Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test / 대한마취과학회지

BACKGROUND: Hypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP). METHODS: In total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began. RESULTS: Preemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P < 0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during OLV, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P < 0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P < 0.05). CONCLUSIONS: Preemptive ARS can improve arterial oxygenation during OLV. Furthermore, a 6 ml/kg tidal volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.

Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium / 대한마취과학회지

BACKGROUND: Rocuronium has been well known to produce withdrawal response in 50-80% patients when administered intravenously. Several drugs are administered prior injection of rocuronium to prevent the withdrawal response. We compared the preventive effect of lidocaine, ketamine, and remifentanil on the withdrawal response of rocuronium. METHODS: A total of 120 patients undergoing various elective surgeries were enrolled. Patients were allocated into 4 groups according to the pretreatment drugs (Group N, normal saline; Groups L, lidocaine 40 mg; Group K, ketamine 0.5 mg/kg; Group R, remifentanil 1 microg/kg). Patients received drugs prepared by dilution to 3 ml volume before injection of rocuronium. Withdrawal responses after injection of rocuronium were graded on a 4-point scale. Hemodynamic changes were observed before and after administration of pretreatment drugs and after endotracheal intubation. RESULTS: Incidence of withdrawal response was significantly lower in group L (20%), group K (30%), and group R (0%), than group N (87%). Severe withdrawal response was observed in 5 of the 30 patients (17%) in group L, and in 9 of the 30 patients (30%) in group K. There was no severe withdrawal response in group R. Mean blood pressure and heart rate were significantly decreased in group R compared to other groups. CONCLUSIONS: It seems that remifentanil (1 microg/kg intravenously) was the strongest and most effective in prevention of withdrawal response after rocuronium injection among the 3 drugs.

Effect on thermoregulatory responses in patients undergoing a tympanoplasty in accordance to the anesthetic techniques during PEEP: a comparison between inhalation anesthesia with desflurane and TIVA / 대한마취과학회지

BACKGROUND: It has been known that positive end-expiratory pressure (PEEP) increases the vasoconstriction threshold by baroreceptor unloading. We compared the effect on the thermoregulatory responses according to anesthetic techniques between an inhalation anesthesia with desflurane and a total intravenous anesthesia (TIVA) with propofol and reminfentanil when PEEP was applied in patients undergoing tympanoplasty. METHODS: Forty-six patients with a scheduled tympanoplasty were enrolled and the patients were divided in two study groups. Desflurane was used as an inhalation anesthetic in group 1 (n = 22), while TIVA with propofol and remifentanil was used in group 2 (n = 24). PEEP was applied by 5 cmH2O in both groups and an ambient temperature was maintained at 22-24degrees C during surgery. The core temperature and the difference of skin temperature between forearm and fingertip were monitored for about 180 minutes before and after the induction of general anesthesia. RESULTS: The final core temperature was significantly higher in group 2 (35.4 +/- 0.7degrees C) than in group 1 (34.9 +/- 0.5degrees C). Peripheral thermoregulatory vasoconstriction was found in 5 subjects (23%) in group 1 and in 21 subjects (88%) in group 2. The time taken for reaching the thermoregulatory vasoconstriction threshold was 151.4 +/- 19.7 minutes in group 1 and 88.9 +/- 14.4 minutes in group 2. CONCLUSIONS: When PEEP will be applied, anesthesia with TIVA may have more advantages in core temperature preservation than an inhalation anesthesia with desflurane.

The effect of low dose ketamine and priming of cisatracurium on the intubating condition and onset time of cisatracurium / 대한마취과학회지

BACKGROUND: Both ketamine and priming may accelerate the onset time of neuromuscular blocking agents. We investigate the effect of low dose ketamine and cisatracurium priming on the intubating condition and onset time of cisatracurium. METHODS: After Institutional Review Board approval, 120 consecutive patients undergoing general anesthesia were randomly assigned to one of 4 groups. All patients were injected one of normal saline (group C), cisatracurium 0.01 mg/kg (group P), ketamine 0.5 mg/kg (group K) and combination of cisatracurium 0.01 mg/kg, and ketamine 0.5 mg/kg (group PK) diluted into a 5 ml solution, followed 3 minutes later by cisatracurium 0.15 mg/kg in group C and K, and 0.14 mg/kg cisatracurium in priming group. Onset time was recorded the electromyographical responses using single twitch and intubating conditions were evaluated at 60 seconds after cisatracurium administration. RESULTS: The mean onset time was most significantly accelerated in Group PK and was also significantly more accelerated in Group P and K compared with Group C (P < 0.008). It was 112.7 +/- 13.2, 91.4 +/- 17.9, 84.9 +/- 12.7 and 76.4 +/- 8.3 seconds in Group C, P, K, and PK, respectively. Intubating conditions were significantly improved in Group P, K and PK than Group C (P < 0.008). Especially, Group PK showed most significant improvement of intubating conditions. CONCLUSIONS: The combination of the low dose ketamine and cisatracurium priming accelerated the onset time and was improved the intubating conditions.

Polyphenols of Rubus coreanum Inhibit Catecholamine Secretion from the Perfused Adrenal Medulla of SHRs

The present study was attempted to investigate whether polyphenolic compounds isolated from wine, which is brewed from Rubus coreanum Miquel (PCRC), may affect the release of catecholamines (CA) from the isolated perfused adrenal medulla of the spontaneously hypertensive rats (SHRs), and to establish its mechanism of action. PCRC (20~180 microgram/ml) perfused into an adrenal vein for 90 min relatively dose-dependently inhibited the CA secretory responses to ACh (5.32 mM), high K+ (56 mM), DMPP (100 micrometer) and McN-A-343 (100 micrometer). PCRC itself did not affect basal CA secretion (data not shown). Also, in the presence of PCRC (60 microgram/ml), the CA secretory responses to veratridine (a selective Na+ channel activator (10 micrometer), Bay-K-8644 (a L-type dihydropyridine Ca2+ channel activator, 10 micrometer), and cyclopiazonic acid (a cytoplasmic Ca2+ -ATPase inhibitor, 10 micrometer) were significantly reduced, respectively. In the simultaneous presence of PCRC (60 microgram/ml) and L-NAME (an inhibitor of NO synthase, 30 micrometer), the inhibitory responses of PCRC on the CA secretion evoked by ACh, high K+, DMPP, and Bay-K-8644 were considerably recovered to the extent of the corresponding control secretion compared with that of PCRC-treatment alone. The level of NO released from adrenal medulla after the treatment of PCRC (60 microgram/ml) was greatly elevated compared with the corresponding basal level. Taken together, these results demonstrate that PCRC inhibits the CA secretion from the isolated perfused adrenal medulla of the SHRs evoked by stimulation of cholinergic receptors as well as by direct membrane-depolarization. It seems that this inhibitory effect of PCRC is mediated by blocking the influx of calcium and sodium into the adrenal medullary chromaffin cells of the SHRs as well as by inhibition of Ca2+ release from the cytoplasmic calcium store at least partly through the increased NO production due to the activation of NO synthase.

Foot Necrosis Following Percutaneous Cannulation of the Dorsalis Pedis Artery: A Case Report / 대한구급학회지

Arterial canuulation is generally used to monitor blood pressure and sample blood for gas analysis. Radial and dorsalis pedis arteries are commonly used for arterial cannulation. It is a simple, safe, and uncomplicated procedure, but some complications have been reported, including bleeding, hematoma, infection, pseudoaneurysm, and thromboembolism. Although thromboembolism is not common, it could be serious because it can lead to digital ischemia and necrosis. We present a case of foot necrosis following dorsalis pedis artery cannulation in a 65-year-old patient who underwent small bowel resection.

The comparison of the relaxant effects of propofol, thiopental, ketamine, and etomidate on isolated rat uterine smooth muscle / 대한마취과학회지

BACKGROUND: Intravenous hypnotics are used in pregnancy, labor and delivery. The aim of the present study was to investigate and compare the relaxant effects of propofol, thiopental, ketamine, and etomidate on isolated rat uterine smooth muscles. METHODS: Uterine smooth muscle preparations were obtained from non-pregnant female rats. The uterus of the rat was dissected and cut into 10 mm strips. The muscle strips were bathed in Krebs solution. After spontaneous uterine contractile activity had been accomplished, propofol, ketamine, thiopental, and etomidate in various concentrations were added cumulatively to the baths and resting tension, active tension, and frequency of contration were recorded at each concentration of agents. EC(5), EC(25), EC(50), EC(75), and EC(95) of each drug on active tension and frequency of contraction were calculated using a probit model. RESULTS: Propofol, thiopental, and etomidate reduced uterine contractions in a concentration-dependent manner. Ketamine concentrations of 10(-7) to 10(-5) M augmented uterine contractions but ketamine concentrations of 10(-4) to 10(-3) M attenuated uterine contractions. The EC(50)'s of propofol, thiopental, ketamine, and etomidate on active tension were 1.56 x 10(-5) M, 4.97 x 10(-5) M, 3.52 x 10(-4) M, and 2.73 x 10(-5) M, respectively. CONCLUSIONS: All four intravenous hypnotics relaxed the uterine smooth muscle of rats except for ketamine in low concentrations (10(-7) to 10(-5) M). Propofol had the greatest relaxant effects on isolated rat uterine smooth muscle among these hypnotics. It seems that ketamine is a suitable obstetric hypnotic agent for hypovolemic parturients and propofol is a useful hypnotic agent for uterine relaxation during pregnancy.

Life-threatening Airway Edema after Arthroscopic Repair of Massive Rotator Cuff Tear: A Case Report

Shoulder arthroscopic surgeries are an accepted technique for many shoulder disease and have many advantages over open surgeries4,6). To date, shoulder arthroscopic surgery have been rare complications that compromise patient airway, caused by the leakage of irrigation fluid out of the shoulder joint space into the surrounding soft tissues and then the neck and the pharynx. This report presents a case of life-threatening airway obstruction due to extra-articular saline collection during arthroscopic rotator cuff repair. In concluding we should hourly check the patient's neck swelling undergoing shoulder arthroscopic surgery, because anesthetized patients cannot complain of the airway problem may progress until it becomes life-threatening.

Influence of omega-Conotoxin GVIA, Nifedipine and Cilnidipine on Catecholamine Release in the Rat Adrenal Medulla

The present study was designed to establish comparatively the inhibitory effects of cilnidipine (CNP), nifedipine (NIF), and omega-conotoxin GVIA (CTX) on the release of CA evoked by cholinergic stimulation and membrane depolarization from the isolated perfused model of the rat adrenal medulla. CNP (3 micrometer), NIF (3 micrometer), and CTX (3 micrometer) perfused into an adrenal vein for 60 min produced greatly inhibition in CA secretory responses evoked by ACh (5.32 x 10(-3) M), DMPP (10(-4) M for 2 min), McN-A-343 (10(-4) M for 2 min), high K+ (5.6 x 10(-2) M), Bay-K-8644 (10(-5) M), and cyclopiazonic acid (10(-5) M), respectively. For the CA release evoked by ACh and Bay-K-8644, the following rank order of potency was obtained: CNP > NIF > CTX. The rank order for the CA release evoked by McN-A-343 and cyclopiazonic acid was CNP > NIF > CTX. Also, the rank orders for high K+ and for DMPP were NIF > CTX > CNP and NIF > CNP > CTX, respectively. Taken together, these results demonstrate that all voltage-dependent Ca2+ channels (VDCCs) blockers of cilnidipine, nifedipine, and omega-conotoxin GVIA inhibit greatly the CA release evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors and the membrane depolarization without affecting the basal release from the isolated perfused rat adrenal gland. It seems likely that the inhibitory effects of cilnidipine, nifedipine, and omega-conotoxin GVIA are mediated by the blockade of both L- and N-type, L-type only, and N-type only VDCCs located on the rat adrenomedullary chromaffin cells, respectively, which are relevant to Ca2+ mobilization. It is also suggested that N-type VDCCs play an important role in the rat adrenomedullary CA secretion, in addition to L-type VDCCs.

Unilateral Spinal Anesthesia with Hyperbaric Levobupivacaine and Bupivacaine for Lower Limb Surgery / 대한마취과학회지

BACKGROUND: Levobupivacaine is the isolated S-enantiomer of bupivacaine and may be a favorable alternative to bupivacaine. The author evaluated the clinical efficacy of levobupivacaine relative to bupivacaine in spinal anesthesia. METHODS: The author randomly allocated 40 ASA physical status I or II patients undergoing lower limb surgery to do unilateral spinal anesthesia with 8% glucose bupivacaine 4 mg (n = 20) or 8% glucose levobupivacaine 4 mg (n = 20). Spinal anesthesia was performed at the L3-4 interspace using a 25-gauge Whitacre spinal needle. The lateral decubitus position was maintained for fifteen minutes after injection. RESULTS: Thirty minutes after injection, unilateral sensory block was present in 60% and 40% of cases, and unilateral motor block was observed in 90% and 85% in levobupivacaine and bupivacaine group, respectively. Levobupivacaine group had no differences as compared to bupivacaine group for spinal block resolution. CONCLUSIONS: It was concluded that 8% glucose levobupivacaine 4 mg and 8% glucose bupivacaine 4 mg provided similar spinal block for lower limb surgery without hemodynamic unstability.

Comparison of Tramadol and Meperidine for Pain Relief after Tonsillectomy in Children / 대한마취과학회지

BACKGROUND: Pain is one of the major problem regarding quality of life in children undergoing tonsillectomy. Preemptive analgesia by medicine given before commencement of surgery is a new recommended for relief of pain during and after operation. We compared intra-and postoperative analgesic and recovery characteristics of tramadol, meperidine with placebo given at induction of anesthesia in 60 children undergoing tonsillectomy with or without adenoidectomy. METHODS: Sixty children (ASA I or II) 4-7 years old undergoing tonsillectomy with or without adenoidectomy were randomly assigned to receive either saline 0.02 ml/kg (group 1, n = 20), tramadol 2 mg/kg (group 2, n = 20) or meperidine 1 mg/kg (group 3, n = 20) at induction of anesthesia. Thiopental sodium (5 mg/kg) and rocuronium (0.6 mg/kg) were used for the induction of anesthesia, and it was maintained with sevoflurane in N2O/O2 (50/50) via an endotracheal tube. Pain assessment was done by facial pain scale. Agitation scores, time to recovery of spontaneous respiration and the incidence of postoperative nausea and vomiting were assessed. Heart rate and mean arterial pressure were recorded. RESULTS: Facial pain scale scores were increased in group 1 and group 2 at 10 and 20 min after tonsillectomy in recovery room. There was no difference for agitation scores in the three groups. Intraoperative mean arterial pressure (15 min) were found to be higher in group 1 and group 2. The time to recovery of spontaneous respiration was delayed in group 3 compared with group 1 and group 2. The incidence of nausea and vomiting was not statistically differed among groups. CONCLUSION: Meperidine was more effective for pain relief than tramadol, even though recovery of spontaneous respiration was delayed in meperidine group.

Naltrexone Inhibits Catecholamine Secretion Evoked by Nicotinic Receptor Stimulation in the Perfused Rat Adrenal Medulla

The purpose of the present study was to examine the effect of naltrexone, an opioid antagonist, on secretion of catecholamines (CA) evoked by cholinergic nicotinic stimulation and membrane-depolarization from the isolated perfused rat adrenal gland and to establish the mechanism of its action. Naltrexone (3x10 (-6) M) perfused into an adrenal vein for 60 min produced time-dependent inhibition in CA secretory responses evoked by ACh (5.32x10 (-3) M), high K+ (5.6x10 (-2) M), DMPP (10 (-4) M) and McN-A-343 (10 (-4) M). Naltrexone itself did also fail to affect basal CA output. In adrenal glands loaded with naltrexone (3x10 (-6) M), the CA secretory responses evoked by Bay-K-8644, an activator of L-type Ca2+ channels and cyclopiazonic acid, an inhibitor of cytoplasmic Ca2+-ATPase, were also inhibited. However, in the presence of met-enkephalin (5x10 (-6) M), a well-known opioid agonist, the CA secretory responses evoked by ACh, high K+, DMPP, McN-A-343, Bay-K-8644 and cyclopiazonic acid were also significantly inhibited. Collectively, these experimental results demonstrate that naltrexone inhibits greatly CA secretion evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors as well as that by membrane depolarization. It seems that this inhibitory effect of naltrexone does not involve opioid receptors, but might be mediated by blocking both the calcium influx into the rat adrenal medullary chromaffin cells and the uptake of Ca2+ into the cytoplasmic calcium store, which are at least partly relevant to the direct interaction with the nicotinic receptor itself.

Acute Respiratory Arrest and Brain Sequale Ocurred after General Anesthesia in Diabetic Autonomic Neuropathy Patient: A Case Report / 대한구급학회지

The incidence of autonomic neuropathy is high in diabetic patients. Cardiovascular complications including sudden cardiorespiratory arrest, bradycardia, hypotension can occur in diabetic patients complicated with autonomic neuropathy. The causes of sudden deaths in diabetics may not always be due to silent myocardial infarction but may also be due to autonomic neuropathy. Patients with diabetic autonomic neuropathy are less able to withstand hypoxia compare to normal people due to sympathetic nerve system damage. We present a case of acute respiratory arrest that occured in a 38 years old diabetic autonomic neuropathy patient after general anesthesia. Even though the patient was carried rapid and adequate airway management within 5 minutes, the patient had severe brain sequale. We conclude that the diabetic autonomic neuropathy patients require more careful monitoring and management for the hypoxia and cardiovascular status because they are more sensitive in hypoxia.

The Comparative Effects of Caudal Block and IV Ketorolac on Emergence Delirium after Sevoflurane Anesthesia in Children / 대한마취과학회지

BACKGROUND: Children usually exhibit pain-related behavior in the postanesthetic care unit. The aim of the present study was to compare the recovery and emergence profiles of children who received sevoflurane with caudal block or IV ketolorac or none for inguinal herniorrhaphy. METHODS: Forty five children, ASA 1, scheduled for herniorrhaphy were randomly assigned to receive either caudal block(n = 15), IV ketorolac (n = 15), or none (n = 15). All children were premedicated with midazolam(0.05 mg/kg) and glycopyrrolate (0.004 mg/kg) an hour before anesthesia induction. Thiopental sodium (5 mg/kg) and mask inhalation of sevoflurane 2 vol% in N2O/O2 50/50 were used to induce anesthesia. After induction, group 1 received none, while groups 2 and 3 received a caudal block and IV ketorolac, respectively. Anesthesia was maintained by sevoflurane with N2O/O2 inhalation via an endotracheal tube. Recovery was assessed by an independent observer using a postansthetic recovery score. Pain score was also assessed by an independent observer using a pain/discomfort scale. Recovery and agitation characteristics on emergence were compared between the three groups. RESULTS: There were no difference between the groups with respect to age, weight, duration of inhalation exposure, or recovery score. Agitation and pain scores were less in both the caudal block and IV ketorolac groups (P <0.05). Emergence delirium occurred less frequently in the caudal block and IV ketorolac groups (P <0.05). There was no significant difference between the caudal block and the IV ketorolac groups in emergence delirium. CONCLUSIONS: Emergence delirium after sevoflurane anesthesia was less common in the caudal block and IV ketorolac groups. Thus, it is presumed that the postoperative analgesic actions of caudal block or IV ketorolac reduce emergence delirium during recovery from sevoflurane anesthesia.

Common Peroneal Nerve Palsy after Lithotomy Position: Two case reports / 대한마취과학회지

Motor neuropathy of a lower extremity is well recognized potential complication of procedures performed on patients in a lithotomy position. Mechanisms of nerve injury are unclear but the incidence of perioperative nerve injuries can be reduced if anesthetists are aware of their causes and pathophysiolgies. It is important to note that reduced duration in lithotomy position may reduce the risk of lower extremity neuropathies. We experienced two case of common peroneal nerve palsy after lithotomy positioning. Diagnosis was based on history, a clinical examination and electrophysiologic studies. A neurologic examination revealed hypersthesia over the dorsum of the left foot with inability to perform active dorsiflexion. Electrophysiologic studies showed delayed latency and low amplitude of nerve action potential.

The Effect of Music on Intraoperative Anxiety during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Most surgical patients experience perioperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contributes to postoperative pain. The effect of music on perioperative patient anxiety was studied. METHODS: Forty patients undergoing surgery with spinal anesthesia, were divided into two groups. Group I (n = 20) did not listen to music, and Group II (n = 20) listened to music selected by the patient. At ward, hemodynamic variables including systolic and diastolic blood pressures and pulse rates were measured as control values. Hemodynamic variables and the anxiety scores by the Hamilton anxiety rating scale and the Visual Analogue Scale (VAS) were prepared for Group I and Group II in the operating room. RESULTS: No difference was observed between the groups with regard to systolic blood pressure, diastolic blood pressure, mean arterial pressure, or pulse rate when patients arrived at the operating room. In Group II, 30 minutes after listening to music, anxiety scores, VAS, systolic blood pressures, and mean arterial pressures were significantly lower than in Group I. CONCLUSIONS: Music was found to effectively reduce intraoperative anxiety.

The Analgesic Effects of Epidural Dexamethasone after Simple Lumbar Discectomy / 대한마취과학회지

BACKGROUND: Epidural steroids have been suggested to prevent postoperative epidural fibrosis after lumbar laminectomy. The purpose of this prospective study was to compare the degree of postoperative pain in patients undergoing simple lumbar discectomy with and without epidural dexamethasone administration. METHODS: Thirty-six patients undergoing simple lumbar discectomy were randomly allocated to two groups to be given the following agents, just after the end of surgery via an epidural lumbar catheter previously inserted by the surgeon: normal saline 6 ml (group I), and a total of 6 ml normal saline with dexamethasone 5 mg (group II). The outcome measures included pain scores at 1, 2, 6, 12, and 24h and total morphine consumption over the first 24 postoperative hours. RESULTS: There were significant differences in the postoperative visual analogue scale (VAS) score at 1 and 2 h between the two Groups, and the 24h total morphine consumption in Group II was significantly lower than in Group I. CONCLUSIONS: Epidural administration of dexamethasone decreased the degree of postoperative pain after simple lumbar discectomy.

A Comparison of the Effect between Intravenous Fentanyl and Interpleural Bupivacaine Following Thoracoscopic Surgery / 대한마취과학회지

BACKGROUND: Epidural and intravenous administration of opioids had been commonly used for postoperative pain management in thoracoscopic surgery. Recently, interpleural analgesia was frequently used. The aim of this study was to compare the effect of an intravenous continuous infusion of fentanyl (F-IV) with interpleural bupivacaine (B-IP) using a continuous infusion system in the management of post-thoracoscopic pain. METHODS: An interpleural continuous infusion of bupivacaine (B-IP group: basal infusion 7(ng/kg/min) was compared with an intravenous continuous infusion of fentanyl (F-IV group: basal infusion 0.33ng/ kg/hr) in forty patients who had undergone elective thoracoscopic surgery. During the postoperative 48 hours, the visual analogue scale (VAS), Prince-Henry score (PHS), heart rate, respiratory rate and peripheral oxygen saturation were measured. RESULTS: The postoperative heart rate in both groups was significantly higher than the preoperative value (P < 0.05 1 h and 4 h after operation), but there were no differences in the respiratory rate and peripheral oxygen saturation between the two groups. There were significant improvement of the degree of pain in VAS and PHS after administration of the analgesic, but there was no significant differences in the two groups during 48 hours. The incidence of adverse effects such as nausea, vomiting, dizziness, urinary difficulty and respiratory depression was higher in the F-IV than the B-IP group. CONCLUSIONS: The interpleural continuous infusion of local anesthetics and intravenous continuous infusion of fentanyl provided effective analgesia in this study. The side effects were significantly lower in the interpleural continuous infusion of local anesthetics than intravenous continuous infusion of fentanyl. Therefore, interpleural continuous infusion of local anesthetics could be a useful alternative for postoperative analgesia after thoracoscopic surgery.

One-lung Anesthetic Experience for Video-assisted Thoracoscopic Surgery in Two Children / 대한마취과학회지

Video-assisted thoracic surgery (VATS) has been increasingly used because of it is a less invasive procedure than the open thoracotomy. Neither commercially available double-lumen tubes nor the univent tube can be used in small children. An ordinary uncuffed tracheal tube was introduced into the main bronchus of the right lung. This technique proved to be a simple and effective method of isolating and ventilating the other lung. We describe our experience providing one-lung ventilation with ordinary endotracheal tube during VATS in two young children. (Korean J Anesthesiol 2001; 40: 824 ~ 828)

The Effects on Pain Relief of Intraarticular Tramadol and Neostigmine after Knee Arthroscopic Surgery / 대한마취과학회지

BACKGROUND: Evidence has accumulated that tramadol hydrochloride can produce relief of moderate to severe pain across the range of acute and chronic pain states by combining a synergistically weak opioid and a monoaminergically mediated antinociceptive mechanism. Neostigmine can produce antinociceptive effects by interacting with muscarine receptors in peripheral tissues. This study was designed to determine whether intraarticular tramadol results in better analgesic effect and whether tramadol and neostigmine would provide superior analgesia to tramadol alone, after knee arthroscopic surgery. METHODS: Forty-five ASA class 1 or 2 patients undergoing arthroscopic knee surgery were randomly allocated to three treatment groups. All patients received general anesthesia with nitrous oxide, O2 and inhalational agents. When the surgical procedure was completed, the study drug was injected into the patient's knee joint through the arthroscope. Patients in group 1 (n = 15) received 30 ml of 0.5% mepivacaine; patients in group 2 (n = 15) received tramadol 50 mg and 30 ml of 0.5% mepivacaine; patients in group 3 (n = 15) received a combination of tramadol 50 mg, neostigmine 100 micro gram and 30 ml of 0.5% mepivacaine. Postoperative pain was assessed using the visual analogue scale (VAS) at 1, 2, 4, 6, 12 and 24 hours after the intraarticular injection. RESULTS: There were no significant differences among the three groups in the 1 to 2 hour postoperative period and groups 2 and 3 showed significantly lower VAS score than group 1 from 4 to 24 hours postoperatively. CONCLUSIONS: It is concluded that after knee arthroscopy, intraarticular injection of tramadol had a good analgesic effect, whereas neostigmine added to tramadol did not show superior analgesic effects over tramadol alone.