General anesthesia versus monitored anesthetic care with dexmedetomidine for closed reduction of nasal bone fracture / 대한마취과학회지

BACKGROUND: Reduction of nasal bone fracture can be performed under general or local anesthesia. The aim of this study was to compare general anesthesia (GA) and monitored anesthetic care (MAC) with dexmedetomidine based on intraoperative vital signs, comfort of patients, surgeons and nurses and the adverse effects after closed reduction of nasal bone fractures. METHODS: Sixty patients with American Society of Anesthesiologists physical status I or II were divided into a GA group (n = 30) or MAC group (n = 30). Standard monitorings were applied. In the GA group, general anesthesia was carried out with propofol-sevoflurane-N2O. In the MAC group, dexmedetomidine and local anesthetics were administered for sedation and analgesia. Intraoperative vital signs, postoperative pain scores by visual analog scale and postoperative nausea and vomiting (PONV) were compared between the groups. RESULTS: Intraoperatively, systolic blood pressures were significantly higher, and heart rates were lower in the MAC group compared to the GA group. There were no differences between the groups in the patient, nurse and surgeon's satisfaction, postoperative pain scores and incidence of PONV. CONCLUSIONS: MAC with dexmedetomidine resulted in comparable satisfaction in the patients, nurses and surgeons compared to general anesthesia. The incidence of postoperative adverse effects and severity of postoperative pain were also similar between the two groups. Therefore, both anesthetic techniques can be used during the reduction of nasal bone fractures based on a patient%s preference and medical condition.

The Effects of Alfentanil on Mother and Neonate during the Induction of General Anesthesia for a Cesarean Section / 대한마취과학회지

BACKGROUND: During general anesthesia for a cesarean section, light depth of anesthesia frequently leads to maternal awareness and pain responses. The aim of this study was to evaluate the effects of alfentanil on the mother and neonate during a cesarean section. METHODS: Forty four parturients undergoing general anesthesia for an elective cesarean section were enrolled in this study. General anesthesia was induced with propofol 2 mg/kg and succinylcholine 1.5 mg/kg after an intravenous injection of normal saline 0.02 ml/kg for the control group or alfentanil 10microgram/kg for the alfentanil group. After tracheal intubation, anesthesia was maintained with O2 (2 L/min)-N2O (2 L/min)-isoflurane (0.5% end tidal). Mean blood pressure (MBP), heart rate, bispectral index (BIS) and maternal pain responses by an isolated forearm technique were measured every 1 min until delivery. Apgar scores of neonates were measured at 1 min and 5 min after delivery. RESULTS: There were no differences between groups in the MBP, BIS or maternal pain responses. However heart rates were lower in the alfentanil group than in the control group (P = 0.017). CONCLUSIONS: The supplemental administration of alfentanil 10microgram/kg can attenuate the changes in maternal heart rate during general anesthesia for a cesarean section without neonatal Apgar score decline.