Pseudo-Froin's syndrome, xanthochromia with high protein level of cerebrospinal fluid / 대한마취과학회지

No abstract available.

Pseudo-Froin's syndrome, xanthochromia with high protein level of cerebrospinal fluid / 대한마취과학회지

No abstract available.

Effect of isoflurane versus propofol-remifentanil anesthesia on neuromuscular blockade and hemodynamic responses by cisatracurium bolus injection / 대한마취과학회지

BACKGROUND: Inhalational anesthetics potentiate nondepolarizing muscle relaxants. Cisatracurium is a recently introduced neuromuscular blocker in Korea. We studied the effect of inhalational anesthesia and total intravenous anesthesia (TIVA) on neuromuscular blockades and hemodynamic responses by cisatracurium bolus injection. METHODS: Forty patients undergoing elective surgery were randomly divided into isoflurane and propofol-remifentanil groups. A bolus dose of cisatracurium of 0.15 mg/kg (3 x ED95) was administered after induction and the onset time and clinical duration of action were recorded. The nueromuscular blockade was monitored using train-of-four (TOF) stimulation. Hemodynamic parameters were also recorded. RESULTS: Onset time was 194.0 +/- 39.1 sec in the isoflurane group and 226.5 +/- 62.2 sec in the propofol-remifentanil group. Clinical duration of action was 49.2 +/- 9.0 min in the isoflurane group and 43.0 +/- 9.2 min in the propofol-remifentanil group. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) immediately before intubation decreased in the propofol-remifentanil group. Heart rate (HR), SBP and DBP 1 and 3 min after tracheal intubation increased in the isoflurane group. CONCLUSIONS: Onset time was similar between isoflurane and propofol-remifentanil anesthesia. Clinical duration of action was significantly longer in isoflurane anesthesia. SBP and DBP immediately before intubation and HR, SBP and DBP 1 and 3 min after tracheal intubation were significantly different between the two groups.

Interruption in the supply of breathing gas during general anesthesia due to malposition of the vaporizer: A case report / 대한마취과학회지

We report a case of interruption in the supply of breathing gas during general anesthesia caused by malposition of the Drager Vapor 2000(R) vaporizer, which was accidentally tilted and lifted off the Selectatec manifold of the anesthesia machine. Because the patient was an 1-month-old infant, we couldn't check if he had experienced awareness with recall. We emphasize the importance of checking the anesthetic vaporizer after mounting it on the back bar of the anesthesia machine.

A study on agreements among screening tests and related factors with postpartum depression / 대한산부인과학회지

OBJECTIVE: This study was performed to assess agreements among screening tests, to estimate prevalence, and to identify related factors with postpartum depression. METHODS: For 323 women at 7 days postpartum, self-administered questionnaires were given including postpartum depression screening test such as EPDS, QIDS-SR16, BDI and questionnaires for their demographic and psycho-social information. Obstetric information were collected from medical records. Simultaneous positive cases in EPDS and BDI were defined as gold standard and used to estimate the prevalence of postpartum depression and agreements between 3 kind of screening test and gold standard. Related factors of postpartum depression were analysed by using SPSS. RESULTS: The prevalence of postpartum depression was 19.8% and the Kappa indices were 0.711 in BDI, 0.803 in EPDS, and 0.395 in QIDS-SR16. Feeding method, smoking history, antenatal anxiety/depression symptoms, residence status, marital satisfaction, relationship with husband's parents, and postpartum care method in univariate analysis and premature delivery (odds ratio: 2.9), formulated feeding (odds ratio: 3.8), marital dissatisfaction (odds ratio: 4.3), professional husband's occupation (odds ratio: 4.4), and antenatal anxiety/ depression symptoms (odds ratio: 4.4) in the logistic regression analysis were significantly related to postpartum depression (P<0.05). CONCLUSIONS: Simultaneous test of BDI and EPDS was effective to evaluate postpartum depression prevalence at 1-week postpartum and highly agree with EPDS. Significant related factors were defined and further prospective community-based studies are warranted.

Ventricular fibrillation by hypothermia in spinal fusion surgery: A case report / 대한마취과학회지

A 63-year-old man was scheduled for T12-S1 posterolateral spinal fusion surgery. The patient's vital signs were stable and there were no specific laboratory findings except for high triglycerides. In addition, echocardiography showed mild left ventricular hypertrophy, but normal left ventricular function, no regional wall abnormal contractility and normal ejection fraction. During the operation, a warming blanket and fluid warmer were applied. Near the end of the operation, the blood pressure waveform from the radial artery and pulse oxymeter became flat. Cardiotonics were administered and an infusion of intraoperative salvage of blood was administered using the cell-saver. However, the hemodynamic status of the patient deteriorated to severe hypotension, with ventricular fibrillation. The patient's vital signs with temperature became stabilized after warming for 4 hours using active warming methods, including a forced air warming blanket and warming of the fluids and blood components with a rapid infusion system.

Study on optimum dose of remifentanil in a combined pediatric anesthesia with sevoflurane during inguinal minor surgery

BACKGROUND: Remifentanil can maintain hemodynamic stability in pediatric anesthesia. However, it is also known to frequently have hemodynamic adverse effects including hypotension and bradycardia when large doses are used. Therefore, we aimed to find the optimum dose of remifentanil that can minimize the hemodynamic changes when it is used in combination with sevoflurane in pediatric anesthesia. METHODS: We studied 59 patients who were planned for under general anesthesia, aged between 2 and 8 years. They were randomly divided into two groups. The children in the Group S were anesthetized using sevoflurane 1 MAC and those in the Group R were given a combination of sevoflurane 0.5 MAC and remifentanil 0.1?0.2microg/kg/min. During anesthesia, the N2O was maintained at 50% in all subject children and the anesthesiologist recorded hemodynamic changes before, immediately after and at 5, 10, 15, 20, 25 and 30 minutes after tracheal intubation. The total dose of remifentanil administered during the anesthesia was recorded after the completion of the anesthesia. RESULTS: There was no significant difference of blood pressure observed between the two groups. Significant difference of heart rate was observed in the Group R at 5, 10, 15, 20, 25 and 30 minutes after tracheal intubation as compared with the Group S. The average dosage of remifentanil administered during the surgery in the Group R was 0.121 +/- 0.057microg/kg/min. CONCLUSIONS: In pediatric anesthesia, a combined administration of 0.5 MAC sevoflurane and remifentanil (0.12microg/kg/min) could achieve similar degree of the depth of anesthesia and hemodynamic stability as 1 MAC sevoflurane only.

Acute pulmonary edema progressing from unilateral to bilateral after brief laparoscopic surgery under lateral position in elderly patient: A case report / 대한마취과학회지

Although pulmonary vascular permeability and gravity changes have been known to be the mechanism of pulmonary edema, yet the etiology of pulmonary edema remains speculative. The multiple conditions such as congestive heart failure, fluid overload, hypoalbuminemia, upper air way obstruction, increased pulmonary artery pressure and laparoscopic surgery cause poor pulmonary circulatory condition. Pulmonary edema usually occurs bilaterally, but unilateral pulmonay edema is uncommon entity. Unilateral pulmonary edema was reported to occur in special circumstances such as one lung ventilation, lateral decubitus position and unilateral pulmonary damage. We experienced abruptly onset and rapid healing pulmonary edema from unilateral to bilateral after brief laparoscopic operation under lateral decubitus position. Thus, we report this case as complicated condition of acute pulmonary edema in elderly patient without fluid overload, long operation time.

The Effect of Combined Use of Remifentanil on Postoperative Recovery Time and Emergence Agitation during Sevoflurane Anesthesia in Children / 대한마취과학회지

BACKGROUND: Sevoflurane anesthesia may show emergence agitation and delirium in children, compared to other inhalation agents. Therefore, we studied the effect of low dose sevoflurane on recovery time and emergence agitation in children. METHODS: We studied 50 patients who were planned for surgery under general anesthesia, aged between 2 and 8 years. They were randomly divided into two groups. Patients of group S were anesthetized with sevoflurane 2.5-3 vol%, whereas those of group R were given sevoflurane 1.2-1.5 vol% and continuous intravenous infusion of remifentanil 0.1-0.2microgram/kg/min. All patients received N2O:O2 50:50 during maintenance of anesthesia. After the surgery, the anesthesiologist recorded recovery time and determined agitation score using 5-point scoring scale in both groups. Agitation score, incidence of emergence agitation and recovery time were compared with each other between the two groups. RESULTS: The agitation scores were 2.72 +/- 0.98 and 2.64 +/- 0.95 in S and R groups, respectively, showing statistical insignificance. The incidence of emergence agitation score 4 or 5 was not significantly different, either. The recovery time was statistically shorter in R group (P<0.05). CONCLUSIONS: Compared with sevoflurane inhalation anesthesia alone, the use of sevoflurane and remifentanil in combination provided shorter recovery time, but no effect on emergence agitation.

Evaluation of Minimal Dose of Midazolam for Sedation in Geriatric Spinal Anesthesia / 대한마취과학회지

BACKGROUND: It is stated that spinal anesthesia may alter susceptibility to the soporific effects of sedatives. In the geriatric patients who are susceptible to midazolam, the adequate dosage of midazolam for sedation was evaluated in spinal anesthesia. METHODS: ASA 1 or 2 50 elderly patients (over 65 years old) who were scheduled for lower abdominal or extremities operations, were randomly assigned into two groups. Midazolam 0.01 mg/kg was administered every 5 minutes until becoming sedated before general anesthesia in the control group, while 0.01 mg/kg was administered every 5 minutes after stabilized for 15 minutes after spinal anesthesia in the study group. RESULTS: It took 15 +/- 5.0 minutes for the control group to fall asleep while the spinal anesthesia group showed significantly less time with 11 +/- 4.2 minutes. The total amount of midazolam administered were 1.5 +/- 0.6 mg in the control group and 1.2 +/- 0.5 mg in the study group, which showed no significance. However, the amount of midazolam compared with the body weight revealed 0.031 mg in the control group and 0.023 mg in the spinal anesthesia group suggesting significantly decreased dosage in the study group. CONCLUSIONS: Midazolam revealed significant sensitivity as well as sedative susceptibility in the elderly patients who underwent spinal anesthesia. Therefore, the dosage titration of midazolam for the elderly patients in spinal anesthesia should be carefully considered.

A Comparative Study of Emergence Agitation between Sevoflurane and Desflurane Anesthesia in Children / 대한마취과학회지

BACKGROUND: Inhalation anesthesia has been widely used since it has easier administration and excretion through the lung and also provides immediate measurement and alteration of the anesthetic depth. Sevoflurane and desflurane are currently used widely with rapid awakening each with 0.66 and 0.42 blood/gas partition coefficients compared to the existing anesthetics. However, there has been a report that both anaesthetics may show emergence agitation in children. Therefore, we compared the degree of emergence agitation between the sevoflurane and desflurane anesthesia in children. METHODS: Out of 60 patients who are between 2-12 years of age and belonged to American anesthesiology society grade I, of which scheduled for general anesthesia, we selected and randomized two groups each with S group (using sevoflurane) and the D group (using desflurane). During the anesthesia, sevoflurane was administered as 2.0-2.5 vol% and desflurane with 4.0-7.0 vol%, of which controlled according to the vital sign, and N2O:O2 was applied as 1.5 L:1.5 L in both groups. After the operation, anaesthetics were stopped, and the patient was carried to the recovery room after confirming that the patient was in a stable condition with the prompt recording of the time of spontaneous breathing, which was followed by extubation. Recovery time was recorded by the anesthesiologist until it has reached the score of 6, and classified the degree of agitation in the score of 1 through 5, which was then regarded as emergence agitation when score was above 4. All results were used with average +/- standard deviation or the frequency rate (%). Chi-square test and unpaired t-test were used for the comparison of the two groups, with the results statistically significant when P values are less than 0.05. RESULTS: No significant differences between the age, weight, sex and the duration of operation in the two groups were noted. Moreover, agitation score was each with 3.00 +/- 0.98 (S group), 2.87 +/- 1.01 (D group), and the emergence agitation frequency with 26.7% (S group), 20.0% (D group), but with no significant differences. However, in the case of recovery time, D group showed significantly faster time than the S group, each with 6.67 +/- 2.59 and 8.67 +/- 2.26 (P < 0.05). CONCLUSIONS: Both sevoflurane and desflurane revealed rapid awakening period among patients, with little faster in desflurane compared to the sevoflurane. No significant difference in emergence agitation was noted in both anesthetics. More research and consideration of the emergence agitation in children may provide better anesthesiological environment for administering the above two anesthetics.

A Study of Lumbar (L3-4, L4-5) Epidural Depth using Magnetic Resonance Imaging and its Correlation to Physical Measurements / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the correlations between lumbar epidural depth by MRI and physical measurements. METHODS: The anatomy of the lumbar epidural space was evaluated using MRI scans of 121 patients (93 male and 31 female). Epidural depth was measured from the skin to the center of the posterior epidural space at the L3-4 and L 4-5 levels by two methods (in a parallel line to the lumbar spinous process [SKEP I] and in a vertical line to the long axis of the spine [SKEP II]). Physical measurements such as weight, height, foot size, and waist were measured, other physical measurements such as the Ponderal index (PI), body mass index (BMI), and obesity (Broca's index) were calculated. RESULTS: Significant correlations between depth from the skin to the posterior epidural space were found for Ponderal index (PI), body mass index (BMI), obesity (Broca's index), weight, waist circumference, height, and foot size. The depth from the skin to the supraspinous ligament correlated with BMI, obesity (Broca's index), PI, weight, and waist circumference. The depth from the supraspinous ligament to the posterior epidural space were found to correlate with height and foot size. CONCLUSIONS: PI had a higher predictive value for epidural depth than the other physical measurements.

The Evaluation of Epidural Depth at L3-4 and L4-5 Using Magnetic Resonance Imaging and its Relationship to BMI / 대한마취과학회지

BACKGROUND: This study was performed to evaluate lumbar epidural depth using two methods, and to identify the correlation between epidural depth and body mass index (BMI). METHODS: The anatomy of the lumbar epidural space was evaluated using MRI images in 124 patients (93 male and 31 female patients). Epidural depth was measured from the skin to the center of the posterior epidural space at the L3-4 and L4-5 level using two methods (in a parallel line to the lumbar spinous process [EP-I] and in a vertical line to the long axis of the spine [EP-II]). RESULTS: The mean +/- SD of epidural depth by EP-I was 4.82 +/- 1.16 cm at L3-4 and 5.08 +/- 1.08 cm at L4-5, and depth by EP-II was 4.18 +/- 0.97 cm at L3-4 and 4.78 +/- 1.02 cm at L4-5. The epidural depths were 3.71 to 4.37 cm (L3-4) and 4.36 to 4.65 cm (L4-5) in normal weight patients, 4.29 to 4.86 cm (L3-4) and 4.79 to 5.06 cm (L4-5) in overweight patients, and 5.16 to 5.87 cm (L3-4) and 5.79 to 6.16 cm (L4-5) in obese patients. CONCLUSIONS: Epidural depth showed a close correlation with BMI, but not with sex.

Quantification and Comparison of D-dimer after Pneumatic Tourniquet Release in Patients Undergoing Arthroscopic Knee Surgery on General Anesthesia and Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Several studies have indicated that lumbar epidural anesthesia may decrease the incidence of deep vein thrombosis and pulmonary embolism, particulary after total hip replacement. Moreover venous thromboembolism also occurs after the release of a tourniquet in orthopedic surgery. The d-dimer test has been reported to be useful for predicting lower limb DVT and PE. Of the d-dimer test methods, the latex agglutination method shows excellent sensitivity and specificity. METHODS: We compared the quantity of d-dimer for General (n = 21) and Epidural (n = 20) anesthesia after tourniquet release in patients undergoing arthroscopic knee surgery. RESULTS: D-dimer significantly increased after tourniquet release in both groups, whereas the increase of d-dimer in the Epidural group was no smaller than that in the General group. Epidural group showed a correlation between tourniquet application and d-dimer. CONCLUSIONS: The present data suggest that DVT and PE after tourniquet release could occur during arthroscopic knee surgery and that epidural anesthesia may increase the fibrinolysis of a tourniquet induced thrombus.

A Study on Analgesic Effect of Metoclopramide before an Injection of Propofol / 대한마취과학회지

BACKGROUND: Propofol is a good induction agent. but it has a disadvantage of pain on intravenous injection. Pretreatment of metoclopramide or lidocaine have been reported to reduce pain on injection. thus, we have evaluated the quantity and quality of anagesic effect of metoclopramide and lidocaine. We observed differences in quality of pain according to venous cannula sizes and intravenous injection sites as well as nausea and vomiting in the postoperative state. METHODS: Eighty patients scheduled for an elective operation by general anesthesia were chosen according to ASA (I or II) and divided into four groups randomly. Each group was injected through venous cannulas with normal saline (control group), metoclopramide 5 mg (group 1), metoclopramide 10 mg (group 2), or 2% lidocaine 40 mg (group 3) respectively. Then, propofol was injected of a 2 mg/kg dose with 0.5 ml/sec to all groups and we asked questions about injection pain after 10 seconds. RESULTS: Pain relief was shown in all groups compared with the control. but metoclopramide 10 mg and lidocaine 40 mg pretreatment groups showed significant pain reief. Pain was relieved significantly when the drug was injected in the antecubital area. Postoperative nausea and vomiting were not observed. CONCLUSIONS: Metoclopramide 10 mg or lidocaine 40 mg pretreatment to induction by propofol revealed a good analgesic effect for propofol injection pain.

A Case Report of Complete Testicular Feminization Syndrome with Rudimentary Salpinx / 대한산부인과학회잡지

The Complete testicular feminization syndrome is a hereditary syndrome characterized clinically by female phenotype with 46, XY karyotype and bilateral testes. There is a congenital insensitivity to androgens, transmitted by means of a maternal X-linked recessive gene responsible for the androgen intracellular receptor. Therefore, androgen induction of Wolffian duct development does not occur. However, anti-mullerian hormone activity is present and the individual does not have mullerian development. Principle of treatment is reinforced to live normal female life. This is a case report of testicular feminization syndrome with rudimentary salpinx with the brief review of literatures.

Spinal Anesthesia with 0.75% Isobaric Ropivacaine for Lower Extremity Operation / 대한마취과학회지

BACKGROUND: Ropivacaine closely resembles bupivacaine with propyl group substitutes for butyl group at the same position. Ropivacaine is presented as 100% S-isomer with important implication of safety and less cardiotoxic than bupivacaine. Because of this, ropivacaine is used as an epidural anesthesia. However this study was performed to evaluate clinical effects of ropivacaine for spinal anesthesia. METHODS: Thirty patients (ASA I-II) scheduled for elective lower extremity operation were randomly selected and received spinal anesthesia with 3 ml of 0.75% isobaric ropivacaine. The patients were placed in the lateral position and dura puncture was performed at the L3-4 interspace using the median or paramedian approach with a 25 G Quincke spinal needle. After spinal anesthesia, sensory block was assessed using the pin-prick test every 2 min., motor block was assessed using a four-point scale, and circulatory variables were monitored every 5 min. RESULTS: The mean sensory block level was T 8.6 and the maximum sensory block level was T4. Time needed for extremity motor block was 10.8 min. and 25 of 30 patients reached Bromage scale 3. Duration of motor and sensory block were 260.6 min. and 422.3 min. Hemodynamic changes (arterial pressure and pulse) were stable during anesthesia and complications were rare. CONCLUSIONS: We concluded that 0.75% isobaric ropivacaine was suitable for spinal anesthesia with good lower extremity sensory and motor block, and it was long-lasting without any specific complications.

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.

Midazolam Effects on Preoperative Anxiety and Hemodynamic Changes for Hypertensive and Normotensive Elderly Patients / 대한마취과학회지

BACKGROUND: Midazolam, a water soluble benzodiazepine, is a good sedative, hypnotic, anxiolytic, and anticonvulsant drug. During stressful condition such as an operation, sympathetic tone increases and cardiovascular variables are unstable. This study evaluated the effects of midazolam for cardiovascular stability in elderly patients during anxiety and stress conditions. Method: Thirty patients (aged 61-93 yrs and in ASA 1, 2, and 3), who were scheduled for lower extremity surgery and showed elevated blood pressure before anesthesia, were divided into two groups. Group 1 (n = 15) has taken antihypertensive medication and group 2 (n = 15) had no hypertension history. Blood pressure and pulse of all patients were checked at 8 AM on operation day, arrival in operation room, 5, 10, 15 min. before anesthesia and every 5 min after anesthesia. Patients were given intravenous midazolam 0.01 mg/kg every 5 min until blood pressure lowered to 140/90 mmHg or spontaneous eye closing. RESULTS: The midazolam doses were 1.7 mg in group 1, 1.2 mg in group 2, and the total dose of midazolam for elderly patient was 1.5 mg (0.03 mg/kg). The sedation level was between the Ramsey scale 3-4. Age is a major determinant in deciding the dose of the drug. Blood pressure at arrival in the operation room was significantly elevated, but, 15 min after the midazolam injection, blood pressure was decreased to blood pressure level at 8 AM of the operation day. Conclusion: The total dose of midazolam for the elderly is nearly 1/3-1/4 of the recommened dose for healthy young adults. Small doses of midazolam in elderly patients were good for anxiolysis and cardiovascular stability.

Selective Median Nerve Injury after Axillary Brachial Plexus Block / 대한마취과학회지

A 25 years old male received an emergency operation for tendon repair of the right 3rd. finger under axillary brachial plexus block using a paresthesia technique. He had no specific medical problem in hand function except limitation of the right 3rd. finger flexion. After the operation, he complained about hand numbness, especially around the palm side of the 3rd. finger, and a tingling sensation which originated from the axilla to the 3rd. finger. Those symptoms did not subside, thus the patient was advised to seek rehabilitation medicine. On the 21st post operative day, EMG (Electromyography) indicated a right median nerve injury at the median branch level of the brachial plexus. The complete withdrawal of the symptoms was reported at the 7th week after the operation. In this case, the highly suggestive cause of selective median nerve injury was a direct nerve injury by injection needle or intraneural injection of local anesthetic drug during the brachial plexus block procedure. However, we didn't completely rule out the possibility of nerve damage by tourniquet and improper position.