Effects of Fentanyl or Clonidine on Postoperative Analgesia and Urinary Retention after Caudal Anesthesia / 대한마취과학회지

BACKGROUND: Caudal administration of local anesthetics, opioids, and the alpha2 adrenergic agonists is effective for postoperative pain. Intrathecal and epidural opioids may commonly result in urinary retention. The purpose of this study was to evaluate the effects of fentanyl or clonidine on postoperative analgesia and urinary retention. METHODS: Forty patients undergoing a hemorrhoidectomy were randomly assigned to receive 20ml of 2% lidocaine and 1 : 200,000 epinephrine plus clonidine 100 microgram (group C100, n = 10), clonidine 150 microgram (group C150, n = 10), fentanyl 50 microgram (group F50, n = 10), or fentanyl 100 microgram (group F100, n = 10) for caudal anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were measured before anesthesia and immediately postanesthesia, and every 5 min after caudal administration for 30 min. The following variables were recorded: onset time, analgesic time, voiding time, and urinary retention. RESULTS: The MAP at 20, 25, and 30 min in group C150 (91 +/- 7, 91 +/- 6, and 90 +/- 7 mmHg, respectively) was less than in group F50 (99 +/- 4, 101 +/- 6, and 101 +/- 5 mmHg, respectively) (P < 0.05). There was no difference in HR and onset time of anesthesia among the groups. Analgesic times in groups C150, F50, and F100 (270 +/- 22, 265 +/- 23, and 323 +/- 82 min, respectively) were longer than in group C100 (207 +/- 59 min), (P < 0.05). The number of patients using a urinary catheter to void was much higher in group F100 (7 patients) than in the groups C100, C150, or F50 (4, 5, and 3 patients, respectively) (P < 0.05). The voiding time was longer in group C150 than in group C100 (369 +/- 122 min vs 266 +/- 83 min, P < 0.05). No side effects were reported. CONCLUSIONS: We conclude that clonidine 150 microgram is adequate to provide effective analgesia and a low incidence of urinary retention during caudal anesthesia.

The Effects of Warming Intravenous Fluids, Sensory Block Level, and Skin Temperature on Postanesthetic Shivering during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Shivering, which occurs in the postanesthetic period, annoys many patients, so we examined the correlation of postanesthetic shivering (PAS) and warming intravenous fluids, the level of sensory blockade, and skin temperature during spinal anesthesia. METHODS: 65 patients undergoing an operation on a lower extremity were randomly allocated to 2 groups. The patients in group 1 and 2 received 500 ml of the unwarmed (ambient temperature) and warmed fluids prior to spinal anesthesia, respectively. All patients were anesthetized with 0.5% bupivacaine in 8% glucose. We measured the decrements of mean blood pressure (MBP) and heart rate, the highest sensory block level, and the increment of skin temperature 30 min after anesthesia, and the operating room temperature. After the operation we also evaluated the PAS by using the 10-mm visual anlalogue scale. RESULTS: The decrement of MBP was higher in group 2 than in group 1 (13 mmHg vs 5 mmHg, P<0.05). The highest sensory block level was higher in group 2 than in group 1 (T6.4 vs T7.6, P<0.05). However, there was no significant difference in heart rate decrement, skin temperature increment, ambient temperature, and PAS between groups. The more the MBP decrement, the less the PAS in all patients (r = 0.326, P = 0.008) and in group 1 (r = 0.480, P = 0.005), but there was no correlation between PAS and MBP decrement in group 2. The more the ambient temperature, the less the PAS in all patients (r = 0.334, P = 0.007), in group 1 (r = 0.386, P = 0.027), and in group 2 (r = 0.394, P = 0.026). The heart rate decrement, skin temperature increment, and sensory blockade level did not correlate with PAS. CONCLUSIONS: PAS lowers as MBP decreases and operating room temperature increases during spinal anesthesia, but warming intravenous fluids, sensory block level, and skin temperature change doesn't affect PAS.

Spontaneous Intracranial Hemorrhage Occurring during General Anesthesia in a Patient with Metastatic Brain Tumor: A case report / 대한마취과학회지

Spontaneous intracranial hemorrhage (ICH) occurs rarely during general anesthesia. We report a case of metastatic brain tumor producing an ICH during general anesthesia. A 47-year-old man was scheduled for the wedge resection of left lower lobe of lung under general anesthesia. He did not show any abnormal neurological sign and coagulation abnormality on arrival in the operating room. But he had a history of right hemiplegia 9 months ago which resolved completely. He was anesthetized for about 2 hours. Until 1 hour after the end of anesthesia and operation he did not regain his consciousness, but responded well to external stimuli. He was expected to be better, but his mentality became worse. Immediate computerized tomogram of brain revealed a left ICH. An emergency craniectomy was performed to remove the hematoma. Pathological investigations demonstrated a metastatic brain tumor from liver cell carcinoma. We presume that this intratumoral bleeding was produced by high intracranial blood pressure relating to general anesthesia or obstruction of jugular venous drainage by abnormal positioning of head.