Clinical Experiences of Balanced Anesthesia with Nalbuphine or Fentanyl in Cesarean Section / 대한마취과학회지

ABSTRACT

The effect of fentanyl and nalbuphine used as analgesics in balanced anesthesia were evaluated in 60 full term parturients, ASA physical status class I or II, sheduled for elective cesarean section. They were injected intramusculary with 0.2 mg of glycopyrrolate 30 minutes to one hour prior to the induction of anesthesia. Four mg/kg of thiopental sodium and one mg/kg of succinylcholine were administered intravenously for the induction and endotracheal intubation. Anesthesia was maintained with 66% of nitrous oxide in oxygen until delivery. Following the intravenous injection of 4 mg-vecuronium, controlled ventilation was applied to maintain at PCO1 30 to 40 mmHg. Immediately after clamping of the umbilical cord, 3 ug/kg of fentanyl(F group) or 0.3 mg/kg of nalbuphine(N group) with 5 mg of droperidol were administered. In the F group, the systolic and diastolic blood pressures at three minutes after fentanyl were significantly lower than those during the preinduction period and during recovery room stay. The systolic BP in the preinduction period was significantly higher than those of three minutes after nalbuphine, and the diastolic BP at the preinduction period was also higher than those of three minutes after nalbuphine and during recovery room stay. Heart rates were significantly increased three minutes after nalbuphine than at recovery room. The blood presures and heart rates were not significantly different between the two groups. The time intervals from the end of the operation to the first analgesics were significantly longer in the N group(mean 11.3 hours) in contrast to the F group(mean 6.9 hours). There were a few complications such as nausea, headache, dizziness, somnolence and euphoria. The incidences of awareness was 13.3 and 6.7% in the F and N group, respectively. We concluded that the balanced anesthetic technique using nalbuphine with droperidol nuder the inhalation of 66%-nitrous oxide resulted in a satisfactory anesthesia for cesarean seetion with good postoperative analgesia.