Preventive effect of ketamine gargling for postoperative sore throat after endotracheal intubation

BACKGROUND: Postoperative sore throat (POST) is a relatively common complication after endotracheal intubation, and various methods has been proposed to prevent it. In the present study, we assessed the effectiveness of ketamine gargling for reducing POST. METHODS: This study was conducted in a prospective, randomized, placebo-controlled, and single-blinded manner. The study populations consisted of 40 patients between 20 and 60 years old who were classified as American Society of Anesthesiologists physical status I-II and were scheduled for elective laparoscopic cholecystectomy. Patients in group K received ketamine (1 ml, 50 mg) in normal saline (29 ml), and they gargled with the given solution for 30 s before induction. Patients in group C received normal saline (30 ml) and gargled it for 30 s before induction. All patients were interviewed 1, 6, and 24 h after the operation. The visual analog scale (VAS) score of POST was checked. RESULTS: The VAS scores of POST were significantly lower in group K than in group C at 1 and 6 h after the operation. However, there were no significant differences in VAS scores at 24 h after the operation. CONCLUSIONS: Preoperative ketamine gargling temporarily reduced POST in patients that underwent laparoscopic cholecystectomy.

General anesthesia for a patient with multiple system atrophy / 대한마취과학회지

No abstract available.

General anesthesia for a patient with multiple system atrophy / 대한마취과학회지

No abstract available.

Effect of beach chair position on bispectral index values during arthroscopic shoulder surgery / 대한마취과학회지

BACKGROUND: Bispectral index (BIS) monitoring reduces the cases of intraoperative awareness. Several factors can alter BIS readings without affecting the depth of anesthesia. We conducted a study to assess the impact of beach chair position (sitting position) on BIS readings. METHODS: General anesthesia was administered to 30 patients undergoing arthroscopic shoulder surgery. Patients were kept in neutral position (supine) for 10 minutes and BIS readings, mean arterial blood pressure, heart rate, end-tidal carbon dioxide, and end-tidal sevoflurane were recorded. Patients were then shifted to beach chair position. After 15 minutes, data were recorded. RESULTS: A significant decrease in BIS values (P < 0.01) associated with a position change from neutral position to beach chair position was evident. CONCLUSIONS: BIS values are significantly decreased in the beach chair position compared with the neutral position and might affect interpretation of the depth of anesthesia.

Comparison of two topographical airway length measurements in adults / 대한마취과학회지

BACKGROUND: A correct estimate of the tracheal tube insertion depth can prevent complications, including endobronchial intubation and vocal cord trauma. We evaluated a new topographical method for endotracheal tube positioning relative to the carina, using a well-known prior topographical method for comparison. METHODS: One hundred adult (male 50, female 50) patients were studied. The comparison topographic length (in cm) was measured by adding the distance between the right mouth corner and the right mandibular angle to the distance between the right mandibular angle and the center of the sternal manubrium. The new endotracheal tube insertion depth (in cm) was determined by adding the distance between the right mouth corner and the vocal cords, measured with the endotracheal tube itself, to the distance between the thyroid prominence and the manubriosternal joint, and then subtracting 4 cm. After intubation, the endotracheal tube was positioned properly at the right mouth corner and the endotracheal tube tip was evaluated using a fiberoptic bronchoscope at the carina. RESULTS: The distances from the tip of the endotracheal tube to the carina were not significantly different between the methods in the same gender. However, our method allowed endotracheal tube tip placement between 3 cm and 5 cm, above the carina more frequently than the prior method in males. CONCLUSIONS: The new topographical method can be used as a guide to positioning the endotracheal tubes.

Audiovisual stimulation with synchronized pulsed tones and flickering lights set at a delta frequency can induce a sedative effect / 대한마취과학회지

No abstract available.

Effects of the tourniquet deflation on bispectral index during knee arthroscopic surgery under the general anesthesia / 대한마취과학회지

BACKGROUND: Tourniquet deflation during lower extremity surgery affects the hemodynamics and metabolism of the patient, which can affect brain activity. This study examined the changes in brain activity during tourniquet deflation by measuring the bispectral index (BIS). METHODS: The BIS was measured during surgery in forty patients who had received knee arthroscopic surgery under general anaesthesia. The BIS was measured 5 minutes before deflation (DB5) and 5 minutes after deflation (DA5). RESULTS: The BIS at DB5 and DA5 was 50.2 +/- 9.9 and 44.4 +/- 10.4, respectively. The BIS of DA5 was significantly lower than that of DB5 (P < 0.05). CONCLUSIONS: Tourniquet deflation during lower extremity surgery decreases the BIS associated with hemodynamic and metabolic changes. However, its clinical significance in neurologically critical patients, such as geriatric or neurologically disabled patients, remains to be clarified.

Effects of esomeprazole premedication on gastric pH during laparoscopic surgery / 대한마취과학회지

BACKGROUND: The use of CO2 for pneumoperitoneum during laparoscopic surgery provokes a decrement in the gastric pH. Since the incidence rate of PONV increases after laparoscopic surgery, the possibility of lung aspiration of gastric juice with a low pH during a postanesthetic emergence may increase and this could be fatal for the patient. We conducted this study to determine the effects of esomeprazole premedication on inhibiting the decrement of the gastric pH during laparoscopic surgery. METHODS: 40 adult patients with no underlying diseases were chosen and 20 patients each were grouped as C (the control group) and E (the esomeprazole group). In both group, 0.2 mg glycopyrrolate was given intramuscularly 30 minutes prior to the surgery. In group E, esomeprazole was given orally 2 hours prior to the surgery. The pH, PaCO2, and PETCO2 were measured via pH probe, an ABGA and an capnogram at preinsufflation and 15, 30 and 60 minutes after the CO2 insufflation and right before CO2 exhaustion (predeflation). RESULTS: Comparing the measurements of the gastric pH between group E and group C, all the results showed a significant increase in group E (P < 0.05). The difference of the PaCO2 and PETCO2 in the two groups was not significance. CONCLUSIONS: In contrast to the decrease in the gastric pH as the PaCO2 and PETCO2 increased in group C, the gastric pH in group E remained high until the end of the surgery despite the increase in the PaCO2 and PETCO2. Esomeprazole premedication seem to have an effect for inhibiting the gastric pH decrement regardless of the increase in the PaCO2 and PETCO2 during laparoscopic surgery.

The Effects of Perioperative Intravenous Lidocaine Injection on Postoperative Pain following Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Although a laparoscopic cholecystectomy results in less pain than an open cholecystectomy, it is not a pain-free procedure. Therefore, this study was conducted to determine whether perioperative intravenous lidocaine would reduce postoperative pain after a laparoscopic cholecystectomy. METHODS: Fifty patients undergoing laparoscopic cholecystectomy were divided into two groups; a lidocaine group, in which patients were injected with a lidocaine bolus (1.5 mg/kg) and infusion (1.5 mg/kg/h); and a control group, in which patients were injected with the same volume of saline bolus and infusion. Intravenous lidocaine was initiated before anesthesia was administered and continued for 1 hour postoperatively. The intensity of abdominal and shoulder pain was then assessed 1, 6, 12 and 24 hours after surgery and recorded using a visual analog pain score (VAS) and verbal rating score (VRS). RESULTS: The abdominal pain score (VAS and VRS) was significantly lower in the lidocaine group than in the control group at all times evaluated during the first 24 hours after surgery (P < 0.05). In addition, the shoulder pain score and incidence were significantly lower in the lidocaine group than the control group at 12 hours and 24 hours after surgery (P < 0.05). In the lidocaine group, the incidences of epigastric, right flank, and back pain were lower than that of the control group, but these differences were not statistically significant. CONCLUSIONS: Perioperative intravenous lidocaine reduces shoulder and abdominal pain for 24 hours after laparoscopic cholecystectomy.

Measurement of Hemodynamic Changes Caused by Administration of Atracurium Besylate after Pretreatment with Anti-histamine Agent / 대한마취과학회지

BACKGROUND: Hemodynamic changes through the histamine-induced release of atracurium are relatively common, but can be particularly dangerous in hemodynamically unstable patients. This study evaluated the effectiveness of a pretreatment with an anti-histamine agent before the administration of atracurium in the prevention of histamine-induced hemodynamic changes. METHODS: Forty-eight ASA class I and II patients were assigned to four groups. Groups 1 and 2 were assigned to receive atracurium through a bolus 0.5 mg/kg. Groups 3 and 4 were assigned to receive atracurium through a bolus 1.0 mg/kg. Group 1 and 3 were pretreated with pheniramine (H1-blocker) and ranitidine (H2-blocker) intravenously before the induction of general anesthesia. After induction, HemosonicTM 100 was installed and the following hemodynamic parameters were measured: systemic vascular resistance (SVR), cardiac index (CI), heart rate (HR) and blood pressure (BP) immediately before, 1, 2, 3, 5 and 10 min after the rapid administration of the atracurium bolus before the skin incision. RESULTS: Groups 1 and 3 showed more stable hemodynamics than groups 2 and 4. Group 2 showed more significant changes in the SVR, CI, BP, HR than group 1 (P< 0.05). Group 4 showed more significant changes in the SVR, CI, BP, HR than group 3, and some cases were significant hemodynamically (P< 0.05). Group 4 showed more significant changes in the SVR, CI, BP, HR than group 2 (P <0.05). CONCLUSIONS: Pretreatment with an anti-histamine drug prior to the administration of atracurium can be effective in attenuating the hemodynamic responses.

The Effects of Continuous Nicardipine Infusion on Blood Pressure and Heart Rate during Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Laryngoscopy and tracheal intubation often induced an undesirable increase in blood pressure and heart rate. We evaluated the preventing effect of nicardipine infusion on the increase of the blood pressure (BP) and heart rate (HR) following a direct laryngoscopy and tracheal intubation. METHODS: Sixty, ASA physical status 1-2, adult patients were selected with informed consent, and randomly allocated into two groups; control group (n = 30) and nicardipine group (n = 30). In the control group, 1.8 ml/kg/h of normal saline was infused, and in the nicardipine group, 5microgram/kg/min of nicardipine was infused continuously from 2 minutes before intubation to 3 minutes after intubation. BP and HR were measured by non-invasive method after arrival at the operating room, before tracheal intubation, shortly after tracheal intubation, and 1, 3, 5, and 10 minutes following intubation. Data were analyzed by repeated measure of ANOVA and t-test. RESULTS: Systolic and diastolic BP were significantly lower in the nicardipine group than in the control group (P < 0.05). HR showed significantly higher value in the nicardipine group (P < 0.05). CONCLUSIONS: The continuous infusion of nicardipine (5microgram/kg/min) was effectively attenuating an increase of BP during tracheal intubation. But the increase in HR is not blunted by nicardipine infusion and there is a significant increase in HR. Although rate-pressure product (RPP) does not increase, the use of nicardipine for blunting hemodynamic responses should be considered carefully in patients with ischemic heart disease.

Comparison of Dexamethasone with Ondansetron for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy

BACKGROUND: Postoperative nausea and vomiting (PONV) are very common side effects of laparoscopic procedures. The aim of this study was to compare the effectiveness of dexamethasone with that of ondansetron in prevention of PONV after laparoscopic cholecystectomy. METHODS: Seventy-five ASA class 1, 2 patients planned for laparoscopic cholecystectomy were assigned to receive intravenously either dexamethasone 5 mg (dexamethasone group, n = 25), ondansetron 4 mg (ondansetron group, n = 25), or normal saline 2 ml (control group, n = 25) just after induction of general anesthesia. During the maintenance, end-tidal carbon dioxide tension was controlled to maintain 35-40 mmHg and intraabdominal pressure was controlled to maintain 12 mmHg. Patient's nausea and vomiting were observed in the recovery room just after operation and 6 h, 12 h and 24 h after operation. RESULTS: Incidences of PONV were significantly lower in dexamethasone group and ondansetron group than control group. However there was no significant difference between the two antiemetic groups. CONCLUSIONS: Both of dexamethasone and ondansetron were effective for the prevention of PONV after laparoscopic cholecystectomy.

Anesthetic Management of a Patient with Proteus Syndrome: A case report / 대한마취과학회지

Proteus syndrome is a rare condition that can be loosely categorized as a hamartomatous disorder. It is a complex disorder with multisystem involvement and great clinical variability. At this time, it is unknown how many individuals have Proteus syndrome, since not all cases of Proteus syndrome are documented. We do not know whether anesthetic problems in Proteus syndrome are common or not, but as there is a high incidence of cervical spine involvement, we anticipate significant anesthetic problems. We experienced such a case under general anesthesia for liposuction to lipomatosis in the posterior neck and right upper back, in a 18-year-old boy with Proteus syndrome. We report this case of Proteus syndrome and review the literature on this rare disease.

The Effect of Metoclopramide or Lidocaine Pretreatment on Pain during Rocuronium Injection / 대한마취과학회지

BACKGROUND: Rocuronium has a high incidence of inducing pain by intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effects of lidocaine and metoclopramide pretreatments on rocuronium injection pain. METHODS: Ninety healthy patients scheduled for general anesthesia were randomly divided into three groups; a saline group (n = 30), a lidocaine group (n = 30), and a metoclopramide group (n = 30). Each patient received 2 ml of pretreatment solution (normal saline, 2% lidocaine, or 0.5% metoclopramide) via an 18 G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, and this was followed by an intravenous injection of 0.6 mg/kg of rocuronium. General anesthesia then induced with thiopental sodium (5 mg/kg). The assessment of pain was made at the induction of anesthesia and in the recovery room, and the severity of pain was classified as none, mild, moderate, or severe by an observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine and metoclopramide groups compared with the saline group at the induction of anesthesia (P < 0.05), but no significant difference was observed between the lidocaine and metoclopramide groups. Similar results were obtained in the recovery room; one patient in each of the saline and metoclopramide groups had no recall regarding injection pain. CONCLUSIONS: Intravenous metoclopramide pretreatment is as effective as intravenous lidocaine pretreatment for alleviating rocuronium injection pain.

The Heart Rate Response to Intravenous Atropine during Propofol or Enflurane Anesthesia / 대한마취과학회지

BACKGROUND: Propofol increases the risk of bradycardia compared with other anesthetics. This paper reports the heart rate response to intravenous atropine during propofol and enflurane anesthesia. METHODS: Sixty patients undergoing a transabdominal hysterectomy under general anesthesia were randomly assigned to two groups: the propofol group and the enflurane group. All the patients received midazolam 2 mg intramuscularly and were then anesthetized with propofol or enflurane. The blood pressure and heart rate were taken at 1 min intervals for 10 min after a bolus injection of atropine 5microgram/kg. RESULTS: In the enflurane group, the systolic blood pressure and heart rate were increased significantly at 1, 2 and 3 min after the atropine injection (P<0.05). When the two groups were compared, the heart rate in the enflurane group was significantly higher at 1, 2 and 3 min after atropine injection than in the propofol group (P<0.05). CONCLUSIONS: The heart rate response to intravenous atropine during propofol anesthesia is attenuated compared with enflurane anesthesia.

Effect of Ondansetron and Lidocaine on Vascular Pain Associated with Intravenous Propofol Injection / 대한마취과학회지

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of ondansetron pretreatment on propofol injection pain. METHODS: Ninety healthy female patients scheduled for general anesthesia were randomly divided into three groups; saline group (n = 30), lidocaine group (n = 30) and ondansetron groups (n = 30). Each patient received 2 ml of pretreatment solution (normal saline, 1% lidocaine, ondansetron) via 18 G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, followed by intravenous injection of 2.5 mg/kg of propofol. The assessment of pain was made at the induction of anesthesia and in the recovery room and the severity of pain was classified as none, mild, moderate, severe by one observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine group and the ondansetron group compared with the saline group at the induction of anesthesia (P < 0.05) and there was no significant difference between the lidocaine group and ondansetron group. We had similar results in the recovery room and one patient from the saline group and two patients from the ondansetron group had no recall regarding injection pain. CONCLUSIONS: Intravenous ondansetron pretreatment is as effective as intravenous lidocaine pretreatment in alleviating the propofol injection pain.

Effect of Covering the Head and Face on Intra-operative Core Temperature / 대한마취과학회지

BACKGROUND: Hypothermia is a common complication of anesthesia and surgery. Because maintenance of the body temperature is an important aspect of anesthesia management, various methods have been used to prevent its occurrence. Covering the patient's skin surface with cloth is believed to prevent intra-operative hypothermia. So, we evaluated the efficacy of covering the head and face with a towel and sheet. METHODS: Sixty patients for abdominal surgery were assigned randomly to a control group or a covered group. After the induction of anesthesia, all patients were covered with towels and sheets as usual. In covered group of patients, the head and face were covered fully. Core temperature was measured at the esophagus continuously and recorded at 15 min intervals for 90 min and then at 30 min intervals over 90-240 min. Room temperature was 23-24 degrees C. RESULTS: Esophageal temperature after 90 min in the covered group was higher than in the control group (P < 0.05). Hypothermia occurred after 45 min in the control group and after 90 min in the covered group. CONCLUSIONS: Covering the patient's head and face helps maintain intra-operative core temperature.

An Anesthetic Management of a Patient with Parkinson's Disease Who Underwent Whipple's Operation by Enteral Levodopa Administration / 대한마취과학회지

Parkinson's disease is a relatively common neurologic disorder that afflicts approximately 1% of the population over 50 years old. Many drugs currently used for the treatment of Parkinson's disease may interact with anesthetic drugs. Brief interruption of levodopa during surgery may result in exacerbation of Parkinson's symptoms. However, safe and effective way to administer levodopa during surgery are not widely known. We report the perioperative treatment of a patient with Parkinson's disease by using intraoperative administration of levodopa through nasogastric tube and feeding jejunostomy tube. This method of levodopa administration successfully prevented the exacerbation of Parkinsonian symptoms.

Effects of Intraperitoneal Lidocaine on Abdominal and Shoulder Pain after a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Although a laparoscopic cholecystectomy results in less pain than an open cholecystectomy, it is not a pain-free procedure. A controversy exists over the effectiveness and clinical value of intraperitoneal local anesthetics for treating pain after a laparoscopic cholecystectomy. We investigated the effects of intraperitoneal lidocaine on pain after a laparoscopic cholecystectomy. METHODS: Forty patients were randomly assigned to receive 200 ml saline containing 200 mg lidocaine or the same volume of saline instilled under the right hemidiaphragm and cholecystectomy site at the end of surgery. Intensity of abdominal and shoulder pain were assessed 0, 1, 6, 12, 24 and 48 hours after surgery and recorded on a visual analog scale (VAS) and verbal rating scale (VRS). RESULTS: The abdominal pain scores (VAS and VRS) were significantly lower in the lidocaine group than the control group at 0 - 24 hours after surgery (P < 0.05). The shoulder pain scores and incidence were significantly lower in the lidocaine group than the control group at 6 - 12 hours after surgery. In the lidocaine group, the incidence of epigastric and right flank pain were significantly lower than the control group. CONCLUSIONS: Intraperitoneal instillation of lidocaine significantly reduces shoulder and abdominal pain for 24 hours after a laparoscopic cholecystectomy.

Role of Fiberoptic Bronchoscopy in Conjunction with the Use of a Single Lumen Tube with Bronchial Blocker for Thoracic Anesthesia / 대한마취과학회지

BACKGROUND: Fiberoptic bronchoscopy has been recommended to verify the position of single lumen tubes with bronchial blockers (Univent(R) tube), but this remains controversial. The authors studied the role of a bronchoscopy for placing and monitoring bronchial blockers (BB) after blind intubation and after positioning the patient. METHODS: One hundred patients having thoracic surgery requiring a Univent tube insertion were prospectively studied. After "blind" tracheal intubations with Univent tubes, BB were advanced in the left-side mainstem bronchus for 60 patients and the right-side for 40 patients. A bronchoscopy was performed after conventional clinical verification of correct placement and after patient positioning for a thoracotomy. A BB was considered malpositioned when it had to be moved < 0.5 cm to correct its position. RESULTS: After "blind" BB intubation, clinical evidence of malpositioning was found in 5 patients. This was confirmed by fiberoptic assessment. In 95 patients in whom placement was judged correct by clinical assessment, malpositioning was detected by bronchoscopy in 39 cases. After patient positioning, BB were found to be displaced in 29 patients. Right-side BB were significantly more likely to be malpositioned than were left-side BB. CONCLUSIONS: After blind intubation and patient positioning, more than one third of BB required repositioning. A routine bronchoscopy is therefore recommended after intubation and after patient positioning.