Studies of 24 Cases in Continuous Epidural Anesthesia for Cesarean Section in Preeclamptic Parturients / 대한마취과학회지

BACKGROUND: Adequate evaluation and monitoring for pre-eclamptic paturient and capable assistance before induction for anesthesiologist, must be taken to avoid sudden severe maternal hypertension with intubation during a Rapid Sequence intravenous induction. Such event predispose the paturient to intracranial hemorrhage and pulmonary hypertension with pulmonary edema. To diminish danger of hypertension that can be developed during general anesthesia and facilitate control of blood pressure, 24 women presenting for cesarean section were studied. METHODS: All received 17.9+/-2.6ml of 0.5% bupivacaine, including 3ml of test dose, through the epidural catheter inserted in T12-L1 interspace using 18 gauge Tuohy needle to the patients with a lateral decubitus position. We measured blood pressure and heart rate in 5, 10, 15, 20, 30, 45, and 60 minutes after injection of 0.5% bupivacaine and 15 minutes after transferred to recovery room. RESULTS: The blood pressure of the patients started to decrease in 5 minutes and most decreased in 20 minutes after injection, the heart rate had little change but decreased significantly in 45 minutes. Apgar Scores of the neonates at 1 and 5 minutes were 7.3+/-2.0 and 9.2+/-1.5. The patients used ephedrine and crystalloid solution for correction of hypotension were 6 of 24 women and had no any systemic toxicity or neurologic symptoms by local anesthetics(bupivacaine). CONCLUSION: Continuous epidural anesthesia for cesarean section in preeclamptic patients is recommended for safe anesthesia.

Cardiovascular Responses during Fentanyl - O2 Anesthesia for Cardiac Valvular Replacement Operation / 대한마취과학회지

Intravenous administration of high dose of fentanyl is gaining wide popularity as the sole anesthetic agent for patients undergoing cardiac surgery because of its favorable characteristics such as, simplicity, stable hemodynamics and supression or modification of stress response to surgery. But some investigators reported the necessity of supplementary anesthetic agent in addition to fentanyl to maintain hemodynamic stability during the surgical procedure. Therefore, we measured the heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), and rate pressure product(RPP) at induction, tracheal intubation, skin incision, and sternotomy time to evaluate the cardiovascular responses to surgical procedure under fentanyl-O2 anesthesia on 12 patients with acquired valvular heart disease. The patients were anesthetized with a loading dose (30ug/kg fentanyl for induction and 1.5ug/ kg/min until sternotomy) followed by continuous infusion of fentanyl (0.3pg/kg/min until the end of cardiopulmonary bypass.) The patients required total doses of 108+/-4.6ug/kg fentanyl for the entire operation. These measurements were compared with control data (before induction). The results were as followings: 1) During induction (infusion of fentanyl 30ug/kg), HR, SBF, DBP, MAP, and RPP revealed no significant change compared with control data. 2) During intubation and skin incision, HR, SBP, DBP, MAP, and RPP slightly increased but were not statistically significant (p>0.05) 3) During sternotomy, SBP increased from 119.8+/-16.36 torr to 136.5+/-15.22 torr, DBP increased from 79.1+/-12.76 torr to 95.4+/-10.87 torr, MAP increased from 99.4+/-13.96 torr to 115.5+/-12.70 torr, and RPP increased from 10929+/-2206 torr.beats/min to 13889+/-2865 torr. beats/min (p 0.05). 4) One of the patients had recall of the sternotomy and spreading of the chest with the sternal retractor. These data demonstrate that anesthetic doses of fentanyl and O produce minimal change in cardiovascular dynamics during the surgical procedures except sternotomy time. Our findings suggest that fentanyl-O2 anesthesia may be an attractive anesthetic technique in patients with valvular heart disease undergoing valve replacement operations but, will be needed considerations about infusion method, dosage of fentanyl and use of supplementary anesthetic agent according to patients conditions.

The metabolic Effects of Torniquet in the Adult Lower Extremity / 대한마취과학회지

The use of a pneumatic torniquet to obtain a blood less field in the extremities is essential in the precise operations of present-day plastic and orthopedic surgery. There have been studies conducted regarding systemic and metabolic change in response to torniquet ischemia and complication, associated with torniquets have been reported such as injuries to nerves, muscles and blood vessel. The purpose of this investigation was to examine changes in the systemic circulation, blood gases serum potassium and base status on release of torniquet ischemia in adult. The results were as follows: 1) The mean blood pressure and heart rate did not change significantly after torniquet release. 2) The pH decreased significantly after the torniquet release. 3) The PaO2, and PaCO2, did not charge significantly after torniquet release. 4) The HCO3, and BE decreased significantly after torniquet release (P<0.05). 5) The serum potassium levels tended to increase after torniquet release but the changes was not significant. There-fore to minimize the predictable complications, the ventilatory control and rapid volume replacement are needed during the time immediately preceeding and following torniquet release.