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1.
Korean Journal of Anesthesiology ; : 300-304, 2018.
Artigo em Inglês | WPRIM | ID: wpr-716346

RESUMO

BACKGROUND: The aim of this study was to develop a formula guiding the peripherally inserted central catheter (PICC) tip placement based on anatomical landmarks such as the upper arm, clavicle, and sternum as well as the patient’s height, weight, and body mass index. METHODS: Fifty-five patients who were scheduled to have PICCs were included in the study. We measured four distances along the passage of the PICC, which were as follows; the tip of the third finger to the middle of the elbow crease (Distance A), the middle of the elbow crease to the acromion process (Distance B), the acromion process to the sternal head of the clavicle (Distance C), and the sternal head of the clavicle to the end of the xiphoid process (Distance D). The lengths from the elbow creases to their carina bifurcations as determined by fluoroscopy during PICC insertions were recorded and used as reference. RESULTS: The formula for determining PICC depth based on the four distances was determined by regression analysis. The optimal formula was determined to be 25.3 + 0.5 × (Distance C) + 0.6 × (Distance D) which yielded an R2 value of 0.3. CONCLUSIONS: The formula proposed for proper depth of the adult, 25.0 + 0.5 × (clavicle length) + 0.6 × (sternum length) for PICC insertion can be used to place the tip at the carina bifurcation level. The distance from elbow crease to catheter insertion point should be added to the length generated by this formula.


Assuntos
Adulto , Humanos , Acrômio , Pontos de Referência Anatômicos , Braço , Índice de Massa Corporal , Cateterismo Periférico , Catéteres , Clavícula , Cotovelo , Dedos , Fluoroscopia , Cabeça , Análise de Regressão , Esterno
2.
Korean Journal of Anesthesiology ; : 307-307, 2016.
Artigo em Inglês | WPRIM | ID: wpr-26716

RESUMO

In the original article contained an error in Accepted date.

3.
Yonsei Medical Journal ; : 1421-1429, 2014.
Artigo em Inglês | WPRIM | ID: wpr-44320

RESUMO

PURPOSE: Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications. MATERIALS AND METHODS: A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer's Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded. RESULTS: The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications. CONCLUSION: BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anestésicos Intravenosos/administração & dosagem , Monitores de Consciência , Endoscopia/métodos , Complicações Intraoperatórias/prevenção & controle , Monitorização Fisiológica/métodos , Piperidinas/administração & dosagem , Propofol/administração & dosagem
4.
Yonsei Medical Journal ; : 800-806, 2014.
Artigo em Inglês | WPRIM | ID: wpr-159369

RESUMO

PURPOSE: This analysis was done to investigate the optimal regimen for fentanyl-based intravenous patient-controlled analgesia (IV-PCA) by finding a safe and effective background infusion rate and assessing the effect of adding adjuvant drugs to the PCA regimen. MATERIALS AND METHODS: Background infusion rate of fentanyl, type of adjuvant analgesic and/or antiemetic that was added to the IV-PCA, and patients that required rescue analgesics and/or antiemetics were retrospectively reviewed in 1827 patients who underwent laparoscopic abdominal surgery at a single tertiary hospital. RESULTS: Upon multivariate analysis, lower background infusion rates, younger age, and IV-PCA without adjuvant analgesics were identified as independent risk factors of rescue analgesic administration. Higher background infusion rates, female gender, and IV-PCA without additional 5HT3 receptor blockers were identified as risk factors of rescue antiemetics administration. A background infusion rate of 0.38 microg/kg/hr [area under the curve (AUC) 0.638] or lower required rescue analgesics in general, whereas, addition of adjuvant analgesics decreased the rate to 0.37 microg/kg/hr (AUC 0.712) or lower. A background infusion rate of 0.36 microg/kg/hr (AUC 0.638) or higher was found to require rescue antiemetics in general, whereas, mixing antiemetics with IV-PCA increased the rate to 0.37 microg/kg/hr (AUC 0.651) or higher. CONCLUSION: Background infusion rates of fentanyl between 0.12 and 0.67 microg/kg/hr may safely be used without any serious side effects for IV-PCA. In order to approach the most reasonable background infusion rate for effective analgesia without increasing postoperative nausea and vomiting, adding an adjuvant analgesic and an antiemetic should always be considered.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Analgesia Controlada pelo Paciente/efeitos adversos , Fentanila/administração & dosagem , Estudos Retrospectivos , Fatores Sexuais
5.
Yonsei Medical Journal ; : 1273-1281, 2013.
Artigo em Inglês | WPRIM | ID: wpr-74272

RESUMO

PURPOSE: Opioid-based intravenous patient-controlled analgesia (IV PCA) is popular method of postoperative pain control, but many patients suffer from IV PCA-related postoperative nausea and vomiting (PONV). In this retrospective observational study, we have determined independent predictors of IV PCA-related PONV and predictive values of the Apfel's simplified risk score in pursuance of identifying high-risk patients. MATERIALS AND METHODS: We analyzed 7000 patients who received IV PCA with background infusion after elective surgery. Patients who maintained IV PCA for a postoperative period of 48 hr (completion group, n=6128) were compared with those who have discontinued IV PCA within 48 hr of surgery due to intractable PONV (cessation group, n=872). Patients, anesthetics, and surgical factors known for predicting PONV were evaluated by logistic regression analysis to identify independent predictors of IV PCA related intractable PONV. RESULTS: In a stepwise multivariate analysis, weight, background infusion dose of fentanyl, addition of ketolorac to PCA, duration of anesthesia, general anesthesia, head and neck surgery, and Apfel's simplified risk score were revealed as independent risk factors for intractable PONV followed by the cessation of IV PCA. In addition, Apfel's simplified risk score, which demonstrated the highest odds ratio among the predictors, was strongly correlated with the cessation rate of IV PCA. CONCLUSION: Multimodal prophylactic antiemetic strategies and dose reduction of opioids may be considered as strategies for the prevention of PONV with the use of IV PCA, especially in patients with high Apfel's simplified risk scores.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Analgesia Controlada pelo Paciente/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Antieméticos/administração & dosagem , Fentanila/administração & dosagem , Análise Multivariada , Razão de Chances , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
6.
Korean Journal of Anesthesiology ; : 317-321, 2013.
Artigo em Inglês | WPRIM | ID: wpr-100102

RESUMO

BACKGROUND: Hypotension is a common phenomenon after spinal anesthesia in hypertensive patients. We investigated whether heart rate variability could predict the occurrence of hypotension after spinal anesthesia in hypertensive patients. METHODS: Forty-one patients undergoing spinal anesthesia were included. Heart rate variability was measured at five different time points such as before fluid loading (baseline), after fluid loading as well as 5 min, 15 min and 30 min after spinal anesthesia. Fluid loading was performed using 5 ml/kg of a crystalloid solution. Baseline total power and low to high frequency ratio (LF/HF) in predicting hypotension after spinal anesthesia were analyzed by calculating the area under the receiver operating characteristic curves (AUC). RESULTS: Moderate hypotension, defined as a decrease of mean arterial pressure to below 20-30% of the baseline, occurred in 13 patients and severe hypotension, defined as a decrease of mean arterial pressure greater than 30% below the baseline, occurred in 7 patients. LF/HF ratiosand total powers did not significantly change after spinal anesthesia. AUCs of LF/HF ratio for predicting moderate hypotension was 0.685 (P = 0.074), severe hypotension was 0.579 (P = 0.560) and moderate or severe hypotension was 0.652 (P = 0.101), respectively. AUCs of total power for predicting moderate hypotension was 0.571 (P = 0.490), severe hypotension was 0.672 (P = 0.351) and moderate or severe hypotension was 0.509 (P = 0.924), respectively. CONCLUSIONS: Heart rate variability is not a reliable predictor of hypotension after spinal block in hypertensive patients whose sympathetic activity is already depressed.


Assuntos
Humanos , Raquianestesia , Área Sob a Curva , Pressão Arterial , Frequência Cardíaca , Coração , Hipertensão , Hipotensão , Soluções Isotônicas , Sistema Nervoso Parassimpático , Curva ROC , Sistema Nervoso Simpático
7.
The Korean Journal of Pain ; : 39-45, 2013.
Artigo em Inglês | WPRIM | ID: wpr-40591

RESUMO

BACKGROUND: Good postoperative pain control is an important part of adequate postoperative care. Patient-controlled epidural analgesia (PCEA) provided better postoperative analgesia compared to other conventional analgesic methods, but several risks have been observed as well. We therefore surveyed the efficacy and safety of PCEA in this retrospective observational study. METHODS: We analyzed collected data on 2,276 elective surgical patients who received PCEA with ropivacaine and fentanyl. Patients were assessed by a PCA service team in the post-anesthesia care unit (PACU), at 1-6 h, 6-24 h, and 24-48 h postoperatively for adequate pain control. The presence of PCEA-related adverse events was also assessed. RESULTS: Numerical pain score (median [interquartile range]) were 3 [1-4], 5 [4-7], 4 [3-5], and 3 [3-5] in the PACU, at 1-6 h, 6-24 h, and 24-48 h postoperatively. Median pain scores in patients underwent major abdominal or thoracic surgery were higher than other surgical procedure in the PACU, at 1-6 h after surgery. Nausea and vomiting (20%) and numbness and motor weakness (15%) were revealed as major PCEA-related adverse events during the postoperative 48 h period. There were 329 patients (14%) for whom PCEA was ceased within 48 h following surgery. CONCLUSIONS: Our data suggest that the use of PCEA provides proper analgesia in the postoperative 48 h period after a wide variety of surgical procedures and that is associated with few serious complications. However, more careful pain management and sustainable PCEA monitoring considering the type of surgical procedure undergone is needed in patients with PCEA.


Assuntos
Humanos , Amidas , Analgesia , Analgesia Epidural , Analgesia Controlada pelo Paciente , Fentanila , Hipestesia , Náusea , Manejo da Dor , Dor Pós-Operatória , Anafilaxia Cutânea Passiva , Cuidados Pós-Operatórios , Estudos Retrospectivos , Cirurgia Torácica , Vômito
9.
Korean Journal of Anesthesiology ; : 465-468, 2012.
Artigo em Inglês | WPRIM | ID: wpr-227532

RESUMO

Relapsing polychondritis is a rare disease characterized by progressive inflammation and destruction of cartilaginous structures such as ears, nose, and tracheolaryngeal structures. As a result, tracheolaryngeal involvement makes anesthetic management a challenge. Anesthetic management of a patient with relapsing polychondritis may encounter airway problems caused by severe tracheal stenosis. We present the case of a 60-year-old woman with relapsing polychondritis who underwent wedge resection of the stomach under epidural analgesia. Thoracic epidural blockade of the T4-10 dermatome was achieved by epidural injection of 7 ml of 0.75% ropivacaine and 50 microg of fentanyl. The patient was tolerable during the operation. We suggest that epidural analgesia may be an alternative to general anesthesia for patients with relapsing polychondritis undergoing upper abdominal surgery.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Amidas , Analgesia Epidural , Anestesia Geral , Orelha , Fentanila , Inflamação , Injeções Epidurais , Nariz , Policondrite Recidivante , Doenças Raras , Estômago , Estenose Traqueal
10.
Korean Journal of Anesthesiology ; : 201-204, 2011.
Artigo em Inglês | WPRIM | ID: wpr-229282

RESUMO

BACKGROUND: The purpose of this study was to compare the effectiveness of the trapezius squeezing test with that of the jaw thrust maneuver as clinical indicators of adequate conditions for laryngeal mask airway (LMA) insertion in adults under sevoflurane anesthesia. METHODS: One hundred adult patients of ASA physical status 1 or 2 undergoing minor surgical procedures were randomly allocated to the T (trapezius squeezing, n = 50) group or the J (jaw thrust, n = 50) group. The LMA was inserted immediately after the loss of response to trapezius squeezing or jaw thrust. Successful and unsuccessful attempts were recorded. An unsuccessful attempt was defined as the occurrence of coughing, gagging, gross purposeful movements, breath-holding, laryngospasm, or an SpO2 < 90% during LMA insertion. Insertion time, end-tidal sevoflurane concentration, mean arterial pressure, and heart rate were recorded. RESULTS: The incidence of successful attempts was significantly higher in the T than in the J group (48/50 vs. 36/50, respectively). CONCLUSIONS: The trapezius squeezing test is a superior indicator of an adequate condition for LMA insertion compared to the jaw thrust maneuver in adults under sevoflurane anesthesia.


Assuntos
Adulto , Humanos , Anestesia , Pressão Arterial , Tosse , Engasgo , Frequência Cardíaca , Incidência , Arcada Osseodentária , Máscaras Laríngeas , Laringismo , Éteres Metílicos , Procedimentos Cirúrgicos Menores
11.
Korean Journal of Anesthesiology ; : 98-102, 2011.
Artigo em Inglês | WPRIM | ID: wpr-149650

RESUMO

BACKGROUND: Bilateral total knee arthroplasty is generally accompanied by a significant amount of blood loss. We investigated the relationship between the intensity of pain and the amount of blood loss in the early postoperative period after bilateral total knee arthroplasty. METHODS: A prospective study was conducted on 91 patients who underwent elective sequential bilateral total knee arthroplasty for osteoarthritis. All patients received combined spinal and epidural anesthesia. Patients were divided into three groups based on their scores on the verbal numerical rating scale (VNRS) for pain at 6 hours postoperatively. The VNRS was classified as follows; mild pain (n = 34, VNRS score 0-4), moderate pain (n = 24, VNRS score 5-6), and severe pain (n = 33, VNRS score 7-10). We compared the mean arterial pressures and the amount of blood loss during the first 24 postoperative hours in the three groups. Factors influencing postoperative blood loss were analyzed. RESULTS: Postoperative mean arterial pressures and blood loss were not different among the groups. Of the factors examined, the amount of postoperative blood loss was only dependent on the amount of intraoperative blood loss (P = 0.001). CONCLUSIONS: Early postoperative pain has no effect on postoperative blood pressure and the amount of blood loss after bilateral total knee arthroplasty. For postoperative blood loss, intraoperative blood loss is the main determinant.


Assuntos
Humanos , Anestesia Epidural , Pressão Arterial , Artroplastia , Pressão Sanguínea , Joelho , Osteoartrite , Dor Pós-Operatória , Hemorragia Pós-Operatória , Período Pós-Operatório , Estudos Prospectivos
12.
Yonsei Medical Journal ; : 475-477, 2010.
Artigo em Inglês | WPRIM | ID: wpr-114976

RESUMO

A patient received combined spinal-epidural anesthesia for a scheduled total knee arthroplasty. After an injection of spinal anesthetic and ephedrine due to a decrease in blood pressure, the patient developed a severe headache. The patient did not respond to verbal command at the completion of the operation. A brain CT scan revealed massive subarachnoid and intraventricular hemorrhages, and a CT angiogram showed a ruptured aneurysm. Severe headaches should not be overlooked in an uncontrolled hypertensive patient during spinal anesthesia because it may imply an intracranial and intraventricular hemorrhage due to the rupture of a hidden aneurysm.


Assuntos
Idoso , Humanos , Masculino , Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Aneurisma Roto/induzido quimicamente , Ventrículos Cerebrais/fisiopatologia , Hemorragias Intracranianas/etiologia , Hemorragia Subaracnóidea/etiologia
13.
Korean Journal of Anesthesiology ; : 244-248, 2010.
Artigo em Inglês | WPRIM | ID: wpr-176341

RESUMO

BACKGROUND: Several studies have demonstrated that ephedrine shortens the onset time of muscle relaxants, and it does so probably by increasing the cardiac output. However, elevation of the systemic blood pressure through alpha adrenergic stimulation via ephedrine may affect the onset of muscle relaxants during the induction of anesthesia. We investigated the effect of phenylephrine, which is a selective alpha-1 agonist, on the onset time of rocuronium and the intubating conditions in adults after the administration of propofol. METHODS: Sixty-four patients were randomly assigned to two groups. Phenylephrine (0.9 microgram/kg) (P group) or the same volume of saline (S group) was injected before rocuronium (0.6 mg/kg) administration. Anesthesia was induced with fentanyl 2 microgram/kg and propofol 2 mg/kg. The onset time was defined as the time from the end of rocuronium injection to the time when a single twitch height gets to 0% or the minimum level. A well-trained anesthesiologist who was 'blinded' to the treatment groups evaluated the intubating conditions. The mean arterial pressure and heart rate were recorded before induction, before intubation, immediately after intubation and 1 minute and 2 minutes after intubation. RESULTS: The onset time was 84 +/- 18 sec in the P-group and 72 +/- 14 sec in the S-group. There was no difference of the intubating conditions, the mean arterial pressure and the heart rate between the two groups. CONCLUSIONS: A small dose of phenylephrine, which has a limited effect on blood pressure, delayed the onset time of rocuronium after the administration of propofol, and the vasoconstriction effect of phenylephrine may affect the prolongation of the rocuronium onset time at the induction of anesthesia with using propofol.


Assuntos
Adulto , Humanos , Androstanóis , Anestesia , Pressão Arterial , Pressão Sanguínea , Débito Cardíaco , Efedrina , Fentanila , Frequência Cardíaca , Intubação , Músculos , Fenilefrina , Propofol , Vasoconstrição
14.
Journal of the Korean Medical Association ; : 184-188, 2010.
Artigo em Coreano | WPRIM | ID: wpr-199400

RESUMO

Subspecialty board certification is a post-graduate program in which clinicians can acquire the qualifications for special areas or techniques, after they have received a board certification in a specialty in clinical medicine. Considering the trend of increasingly sub-classified and professionalized medicine and the higher demand on specialized medical services, introduction of subspecialty board certification is inevitable. However, given the characteristics of the medical environment in Korea, such as the medical payment system, a possibility of undesirable outcomes should not be overlooked. An imprudent administration of the specialty board system would cause conflict and split within communities of medical professionals and also produce confusion among medical consumers. Accordingly, the establishment of subspecialty board system should proceed based on academic communications as well as organic collaboration with the parent academic society and/or the relevant academic societies. Individuals can submit an application for a subspecialty board qualification under the agreement of specialized academic societies which have already been authorized, but the authorization of the societies is determined following a rigorous assessment by the Korean Academy of Medical Sciences (KAMS). An active intervention by KAMS is essential for maintaining the quality of specialty board system and preventing imprudent administration. KAMS will make the best effort to prevent distribution of unauthorized certificates and to rectify rational implementation of the subspecialty board certification system.


Assuntos
Humanos , Acreditação , Certificação , Medicina Clínica , Comportamento Cooperativo , Coreia (Geográfico) , Pais , Conselhos de Especialidade Profissional
15.
Korean Journal of Anesthesiology ; : 273-279, 2009.
Artigo em Inglês | WPRIM | ID: wpr-104666

RESUMO

BACKGROUND: Spinal anesthesia in the sitting position with low-dose local anesthetics usually provides satisfactory anesthesia for diabetic foot surgery because most operations do not require tourniquet application. This study was designed to investigate the influence of different sitting periods after subarachnoid injection of low dose bupivacaine on the spread of analgesia. METHODS: In this randomized, controlled clinical trial, 60 patients undergoing diabetic foot surgery under spinal anesthesia without a tourniquet were randomized to three groups. Patients remained sitting for 2 (Group D2, n = 20), 5 (Group D5, n = 20), or 10 (Group D10, n = 20) min after the completion of subarachnoid administration of 3.75 mg of 0.25% hyperbaric bupivacaine solution. They were then placed in the supine position. Analgesia levels were assessed bilaterally using pinpricks. Blood pressure and heart rate were also recorded. RESULTS: The maximal sensory block level [median (range)] was higher in Group D2 [L3 (L2-L3)] compared with Group D10 [L4 (L3-L4)] (P = 0.002). The highest sensory block levels were T12, T11, and L2 in Group D2, 5 and 10, respectively. There were no hemodynamic differences among the three groups and none of the patients showed hemodynamic instability except for one patient in Group D10. CONCLUSIONS: Although spinal anesthesia using a minimal dose of 0.25% hyperbaric bupivacaine provides adequate anesthesia for diabetic foot surgery without profound hypotension, regardless of the time spent in the sitting position, maintaining the position for 10 min required to confine the sensory blockade on the lower level.


Assuntos
Humanos , Analgesia , Anestesia , Raquianestesia , Anestésicos Locais , Pressão Sanguínea , Bupivacaína , Pé Diabético , Frequência Cardíaca , Hemodinâmica , Hipotensão , Decúbito Dorsal , Torniquetes
16.
Korean Journal of Anesthesiology ; : 507-510, 2009.
Artigo em Coreano | WPRIM | ID: wpr-171235

RESUMO

Glanzmann's thrombasthenia is an autosomal recessive bleeding disorder caused by qualitative or quantitative abnormalities of the platelet glycoprotein IIb/IIIa (GP IIb/IIIa), which can lead to excessive bleeding. Glanzmann thrombasthenia is associated with clinical variability, with some patients only having minimal bruising and others having frequent, severe and potentially fatal hemorrhages. Platelet transfusions, which used to be the standard treatment, may lead to the development of antibodies to HLA and/or GPIIb/IIIa, thereby rendering future transfusions ineffective. Glanzmann's thrombasthenia can be a severe hemorrhagic disease; however, the prognosis is excellent with careful supportive care. In this case, administering allogenic plateletpheresis to patients with Glanzmann's thrombasthenia who were refractory to platelet transfusions was found to be successful during bone surgeries.


Assuntos
Humanos , Anestesia Geral , Anticorpos , Plaquetas , Glicoproteínas , Hemorragia , Ortopedia , Transfusão de Plaquetas , Plaquetoferese , Prognóstico , Trombastenia
17.
Yonsei Medical Journal ; : 252-256, 2009.
Artigo em Inglês | WPRIM | ID: wpr-202313

RESUMO

PURPOSE: Previous lumbar spinal surgery (PLSS) is not currently considered as a contraindication for regional anesthesia. However, there are still problems that make spinal anesthesia more difficult with a possibility of worsening the patient's back pain. Spinal anesthesia using combined spinal-epidural anesthesia (CSEA) in elderly patients with or without PLSS was investigated and the anesthetic characteristics, success rates, and possible complications were evaluated. MATERIALS AND METHODS: Fifty patients without PLSS (Control group) and 45 patients with PLSS (PLSS group) who were scheduled for total knee arthroplasty were studied prospectively. A CSEA was performed with patients in the left lateral position, and 10 mg of 0.5% isobaric tetracaine was injected through a 27 G spinal needle. An epidural catheter was then inserted for patient controlled analgesia. Successful spinal anesthesia was defined as adequate sensory block level more than T12. The number of skin punctures and the onset time were recorded, and maximal sensory block level (MSBL), time to 2-segment regression, success rate and complications were observed. RESULTS: The success rate of CSEA in Control group and PLSS group was 98.0%, and 93.3%, respectively. The median MSBL in PLSS group was higher than Control group [T4 (T2-L1) vs. T6 (T3-T12)] (p < 0.001). There was a significant difference in the number of patients who required ephedrine for the treatment of hypotension in PLSS group (p = 0.028). CONCLUSION: The success rate of CSEA in patients with PLSS was 93.3%, and patients experienced no significant neurological complications. The MSBL can be higher in PLSS group than Control group.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Raquianestesia/métodos , Vértebras Lombares/cirurgia , Estudos Prospectivos , Tetracaína/administração & dosagem
18.
Korean Journal of Anesthesiology ; : S40-S42, 2008.
Artigo em Inglês | WPRIM | ID: wpr-82541

RESUMO

A 33 year old female patient was scheduled for laser laryngomicrosurgery to remove a polyp arising from the posterior one third of the vocal cord.A double lumen central venous catheter was inserted through the cricothyroid membrane and transtracheal high frequency jet ventilation was performed via the distal lumen.The proximal lumen was connected to a capnography monitor, enabling breath by breath monitoring of PETCO2.The surgery was successfully completed, and the patient was discharged from the post anesthesia care unit (PACU) three hours after surgery without any complication.


Assuntos
Feminino , Humanos , Anestesia , Capnografia , Cateteres Venosos Centrais , Ventilação em Jatos de Alta Frequência , Membranas , Compostos Organotiofosforados , Pólipos
19.
Korean Journal of Anesthesiology ; : 367-372, 2008.
Artigo em Coreano | WPRIM | ID: wpr-57123

RESUMO

BACKGROUND: Neuromuscular block is commonly monitored using the adductor pollicis (AP) because of its easy access. However, the hand may not always be accessible for neuromuscular monitoring during surgery. In that situation, monitoring of the flexor hallucis brevis (FHB) secondary to stimulation of the tibial nerve at the ankle joint may be used as an alternative. METHODS: During propofol and remifentanil anesthesia, acceleromyography of the thumb and big toe were recorded. Single twitch responses were measured simultaneously after cumulative administration of rocuronium from 80 to 200microgram/kg at intervals of 40microgram/kg. Furthermore, the amount of rocuronium required for 50% and 95% twitch height depression were calculated. Rocuronium was infused continuously to maintain 5% to 15% twitch responses. We also obtained the onset, duration of action, and antagonism effect of neostigmine from both muscles via neostigmine (20microgram/kg) administration. RESULTS: ED50 and ED95 were significantly lower in the AP than in the FHB. The highest twitch response at peak and neostigmine antagonism were significantly higher in the FHB than in the AP. However, there was no significant difference in the onset time or duration of neostigmine between AP and FHB. CONCLUSIONS: Due to its resistance to rocuronium, the onset of FHB is not a good indicator of optimal conditions for tracheal intubation. Also, because of its higher antagonism effect, there is potential risk of overlooking a residual block. Sufficient recovery of the block should be readjusted to estimate recovery in the FHB with the use of other reliable clinical tests.


Assuntos
Androstanóis , Anestesia , Articulação do Tornozelo , Depressão , Mãos , Intubação , Músculos , Neostigmina , Bloqueio Neuromuscular , Monitoração Neuromuscular , Piperidinas , Propofol , Polegar , Nervo Tibial , Dedos do Pé
20.
Korean Journal of Anesthesiology ; : 378-383, 2008.
Artigo em Coreano | WPRIM | ID: wpr-57121

RESUMO

BACKGROUND: Rocuronium is considered a good candidate for rapid-sequence induction of anesthesia. Increased dose of rocuronium shortens the onset time but prolongs the duration of action. However, the ceiling effect of onset time appears when larger doses are used.Clinical trials have not shown the exact dose of ceiling effect. We performed this study to find dose producing the ceiling effect of onset time. METHODS: One hundred forty young male adults were randomized to oneof seven doses of rocuronium:0.6, 0.7, 0.8, 0.9, 1.0, 1.1 or 1.2 mg/kg.Anesthesia was induced with IV thiopental sodium and maintained with sevoflurane after tracheal intubation. Neuromuscular block was monitored with acceleromyography using single twitch.The onset time, the recovery of single twitch to 10% and also the changes in hemodynamics were checked. RESULTS: A dose of up to 1.0 mg/kg shortens the onset time but no further decrement was seen with doses larger than 1.0 mg/kg.The recovery time was prolonged as doses were increased but there were no differences in the hemodynamics. CONCLUSIONS: This study showed that in young male adults under IV induction with thiopental sodium, the ceiling effect of onset time appeared with rocuronium doses in excess of 1.0 mg/kg.


Assuntos
Adulto , Humanos , Masculino , Androstanóis , Anestesia , Hemodinâmica , Intubação , Éteres Metílicos , Bloqueio Neuromuscular , Tiopental
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