The Effect of Aging on the Hemodynamic Response to Endotracheal Intubation during the Induction of Anesthesia

BACKGROUND: The aim of this study was to evaluate the effect of aging on the hemodynamic response to endotracheal intubation during the induction of anesthesia. METHODS: Fifty patients with American Society of Anesthesiologists physical status classification 1 or 2 were enrolled and allocated according to age to either group N (35-44 years, not elderly, n=25) or group E (65-74 years, elderly, n=25). The patients were administered 3 minimum alveolar concentrations of sevoflurane for 5 minutes for the induction of anesthesia. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before (baseline), immediately after (T0), and at 1-minute intervals during the first 4 minutes after endotracheal intubation (T1-T4). RESULTS: SAP increased by 15.4% and 10.8%(p<0.05) from the baseline at T0 and T1, respectively, in group N, and by 21.6%, 17.8%, and 11.8%(p<0.05) from the baseline at T0, T1 and T2 respectively, in group E. The SAP increases at T0, T1 and T2 were significantly greater in group E than in group N (p<0.05). The HR increases at T0 and T1 were significantly greater for group N than for group E (p<0.05). CONCLUSION: We recommend that anesthesiologists vigilantly monitor and attenuate adverse hemodynamic responses for at least 5 minutes after endotracheal intubation especially in elderly patients, particularly because significant systolic hypertension can occur in this age group.

Effect of a target-controlled infusion of remifentanil in combination with desflurane during the "maintenance" phase of general anesthesia / 대한마취과학회지

BACKGROUND: The goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane. METHODS: Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries, were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2 ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock. RESULTS: The end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 +/- 0.5 vol%; P < 0.001) and 2 ng/ml remifenanil (4.4 +/- 0.5 vol%; P < 0.001) compared to patients in group D (7.9 +/- 0.5 vol%). CONCLUSIONS: We recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia.

Comparison with hemodynamic changes of laparoscopic surgery by body position

BACKGROUND: The authors evaluated the hemodynamic effects of body position measured by esophageal Doppler monitor (EDM) during laparoscopic cholecystectomy or gynecologic laparoscopic surgery. METHODS: Fifty patients scheduled to undergo laparoscopic cholecystectomy (Group C) or gynecologic laparoscopic surgery (Group G), were divided into two groups. Pneumoperitoneum was instituted by CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured by the use of EDM: before skin incision (T1), 5, 10 and 15 min after changing position (T2, T3 and T4), and 5 min after CO2 exsufflation (T5). RESULTS: MAP (mean arterial pressure) was significantly higher in Group G when compared with Group C 10 min after changing position (T3) (P< 0.05). CO (cardiac output) was significantly decreased in Group G when compared with Group C 10 min after changing position (T3) (P< 0.05). And there were not significant differences in HR (heart rate) between two groups. PV (peak velocity) was significantly decreased in Group G when compared with Group C 10 min after changing position (T3) (P< 0.05). And there were not significant differences in FTc (corrected flow time) between two groups. But FTc in Group C was restored after CO2 exsufflation, FTc in Group G was not restored after CO2 exsufflation. CONCLUSIONS: Changing position in the gynecologic laparoscopic surgery group can elevate MAP and decrease CO. Therefore, careful caution is required in patients with cardiovascular disease who are undergoing gynecologic laparoscopic surgery.

Respiratory failure due to myotonic dystrophy combined with peripartum cardiomyopathy: A case report / 대한마취과학회지

Myotonic dystrophy is an autosomal-dominant inherited neuromuscular disorder that's characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, the heart, lung and intestine. Its most common complication is postoperative respiratory failure. We encountered a patient who developed sudden unexpected peripartum cardiomyopathy (PPCM) and respiratory failure due to presumed myotonic dystrophy after cesarean section. We report here on our clinical experience with this malady and we include a brief review of the medical literature on myotonic dystrophy.

Hemodynamic Effects of Nicardipine Measured by Esophageal Doppler Monitor during Gynecologic Laparoscopic Surgery

BACKGROUND: The authors performed this study to investigate the hemodynamic effect of nicardipine using an esophageal Doppler monitor (EDM) during gynecologic laparoscopic surgery. METHODS: Forty patients scheduled to undergo gynecologic laparoscopic surgery, were divided into two groups; the control group (Group C) and the nicardipine group (Group N). Pneumoperitoneum was initiated using CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured using EDM, i.e., before skin incision (T1), 5, 10 and 15 min after the initiation of pneumoperitoneum (T2, T3 and T4), and 5 min after deflation (T5). RESULTS: Mean arterial pressure (MAP) was significantly lower in Group N patients than in Group C patients at 5 and 10 min after the initiation of pneumoperitoneum (T2 and T3) (P < 0.05). No significant heart rate (HR) differences were observed between the two study groups. Cardiac output (CO), peak velocity (PV) and corrected flow time (FTC) were significantly higher in Group N at 10 min after the initiation of pneumoperitoneum (T3) (all P < 0.05). CONCLUSIONS: The nicardipine continuous infusion at 0.5?2.0microg/ kg/min is effective at attenuating hemodynamic changes after pneumoperitoneum during gynecologic laparoscopic surgery.

Anesthetic Management of a Patient with Complete Tracheal Transection by Blunt Trauma: A case report / 대한마취과학회지

Tracheobronchial rupture due to blunt chest trauma is an uncommon injury and the clinical presentations are variable. Recently, the incidence of tracheobronchial injuries has increased with the increase in traffic accidents and mechanization.The early diagnosis and primary repair of tracheobronchial rupture not only restores normal lung function, but also avoids the difficulties and complications associated with delayed diagnosis and repair.We report our clinical experience in anesthetic management of a patient with complete tracheal transection suffering from progressive dyspnea, subcutaneous emphysema in the neck and anterior chest wall, and bilateral tension pneumothorax.The literature regarding accidental tracheal injuries will be reviewed.

Utility of Esophageal Doppler and the Hemodynamic Effect of Nicardipine during a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: We performed this study to investigate the hemodynamic effect of nicardipine using an esophageal Doppler monitor (EDM) during a laparoscopic cholecystectomy. METHODS: Forty patients scheduled to undergo a laparoscopic cholecystectomy, were divided into two groups; the control group (Group C) and the nicardipine group (Group N). Pneumoperitoneum was initiated by CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured by the use of EDM: before skin incision (T1), 5, 10 and 15 min after the initiation of pneumoperitoneum (T2, T3 and T4), and 5 min after deflation (T5). RESULTS: The mean arterial pressure (MAP) was significantly lower in the Group N patients when compared to the Group C patients 5, 10 and 15 min after the initiation of pneumoperitoneum (T2, T3 and T4), and 5 min after deflation (T5)(P < 0.05). There was no significant differences in heart rate (HR) between patients in the two groups. The cardiac output (CO) was significantly increased in the Group N patients when compared to the Group C patients 5 min after the initiation of pneumoperitoneum (T2)(P < 0.05). The peak velocity (PV) was significantly increased in the Group N patients when compared to the Group C patients 5 and 10 min after the initiation of pneumoperitoneum (T2 and T3)(P < 0.05). The corrected flow time (FTC) was significantly increased in the Group N patients when compared to the Group C patients 5 min after the initiation of pneumoperitoneum (T2)(P < 0.05). CONCLUSIONS: We conclude that nicardipine continuous infusion with 0.5-2.0microgram/kg/min is effective in attenuating the hemodynamic change after pneumoperitoneum during a laparoscopic cholecystectomy.

Sequelae Associated with Spinal Anesthesia in a Undiagnosed Tethered Cord Syndrome Patient: A case report / 대한마취과학회지

Tethered cord syndrome is a form of spinal dysraphism, with a low-lying conus frequently associated with an intraspinal lipoma, diastematomyelia or fibrous band. The clinical manifestations include spine abnormalities, such as spina bifida, or various neurological symptoms involving the lower extremities and sphincters. Herein, our experience of a 42-year-old female tethered cord syndrome patient, with deficit, paresthesia and incontinence following spinal anesthesia for anti-incontinence surgery, is reported with a brief review of literature.

Removal of Sawdust Aspiration and Anesthetic Management: A case report / 대한마취과학회지

The aspiration of a tracheobronchial foreign body can be a life-threatening incident. Early diagnosis and the bronchoscopic removal of the foreign bodies can protect a patient from serious morbidity and even mortality. We report an unusual case of a 28-year-old man who inhaled sawdust that required emergency airway management and bronchoscopic removal of the sawdust fragments. Anesthesia for a rigid bronchoscopy is a challenging procedure for an anesthesiologist who must share the airway with the bronchoscopist and maintain the adequate depth of anesthesia. Most of the sawdust fragments were extracted successfully using a rigid bronchoscope. The patient was discharged uneventfully within one week of hospitalization.

Pneumothorax during Retroperitoneal Laparoscopic Nephrectomy: A case report / 대한마취과학회지

Recently, laparoscopic techniques are being increasingly used for retroperitoneal surgery. These procedures are considered relatively safe and non-invasive, however, there exists a small but important risk of developing complications related to insufflation with carbon dioxide (CO2). A 51-year-old female patient was admitted for retroperitoneal laparoscopic nephrectomy under general anesthesia. About 60 minutes after carbon dioxide pneumoperitoneum, the patient's oxygen saturation decreased. A chest x-ray was taken in the operating room, which showed pneumothorax in the right lung. We concluded that anesthesiologists should be aware of the occurrence of pneumothorax during the retroperitoneal laparoscopic procedure careful monitoring and appropriate management are needed.

Intubating Conditions and Hemodynamic Changes during Tracheal Intubation with Propofol Followed by Remifentanil without the Use of Muscle Relaxant / 대한마취과학회지

BACKGROUND: Studies have shown that tracheal intubation can be facilitated safely and effectively after induction of anesthesia with hypnotic and opioid without employing any muscle relaxants. Remifentanil is a new, ultra-short acting, selective mu-receptor agonist. The goal of our present study was to evaluate the appropriate induction dose of remifentanil with propofol for tracheal intubation without employing any muscle relaxants. METHODS: We have assessed intubating conditions in three groups of 45 ASA I or II Patients. Each group received intravenous dosage of 2 mg/kg of propofol with remifentanil 1microgram/kg (Group I), 2microgram/kg (Group II) or 3microgram/kg (Group III), respectively. No muscle relaxant was administered. Intubating conditions were assessed based on jaw relaxation, vocal cord position, vocal cord movement, airway reaction, and movement of limbs. Intubating conditions, mean arterial blood pressure and heart rate were measured just before induction (T00, baseline), before intubation (T0), 1 minute after intubation (T1), 2 minutes after intubation (T2) and 3 minutes after intubation (T3). RESULTS: Intubating conditions were clinically acceptable in 26.7, 86.7 and 93.3% of patients, after 1, 2 or 3microgram/kg administration of remifentanil, respectively. Clinically acceptable intubating conditions were significantly more in Group II and III when compared with Group I (P<0.05). Both HR (heart rate) and MAP (mean arterial pressure) were significantly lower in Group III when compared with Group I before intubation (T0), 1 minute after intubation (T1), 2 minutes after intubation (T2) and 3 minutes after intubation (T3) (P<0.05). CONCLUSIONS: We conclude that 2-3microgram/kg of remifentanil may reliably provide 'good' to 'excellent' conditions for tracheal intubation when administered after administration of 2 mg/kg propofol. The conditions for intubation were significantly better in patients receiving 2 mg/kg of propofol followed by 2-3microgram/kg of remifentanil than those receiving 1microgram/kg of remifentanil.

A Ratio of Arterial Oxygen Tension to Inspired Oxygen Fraction (PaO2/FiO2 ratio) after Cardiopulmonary Bypass in Coronary Artery Bypass Graft Surgery: Amrinone-Dopamine versus Isosorbide Dinitrate-Dopamine / 대한마취과학회지

BACKGROUND: Cardiopulmonary bypass (CPB) may produce lung injury with decreased PaO2/FiO2 ratio in patients undergoing CABG surgery. We examined PaO2/FiO2 ratio and incidence of PaO2/FiO2 < 300 or 150 to determine the differences in oxygenation with the use of amrinone-dopamine (DP) or isosorbide dinitrate (IDN)-DP in patients undergoing CABG. METHODS: Twenty patients undergoing elective CABG were divided into two groups according to drug used on separation from CPB: IDN-DP (Group 1, n = 10) or amrinone-DP (Group 2, n = 10). Anesthesia was induced and maintained with propofol, fentanyl and vecuronium. IDN infusion (1.0microgram/kg/min) was started preoperatively in both groups. Mild hypothermic CPB was applied with a roller pump and nonpulsatile flow maintained a mean arterial pressure of 60-80 mmHg. In Group 2, amrinone was administered (0.75 mg/kg + 10microgram/kg/min) instead of IDN at the time of CPB separation. DP infusion (3microgram/kg/min) was started at a rectal temperature more than 35.5oC and adjusted to maintain acceptable hemodynamics. IDN-DP or amrinone-DP infusion, monitoring and sedation with propofol were continued in the intensive care unit (ICU). PaO2/FiO2 ratio under controlled ventilation with air/O2 mixture (FiO2 0.6) was checked immediately before CPB (pre-CPB), 30 mins (post-CPB30), 60 mins after CPB (post-CPB60) and 30 mins after admission to ICU (ICU30). RESULTS: There was no significant difference between the groups in the terms of the duration of arotic cross clamp, PaO2/FiO2 at pre-CPB, PaO2/FiO2 at post-CPB60, PaO2/FiO2 at ICU30 or in the incidence of PaO2/FiO2 < 150, PaO2/FiO2 < 300 at ICU30. But there was a significant difference in PaO2/FiO2 post CPB30 (263.3 +/- 105.5 in Group 1 vs. 381.7 +/- 69.5 in Group 2, P<0.05). CONCLUSIONS: Amrinone-DP provides more favorable oxygenation immediately after CPB in CABG surgery than IDN-DP.

Early Recognition of Air Leakage from the Balloon of Pulmonary Artery Catheter during Its Advancement by Transesophageal Echocardiography / 대한마취과학회지

Transesophageal echocardiography (TEE) in addition to the conventional pressure tracing method may enhance a proper insertion of pulmonary artery (PA) catheter by providing information about the real-time location of catheter. We report a case of abrupt air leakage from the balloon of PA catheter during its advancement that was immediately diagnosed by TEE in 54-year-old male with moderate tricuspid regurgitation for elective CABG. Introducer and sheath of PA catheter were inserted in right internal jugular vein. After checking balloon function, connecting distal port to a previously zeroed transducer and confirming the location in right atrium, PA catheter was advanced under direct the visual surveillance by TEE images as well as pressure tracing. During the third trial of catheter advancement through tricuspid valve, multiple air shadows, which convincing balloon leakage, were appeared in right atrium in the view of TEE after inflation of air. We withdrew catheter immediately without any further effort of balloon inflation or advancement, then, balloon leakage and the incapability of balloon expansion were confirmed by saline injection, instead of air, into the balloon port. We replaced the injured PA catheter to new one, and advanced it successfully to the wedged position by the aid of TEE and pressure tracing. We assumed that TEE image might be a beneficial aid to enhancing PA catheter placement in a proper position and preventing possible complications or side effects produced by advancing it with unawareness or delayed recognition of its dysfunction.

Analgesic Effects of Addition of Neostigmine or Morphine into Intraarticular Bupivacaine in Simple Arthroscopic Knee Surgery / 대한마취과학회지

BACKGROUND: Intra-articular (IA) bupivacaine, morphine, or neostigmine were known to produce an analgesic effect in knee arthroscopic surgery. But there were some arguing reports about the analgesic efficacy of addition of morphine or neostigmine into IA bupivacaine and IA administration of these drugs in a simple arthroscopic surgery. We performed this study to determine whether the addition of morphine or neostigmine into IA bupivacaine produces superior analgesic effect or increases patient satisfaction than IA bupivacaine alone. METHODS: Fifty-one patents for simple arthroscopic knee surgery were allocated to 4 groups following their addition into IA 0.5% bupivacaine 20 ml; placebo (Group 1, n = 10), neostigmine 500ng (Group 2, n = 16), morphine 2 mg (Group 3, n = 11) or neostigmine 250ng and morphine 1 mg (Group 4, n = 14). Anesthesia was performed with propofol, fentanyl and vecuronium. The VAS scores and patient satisfaction in 1, 3, 6, 12, and 36 hours after surgery were compared in addition to the side effects between groups. RESULTS: The VAS score of Group 2 (2.6 +/- 0.8), 3 (2.8 +/- 0.4) and 4 (2.3 +/- 0.9) are lower than that of Group 1 (3.3 +/- 0.7) at 1 hour after surgery (P = 0.038). The VAS scores were decreased by the following order: Group 1, Group 2 or 3 and Group 4, at 1 and 24 hours after surgery, (P = 0.048 and 0.036 respectively). The distribution of patient satisfaction was significantly different at 24 hour after surgery (P = 0.036), in which rate of patients showing good or fair in Group 2, 3 and 4 were larger than that of Group 1 (P = 0.057, 0.032 and 0.014, respectively). There was no significant difference in the incidence of side effects between groups. CONCLUSIONS: We concluded that the addition of morphine 2 mg, neostigmine 500ng or each morphine 1 mg and neostigmine 250ng into IA bupivacaine showed a similar analgesic effect, patients satisfaction and side effect during 36-hours postoperative period, compared with IA bupivacaine alone, except for the better analgesic effect in an immediate-postoperative period.

Anesthetic Management of Ovarian Bleeding with Eisenmenger's Syndrome: A case report / 대한마취과학회지

Eisenmenger's syndrome is defined as a high pulmonary vascular resistance associated with pulmonary hypertension or high pulmonary pressure close to systemic values with a reverse or bidirectional shunt at aortopulmonary, interventricular or interatrial levels. We report the case of a 42-year-old woman with an emergency operation for ovarian bleeding with Eisenmenger's syndrome secondary to large VSD. She had abdominal pain and vaginal spotting which developed one month earlier. In a preoperative abdominal ultrasonography, there was a fluid collection on the Cul-de-sac. There was no significant cardiorespiratory symptom except peripheral cyanosis. Anesthesia was performed with fentanyl, midazolam and vecuronium in standard monitorings including pulmonary artery pressure monitoring. Bolus and continuous infusions of amrinone were given to decrease right to left shunt. After the administration of amrinone, PaO2, PaO2/FiO2, P(A-a)O2 and P(a/A)O2 were improved and pulmonary arterial pressure was preferentially decreased compared with systemic arterial pressure. There was no significant problem throughout the operation, a right ovarian wedge resection. She was transferred to the intensive care unit in an intubated state postoperatively and discharged one week later without any complications.

Ibuprofen Potentiates an Analgesic Effect and Hastens a Recovery after Tonsillectomy in Children / 대한마취과학회지

BACKGROUND: Various methods or regimens treating pain after a pediatric tonsillectomy were postulated. Ibuprofen, an NSAIDs, is Known to be useful due to its analgesic effects and safety in a pediatric tonsillectomy. Even though with rapid induction, emergence and nonirritating airway properties, sevoflurane may be associated with a agitation or delirium in a higher incidence compared with halothane in children. We performed this study to determine whether oral ibuprofen could have an influence on characteristics during emergence in addition to analgesic effects after use of sevoflurane/fentanyl in a pediatric tonsillectomy. METHODS: Twenty nine pediatric patients scheduled for a tonsillectomy were assigned into two groups; an oral placebo (Group 1, n = 13) or ibuprofen 5 mg/Kg (Group 2, n = 16) was given 60 min before the operation. Rapid masK induction with sevoflurane and maintenance with sevoflurane, nitrous oxide and fentanyl were performed. After the tonsillectomy, patients were transferred to the PACU with prompt recovery. Postoperative pain and emergence were accessed by using VAS (1-5) and Aldrete scores at 5 min after the discharge from operating room. The incidences of agitation, vomiting and postoperative bleeding in addition to VAS scores and Aldrete scores were compared in both groups. RESULTS: The VAS score in Group 2 (1.69 +/- 0.79) was lower than that of Group 1 (2.85 +/- 1.25) (P < 0.05). Aldrete score in Group 2 (8.69 +/- 0.86) is higher than that of Group 1 (9.88 +/- 0.34) (P < 0.05). There was no significant difference in incidence of agitation (38.5% in Group 1 and 18.8% in Group 2). There was no vomiting and bleeding in either groups. CONCLUSIONS: Preoperative oral ibuprofen potentiates analgesic effects and hastens emergence time without any increase in the incidences of vomiting and bleeding. However ibuprofen does not decrease the incidence of agitation.

A Comparative Study of Postoperative Early Ambulation with Intrathecal Morphine by 27-gauge Whitacre Needle and Bed Rest without Morphine by 25-gauge Quincke Needle / 대한마취과학회지

BACKGROUND: Early ambulation after anorectal surgery may be possible by relieving pain with intrathecal morphine and decreasing headache and backache with a much thinner and pencil-point needle. The difference in urinary peak flow rate in upright posture compared with recumbent position was reported to be highly significant, although acute urinary retention induced by intrathecal morphine may be decreased by early ambulation. METHODS: Eighty patients due for anorectal surgery were selected to receive spinal anesthesia. Subjects in group A (n=40) received 0.5% tetracaine 5 6 mg through a 25-gauge Quinke needle while group B (n=40) received 0.5% tetracaine 5 6 mg and intrathecal morphine 0.2 mg through a 27-gauge Whitacre needle. Postoperatively, group A received 24 hours bed rest and group B was recommended to walk as soon as possible. The duration of pain relief, onset time to ambulation, headache, backache, urinary retention and nausea were observed in both groups. RESULTS: The average onset time of early ambulation and duration of postoperative pain relief in group B was 3.6 +/- 1.0 and 15.1 +/- 3.5 hours respectively. The incidence of postspinal headache and backache was 2.5 and 5.0% in group B respectively and decreased significantly in comparison with group A (20.0 and 22.5%) respectively (P < 0.05). However, the incidence of postoperative nausea was 35.0% in group B and increased in comparison with group A (12.5%) (P < 0.05). Group B yielded a relatively lower urinary retention rate (40.0%) than group A (52.5%), but the difference did not reach statistical significance. CONCLUSIONS: Intrathecal morphine infused by a 27-gauge Whitacre needle provided postoperative pain relief with early ambulation, and decreased headache and backache, but we suggest that there is a need to select another drug or method instead of intrathecal morphine to decrease the incidence of urinary retention and nausea.

Effects of Oral Clonidine and Intravenous Esmolol on Blood Pressure and Heart Rate during Tracheal Intubation / 대한마취과학회지

BACKGROUND: This study was designed to determine the efficacy of a combined use of oral clonidine and intravenous esmolol for blunting the sympathetic response during tracheal intubation. METHODS: Forty-eight patients for hysterectomy were randomly divided into four groups: placebo A and B in Group I (n = 12), placebo A and esmolol (1.0 mg/kg) in Group II (n = 12), clonidine (4 microgram/kg) and placebo B in Group III (n = 12), and clonidine (2 microgram/kg) and esmolol (0.5 mg/kg) in Group IV (n = 12) were administered respectively. Premedication with oral clonidine or placebo A at 90 minutes before induction and intravenous esmolol or placebo B just prior to induction were given. Patients were induced with thiopental and ventilated with N2O-O2-enflurane (1.5 vol%). Vecuronium was given immediately after administration of thiopental for tracheal intubation. BP and HR were recorded at the resting state before premedication (control), at 1 min before induction (T - 1), immediately after intubation (T + 0), 3 min and 5 min after intubation (T + 3 and T + 5), and were converted into a percentage (%) of the control value (Vcontrol). RESULTS: SBP increased in Group I (T + 0 and T + 3) and decreased in Group III (T + 5) compared with Vcontrol (P < 0.05). HR increased in Group I (T + 0 and T + 3) and Group III (T + 0) compared with Vcontrol (P < 0.05). SBP% of Vcontrol in Groups II, III and IV (T + 0 and T + 3) were lower than that of Group I (P < 0.05). HR% of Vcontrol in Group II and IV (T + 0, T + 3 and T + 5) were lower than those of Groups I and III (P < 0.05). There were one episode of hypotension in Group II at 5 min after intubation and two cases of intraoperative hypotension in Group III. CONCLUSIONS: Combined administration of oral clonidine and intravenous esmolol was effective in attenuating the increase of BP and HR during tracheal intubation without any side effects. This combined method would be an effective method when dose-related side effects of each drug limit their use.

Pain Management by the Longitudinal Introducing Method of an Extrapleural Catheter after Thoracotomy / 대한마취과학회지

BACKGROUND: Sufficient accumulations of local anesthetics in the extrapleural space promotes effective access to several intercostal nerves and, consequently, analgesia. The total volume of leakage of these anesthetics from the space can depend on the technique of extrapleural catheter insertion which is chosen. METHODS: Twenty patients due for thoracotomy were randomly selected to be provided with postoperative pain relief by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced at a longitudinal lie in a cephalad direction, before the thoracic cavity was closed. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfactory to patients and thoracic surgeons. The average numbers of analgesic dermatomes obtained by pinprick tests, VAS, and Prince Henry pain scores were 5.2 0.5, 2.0 0.5 cm and 1.6 0.6, respectively. Changes in mean arterial pressure were insignificant, and heart rate increased at the postoperative hours of 1, 4 and 8 (P value < 0.05). FVC and FEV1 were restored to levels up to 67.2 and 71.0% of their preoperative values at the postoperative hour of 48. CONCLUSIONS: These results suggest that the technique of a catheter introduced at a longitudinal lie in a cephalad direction was effective and clinically useful for pain relief following thoracotomy regardless of some leakage of bupivacaine.

Pain Management by the Longitudinal Introducing Method of an Extrapleural Catheter after Thoracotomy / 대한마취과학회지

BACKGROUND: Sufficient accumulations of local anesthetics in the extrapleural space promotes effective access to several intercostal nerves and, consequently, analgesia. The total volume of leakage of these anesthetics from the space can depend on the technique of extrapleural catheter insertion which is chosen. METHODS: Twenty patients due for thoracotomy were randomly selected to be provided with postoperative pain relief by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced at a longitudinal lie in a cephalad direction, before the thoracic cavity was closed. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfactory to patients and thoracic surgeons. The average numbers of analgesic dermatomes obtained by pinprick tests, VAS, and Prince Henry pain scores were 5.2 0.5, 2.0 0.5 cm and 1.6 0.6, respectively. Changes in mean arterial pressure were insignificant, and heart rate increased at the postoperative hours of 1, 4 and 8 (P value < 0.05). FVC and FEV1 were restored to levels up to 67.2 and 71.0% of their preoperative values at the postoperative hour of 48. CONCLUSIONS: These results suggest that the technique of a catheter introduced at a longitudinal lie in a cephalad direction was effective and clinically useful for pain relief following thoracotomy regardless of some leakage of bupivacaine.