Optimizing dose infusion of 0.125% bupivacaine for continuous femoral nerve block after total knee replacement / 대한마취과학회지

BACKGROUND: The optimal dose infusion of 0.125% bupivacaine via a femoral catheter after total knee replacement (TKR) has not been defined. This study examined various dose infusions of bupivacaine to determine the analgesic quality in patients receiving a continuous femoral nerve block (CFNB). METHODS: Patients were randomized to receive a single-injection femoral nerve block (SFNB) or CFNB performed with 20 ml of 0.125% bupivacaine, followed by a continuous infusion of 0.125% bupivacaine in four groups (n = 20 per group): 1) 0 ml/h (SFNB), 2) 2 ml/h, 3) 4 ml/h, and 4) 6 ml/h. The pain intensity at rest and on knee movement was assessed using a visual analog scale (VAS) for the first 2 postoperative days. The cumulative bolus use of IV patientcontrolled analgesia (PCA) with a morphine-ketorolac combination was evaluated. RESULTS: A lower cumulative bolus of IV PCA was noted in all CFNB groups compared to SFNB on postoperative days (PODs) 1 and 2, respectively (P < 0.05). Lower VAS scores at rest were observed in the 4 ml/h and 6 ml/h groups than in the SFNB group on PODs 1 and 2, respectively, but only on POD 2 in the 2 ml/h group (P < 0.05). Lower VAS scores on movement were noted in the 4 ml/h than the SFNB group on PODs 1 and 2, but only on POD 1 in 6 ml/h (P < 0.05). CONCLUSIONS: The minimum effective infusion rate of 0.125% bupivacaine for CFNB after TKR appears to be 4 ml/h according to the VAS pain scores.

Optimizing the dose of intrathecal morphine when combined with continuous 3-in-1 nerve block after total knee replacement / 대한마취과학회지

BACKGROUND: Continuous femoral 3-in-1 block alone is insufficient for the treatment of severe pain after total knee replacement (TKR). Intrathecal (IT) morphine provides effective postoperative analgesia but may result in many side effects. The optimal dose of spinal morphine when combined with continuous 3-in-1 block after TKR is not known. METHODS: Patients were randomized to receive IT morphine in five groups (n = 20 per group): 1) 0.0 mg, 2) 0.05 mg, 3) 0.1 mg, 4) 0.15 mg, and 5) 0.2 mg. All patients received continuous 3-in-1 block performed with 20 ml of 0.25% bupivacaine, followed by a continuous infusion of 0.125% bupivacaine at the rate of 2 ml/h plus PCA boluses of 1 ml with a lockout of 10 minutes. The intensity of pain at rest and on movement of the knee was assessed by using a visual analog scale for the first two postoperative days. RESULTS: All treatment groups produced effective pain relief and decreased cumulative femoral PCA bolus use of 0.125% bupivacaine compared with control, respectively (P < 0.05); however, there were no significant differences among the treatment groups. The incidence of vomiting was significantly more frequent with 0.1-0.2 mg IT morphine groups compared with control, respectively (P < 0.05). The rate of administration of antipruritic medication was increased as IT morphine dose increased (P < 0.05). CONCLUSIONS: Use of 0.05 mg IT morphine would appear to provide the optimal balance between pain relief and adverse effects following TKR.

The Effect of Intrathecal Morphine Added to Continuous Femoral 3-in-1 Nerve Block for Analgesia after Total Knee Replacement / 대한마취과학회지

BACKGROUND: Most of the patients who received a 3-in-1 nerve block for analgesia after total knee replacement (TKR) complained of pain in the back of the knee. We investigated the value of an intrathecal (IT) morphine in patients receiving continuous 3-in-1 nerve block with a PCA technique for pain control after unilateral TKR. METHODS: Group 1 (n = 20) received spinal anesthesia with IT fentanyl 10microgram. Group 2 (n = 20) received spinal anesthesia with IT morphine 0.1 mg. All patients received continuous 3-in-1 nerve block performed with 20 ml of 0.25% bupivacaine with epinephrine 1 : 200000, followed by a continuous infusion of 0.125% bupivacaine at the rate of 2 ml/h plus PCA boluses of 1 ml with a lockout of 10 min. The intensity of pain at rest and on movement was assessed by the patients using a visual analog scale (VAS) for the first 2 postoperative days. RESULTS: Patients in Group 2 reported significantly lower VAS pain scores at rest than those in Group 1 for the first 1 day (P < 0.05). Cumulative PCA bolus use of 0.125% bupivacaine in Group 2 was significantly lower than those in Group 1 for the first 2 days (P < 0.05). The incidences of pruritus in Groups 1 and 2 were 0 and 50%, respectively (P < 0.01). CONCLUSIONS: We determined that the addition of IT morphine 0.1 mg to continuous femoral 3-in-1 nerve block improves postoperative analgesia after TKR.

Comparison of Continuous Three-in-One Block and Intravenous Patient-Controlled Analgesia for Postoperative Pain after Total Knee Replacement / 대한마취과학회지

BACKGROUND: Severe postoperative pain can delay knee rehabilitation and prolong the duration of convalescence after a total knee replacement (TKR). This study compared a continuous 3-in-1 block using a patient-controlled analgesia (PCA) technique and IV PCA for analgesia after a unilateral TKR. METHODS: Forty patients scheduled for an elective TKR under spinal anesthesia were randomly divided into two groups. Group 1 received an IV PCA with butorphanol and ketorolac. Group 2 received a continuous 3-in-1 block performed with 20 ml of 0.25% bupivacaine and epinephrine 1 : 200,000, followed by a continuous infusion of 0.125% bupivacaine through a femoral catheter at a rate of 2 ml/h plus 1 ml PCA boluses of a lockout time of 10 min. The level of pain was assessed at rest and during continuous passive motion using a visual analog scale (VAS). The VAS pain scores, nausea and vomiting were recorded in the postanesthetic care unit, at 6 PM on the day of operation, and at 8 AM and 6 PM on postoperative days 1 and 2, respectively. The duration of surgery, anesthesia time, blood loss, and hospital stay were compared. RESULTS: The patients in Group 2 reported lower VAS pain scores than those in Group 1 (P < 0.05). The duration of surgery, nausea and vomiting, blood loss, and hospital stay were similar in the two groups except for the anesthesia time. CONCLUSIONS: A continuous 3-in-1 block with a PCA technique provides better pain relief than IV PCA with butorphanol and ketorolac after TKR.

Hydrohemothorax and Subclavian Artery Laceration during Internal Jugular Vein Cannulation: A case report / 대한마취과학회지

Central venous cannulation via an internal jugular vein has become a common procedure in the management and monitoring of severely ill patients. Although complications such as carotid artery puncture or pneumothorax have been reported, hemothorax is relatively uncommon. We describe a case of hydrohemothorax and subclavian artery laceration which occurred during right internal jugular vein cannulation. A 44-year-old female patient was admitted for laparoscopic adrenalectomy under general anesthesia. For central venous pressure monitoring, central venous cannulation performed. However, dilator overinsertion injured the right subclavian artery. This led to a massive ipsilateral hydrohemothorax requiring thoracotomy for subclavian artery repair. This case suggests that central venous cannulation should be done carefully and improves awareness of the potential for dilator induced injury.

Anesthetic Management of Emergent Cesarean Section in a Patient with Allergic Reaction to an Antibiotic: A case report / 대한마취과학회지

Allergic reactions developed in parturients can cause fetal asphyxia and some difficulties in anesthetic management. We performed general anesthesia for an emergent cesarean section on 30 yrs old woman who showed an allergic reaction to an antibiotic. Dyspnea, urticaria, sweating, generalized edema and fetal bradycardia suddenly occurred after an intravenous injection of the antibiotic. Dexamethasone 10 mg was administered intravenously. General anesthesia was induced with pentothal and succinylcholine. Despite of severe airway edema, endotracheal intubation was successful. During the operation, the allergic signs became decreased. After the operation, no additional problems were evident. Potential epitopes should be removed in susceptible parturients and medical staff should be familiar with anesthetic management in allergic patients during pregnancy.

Therapy of Pulmonary Embolism under Cardiopulmonary Bypass during Bipolar Endoprosthesis of the Hip / 대한마취과학회지

Although the occurrence of fatal pulmonary embolism may be diminishing, it still accounts for a substantial proportion of postoperative deaths in the middle-aged and older persons, especially among those undergoing major orthopedic surgery, despite improvements in patient management. We experienced cardiac arrest during bipolar endoprosthesis. Cardiopulmonary resuscitation was started and the transesophageal echocardiogram showed right heart failure. We suspected acute pulmonary thromboembolism and decided to perform thromboembolectomy with cardiopulmonary bypass. A massive old blood clot and a 1.0 x 1.5 cm thrombus were removed from both pulmonary arteries. However, despite massive fluid therapy and the use of inotropic agent, the patient failed to recover successfully with postoperative management in the intensive care unit.

Comparison of Postoperative Nausea and Vomiting between Gynecologic Surgery and Cesarean-Section during Intravenous Patient-Controlled Analgesia with Fentanyl / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the incidence of postoperative nausea and vomiting (PONV) in patients undergoing major gynecologic surgery with those undergoing Cesarean-section during intravenous patient-controlled analgesia (PCA). METHODS: Seventy two patients received general anesthesia with enflurane. Group 1 patients underwent major gynecologic surgery, and group 2 patients were parturients who underwent Cesarean-section. Postoperatively, fentanyl was continuously infused i.v. using Accufuser PLUS (basal, 2 ml/h; bolus, 0.5 ml; lockout interval, 15 min) containing fentanyl 25microgram/kg in saline. PONV was evaluated at 6, 12, 24 and 36 h after starting continuous infusion and compared in the two groups. RESULTS: The incidence of PONV was significantly lower in group 2 (14%) than in group 1 (67%) (P < 5). CONCLUSIONS: Our results show that the incidence of PONV was lower for Cesarean-section than for gynecologic surgery.

The Effect of Monitored Anesthesia Care using Alfentanil and Ketorolac in Patients Undergoing Endoscopic Sinus Surgery / 대한마취과학회지

BACKGROUND: Monitored anesthesia care (MAC) has become increasingly important as a means of ensuring patient comfort, safety and satisfaction during surgery under local anesthesia. The purpose of this study was to evaluate the effect of monitored anesthesia care using alfentanil and ketorolac in patients undergoing endoscopic sinus surgery (ESS). METHODS: We studied 47 adult patients premedicated with glycopyrrolate 0.2 mg and midazolam 0.02 mg/kg IV. Using a 5.0 endotracheal tube, 5 L/min of oxygen was delivered via mouth. A mixture of 30 mg of ketorolac and 2,500microgram of alfentanil in 25 ml of saline was infused to patients at a rate of 1microgram/kg/min alfentanil after a bolus injection of 5microgram/kg alfentanil before operation. During operations we monitered vital signs, SpO2, OAA/S (Observer's Assessment of Alertness/Sedation) scale and BIS scores. Six hours postoperatively we assessed patient degree of satisfaction via NRS (1-10) with the anesthetic technique and side effects. RESULTS: Mean duration of drug infusion was 35 +/- 10.1 min, and the mean infusion rate of alfentanil was 1.09 +/- 0.23microgram/kg/min. Significant differences were observed between OAA/S scale scores at 10 min and 30 min after drug infusion and those in the waiting room (4.63, 4.65 vs 5, P <0.05)(Fig. 4). The mean patient satisfaction score was 8.3 out of 10, and 93.6% (44/47) of patients said they would recommend this anesthetic technique to others for ESS. CONCLUSIONS: Our results suggest that MAC using a mixture of alfentanil and ketorolac during ESS is a good way of relieving patient anxiety and pain without respiratory depression or excessive sedation. This study also showed a high level of patient satisfaction for those undergoing ESS under local anesthesia.

A Comparison of the Effects of Different Doses of Butorphanol Administered in Conjunction with Ketorolac in Intravenous Patient Controlled Analgesia / 대한마취과학회지

BACKGROUND: We designed a randomized study to assess the analgesic efficacy, side effects, and satisfaction score among different doses of butorphanol by using intravenous patient controlled analgesia (IVPCA) for pain relief following a cesarean section. METHODS: Sixty women who received a cesarean section were randomly divided into 3 groups. Each group received butorphanol 3 mg (Group 1), 5 mg (Group 2) or 7 mg (Group 3) with ketorolac 150 mg. Butorphanol and ketorolac were administerd by a two day infusor at the rate of 2 ml/hr. Assessments for pain with NRS, and side effects were evaluated in the recovery room, at 3 hr, 6 hr, 12 hr, 24 hr and 48 hr after the operation. A patient satisfaction score was evaluated at 24 hr and 48 hr after the operation. RESULTS: Pain score at 3 hr after the operation was significantly lower ine Group 2 than Group 1 (P<0.05), at 6 hr and 12 hr after the operation was significantly lower in Group 2 and Group 3 than Group 1 (P<0.05). However, there was no significant difference between Group 2 and Group 3. Patient satisfaction score at 24 hr and 48 hr after the operation did not show any significant difference among the three groups. One patient in Group 2 revealed sedation over 3 on a 4-point scale at 3 hr after the operation, but there was no significant difference among the three groups. CONCLUSIONS: The above results suggested that both butorphanol 5 mg and 7 mg with ketorolac 150 mg via IVPCA were an effective dosage for postoperative pain control during two days after a cesarean section without any significant side effects.

Acute Dystonia by Droperidol during Intravenous Patient-Controlled Analgesia in Young Patients

Patient-controlled analgesia (PCA) is an important means for postoperative analgesia with parenteral opioid. However, postoperative nausea and vomiting (PONV) remains a major problem with a PCA system. Droperidol is used in PCA to prevent PONV. Extrapyramidal reactions by droperidol are, however, occasionally induced. We describe two cases of severe extrapyramidal hypertonic syndrome with an intravenous administration of droperidol in PCA in young patients, following orthopedic surgery.

Acute Dystonia by Droperidol during Intravenous Patient-Controlled Analgesia in Children / 대한마취과학회지

Patient-controlled analgesia (PCA) is an important means for postoperative analgesia with parenteral opioids. However, postoperative nausea and vomiting (PONV) remains a major complication with a PCA system. Droperidol is used in PCA to prevent PONV. Extrapyramidal reactions by droperidol are, however, occasionally induced. We describe two cases of severe extrapyramidal hypertonic syndrome with an IV administration of droperidol in PCA in two children, following orthopedic surgery. One patient showed a hypertonic syndrome 20 minutes after receiving droperidol 1.0 mg IV and the symptoms persisted for nearly 12 h without prescription. Another patient revealed an acute rigidity 19 h after the beginning of PCA and was treated with an IM administration of midazolam 2 mg successfully.

Effect of Elimination of CO2 Absorption Canisters on the Rate of Recovery from General Anesthesia / 대한마취과학회지

BACKGROUND: The most important route for elimination of inhalation anesthetics is exhalation. The lower anesthetic circuit volume and absorption by the anesthetic circuit maKes recovery more fast. The purpose of this study is to evaluate the effect of the elimination of CO2 absorption canisters on the rate of recovery from anesthesia. METHODS: Forty patients were randomly assigned into two groups. Group 1 patients recovered from enflurane anesthesia with CO2 absorption canisters (baralyme), but group 2 patients emerged from anesthesia without CO2 absorption canisters. The changes of expiratory enflurane and inspiratory nitrous oxide concentration at 30, 60, 90, 120, 150, 180 sec after the end of anesthetic administration, and time from the end of anesthetic administration to extubation were measured and compared between the groups. RESULTS: Enflurane and nitrous oxide concentrations after the end of anesthetic administration in group 2 were significantly lower than in group 1 at each time interval (P < 0.05). Time from the end of anesthetic administration to extubation in group 2, 7.7 +/- 1.4 min, was significantly shorter than in group 1, 10.5 +/- 2.6 min (P < 0.05). CONCLUSIONS: The results show that the patients emerging from anesthesia without CO2 absorption canisters can recover from anesthesia more rapidly than those with CO2 absorption canisters.

Alterations in Arterial Blood Gas and Electrolytes Following Crystalloid Infusion during Orthopedic Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study is to evaluate the effects of crystalloid solutions on the arterial blood gas and electrolytes in spinal (n = 58) and hip joint surgery (n = 2). METHODS: Sixty patients were randomly divided into three groups according to the kind of crystalloid solutions. Group 1 patients (n = 20) received Hartmann's solution (HS), group 2 patients (n = 20) received HS plus normal saline (NS) in a 1 : 1 volume ratio, and group 3 patients (n = 20) received NS. Arterial blood gas and electrolytes were measured after induction and at the end of the operation. RESULTS: The replacement volumes of the crystalloid solutions in groups 1, 2 and 3 were 2545 +/- 931, 3050 +/- 1013 and 3240 +/- 1056 ml, respectively. The degree of the change in pH from after induction until the end of the operation was the greatest in group 3 (0.125) than in group 1 (0.04) and group 2 (0.079) (p < 0.05). The degree of the changes in the serum chloride value in groups 2 (9.1 mEq/L) and 3 (12.1 mEq/L) was greater than that in group 1 (4.2 mEq/L), respectively (p < 0.05). In the relationships among the parameters in group 3, the pH values tended to decrease with increasing volume replacements of NS (P = 0.005); and the chloride values tended to increase with increasing volume replacements of NS (P = 0.005). CONCLUSIONS: The results suggest that HS is the superior crystalloid solution because there were less changes in acid-base balance and chloride value than when NS was infused alone. HS did not alleviate the changes of acid-base balance and chloride value caused by NS when both of them were infused at the same time.

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.

The Effect of Induced Hypotension on Intraoperative Blood Loss during Spinal Surgery / 대한마취과학회지

BACKGROUND: This study was performed to evaluate whether the degree of hypotension influences blood loss during spinal surgery. METHOD: Fifty patients undergoing only one level spinal fusion were assigned to one of three groups. In group 1 (n = 14), the systolic blood pressure (SBP) was maintained at 100 120 mmHg with enflurane. In groups 2 (n = 18) and 3 (n = 18), the SBP were maintained at 80 100 and 60 80 mmHg, respectively. Hydralazine and esmolol were used in the hypotensive groups. RESULTS: Blood losses during operation in groups 2 (554 +/- 287 ml) and 3 (456 +/- 162 ml) were significantly lower than in group 1 (1141 +/- 690 ml) (P < 0.05), although there was no significant difference between groups 2 and 3. The percentage of patients receiving transfusions during the operation in groups 1 and 2 were 57.1 and 5.6%, respectively. CONCLUSIONS: The results show that a moderate reduction in SBP (80 - 100 mmHg) reduces blood loss by more than half in comparison to a mild reduction in SBP (100 - 120 mmHg). However, a severe reduction in SBP (60 - 80 mmHg) does not increase the reduction in blood loss in comparison to moderate hypotension.

The Effect of Induced Hypotensive Anesthesia on the Postoperative Liver Function in Spine Surgery / 대한마취과학회지

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility, but may produce an ischemic damage on liver. The purpose of this study is to evaluate postoperative liver function according to the degree of induced hypotension in spine surgery. METHODS: Sixty patients were classified into three groups. In group 1 (n=20) undergoing simple laminectomy, the systolic blood pressure (SBP) was maintained at 120 to 100 mmHg with controlling the concentration of enflurane. Hydralazine and/or esmolol were given to maintain the SBP at 100 to 80 mmHg in group 2 (n=20) and 80 to 60 mmHg in group 3 (n=20) as needed. Preoperative and postoperative 1, 3, 5, 7 day's serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT) and alkaline phosphatase (ALP) were evaluated. RESULTS: In group 1, postoperative SGOT levels were increased significantly on postoperative 1, 3, 5, 7 day and postoperative SGPT levels were increased significantly on postoperative 7 day only. In group 2, postoperative SGOT levels were increased significantly on postoperative 1, 3, 5, 7 day and there was no significant difference between preoperative and postoperative SGPT levels. In group 3, postoperative SGOT levels were increased significantly on postoperative 1, 3 day and postoperative SGPT levels were increased significantly on postoperative 3, 5, 7 day. There was no significant difference among three groups in SGOT and SGPT levels. Postoperative ALP levels were decreased on postoperative 1, 3, 5, 7 day in all groups and there was no significant difference among three groups except a significant difference between group 1 and 3 on postoperative 1, 3 day in ALP levels. CONCLUSIONS: These results suggest that severe reduction in SBP at 80 to 60 mmHg by hydralazine and/or esmolol under general anestheia with enflurane can not exclude the possibility of liver damage.

Prolonged Urinary Retention following Continuous Epidural Infusion of Morphine and Fentanyl Using Continuous Drug Infusor: A case report / 대한마취과학회지

Epidural injection of morphine is widely used for relief of postoperative pain. However urinary retention, the side effect, following epidural morphine is troublesome for patient. A 45 year old male patient was admitted due to avascular necrosis of right hip joint and received bipolar endoprosthesis under continuous epidural anesthesia with 2% lidocaine 15 ml. In recovery room after operation, we applied 2 day,s continuous drug infusor (Baxter Infusor(R), Baxter Healthcare Co., USA) with morphine 2 mg and fentanyl 300 g in saline through epidural catheter. At 2 hour after operation, morphine 2 mg was added to the continuous drug infusor due to severe surgical pain. In ward, at 5 hour, he complained of voiding difficulty and abdominal distension. At 6 hour, Nelaton catheter was inserted and 1000 ml of urine was voided. On the 1st postoperative day, the continuous drug infusor was removed and he received naloxone 0.1 mg, two times, intravenously. But voiding difficulty was persisted. Intermittent Nelaton catheter or indwelling Foley catheter was inserted alternatively. Bethanechol chloride (Besacholine(R)) 15~90 mg/day and prazosin hydrochloride (Minipress(R)) 2~3 mg/day were administered orally and hot bag was applied on lower abdomen. On the 25th postoperative day, he was ultimately released from voiding difficulty and discharged without any problems. We suggested that the causes of urinary retention were bladder atony by overdistention of the bladder and contraction of internal urethral sphincter following epidural anesthesia, surgical pain and immobilization.

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.

The Comparison between the Postoperative Predicted and Actual Hematocrit / 대한마취과학회지

BACKGREOUND: Several formulas for estimating allowable pre-transfusion blood loss were used to reduce unnecessary intraoperative blood replacement. The postoperative predicted hematocrit computed by formula was compared with the actual hematocrit and was tested which formula was more accurate in spine surgery. METHOD: Total blood volume was estimated in spine surgery of 34 patients. The target hematocrit (Hct) was suggested on 30% and the allowable blood loss was computed using the formula 1 and 2. For each patients, simultaneous measurement of blood loss and Hct was obtained at the end of operation. The postoperative predicted Hct by the formula 1 and 2 was calculated and compared with the actual Hct, and the difference between the formula 1 and 2 was evaluated. Allowable blood loss=Estimated blood volume (Initial Hct Target Hct)/Initial Hct ... Formula (1) Allowable blood loss=Estimated blood volume (Initial Hct Target Hct)/Average Hct ... Formula (2) RESULTS: 1) The preoperative Hct was 40.7 3.9%. The postoperative predicted Hct by the formula 1 and 2 were 34.3 4.6 and 34.9 4.3% respectively. The postoperative actual Hct was 30.1 4.6%.2) The difference between the predicted Hct by the formula 1 and the actual Hct was 4.2% (P<0.05). The difference between the predicted Hct by the formula 2 and the actual Hct was 4.8% (P<0.05). The difference between the predicted Hct by the formula 1 and 2 was 0.6% (P<0.05). It was thought that the predicted Hct by the formula 1 was more closer to the actual Hct. CONCLUSIONS: The predicted Hct by both formulas is underestimated when the results compare with the actual Hct. But the predicted Hct by the formula 1 provides a closer results to the actual Hct than the predicted Hct by the formula 2.