The Effects of Combined Spinal Epidural Anesthesia for Lower Extremity Surgery / 대한마취과학회지

BACKGROUND: Spinal anesthesia is a simple technique requiring a small dose of local anesthetic to provide intense and reliable block. And epidural anesthesia with the catheter technique gives a better control of the level of analgesia and a good postoperative pain relief using opioids, local anestheties or both. Therefore, the combined spinal epidural (CSE) anesthesia was evaluated to provide rapid onse of action, good muscle relaxation, prolonged duration of the block and postoperative pain relief. METHODS: All patients were placed in a lateral position. Using a midline approach at L interspace, a 18G Tuohy needle was introduced into the epidural space. A 27G Whitacre spinal needle was passed through the Tuohy needle until free flow cerebrospinal fluid, and than 0.5% heavy bupivacaine 3ml(15mg) was injected. The spinal needle was withdrawn and the epidural catheter was inserted. The dermatome level and time of sensory block was evaluated using loss of sensation of pinprick test every 1 minute for 30 minutes, until the maximum sensory block was established. Motor block was assessed using the Bromage scale. And postoperatively we interviewed the patients for opinioes on the blockade and complication. RESULTS: The mean values of maximum sensory block level were T8 (T8.0+/-1.7 dermatome) and at that time was 8min 30sec (8.5+/-1.2min). The motor blockade of lower extremity was Bromage 3 in all patients. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Subjective evaluation by the patients about postoperative pain control was excellent. CONCLUSIONS: CSE anesthesia appears to combine the reliabiIity and rapid onset of spinal block, and the ability to extend the block and postoperative analgesia by using the epidural catheter while minimizing their drawbacks.

A Comparison of Serum Catecholamine Levels and Cardiovascular Responses during Anesthesia with Propofol or Enflurane / 대한마취과학회지

BACKGROUND: Surgical trauma is a potent stimulus for the neurohormonal axis. The catecholamine response to surgical stress may be modulated by the anesthetic regimen utilized. We compared the hemodynamic response and catecholamine concentration to lower abdominal surgery during anesthesia with propofol or enflurane. METHODS: Forty six patients undergoing lower abdominal surgery were assigned randomly to two groups. In group I, anesthesia was induced with thiopental sodium 5.0mg/kg and maintained with enflurane-N2O. In group II, anesthesia was induced with propofol 2.0mg/kg and maintained with propofol 12 mg/kg/min by infusion pump. Hemodynamic responeses were recorded at tracheal intubation. Blood samples for later determination of plasma catecholamine were drawn and hemodynamic responses were recorded at preinduction, 1 minute after skin incision, 30minutes after skin incision. RESULTS: There was no statistical significance in systolic and diastolic pressure between two groups. There was statistical significance in heart rate 30minutes after skin incision between two groups. There was no statistical significance in epineprine concentration between two groups. There was statistical significance in norepineprine 30 minutes after skin incision between two groups. CONCLUSIONS: Propofol may be useful alternative at lower abdominal surgery and it may be convenient and safe intravenous anesthetics.