Effect of ketamine and midazolam on oculocardiac reflex in pediatric strabismus surgery / 대한마취과학회지

BACKGROUND: The oculocardiac reflex (OCR) can be elicited during manipulation of the orbital structures in the strabismus correction surgery. A sinus bradycardia is the most common manifestation of OCR; and cardiac dysrhythmia and asystole may also occur. Various efforts to reduce OCR have been attempted, but without coherent outcome results. METHODS: Sixty one children, undergoing elective strabismus surgery, were randomly allocated into 2 groups: Group K received ketamine 1.0 mg/kg; and Group M received midazolam 0.15 mg/kg for induction of anesthesia. Anesthesia was maintained with 1-1.3 MAC of sevoflurane with 50% N2O in O2. Heart rate and blood pressure were measured 30 seconds before extraocular muscle (EOM) traction and immediately after traction. The OCR was defined as a decrease in heart rate more than 20% of the baseline heart rate, following manipulating EOM. Postoperative nausea and vomiting (PONV) and emergence agitation (EA) were assessed in postanesthetic care unit (PACU). RESULTS: Blood pressure before tightening EOM in Group K was higher than that in Group M (P < 0.05). However Delta HR (2.7 +/- 15% vs. - 0.9 +/- 16%) and incidence of OCR (10.0% vs. 19.4%) after traction an EOM were not different between the two groups. The occurrence of PONV (6.7 vs. 9.7%) and EA (30.0% vs. 22.6%) were similar. CONCLUSIONS: Ketamine does not reduce the incidence of OCR compared with midazolam in pediatric strabismus surgery. In addition, ketamine does not increase the incidence of PONV and EA. In conclusion, it is reliable to use ketamine in pediatric strabismus surgery.

Effects of acetaminophen on postoperative emergence delirium in children undergoing epiblepharon correction

BACKGROUND: Emergence delirium is a common problem after general anesthesia in children. Postoperative pain control reduces the incidence of emergence delirium. Opioids and NSAIDs have been successfully used to inhibit intraoperative and postoperative pain. Instead of them, acetaminophen is used to reduce side effects of opioids and NSAIDs. This study evaluated the effect of acetaminophen on emergence delirium after general anesthesia in children undergoing a epiblepharon correction. METHODS: Sixty children, aged 1-10 years (ASA physical status I, II) undergoing epiblepharon correction, were enrolled in this study. Acetaminophen (group A) received 15 mg/kg of acetaminophen, control group (group C) received 1.5 ml/kg of normal saline. Anesthesia was induced with 2.0 mg/kg of ketamine and maintained by 2.0-3.0 vol% sevoflurane with N2O 1.5 L/min-O2 1.5 L/min. The delirium score was recorded at 10 minutes after arrival at recovery room by an independent observer using the four point scale of Aono. RESULTS: There were no significant differences between the two groups regarding the time to extubation and discharge from the recovery room. The incidence of emergence delirium was 23% in group A and 32% in group C, but this did not have statistical significance. The incidence of vomiting was similar in both group. CONCLUSIONS: Preoperative intravenous acetaminophen of 15 mg/kg application does not reduce the incidence of postoperative delirium in children undergoing epiblepharon correction.

The Care of a Jehovah's Witness with Life-threatening Anemia Refusing Ventilator Care: A Case Report / 대한구급학회지

Jehovah's Witnesses refuse the transfusion of blood and blood products, even when it can be lifesaving. Their religious conviction against receiving blood can create a difficult clinical dilemma, particularly in the life threatening situations. We report a case of a 42-year-old female Jehovah's Witness patient who had life-threatening anemia after postpartum hemorrhage. Despite severe anemia, she had a good postoperative recovery without complications.

Analysis for Failure and Immediate Complications of Subclavian Venous Catheterization

BACKGROUND: This study was to investigate success rate, immediate complications, and risk factors of failure and immediate complications of subclavian venous catheterization (SVC). METHODS: All patients requiring SVC, older than 18 years of age and without past history of operation, scar, and radiation therapy at puncture site were included. After general or regional anesthesia was induced, SVC was done via infraclavicular approach. Patient's age, gender, weight, height, the rank of operator, anesthesia method, the side of venipuncture, the number of puncture attempts, arterial puncture, and success or failure were recorded. After the operation, a chest radiography was evaluated to check the occurrence of pneumothorax, hemothorax and the location of the catheter tip. RESULTS: SVC was performed in 1092 patients. Thirty-nine patients were excluded because a chest radiography was not checked. Successful catheterization without immediate complications was performed in 939 patients (89.2%). Failure occurred in 65 patients (6.2%). Arterial puncture, pneumothorax and misplacement of the catheter tip were reported in 26 (2.5%), 5 (0.5%), and 35 (3.3%) patients, respectively. Misplacement of the catheter tip were observed in 26 patients (2.5%) at ipsilateral internal jugular vein, and in 9 (0.8%) at contralateral subclavian vein. Failure and immediate complications of SVC were associated with the number of puncture attempts. The number of puncture attempts were associated with age, puncture side and anesthetic method. CONCLUSIONS: Failure and immediate complications of SVC occurred in 10.8% of cases and were associated with the number of puncture attempts.

The Effects of Prolonged Minimal-flow Sevoflurane Anesthesia on Postoperative Hepatic and Renal Function / 대한마취과학회지

BACKGROUND: Minimal-flow and low-flow anesthesia provide many advantages, including reduced costs and pollution, and conservation of body heat and airway humidity. However, low-flow sevoflurane anesthesia is associated with an increase in the circuit concentration of compound A, which causes nephrotoxicity in rats. Therefore, this study was conducted to assess the effects of prolonged minimal-flow sevoflurane anesthesia on hepatic and renal function. METHODS: Forty female patients who underwent free flap surgery lasting more than 8 hours randomly received either high-flow (5 L/min) or minimal-flow (0.5 L/min) sevoflurane anesthesia. Hepatic functions were then assessed by measuring the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin levels. In addition, renal functions were assessed by measuring the blood urea nitrogen (BUN) and serum creatinine levels and by spot urinalysis. Venous blood and spot urine samples were obtained prior to administration of the anesthesia, and then on the first, third and fifth days following administration of the anesthesia. RESULTS: The anesthetic time (9.9 +/- 1.7 vs. 9.6 +/- 2.0 h) and sevoflurane exposure (8.2 +/- 1.7 vs. 7.4 +/- 1.9 MAC-h) were not different between the high-flow and minimal-flow anesthesia group. The serum AST, ALT, ALP and total bilirubin levels were within the normal range throughout the study period in both groups. Additionally, the BUN and serum creatinine levels were within the normal range throughout the study period in both groups. Furthermore, there were no significant differences in any hepatic or renal biomarkers between the two groups. CONCLUSIONS: No significant differences in postoperative hepatic and renal function were observed between the minimal-flow and high-flow sevoflurane anesthesia groups.

The effect of fentanyl pretreatment on myoclonus during induction of anesthesia with etomidate in elderly patients / 대한마취과학회지

BACKGROUND: Etomidate is frequently used as an induction agent in the elderly patients. This study was done to determine whether etomidate-based induction can provide hemodynamic stability and fentanyl decreases the incidence of myoclonus. METHODS: Eighty ASA II or III patients older than 65 years were randomly allocated to four groups. Group 1 (n = 20) received etomidate 0.2 mg/kg after normal saline 3 ml, Group 2 (n = 20) received etomidate 0.25 mg/kg after normal saline 3 ml, Group 3 (n = 20) received fentanyl 2 ug/kg before the administration of etomidate 0.2 mg/kg, Group 4 (n = 20) received fentanyl 2 ug/kg before the administration of etomidate 0.25 mg/kg. The time interval from etomidate infusion to loss of eyelash reflex, to decrease bispectral index (BIS) 50, to intubation were recorded. We measured hemodynamic change, the BIS index, the incidence, duration and grade of myoclonus. RESULTS: There were no significant differences in time interval, mean arterial pressure (MAP), BIS index between groups. MAP and HR were increased after intubation in all groups. The incidence of myoclonus were 25%, 30%, 0%, 15% respectively. There were no significant differences in incidence and duration of myoclonus between 4 groups, but group 3 had reduced incidence compared with group 1. CONCLUSIONS: Loss of consciousness and hemodynamic changes during induction with 0.2 mg/kg and 0.25 mg/kg of etomidate were appropriate. Pretreatment with fentanyl and small dose of etomidate decrease the incidence of myoclonus.

The Effects of Magnesium Infusion on Left Ventricular Stroke Work Index during off Pump Coronary Artery Bypass Grafting

BACKGROUND: The administration of magnesium provides cellular protection during ischemia, improves the contractile response of the stunned myocardium, increases the threshold for the electrical excitation of myocardial cells, presents arrhythmia, and reduces the level of reperfusion injury. It also causes a decrease in peripheral vascular resistance in association with a secondary increase in the cardiac index and improves the left ventricular stroke work index. The aim of this study was to verify characteristic effects of magnesium infusion during off pump coronary artery bypass grafting (OPCAB). METHODS: In a prospective double-lind trial, 17 patients undergoing OPCAB were randomly assigned to receive intravenous magnesium sulfate (n = 9) or a placebo (n = 8). The mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), heart rate (HR), cardiac index (CI), left ventricular stroke work index (LVSWI), right ventricular stroke work index (RVSWI), systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were measured. RESULTS: MAP, PCWP, HR, CI, LWSWI, RVSWI, SVR, and PVR using the thermodilution method were not significantly different in both groups. Post operative arrhythmia occurred in 1 out of 9 patients after the administration of magnesium and in 1 out of 8 patients after infusing the placebo. CONCLUSIONS: The administration of magnesium does not affect the increase in LVSWI during OPCAB and does not decrease the incidence of post operative arrhythmia in the operating room period.

Comparison of the Hemodynamic Changes following Intraaortic and Intravenous Administration of Protamine after Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Reversal of heparin anticoagulation by protamine often produces hemodynamic changes such as hypotension, bradycardia, decreased cardiac output and various complications as anaphylactic reaction. Some studies have reported that intraaortic administration of protamine prevent profound hypotension and provide stable hemodynamics. The purpose of this study is to compare the hemodynamic changes following intraaortic and intravenous administration of protamine after cardiopulmonary bypass. METHODS: In a prospective double-blind trial, 30 patients undergoing cardiac valve replacement surgery were randomly assigned to receive intravenous protamine (n = 15) or intraaortic protamine (n = 15). Arterial pressure (AP), pulmonary arterial pressure (PAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) were measured. RESULTS: The changes of HR, AP, PAP, CI, SVRI, PVRI were not significantly different between both groups. Both groups maintained hemodynamic stability afer protamine administration. CONCLUSIONS: There were no significant difference in the hemodynamic changes following intraaortic and intravenous administration of protamine after cardiopulmonary bypass. And there were no hemodynamic benefits of intraaortic versus intravenous administration of protamine.

The Effects of Anesthetic Agents on Emergence Delirium in Pediatric Strabismus Surgery / 대한마취과학회지

BACKGROUND: This study was designed to compare the effects of anesthetic methods used recently on emergence delirium in pediatric strabismus surgery. METHODS: Two hundred and thirty two children, aged 2-10 years, undergoing strabismus surgery, were randomly assigned to one of eight groups; ketamine-desflurane (n = 30), ketamine-sevoflurane (n = 30), ketamine-propofol (n = 30), ketamine-remifentanil (n = 27), midazolam-desflurane (n = 28), midazolam-sevoflurane (n = 30), midazolam-propofol (n = 27), and midazolam-remifentanil (n = 30). Anesthesia was induced with ketamine 1.0 mg/kg or midazolam 0.15 mg/kg. Laryngeal mask airway (LMA) was placed with rocuronium 0.5 mg/kg. Anesthesia was maintained with desflurane 5-6 vol%, sevoflurane 2-3 vol%, propofol 7-8 mg/kg/hr, and remifentanil 0.5microgram/kg/min under N2O 66% in O2. Ventilation was controlled to maintain normocapnia. The status of emergence delirium (ED) was evaluated by a blinded observer until discharge from postanesthetic care unit. RESULTS: There was no differences in age, sex, weight, height, anesthetic time, and recovery time among the eight groups. ED occurred in 54 children (23.3%), but severe ED needed treatment was not occurred. Compared with ketamine group, midazolam group showed less incidence of ED. Propofol and remifentanil groups showed less incidence of ED compared with desflurane and sevoflurane groups. ED group was more younger and more temperamental compared with nonED group. CONCLUSIONS: Propofol or remifentanil anesthesia provided less incidence of ED compared with desflurane and sevoflurane in pediatric strabismus surgery.

Comparison of Remifentanil-Propofol and Remifentanil-Sevoflurane Anesthesia for Pediatric Tonsillectomy

BACKGROUND: This study compared the hemodynamic response and recovery profile of remifentanil-sevoflurane anesthesia for a pediatric tonsillectomy with that of remifentanil-propofol anesthesia. METHODS: Fifty healthy children (4-10 yr) undergoing a tonsillectomy were randomly assigned to one of two groups. Anesthesia was induced with remifentanil 1 mcg/kg over 1 min, propofol 2 mg/kg, and rocuronium 0.8 mg/kg. Anesthesia was maintained with remifentanil 0.25 mcg/kg/min and propofol 6 mg/kg/h, or remifentanil 0.25 mcg/kg/min and sevoflurane 1.0 vol%. The propofol and sevoflurane dose was kept unchanged, and remifentanil was titrated according to the hemodynamic response. The perioperative hemodynamics, recovery time, and side effects were assessed. RESULTS: Remifentanil-based anesthesia with propofol or sevoflurane resulted in stable hemodynamics, but sevoflurane was associated with a significantly lower systolic blood pressure. The recovery times were similar for spontaneous ventilation, extubation, eye opening, orientation, and full recovery in both groups. The incidence of side effects was similar in both groups. CONCLUSIONS: Remifentanil/sevoflurane is as equally effective as remifentanil/propofol in pediatric patients. The hemodynamic stability is appropriate and the recovery from anesthesia is rapid.

The Effect of Postoperative Pain Management on Cytokine Response in Patients Undergoing Gastrectomy / 대한마취과학회지

< 0.05) but there was no significant differences between the two groups. CONCLUSIONS: These results suggest that PCEA has no added influences on the cytokine responses after a gastrectomy.

Hemodynamic Response and Recovery Profile of Remifentanil Anesthesia in Pediatric Strabismus Surgery / 대한마취과학회지

BACKGROUND: This study evaluated the hemodynamic response and recovery profile of remifentanil-N2O anesthesia, compared with sevoflurane-N2O anesthesia in pediatric strabismus surgery. METHODS: Fifty-seven healthy children aged 1-9 years undergoing strabismus surgery were randomly assigned to two groups, group R or group S. None of the children was premedicated with an anticholinergic agent. Anesthesia was induced with intravenous ketamine 1.0 mg/kg. A laryngeal mask airway (LMA) was placed with rocuronium 0.4 mg/kg. Anesthesia was maintained with sevoflurane 2.0-3.0 vol% and N2O 66% in group S, and with remifentanil 0.75 microgram/kg over 1 min followed by remifentanil 0.5 microgram/kg/min and N2O 66% in group R. At the end of surgery, the anesthetic agents were discontinued, and the early emergence, recovery, and side effects were assessed. RESULTS: During anesthesia, the heart rate and blood pressure were lower in group R (P < 0.05). The incidence of an oculocardiac reflex was similar in both groups. The times to spontaneous ventilation and the removal of LMA were similar in the two groups. The times from eye opening to command, orientation and full recovery were faster in group R (P < 0.05). The incidence of postoperative nausea and vomiting was similar in both groups. The incidence of coughing was lower in group R (P < 0.05). Mild pruritus developed in 17.2% of patients in group R. CONCLUSIONS: In pediatric strabismus surgery, remifentanil provided similar hemodynamic stability, and an earlier and smoother recovery, compared with sevoflurane anesthesia.

Hemodynamic Changes and Transesopahgeal Echocardiographic Findings of Intravenous Amiodarone Loading in Patients Undergoing CABG / 대한마취과학회지

BACKGROUND: Determining the precise magnitude, duration, and mechanism of hypotension caused by intravenous amiodarone could potentially increase the safety of drug administration to critically ill patients. The objective of this study was to characterize the immediate cardiovascular actions of an intravenous loading dose of amiodarone administered using echocardiographic and hemodynamic measurements. METHODS: In a prospective double-blind trial, 20 patients undergoing off-pump coronary artery bypass graft surgery were randomly assigned to receive intravenous amiodarone (n = 10) or placebo (n = 10). Heart rate (HR), arterial blood pressure (systolic, diastolic, mean; SAP, DAP, MAP), pulmonary artery pressure (systolic, diastolic, mean; PSAP, PDAP, PMAP), cardiac output (CO), central venous pressure (CVP), left ventricular ejection fraction (LVEF) were measured. RESULTS: HR, SAP, DAP, MAP, PSAP, PDAP, PMAP, CO by thermodilution method, CVP, LVEF by echocardiographic measurements was not significantly different in both group. Hypotension requiring intervention occurred in 2 of 10 patients after amiodarone administration and in none of 10 patients after placebo. CONCLUSIONS: Hypotension requiring intervention occurred 20% after amiodarone administration, the cause of these hypotension were thought to be arterial dilatation but was not associated with decreased cardiac output or left ventricular ejection fraction and corrected successfully by intravenous administration of phenylephrine.

Effect of Acute Normovolemic Hemodilution on Homologous Blood Saving during Off-Pump CABG / 대한마취과학회지

BACKGROUND: Acute normovolemic hemodilution (ANH) is accepted to be the easiest and most economical method of autotransfusion. This study was performed to investigate the clinical usefulness of ANH in patients undergoing off-pump CABG. METHODS: Thirty patients were randomly divided into two groups. In the ANH group, 753.3 +/- 51.6 ml of fresh autologous whole blood were sequestrated from a pulmonary artery catheter following induction of anesthesia with simultaneous infusion of colloids and crystalloid solution from a separate line. Perioperative changes of hemoglobin, hematocrit level, platelet counts, prothrombin time, cardiac output, transfusion requirement and the amount of postoperative drainage were compared between the two groups. RESULTS: Perioperative changes of platelet counts and PT showed no significant differences between the two groups. Less allogenic blood was used in the ANH group (0.27 +/- 0.46 unit) than in the control group (1.27 +/- 0.80 unit) in the operation room. CONCLUSIONS: ANH can decrease the transfusion requirement in off-pump CABG.

Accidental Intrathecal Adminstration of Acetylcysteine: A case report / 대한마취과학회지

We report a case of accidental intrathecal administration of Nucomyt(R)(acetylcysteine), a mucolytic agent used for intratracheal instillation. A 21-year-old healthy female with a complete syndactyly at the 4th and 5th toes was scheduled for a web release under spinal anesthesia. Immediately after accidental intrathecal administration of Nucomyt(R)2.4 ml instead of bupivacaine for spinal anesthesia, tonic extension developed at first in the lower extremities and then the upper extremities, too. Thiopental sodium 200 mg was injected intravenously twice. Endotracheal general anesthesia with N2O- enflurane-vecuronium was maintained for the operation for about two hours. For about 1 hour after emergence of general anesthesia, tonic extension intermittently developed in the lower extremities and was controlled with midazolam. Mild elevated blood pressure, tachycardia, tachypnea, high fever (up to 38.5degrees C) and respiratory acidosis occurred. Thirty minutes later, she became mentally clear with a normal neurologic examination. No delayed sequelae were detectable at a follow-up visit 1 month and 1 year after surgery.

Effect of Positive Suggestions on Postoperative Course / 대한마취과학회지

Background: Post operative nausea, vomiting and pain are the most common distressing symptoms following surgery. Recently much interest has been shown in the influence of auditory stimuli during anesthesia, and studies suggest that thinking may occur while under adequate general anesthesia. The aim of my study was to investigate the effect of intraoperative positive suggestion on the incidence of post operative pain, nausea, vomiting, general well being and gas output time. METHODS: Following ethics committee approval of our hospital, informed written consent was obtained from 60 ASA 1 or 2 patients scheduled for major gynecological surgery. Patients were allocated randomly to study or control groups. Those in the study group were played tapes containing positive suggestions ; those in control group were played a blank tape. Anesthesia was induced with propofol, succinycholine, vecuronium, and was maintained with enflurane 1.5 vol% in a 50% mixture of oxygen in nitrous oxide. Head phones were applied and patients in study group were played a tape suggesting that there would be no pain, nausea or vomiting and that they would be comfortable after the operation. The tape was played repeatedly throughout surgery until skin closure. The severity of postoperative nausea, vomiting, pain, postpoerative well being state and gas output were assessed using a four-point 0-3 verbal rating score (VRS) and scores were collected in the recovery room, at a postoperative 3 hr, 6 hr, 12 hr, 24 hr and 5 days. RESULTS: There was no significant difference between groups for any VRS parameter, i.e., postoperative pain, nausea, vomiting, general state of being or gas output time. CONCLUSIONS: Despite hearing positive suggestion in patients undergoing total hysterectomy surgery during general anesthesia, we were unable to demonstrate any reduction in the incidence of postoperative pain, nausea, vomiting, general well being state scores and gas output time.

Effect of Acute Normovolemic Hemodilution on Postoperative Allogenic Blood Requirement after Total Knee Arthroplasty / 대한마취과학회지

BACKGROUND: Acute normovolemic hemodilution (ANH) is recognized as the easiest, the most economical and valuable autologous blood saved method among the types of autotransfusion. We studied whether this method could reduce the transfusion requirement of allogenic blood in total knee arthroplasty to investigate the efficacy of ANH. METHODS: The thirty patients were randomized and divided into two groups. In the ANH group (n = 15), 2 units of autologous blood were procured from a CVP catheter immediately before or after anesthetic induction, while Ringer's lactate and colloid solution were infused to maintain normovolemia via a different venous catheter. Perioperative changes of hemoglobin, hematocrit, platelets, prothrombin time (PT), transfusion requirements and the amount of postoperative drainage were compared. RESULTS: There were no significant difference between the two groups in terms of perioperative changes of hemoglobin, hematocrit or platelets. And, there was significantly reduced demand for packed RBC transfusion in the ANH group (362.7+/-236.4 ml) compared with the control group (668.0+/-259.3 ml) (P <0.05). However, no significant difference was observed between the two groups in terms of postoperative drainage amount. CONCLUSIONS: ANH can reduce transfusion requirements in total knee arthroplasty surgery if this is accompanied by appropriate patient selection and monitoring.

Comparison of the Antiemetic Efficacy of Droperidol, Granisetron, and Propofol after Epidural Morphine / 대한마취과학회지

BACKGROUND: We compared the antiemetic efficacy of droperidol, granisetron, and propofol in postoperative nausea and vomiting (PONV) in the patients who received epidural anesthesia with bupivacaine and morphine. METHODS: Among one hundred and sixty one ASA physical status I or II patients who received an abdominal hysterectomy under epidural anesthesia, sixty patients who showed PONV and thereby received antiemetics were randomly assigned into 3 groups: droperidol 0.75 mg (droperidol group: n = 20), granisetron 1.0 mg (granisetron group: n = 20) or propofol 20 mg (propofol group: n = 20) by an intravenous injection. Antiemetics were injected according to the patient request up to 3 times of initial dose. Nausea, vomiting, sedation, anxiety, and discomfort were assessed and the time interval between each antiemetic administration was recorded by a blind observer for 30 min after the injection of antiemetics. RESULTS: Success rates in PONV control for 30 min after the 1st antiemetic administration were 90%, 95%, and 85% in the droperidol, granisetron, and propofol group, respectively. The propofol group experienced a higher relapse incidence (90%) than other groups (droperidol: 35%, granisetron: 25%)(P<0.05). The granisetron group showed a longer time interval between the 1st and 2nd antiemetic administration (616 +/- 501 min: P<0.05) than other groups. No patients in the granisetron and propofol groups showed any anxiety and discomfort, however six patients in the droperidol group showed some anxiety and discomfort. CONCLUSIONS: All antiemetics were effective to control the PONV, but droperidol caused some anxiety and discomfort and propofol showed higher relapse incidence.

Efficacy and Safety of Positive Pressure Ventilation through Laryngeal Mask Airway during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: We evaluated the efficacy and safety of positive pressure ventilation (PPV) with a laryngeal mask airway (LMA), compared with an endotracheal tube (ETT) during a laparoscopic cholecystectomy. METHODS: Sixty six, ASA I II adults scheduled for an elective laparoscopic cholecystectomy were randomly assigned to LMA or ETT. Anesthesia was induced with fentanyl 2ng/kg, lidocaine 0.5 mg/kg and propofol 2 mg/kg and maintained with a continuous infusion of propofol 6 - 12 mg/kg/h in 67% N2O, atracurium and fentanyl. An ETT or LMA was placed with atracurium 0.5 mg/kg. Respiratory and hemodynamic parameters were measured before and after intraabdominal CO2 insufflation. The surgeon assessed the degree of change in gastric distension under laparoscope. RESULTS: Oxygen saturation, end-tidal CO2, peak inspiratory pressure, expiratory tidal volume and compliance of the respiratory system didn't differ between both groups. Blood pressure and heart rate were lower in the LMA group than in the ETT group only at 5 min after induction (P < 0.05). The maintenance dose of propofol, fentanyl and atracurium were similar in both groups. Degree of change in gastric distension were similar in both groups. The LMA resulted in less coughing after removal than did the ETT (P < 0.05). CONCLUSIONS: PPV with LMA permits adequate pulmonary ventilation and hemodynamic stability during laparoscopic cholecystectomy. Gastric distension occurs with similar frequency in LMA or ETT.

Monitored Anesthetic Care (MAC) Using Propofol, Ketamine, Fentanyl, and Ketorolac (PKFK) for Minor Surgery / 대한마취과학회지

BACKGROUND: Even when patients agree that anesthesia is indispensable for a safe and comfortable operation, they are reluctant to experience the side effects of conventional general and regional anesthesia. We investigated whether monitored anesthetic care (MAC) using propofol, ketamine, fentanyl, and ketolorac can be substituted for conventional anesthesia in minor surgery. METHODS: One hundred forty six healthy adult patients who received minor surgery were studied. All were fasted, premedicated, and monitored according to conventional general anesthesia. Fentanyl 2 microgram/kg, propofol 1 mg/kg, ketamine 0.2 mg/kg, and ketorolac 30 mg were given intravenously and propofol was maintained at 3 4 mg/kg/h. Before local anesthetics infiltration at the incision site, ketamine 5 mg and propofol 20 mg were added intravenously. During the procedure, fentanyl 25 microgram plus propofol 20 mg were added whenever involuntary movements appeared. We observed vital signs, complications, time to eye opening to verbal command, time to regain orientation, satisfaction with anesthesia, postoperative pain scores, and analgesic consumption. RESULTS: Blood pressure and heart rate were reduced at the beginning of anesthesia, but were not clinically significant. Intraoperatively, respiratory depression (40.4%), SpO2 < 90% (25.3%) were observed, but no patients needed tracheal intubation. Postoperatively, dizziness (29.5%), pain (20.5%), and nausea (15.8%), were observed. The time to eye opening and to regaining of orientation were 57.3+/-119.4 sec, and 8.0+/-4.7 min respectively. Satisfaction with anesthesia was remarkable; surgeon (76.7%), patients (91.8%). Postoperative pain scores were low; 59.6% of patients did not need analgesics for the first 24 h. CONCLSIONS: If careful monitoring and instantaneous management for respiratory depression by anesthesiologist is provided, MAC using PKFK is an excellent and readily applicable method for minor surgery.