Comparative Effects of Continuous Epidural Morphine with Bupivacaine Mixture Infusion and Intramuscular Meperidine on Pulmonary Function after Upper Abdominal Surgery / 대한마취과학회지

BACKGROUND: Pain after upper abdominal surgery may cause shallow and rapid breathing, resulting in postoperative pulmonary complications. Intramuscular injection of narcotics may increase mortality and morbidity of pulmonary complications. Continuous epidural infusion of opioid with local anesthetic mixture may produce good analgesic action without hypoventilation and hypoxia. METHODS: Forty patients for upper abdominal surgery, chosen at random, were studied for postoperative pain relief. In grouop 1 (n=20), pain was managed by intramuscular injection with meperidine and in group 2 (n=20), it was managed by continuous thoracic epidural block with morphine and bupivacaine mixture. In both groups, pulmonary functions were assessed before operation, on the 1st postoperative day. the 2nd day and the 3rd day. RESULTS: In group 1 and 2, On the 1st postoperative day, FEV was 32.1% and 45.4% of the preoperative value, FVC was 31.9% and 42.4% and MEF was 34.4% and 46.7%, respectively(P<0.05). On the 2nd postoperative day, FEV was 38.6% and 54.8%(P<0.01), PEF was 31.7% and 42.5%, FVC was 37.1% and 49.8% and MEF was 43.2% and 59.6%(P<0.05). on the 3rd postoperative day, FEV was 46.3% and 68.7%, PEF was 38.7% and 54.4%, FVC was 43.8% and 63.1%(P<0.01) MEF was 56.1% and 69.7% of the preoperative value(P<0.05). CONCLUSIONS: As a result of pulmonary function test, we suggest that continuous epidural infusion of morphine with bupivacaine mixture will be an appropriate way of postoperative pain relief methods, with its potential effectiveness in aged, smoking, obese and debilitated patients with ventilatory dysfunction.

Cardiovascular effects of esmolol, lidocaine and fentanyl on endotracheal intubation in hypertensive patient / 대한마취과학회지

This study is designed to compare the effectiveness of single-bolus lidocaine, fentanyl and esmolol at the time of postintubation to blunt the hemodynamic intubation response in hypertensive patients. Sixty mildly hypertensive patients, scheduled for elective surgery, were randomly assigned in a double blind to receive a preintubation dose : in the firat group(Group A),20 patients received 1.5mg/kg lidocaine ; in the second group(Group B), another 20 patients received 3 ug/kg fentanyl; and in the third group(Group C), another 20 patients received 100mg esmolol. Within the above mentioned framework, this study obtained the following results : Systolic arterial pressure (SAP), heart rste (HR) and rate-pressure product (RPP) all significantly increased 1 minute after intubation. Fentanyl was more effective in protecting sgainst increase in SAP than lidocaine, which proves to be significant as shown in P<0.05. The statistical result, however, did not show the effectiveness of fentanyl signifieantly differed from that of esmolol in this respect. Esmolol preloading was significantly more effective in blunting hesrt rate than any other drugs. On the other hand, preloading of esmolol or fentanyl was significantly more effective in blunting rate-pressure product thsn lidocaine,which turned out to be P <0.05. Given these results, the present study concludes that esmolol preloading provides a reliable protection against increases in both heart rate and systolic srterial pressure accompanying laryngoscopy and intubation in hypertensive patients.