Rol de la analgesia y anestesia epidural en cirugía abdominal / The role of epidural anesthesia and analgesia in abdominal surgery

Desde 1980 que la anestesia peridural (AP) se ha propuesto para manejar el dolor postoperatorio, en especial en cirugías abdominales. A pesar de que ésta es percibida por varios autores, como la analgesia ideal para las cirugías abdominales mayores, hay algunos que prefieren la administración de antiinflamatorios no esteroidales o de opiodes por vía periférica, ya sea en bolos, infusión continua o controlados por el paciente (PCA). Si bien esta última provee mejor analgesia y satisfacción que la administración convencional, no ha demostrado mejorar la morbimortalidad quirúrgica, cosa que sí lo ha hecho la AP. Se realiza una revisión de la literatura con el objetivo de analizar los efectos benéficos y adversos de la anestesia peridural en los pacientes sometidos a una cirugía mayor abdominal. Se concluye que el uso de anestesia epidural intraoperatoria y postoperatoria está asociado a una disminución de la incidencia, severidad de las alteraciones fisiológicas perioperatorias y morbilidad postoperatoria.

The Effects of Combined Spinal Epidural Anesthesia for Lower Extremity Surgery / 대한마취과학회지

BACKGROUND: Spinal anesthesia is a simple technique requiring a small dose of local anesthetic to provide intense and reliable block. And epidural anesthesia with the catheter technique gives a better control of the level of analgesia and a good postoperative pain relief using opioids, local anestheties or both. Therefore, the combined spinal epidural (CSE) anesthesia was evaluated to provide rapid onse of action, good muscle relaxation, prolonged duration of the block and postoperative pain relief. METHODS: All patients were placed in a lateral position. Using a midline approach at L interspace, a 18G Tuohy needle was introduced into the epidural space. A 27G Whitacre spinal needle was passed through the Tuohy needle until free flow cerebrospinal fluid, and than 0.5% heavy bupivacaine 3ml(15mg) was injected. The spinal needle was withdrawn and the epidural catheter was inserted. The dermatome level and time of sensory block was evaluated using loss of sensation of pinprick test every 1 minute for 30 minutes, until the maximum sensory block was established. Motor block was assessed using the Bromage scale. And postoperatively we interviewed the patients for opinioes on the blockade and complication. RESULTS: The mean values of maximum sensory block level were T8 (T8.0+/-1.7 dermatome) and at that time was 8min 30sec (8.5+/-1.2min). The motor blockade of lower extremity was Bromage 3 in all patients. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Subjective evaluation by the patients about postoperative pain control was excellent. CONCLUSIONS: CSE anesthesia appears to combine the reliabiIity and rapid onset of spinal block, and the ability to extend the block and postoperative analgesia by using the epidural catheter while minimizing their drawbacks.

Effect of Sublinguial Nefedipine on Blood Pressure, Heart Rate and Muscular Relaxation During Tracheal Intubation / 대한마취과학회지

BACKGROUND: Direct laryngoscopy & tracheal intubation for general anesthesia often provoke a marked sympathetic response. Such sympathetic response may be inconsequential in healthy patients but detrimental to those with ischemic heart disease or increased intracranial pressure. METHODS: Cardiovascular parameters after sublinguial administration of nifedipine(nifedipine group, n=13) were compared with parameters which derived from not administred nifedipine(control group, n=15), before administration of nifedipine, 5 minutes after adminitration, immediately before and after intubation, 2.5, 5, 7.5, 10 minutes following intubation. And the muscle twitch, clinical degree of muscular relaxation of intubation condition, the arterial blood gas analysis & electrolyte were measured. RESULTS: 1) The times to 75% and 100% twitch depression of vecuronium and clinical degree of muscle relaxation of intubation condition were no differences in both groups. 2) In both group, heart rate increased immediatly after intubation and thereafter decreased. But it was higher than basal value until 10 minutes after intubation in nifedipine group. 3) Systolic and diastolic arterial pressure increased significantly in both groups and these were decreased significantly in nifedipine group. 4) At arterial blood gas analysis, pH increased significantly and PaCO2 decreased at 15 minutes after nifedipine administration in both groups, compared to basal value. 5) There were no significant differences in electrolyte (Na+, K+, Ca++) values between two groups. CONCLUSIONS: In healthy adult patients, rise in the arterial blood pressure after tracheal mtubation decreased effectively with subligual nifedipine but nifedipine may produce excessive myocardial depression in patient with preexisting left ventricular dysfunction.