[Motor and Sensory Blockade by Combined Spinal-Epidural Anesthesia for Cesarean Delivery].

BACKGROUND: We compared three combined spinal-epidural anesthesia (CSEA) techniques for cesarean delivery. Hypotension, nausea and vomiting are main problems produced by coonventional intrathecal doses. These problems were our secondary observations. Our primary observations were motor recovery and intraoperative pain. METHODS: Sixty patients were randomly allocated to one of the 3 groups (n = 20 per group). Group B (conventional dose): received intrathecally 0.5% hyperbaric bupivacaine (10 mg; < 160 cm in height 11 mg ; ≥ 160 cm in height) and epidural catheter at T12-L1. Group F (low-dose and addition of fentanyl) : received intrathecally 0.5% hyperbaric bupivacaine (70% of group B) with fentanyl 20 mg and epidural catheter at T12-L1. Group E (low-dose and epidural volume extension : EVE) : received intrathecally 0.5% hyperbaric bupivacaine (70% of group B) and epidural catheter at L3-4, through which 10 ml saline was injected 3 minutes after intrathecal injection. RESULTS: Group F and E demonstrated faster motor recovery than group B. More patients in group E than those in group B and F complained of intraoperative pain. There was no incidence of hypotension, nausea and vomiting. CONCLUSIONS: Group F and group E demonstrated similar fast motor recovery, but the former caused less intraoperative pain than the latter. Because this is an observational study, comparison of techniques such as addition of fentanyl, EVE, needs a compatative study.

[Effects of anesthetic agents on seizure duration and hemodynamics in electroconvulsive therapy].

BACKGROUND: Thiopental and suxamethonium have been recommended as anesthetic agents for electroconvulsive therapy (ECT). We hypothesize that propofol and vecuronium can also be used and superior to thiopental and suxamethonium in seizure duration and hemodynamics. METHODS: We made couples of anesthetic and muscle relaxant with these anesthetic agents and obtained four different combinations. We evaluated 10 patients with cross-over design, undergoing first four sequential ECTs using these four combinations in random turn. Total 40 ECTs were divided to four groups and compared with each other in seizure duration, blood pressure, and pulse rate. Group TS: thiopental (2 mg x kg(-1)) and suxamethonium (1.2 mg x kg(-1)), group PS: propofol (0.75 mg x kg(-1) and suxamethonium (1.2 mg x kg(-1)), group TV thiopental (2 mg x kg(-1)) and vecuronium (0.07 mg x kg(-1)), group PV: propofol (0.75 mg x kg-1) and vecuronium (0.07 mg x kg(-1)). Seizure duration was measured by EEG engineer to whom anesthetic agents were unknown. We measured blood pressure and heart rate before anesthetic induction, pre-ictal, post-ictal, and every minute for ten minutes thereafter. Wilcoxon signed-rank test was used as statistic measures. RESULTS: In between-group comparison of dynamics, there was no significant difference in these four groups. In seizure duration there was no significant difference between thiopental and propofol. Vecuronium (group TV: 27.0 +/- 24.6s, group PV: 17.5 +/-15.1s) shortened the seizure duration in comparison with suxamethonium (group TS: 43.0 +/-25.9s, group PS: 39.2 +/- 28.9s). CONCLUSIONS: Rocuronium, which will be used for ECT in future, is needed to be studied in suxamethonium-controlled design.

Effects of pretreatment with magnesium on muscle relaxation and cardiovascular responses in tracheal intubation using the priming principle for vecuronium.

In addition to its direct effects on blood vessels, the myocardium, and neuromuscular junctions, magnesium can act as an adrenergic antagonist and can inhibit the release of catecholamines both from adrenergic nerve terminals and from the adrenal medulla. This study was undertaken to evaluate these effects of magnesium on muscle relaxation and cardiovascular response during tracheal intubation. Forty ASA I or II patients undergoing elective surgery were allocated to a magnesium or a control group. Three minutes after priming with vecuronium 0.015 mg·kg-1, the magnesium group received vecuronium 0.085 mg·kg-1 and magnesium sulfate 40 mg·kg-1, while the control group received an equivalent volume of vecuronium and saline. The percent change from baseline in mean arterial pressure after tracheal intubation was significantly smaller (P<0.01) in the magnesium group than in the control group, but the percent change in heart rate was similar. There were no significant changes in plasma catecholamine concentrations after tracheal intubation in either group. The onset time of vecuronium was significantly shorter in the magnesium group than in the control group. The duration of action of vecuronium was significantly longer in the magnesium group than in the control group. Serum magnesium concentrations at 90 min after its administration were significantly higher than baseline. We concluded that vecuronium priming with magnesium pretreatment inhibits the hypertension associated with tracheal intubation and shortens the onset time of vecuronium, but prolongs it duration of action.