Laparoscopic cholecystectomy under epidural anesthesia: a clinical feasibility study / 대한마취과학회지

BACKGROUND: Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. METHODS: Twelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC. RESULTS: LC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention. CONCLUSIONS: Epidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.

Effects of Pinacidil, Tetrathylammonium and Glibenclamide on Hypoxic Vasoconstriction in Isolated Perfused Rabbit Lungs / 대한마취과학회지

BACKGROUND: This study investigated the effects of the K+ channel opener, pinacidil on hypoxic pulmonary vasoconstriction in isolated perfused rabbit lungs. In order to evaluate the vasodilatation mechanism of K+ channel opener, we also studied the effects of two K+ channel blocker, tetraethylammonium (TEA), a Ca2+ activated K+ channel blocker and glibenclamide (GLB), an ATP-sensitive K+ channel blocker. METHODS: Isolated lungs from white rabbits were ventilated with a normoxic gas (21%O2-5%CO2-74%N2) and a hypoxic gas (3%O2- 5%CO2-92%N2) alternatively, and then perfused with blood-containing perfusate solution. After a hypoxic pressor response (HPR) had been obtained, various drugs were added to the perfusate reservoir to achieve the predetermined circulating concentration, and the influences of the drugs on HPR were then tested. RESULTS: Pinacidil (0.3-6.0 mcM) produced a dose-dependent pulmonary vasodilation on hypoxic ventilation challenge. TEA (1 mM) caused pulmonary vasoconstriction in normoxic ventilation and potentiated a hypoxic pressor response. When the hypoxic pressor response was potentiated by TEA, pinacidil (1.0, 3.0 mcM) reduced the contraction, but GLB did not cause pulmonary vasoconstriction under normoxic ventilation, potentiate a hypoxic pressor response. CONCLUSIONS: Piacidil is capable of opposing the pulmonary responses of acute hypoxia. Moreover the effects of TEA and GLB suggest that HPV might be mediated through Ca2+ activated K+ channels, not through ATP-sensitive K+ channels.

Comparison of Autotransfusion with Homologous Transfusion in Spinal Surgery / 대한정형외과학회잡지

Autotransfusion has been used widely in surgical patients for the purpose of preventing complications associated with homologous transfusion. Recently it has been drawing much attention for the fear of transfusion-transmitted disease, especially AIDS. So we reviewed 54 patients who were trated with spinal surgery to investigate the safety and efficacy of autotransfusion. Among them, 26 patients were transfused with autologous blood with various combinations of its methods,l patient with both autologous and homologous blood and other 27 patients were transfused with homologous blood. We analyzed perioperative changes of complete blood count, transfusion amount and postoperative drainage amount. And we investigated the occurrence of complications associated with transfusion. In our study, 26 of 27 in autotransfusion group need no more homologous blood transfusion additionally and had no complication associated with transfusion. Autotransfusion group showed smaller amount and shorter period of postoprative Hemovac drainage than homologous transfusion group. And perioperative decrease of hemoglobin in autotransfusion group was smaller than that of homologous transfusion group. In conclusion, autotransfusion was carried out safely in orthopedic surgery such as spinal surgery when transfusion was expected, and so we recommend autotransfusion as a method of transfusion by which the complications of homologous transfusion can be averted.

Induced Hypotension by Labetalol during Spine Surgery / 대한마취과학회지

The effect of labetalol on induced hypotension was studied in 13 patients undergoing major spine surgery. Hypotension was induced with initial dose of labetalol 0.4 mg/kg i.v. followed by 0.01 mg/kg/min i.v.infusion. BP, HR, and CVP were measured before, during, and after hypotension. Anesthesia was maintained with isoflurane (0.5-2 vol%) and N2O in 50% O2 supplemented by pancuronium. The time to systolic BP 75-85 mmHg or mean BP 55-65 mmHg was 18.5+/-2.8min and the time for systolic BP to recover 90% of prehypotensive value was 45.5+/-4.2 min. Heart rate was reduced signiTicantly after hypotension but remained stable at 80-90 beats/min thereafter. Central venous pressure showed no significant change irrespective of hypotension. The results suggest that combined use of fentanyl with labetalol or disuse of pancumnium may reduce the required dose of labetalol.

Experience of Autotransfusion in Spinal Surgery / 대한마취과학회지

Autotransfusion has been used widely in surgical patients for the purpose of preventing complications associated with homologous transfusion. Recently it has been drawing much attention for the fear of transfusion-transmitted disease, especially AIDS. So we studied about the auto-transfusion applied to spinal surgical patients with various combinations of its methods in each patient. We measured perioperative changes of complete blood count associated with autotrans-fusion and the amount of blood salvaged by intra-and postoperative autotransfusion. And we scrutinized the occurrence of complications associated with transfusion. After presurgical blood deposit of 3 units (n=12), hemoglobin and hematocrit levels decreased to 12.0+/-1.2 gm% and 35.5+/-2.6% while the initial levels were 14.0+/-1.1 gm% and 40.6+/-2.8% respectively. The average salvaged blood volume during operation by Cell Saver (Haemonetics, USA) was 300+/-110 ml (n=14) and postoperatively salvaged blood volume using Orth-evac(TM) was 313+/-114 ml (n=14). Of those who received postoperative autotransfusion (n=l4), 2 patients revealed febrile reaction immediately after transfusion, but fever subsided thereafter without specific treatment. In conclusion, autotransfusion was carried out safely in operations when transfusion was expected, and so we recommend autotransfusion as a method of transfusion by which the complications of homologous transfusion can be averted.

Experience of Autotransfusion in Spinal Surgery / 대한마취과학회지

Autotransfusion has been used widely in surgical patients for the purpose of preventing complications associated with homologous transfusion. Recently it has been drawing much attention for the fear of transfusion-transmitted disease, especially AIDS. So we studied about the auto-transfusion applied to spinal surgical patients with various combinations of its methods in each patient. We measured perioperative changes of complete blood count associated with autotrans-fusion and the amount of blood salvaged by intra-and postoperative autotransfusion. And we scrutinized the occurrence of complications associated with transfusion. After presurgical blood deposit of 3 units (n=12), hemoglobin and hematocrit levels decreased to 12.0+/-1.2 gm% and 35.5+/-2.6% while the initial levels were 14.0+/-1.1 gm% and 40.6+/-2.8% respectively. The average salvaged blood volume during operation by Cell Saver (Haemonetics, USA) was 300+/-110 ml (n=14) and postoperatively salvaged blood volume using Orth-evac(TM) was 313+/-114 ml (n=14). Of those who received postoperative autotransfusion (n=l4), 2 patients revealed febrile reaction immediately after transfusion, but fever subsided thereafter without specific treatment. In conclusion, autotransfusion was carried out safely in operations when transfusion was expected, and so we recommend autotransfusion as a method of transfusion by which the complications of homologous transfusion can be averted.

The Dosage of Sodium Nitroprusside and its Effects on the Cardiovascular System for Deliberate Hypotension in Halothane Anesthesia / 대한마취과학회지

The effects of deliberate hypotension by sodium nitroprusside (SNP) on the cardiovascular system and dosage of SNP were studied in 10 patients undergone Cotrel-Dubousset instrumentation for the operative treatment of scoliosis, spinal stenosis or herniated intervertebral disc. Mean arterial pressure decreased significantly (p0.05), r= -0.2 (p>0.05), and r= - 0.25 (p>0.05) respectively. The amount of whole blood transfused during the operation was 5. 3+/-1 .7 units. Hemoglobin and hematocrit decreased significantly (p<0.05) from 11.3+/-1.3g/dl and 33.7+/-4.1% to 10.1+/-1.5g/dl and 30+/-4.1% during operation.