSIONS: Our study demonstrate the pneumonectomy do not depress the RV function immediately and RVEF do not show any correlation with PVR or RVEDV.