Will epidural with light general anesthesia increase the incidence of awareness with recall or dream postoperatively.

BACKGROUND: The incidence of awareness with recall during general combined with epidural anesthesia has not been previously reported. The purpose of this study was to quantify the incidence. MATERIALS & METHODS: One hundred patients were divided into two groups. Group 1 (N = 50) received general anesthesia (GA), Group 2 (N = 50) received GA and epidural anesthesia (EA) intraoperatively. No premedication was given. These patients were induced with thiopentol (5 mg/kg) or propofol (2.0 mg/kg) and anectine (1.2 mg/kg) for smooth tracheal intubation and maintained with N2O:O2 = 1.5:1.5, and isoflurane and muscle relaxant of either pavulon or atracurium. No sedatives was given. Before anesthesia, we introduced an epidural catheter into the group 2 patients. After induction, headphones with soft music were given to the patients, in both groups, throughout the operation. 20-36 hours after operation or when the patients were fully awake, we asked the patients if they had heard anything or dreamed intraoperatively. RESULTS: We found that not one of the one hundred patients heard anything or dreamed intraoperatively.

Comparison of antiemetic effect among ephedrine, droperidol and metoclopramide in pediatric inguinal hernioplasty.

Prevention and treatment of postoperative nausea and vomiting with ephedrine, droperidol and metoclopramide have been reported to be effective. To further investigate their efficacy, 100 pediatric patients scheduled to undergo inguinal hernioplasty on ambulatory basis were divided into five groups, namely, group 1: normal saline (iv) control; group 2: ephedrine 0.5 mg/kg, (im); group 3: droperidol 50 micrograms/kg. (iv); group 4: ephedrine 1 mg/kg. (im); group 5: metoclopramide 0.15 mg/kg. (iv). At the end of surgery, each patient received the drug treatment according to the specified group to which he was randomly assigned. The occurrence of postoperative nausea and vomiting was recorded in the recovery room and inquired at home by telephone within 24 h following surgery by a blinded observer. The authors found that there were no significant differences between the control group and ephedrine groups with whichever dose that was used in the prevention of postoperative nausea and vomiting. Droperidol and metoclopramide were effective in dealing with problem in comparison with control group (p less than 0.05). However, metoclopramide was more suitable than droperidol for pediatric outpatient based on duration of somnolence, return of orientation, and time of discharge.

The influence of position and PEEP on arterial blood gas during operation.

From December, 1990 to December, 1991, we studied the influence of PEEP and positional change to arterial blood gas in 60 ASA class II or III, aged 20 to 65 years, non-obese patients. The patients were assigned randomly into six groups. Group 1: head down position without PEEP. Group 2: head down position with PEEP 5 cmH2O. Group 3: lithotomy position without PEEP. Group 4: lithotomy position with PEEP 5 cmH2O. Group 5: supine position without PEEP. Group 6: supine position with PEEP 5 cmH2O. Blood gas analysis were performed at 5, 15, 30, 60, 120, and 180 minutes after positional change in group 1-4 and after anesthesia in group 5 and 6. The ventilator settings were: tidal volume -10 ml x 25 x (height in meters)2, rate 8/min. The results of significant difference inter-grouply were: PaO2 at 15 minutes; PaCO2 at 5 minutes; pH at 60, 120, and 180 minutes; base excess (BE) at 120 and 180 minutes. As the time progressed, PaO2 decreased in group 1, 2, and 3; PaCO2 decreased in group 3 and 5; pH decreased in group 3; BE decreased in all groups. PaCO2 were between 30-40 mmHg and no hypocarbia produced in all groups. In conclusion, ventilation of the non-obese patient based on 10 ml x 25 x (height in meters)2 x 8/min produce normocarbia and PaO2 more than 80 mmHg with 50% oxygen. No significant difference of PaO2 were found whether there were position change or PEEP 5 cmH2O.