Intravenous Propofol Anesthesia in Epilepsy Surgery: A Comparative Clinical Study on the Usefulness of Pofol(R) and Diprivan(R) / 대한마취과학회지

BACKGROUND: Propofol is a new, short-acting intravenous sedative-hypnotic anesthetics for induction and maintenance. Awakening craniotomy for resection of seizure focus is performed when the area to be excited is too close to an eloquent area to be mapping accurately. This study was performed to evaluate the efficacy and the hemodynamic effects of Pofol(R) in comparison with Diprivan(R) for the maintenance of total intravenous anesthesia (TIVA) in epilepsy surgery. METHODS: This procedure is carried out under what has been euphemistically called local anesthesia or monitored anesthesia care (MAC). For induction, 2 mg/kg in bolus was administered in both groups, and the usual maintaining dose was 100 mcg/kg/min. Surgical procedures are divided in 6 stage (I: Craniotomy, II: Electrocorticography (ECoG), III: Functional mapping, IV: Cortical resection, V: Post-resection EEG, VI: Craniotomy closure). RESULTS: Arterial blood gases and vital signs of Pofol(R) group and Diprivan(R) group were analysed. But, awakening time was slightly rapid in Pofol(R) group (8.9+/-2.64 min.) compared with Diprivan(R) group (10.6+/-3.22 min.). And there were no statistically significant differences between the two groups. CONCLUSIONS: We concluded that both Pofol(R) and Diprivan(R) are the ideal total intravenous anesthetics for long time epilepsy surgery. However, Pofol(R) group is more helpful in intraoperative ECoG and functional brain mapping because of its slightly rapid awakening time.

Awareness and Recall During Anesthesia for Cesarean Section / 대한마취과학회지

Balanced anesthesia is being equilibrated with the maintenance of light planes of anesthesia and the relatively free utilization of muscle relaxants to prevent untoward movement of the patient in response to surgical stimuli. However, muscle relaxants per se do not contributes to the state of hypnosis or analgesia. Therfore, awareness during modern anesthesia must be seriously taken. We have given anesthesia in 175 cases for cesarean section in order to investigate intraoperative awareness. Among the 175 anesthetic cases, 13 cases had awareness of pain and 19 cases had auditor awareness. Accordingly the total incidence of awareness in our investigation was 16% which was significantly high and should be considered in clinical anesthesia practice.

Post-spinal Cauda Equina Syndrome / 대한마취과학회지

Cauda equina syndrome is characterized by urinary retention, loss of sexual function, loss of sensation in the perineal region and incontinence of feces. It had been reported by Courville, Kennedy, et al early in 1950. Since then Dripps, Vandam, Philips and others have reviewed many thousands of cases for evalustion of neurologic complications following spinal anesthesia, but there has not been a single case of permanent neurologic sequels reported. This 32 year old male with this postspinal neurologic complication was admitted to this institution on the twelveth post-operative day. His surgery had been carried out under spinal anesthesia for removal of an exostosis of the left knee at a local clinic. According to the history at the local clinic, a lumbar tap was performed at the level between L4-5, then 5% lidocaine in 5% D/W was injected into the subarachnoid space and the surgery was finished untevenfully. He developed pain in his buttocks and coccygeal region 6 hours after the surgery was done, so morphine sulfate was injected into the epidural space. After that, the pain was relieved for a while but he again started having the same pain associated with loss of sensation of the lower extremities, urinary retention, constipation and penile impotence on the 10th post-operative day. He came to this institution for 3 months with the above symptoms on the twelveth post-operative day. A cystoscopy and cystometry was done and showed a neurogenic bladder. He was treated with Urecholine for urinary retention and Dexamethasone for arachnoiditis for 2 months. He also had enemas intermittently for severe constipation and a Foley catheter was inserted. He was trained to void by himself by pressing his lower abdomen. He went home with the same symptoms after the Foley catheter was removed. The possible complications and preventions were listed in tabel l and ll. We will follow the patient.