The Changes of BIS and Hemodynamic Variables during Pediatric Open Heart Surgery with Sevoflurane or Midazolam / 대한마취과학회지

BACKGROUND: The bispectral index (BIS) has been shown to be useful for monitoring the degree of hypnosis in anesthetized adults. Although several studies have been performed to evaluate BIS in pediatric patients, it is unclear whether a BIS monitor can be applied in infants. This study was designed to evaluate changes of BIS, mean arterial pressure and heart rate during anesthesia with sevoflurane or midazolam in pediatric open heart surgery patients. METHODS: Eighteen patients under 3 years of age scheduled for an elective cardiac surgery were studied. Group S (n = 9) received sevoflurane-fentanyl, group M (n = 9) received midazolam-fentanyl. BIS, mean arterial pressure, heart rate, temperature, and end-tidal sevoflurane concentrations were obtained during anesthesia and surgery including cardiopulmonary bypass. The amount of fentanyl injected on an as needed base, total mechanical ventilation duration and intensive care unit stay were compared. RESULTS: A significant overall association between BIS and temperature was observed (Group S; R2 = 0.309, Group M; R2 = 0.225). There were no correlation between BIS and mean arterial pressure, heart rate, end-tidal sevoflurane concentration, and were no difference in the BIS scores of the groups. The mean arterial pressure of the M group from incision to CPB and post CPB 30 minutes were greater than those of the S group. The dose of fantanyl injected as needed during operation was greater in the M group than in the S group. No significant differences in the perisod of ventilation care and ICU stay. CONCLUSIONS: BIS decreased in both groups of patients as temperature decreased. Midazolam and fentanyl anesthesia in congenital heart disease may cause insufficient anesthesia regardless of BIS scores.

Vecuronium Administration for Endotracheal Intubation: The Priming Method vs. Intravenous Infusion Method / 대한마취과학회지

BACKGROUND: Priming significantly shortened the onset of neuromuscular blockade(NMB), but also results in a high incidence of side effects. This study was designed to determine the effect of infusion priming method on the side effects, intubation condition, and onset of NMB compared with divided priming method. METHOD: The effects of different priming method of vecuronium on onset time and endotracheal intubation condition were investigated. 40 patients were studied in two parts. In control part, 20 patients were allocated into two groups(n=10 in each group) receving 10, 20 g/kg vecuronium as a priming dose, followed by a intubating dose(0.1 mg/kg-priming dose) 3 min later; the other part, 20 patients were allocated into two groups(n=10 in each group) receving 0.2 mg/kg/hr vecuronium continuous intravenous infusion, followed by a intubating dose(0.1 mg/kg-total infusion dose) 3, 5 min later. Onset time is calculated by single twitch stimulation test from injection of the intubating dose to maximum depression of the single twitch. Intubatin condition was appreciated based on vocal cord reflex, coughing, and jaw relaxation and scored. RESULTS: The times to fade out on the single twitch of the intravenous infusion priming group were shorter than control priming group. There was no difference between control priming group and infusion priming group to evaluate the intubation conditions. Side effects in the continuous infusion group were lesser than control priming group. CONCLUSION: This results suggest that the use of continuous infusion method is one of the promising methods to shorten the neuromuscular blockade and to provide more comfort to the patients.