Comparison of Liver Function after Induced Hypotension between Enflurane and Isoflurane Anesthesia in Spinal Surgery / 대한마취과학회지

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility, but may produce ischemic damage to the liver. The purpose of this study is to compare liver function after induced hypotension between general anesthesia with enflurane and isoflurane in spinal surgery. METHODS: Forty patients were randomly allocated to enflurane (group 1, n = 20) and isoflurane (group 2, n = 20) group. During operation, hypotension was induced with hydralazine to maintain systolic blood pressure between 60 to 80 mmHg in both groups. Preoperative and postoperative 1, 3, 5 and 7 days' serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT) and alkaline phosphatase (ALP) were evaluated. RESULTS: In group 1, SGOT levels increased significantly at postoperative 1, 3 days, and SGPT levels increased significantly at postoperative 3, 5, 7 days. In group 2, SGOT levels increased significantly at postoperative 1, 3, 5, 7 days, and SGPT levels increased significantly at postoperative 3, 5, 7 days, but there was no significant difference between the groups in SGOT and SGPT levels. ALP levels decreased at postoperative 1, 3, 5 days in group 1, and at postoperative 1, 3 days in group 2; however, there was no significant difference between the groups in ALP levels except in preoperative values. CONCLUSIONS: These results suggest that there is no difference in postoperative liver function between general anesthesia with enflurane and isoflurane in spinal surgery after induced hypotension.

Comparison of Post-operative Liver Function after Induced Hypotention between Thoracic Epidural Bldegrees Ckade and Esmolol / 대한마취과학회지

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provies better visibility. May methods have been used for induced hypotension. Recently Esmolol is favored in induced hypotension because of its short action of sympathetic beta-1 receptor antagonist and easy to control. Thoracic epidural bldegrees Ck can provide cadiovascular stability in induced hypotension. The purpose of the study is to compare postoperative liver function after induced hypotension between thoracic epidural bldegrees Ckade and esmolol combined with general anesthesia with isoflulane. METHOD: Fourty patients scheduled for spinal posterior fusion under general anesthesia were randomly divided into two groups. In thoracic epidural bldegrees Ckade group(Group I, 20 patients), 8~10 ml of 2% liddegrees Caine was injected into the epidural catheter ldegrees Cated in T6~7 interspace in a bolus. In Esmolol group(Group II, 20 patients) received 0.5 mg/kg as loading dose and 50~150 microgram/kg/min continuously. We measured preoperative and postoperative 1, 3, 5, 7 day's serum glutamic-oxaloacetic transaminase(SGOT), serum glutamic-pyruvate transaminase(SGPT) and alkaline phosphatase(ALP). RESULT: In the thoracic epidural bldegrees Ckade group, there was statistically significant increase of SGOT level above normal range on postoperative 1 day, which decreased on postoperative 3 and 5 day(p<0.05). But it was within normal range on postoperative 7 day. SGPT was increased within normal range. Similarly, in the esmolol group, there was statistically significant increase of SGOT level above normal range on postoperative 1 day, which decreased on postoperative 3 and 5 day(p<0.05). But it was within normal range on postoperative 7 day. SGPT was increased within normal range. The level of ALP was increased within normal range in both groups. There was no statistically significant difference in liver function between two groups. CONCLUSION: We consider that postoperative liver function is little influenced with induced hypotension by thoracic epidural bldegrees Ckade and esmolol combined with general anesthesia with isoflurane.

The Comparison of Propofol and Sodium Nitroprusside in Induced Hypotension undergoing Endoscopic Sinus Surgery / 대한마취과학회지

BACKGROUND: The general anesthesia for endoscopic sinus surgery (ESS) is associated with increase in intraoperative bleeding, which can interfere with optimal visualization through the endoscope, so we compared the effectiveness of propofol as induced hypotensive agent with sodium nitroprusside (SNP) in ESS. METHODS: Twenty patients undergoing ESS under general anesthesia were allogated randomly to recieve thiopental sodium induction with enflurane maintenance and induced hypotension by SNP (SNP group), or propofol induction and propofol maintenance (propofol group). The two groups were recieved nalbuphine, vecuronium, nitrous oxide and oxygen for anesthesia. The hypotensive effects, hemodynamic changes were evaluated with mean arterial pressure (MAP), heart rate (HR), hematocrit of preoperative, intraoperative and postoperative period and estimated blood loss (EBL). RESULTS: Mean arterial pressure was significantly decreased during hypotensive anesthesia (p<0.05), but any other parameters (HR, EBL and hematocrit change) were not significantly different in two groups. CONCLUSION: Propofol has an effectiveness of hypotensive agent as SNP; and make endoscopic sinus surgery technically easier and safer by improving endoscopic visualization of the surgical field with less blood loss.

Comparison of the Blood Loss during and after Spinal Surgery under Hypotensive Anesthesia and Effects of Furosemide on the Urine Output during Hypotensive Anesthesia for Spinal Surgery / 대한마취과학회지

BACKGROUND: The induced hypotensive anesthesia may produce serious complications related to central nervous system, heart, liver, kidney and eyes. In this study, the blood loss during and after operation were compared to evaluate the delayed effect of hypotension on postoperative bleeding and also, the urine output was measured in control group and furosemide treated group, to investigate the effect of furosemide on the protection of kidney function. METHODS: Forty patients undergoing spinal surgery were evaluated and the hypotension was induced by the combination of hydralazine, esmolol and propranolol under enflurane anesthesia. During hypotensive anesthesia, the systolic arterial blood pressure was maintained between 65 to 75 mmHg. I compared the arterial blood gas analysis, plasma protein, albumin and calcium level, blood urea nitrogen (BUN), creatinine and complete blood count (CBC) before, durng and after hypotensive anesthesia. And also, the volume of blood loss and the units of transfused blood were measured intraoperatively and postoperatively. To investigate the effect of furosemide on the protection of kidney function, patients were randomly divided to contol group (n=20) and furosemide group (n=20). In furosemide goup, 0.1 mg/kg was administered intravenously and the urine output was measured during and after hypotensive anesthesia in both groups. RESULTS: The systolic arterial blood pressure during hypotensive anesthesia was maintained between 65 to 75 mmHg as planned in all forty patients. The average blood loss during and after operation were 769+/-541 and 786+/-397 ml, respectively and the average total blood loss was 1555+/-784 ml. The average units of transfused packed red cell during and after operation were 2.6+/-0.8 and 1.9+/-0.4 units, respectively, and the average total transfused units were 2.3+/-0.8 units. In both control and furosemide treated groups, all forty patients showed oliguria during first two hours after starting hypotensive anesthesia but urine outputs were recovered after the end of hypotensive anesthesia in both groups. During and after hypotensive anesthesia, pH was slightly but significantly decreased. Plasma protein, albumin, calcium and BUN were decreased during and after hypotensive anesthesia compared with before hypotensive anesthesia values. During and after hypotensive anesthesia, platelet count was decreased significantly but white cell count was increased. Severe oliguria was noted during hypotensive anesthesia in both groups and no serious complication related to hypotensive anesthesia was found. CONCLUSIONS: In this study, the volume of blood loss after anesthesia was almost same as that during anesthesia. And the administration of furosemide 0.1 mg/kg did not prevent oliguria during hypotensive anesthesia.

Comparison of Sodium Nitroprusside and Esmolol Induced Hypotension for Total Hip Arthroplasty / 대한마취과학회지

BACKGROUND: Esmolol is a short acting sympathetic beta receptor antagonist, and it was successfully applied to induced hypotension. Esmolol lowers blood pressure by decreasing cardiac output, and does not cause vasodilation. This property of esmolol may help to decrease bleeding during induced hypotension. In this study, we tried to elucidate the effect of esmolol on induced hypotension for total hip arthroplasty. METHOD: Twenty patients receiving total hip arthroplasty were randomly divided to two groups. Esmolol group (10 patients) received esmolol as a hypotensive agent, and sodium nitroprusside (SNP) group (10 patients) received SNP as a hypotensive agent. We measured arterial blood gas analysis, vital sign, amounts of bleeding, amounts of transfusion and administered fluid, and various laboratory findings. RESULTS: Induced hypotension was successfully performed in either esmolol and SNP group. Heart rate increased by SNP, and decreased by esmolol. There were no statistically significant differences between the two groups in amounts of bleeding, amounts of transfusion or administered fluid, and laboratory findings. Arterial oxygen tension was relatively constant in esmolol group, but decreased in SNP group. CONCLUSION: Esmolol can be used as a single hypotensive agent during induced hypotension without significant side effects during total hip arthroplasty.