The Combined Use of the Timing Principle and LMA to Secure Airway Patency / 대한마취과학회지

BACKGROUND: The timing principle uses a single bolus dose of nondepolarizing neuromuscular blocker followed by an induction drug to reduce airway patency secure time. If anesthetic depth is adequate, the laryngeal mask airway (LMA) can be inserted with or without a low dose nondepolarizing neuromuscular blocker. So we investigated the combined use of the timing principle and LMA to secure airway patency. METHODS: One hundred and two patients were randomly allocated into three groups. Group RP (n = 34) patients received rocuronium followed by propofol and then a LMA was inserted. Group PR (n = 36) patients received propofol followed by rocuronium and group PS (n = 31) patients received propofol followed by succinylcholine before LMA insertion. Accelerographic response to single twitch and train-of-four (TOF) stimulation were measured. LMA insertional conditions were measured using the degree of jaw relaxation, gagging, cough, and aeration. RESULTS: Single twitch and TOF ratio were lower in the RP group than in the PR group. The LMA insertional conditions were similar for the group RP and PS, but were poor for group PR. One patient in group PR recalled discomfort during LMA insertion. CONCLUSIONS: The combined use of the timing principle and LMA is effective at securing airway patency.

The Preemptive Analgesic Effect of Intravenous Ketamine on the Formalin Test in Rats / 대한마취과학회지

BACKGROUND: N-methyl-D-aspartate (NMDA) antagonists can be useful as preemptive analgesic agents and effective in reducing central sensitization. The purpose of this study was to evaluate the preemptive effect of intravenous (IV) ketamine on the behavioral responses between a pre- versus post-formalin test in a rat model. METHODS: Sprague-Dawley rats (250 - 300 g) were prepared with a PE-50 indwelling IV catheter to receive either saline or ketamine. Rats received ketamine 1 mg/kg intravenously through a catheter either 1 min before or 5 min after formalin. The formalin test was performed with 5% formalin 100nl. All rats were randomly divided into one of three groups; a control (n = 8), pre-treatment (n = 7), or post-treatment (n = 7) group. Pain related behaviors were quantified by counting the numbers of flinching of the injected paw for 60 minutes. RESULTS: Intraplantar formalin injection produced a biphasic (phase 1, 0 - 10 minutes; phase 2, 10 - 60 minutes after formalin injection) appearance of flinching behavior in the control, pre-treatment, and post- treatment groups. The pre-treatment group showed less flinching in phase 2 than the control group (P < 0.05), but the post-treatment group didn't. CONCLUSIONS: These results suggest that pre-treatment of IV ketamine 1 mg/kg showed a preemptive analgesic effect.

Comparison of Antinociceptive Effect of Pre- versus Post-treatment with Intrathecal Ketamine on the Formalin Test in Rats / 대한마취과학회지

BACKGROUND: N-methyl-D-aspartate (NMDA) antagonists can be useful as preemptive analgesic agents and effective in reducing established central sensitization. The purpose of this study was to evaluate the preemptive effect of intrathecal ketamine and compare the behavioral antinociceptive responses between pre- versus post-formalin ketamine administration in a rat pain model. METHODS: Sprague-Dawley rats (250 - 300 g) were prepared with a PE 10 indwelling intrathecal catheter to receive either saline (control) or ketamine. Rats received ketamine 100ng intrathecally through a catheter either 7 min before or 5 min after formalin. The formalin test was performed with 5% formalin 100nl. The control (n = 8), pre-treatment (n = 7), and post-treatment (n = 7) groups were studied. Pain related behaviors were quantified by counting the incidences of flinching of the formalin injected paw for 60 minutes. RESULTS: Intraplantar formalin injection produced a biphasic (phase 1, 0 - 10 minutes; phase 2, 10 - 60 minutes after formalin injection) response of flinching behavior in control, pre-treatment, and post-treatment groups. The post-treatment group showed less frequent phase 2 flinching than the control group (P < 0.05). CONCLUSIONS: Post-treatment of intrathecal ketamine 100ng was effective on inhibition of phase 2 nociceptive behaviors following the formalin injection. These results suggested that intrathecal ketamine shows an analgesic effect when administered as a post-treatment.

Optimal Time Interval of Rocuronium Pretreatment for Prevention of Biochemical Changes, Fasciculations and Myalgia Following Succinylcholine Administration / 대한마취과학회지

BACKGROUND: The purpose of this study was to assess the optimal time interval between rocuronium pretreatment and succinylcholine for prevention of the rise in serum potassium and creatine kinase concentrations and the increased incidence of fasciculations and myalgia following succinylcholine administration. METHODS: We have studied 60 patients undergoing a minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 2 ml (Group C), 0.05 mg/kg rocuronium one min before (Group R1) or 3 min before (Group R3) 1.5 mg/kg succinylcholine administration. Serum potassium and creatine kinase were respectively measured 5 min after succinylcholine and 24 h after the operation. Fasciculations and myalgia on postoperative day 1 and day 2 were evaluated. RESULTS: The increase in the serum potassium concentration was not attenuated in any group. The increase in creatine kinase concentration, the incidence of fasciculations and the incidence of myalgia on postoperative day 1 and day 2 were highest in Group C; however, there was no difference between the Group R1 and R3. CONCLUSIONS: Either a 1 min or 3 min pretreatment time interval of the rocuronium has a similar effect on the prevention of the rise in serum potassium and creatine kinase concentrations and an increased incidence of fasciculations and myalgia following succinylcholine administration.

Pain after a Laparoscopic Cholecystectomy: Comparison between Somatic Pain and Visceral Pain / 대한마취과학회지

BACKGROUND: It is known that pain after a laparoscopic cholecystectomy is less compared with an open cholecystectomy. There are various methods of pain relief used but a controversy exists over the effectiveness and value of intraperitoneal local anesthetics. The aim of this study was to investigate which components of pain were more predominant for pain after a laparoscopic cholecystectomy, somatic pain or visceral pain. METHODS: Twenty-four patients who received an elective laparoscopic cholecystectomy were selected. General anesthesia was induced with thiopental sodium and succinylcholine, and maintained with vecuronium and isoflurane. After surgery, the degree of postoperative somatic pain (superficial, sharp and definite in the abdominal wall) and visceral pain (dull, vague and/or colicky in the peritoneal cavity) was assessed at postoperative 1, 3, 6, 9, 24 and 36-hour by a 10 cm-visual analogue scale (VAS) scores and other complaints were recorded. RESULTS: VAS scores of somatic pain were significantly higher than those of visceral pain at all the recorded times. CONCLUSIONS: Somatic pain was predominant after a laparoscopic cholecystectomy compared with visceral pain and it should be helpful to treat pain after a laparoscopic cholecystectomy.

Postoperative Pain Evaluation: Facial Rating Scale Compared with Visual Analogue Scale / 대한마취과학회지

BACKGROUND: Although visual analogue scale (VAS) is a good self-assessment method for postoperative pain, faces pain scale (FPS) may be also used as objective assessment method in patients with unavailable of VAS. We investigated the usefulness of facial rating scale (FRS), the variants of VAS and FPS, compared with VAS in postoperative adult patients. METHODS: One hundred and six, ASA 1 or 2, patients undergoing elective surgery under general anesthesia were educated VAS (10 cm) and FRS. One hour after operation, patients' self-reported VAS and FRS were measured in the recovery room. The scores were analyzed by Spearman's correlation and Intraclass correlation. RESULTS: Correlations indicated a highly significant relationship between VAS and FRS (Spearman's correlation coefficient = 0.84, Intraclass correlation coefficient = 0.92, both of P < 0.01). CONCLSIONS: FRS may be useful for self-reported pain assessment instead of VAS in postoperative adult patients.

The Effect of Anal Packing on Urinary Retention after Hemorrhoidectomy under the Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Urinary retention after anorectal surgery is thought to be a mild complication but has a high incidence. Since anal pain and distention can contribute to the urethral spasm reflex which may cause urinary retention, we investigated the effect of absorbable gelatin sponge (Gelfoam(R)) used for anal packing postoperatively on urinary retention after hemorrhoidectomy under spinal anesthesia. METHODS: One hundred and nineteen ASA Physical Status I patients scheduled for hemorrhoidectomy were selected. Patients were randomly divided into Group A, postoperative anal packing free group and Group B, postoperative anal packing group and studied prospectively. Spinal anesthesia was performed with the bevel of 25 gauge Quincke needle parallel to dura fibers at lumber 3 4 intervertebral space and the injection of hyperbaric 0.5% tetracaine 6 mg (1.2 ml) to patients in sitting position. After hemorrhoidectomy, all patients were permitted to ambulate as soon as possible and urinate spontaneously. If urinary retention occurred, urinary catheterization was done temporarily. The number of patients who received urinary catheterization were recorded. Surgical technique and the total amount of intravenous fluid during the operation were controlled. RESULTS: The incidence of urinary retention in Group A (11/57, 19.3%) was similar to that in Group B (10/62, 16.1%) (P = 0.651, chi 2 = 0.205, degree of freedom = 1). CONCLUSIONS: Our study did not indicate the clue that the absence of anal packing helped to reduce the incidence of urinary retention after hemorrhoidectomy under spinal anesthesia.

Effect of High Doses of Propofol on Myocardium in the Isolated Rat Heart / 대한마취과학회지

BACKGROUND: Propofol, an intravenous anesthetic agent, is known to have potential beneficial cardiac effects through a cardiac L-type calcium channel blocking effect and free radical scavenging activities in a number of myocardial stunning models at clinical concentrations. We investigated the effect of high doses of propofol on myocardium in the isolated rat heart to find out whether it has a cardiac protective effect on a normal, not stunning, conditioned heart. METHODS: Twenty male Sprague-Dawley rats were put under general anesthesia to monitor the heart and perfused with a modified Krebs solution with a Langendorff model. After 30 minutes of stabilization, isolated rat hearts were given 0.5, 1, 5, 10, 50, 100 and 250 micrometer of propofol in an increasing manner for 10 minutes, respectively. At every period, left ventricular pressure, dp/dt, heart rate and coronary flow were recorded and Na+, K+, Ca2+, Mg2+ and protein leakage in the effluent perfusate were measured to observe the myocardial cell damage. RESULTS: Significant negative inotropic and chronotropic effects were seen at higher than 100 micrometer. Propofol dose-dependently increased coronary flow at concentrations of 100 micrometer or lower. Marked potassium and protein leakage in the effluent perfusate were found at a higher concentration of 100 micrometer propofol. CONCLSIONS: These findings suggest that a high dose of propofol exerts direct myocardial depression and myocardial cell damage, instead of a protective effect, in the isolated rat heart.

Preemptive Analgesia of Local Infiltration with Bupivacaine for Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Laparoscopic cholecystectomy is of benefit to reduce postoperative pain but many patients suffer from considerable pain after the surgery. The aim of this study was to investigate whether the preoperative infiltration of bupivacaine at the trocar site reduced the intensity of the postoperative pain or not. METHODS: Sixty patients who underwent elective laparoscopic cholecystectomy were selected. In a randomozed study, patients were divided into three groups. General anesthesia was induced with pentothal and succinylcholine, and maintained with vecuronium and isoflurane. After induction, the preincisional group (n = 20) received 0.25% bupivaciane 20 ml infiltration before skin incision and the postoperative group (n = 20) was given 0.25% bupivacaine 20 ml after peritoneal closure. The control group (n = 20) did not receive bupivacaine at any time. The first time of demand for analgesics and the amount of analgesics given during postoperative 48 hours were checked and recorded. The degree of postoperative pain was assessed hourly by visual analogue scale (VAS) score until 9 hours and checked once more at 24 hours postoperatively. RESULTS: The first times of demand for analgesics were significantly delayed in the preoperative group (12.1+/-6.0 hours) as compared with the control (2.9+/-1.6 hours) and postoperative groups (6.2+/-3.9 hours). The demand for analgesics until 9-hour postoperation by the preincisional group (10.5+/-14.7) was significantly less than that of the control (42.0 20.4) and postoperative groups (31.5+/-22.8). The VAS score of the preoperative group was lower than that of the control or postoperative groups during the postoperative 24 hours. CONCLUSIONS: Local infiltration of 0.25% bupivacaine into the trocar site preincisionally could reduce the early postoperative pain after laparoscopic cholecystectomy.

Preemptive Analgesia of Butorphanol for Hysterectomy / 대한마취과학회지

BACKGROUND: It is necessary to reduce hyperexcitable sensations induced by painful stimulus by preventing central sensitization, so called preemptive analgesia. We observed the effect of butorphanol on postoperative pain after hysterectomy so as to direct analgesic action based on elucidation of the preemptive effect. METHODS: We selected thirty-six patients undergoing elective total abdominal hysterectomy, ASA Physical Status I or II, and employed a double-blind cross-over design. Patients were randomly allocated to one of both groups, receiving intravenous butorphanol 2 mg, either preincisionally or postoperatively. Anesthesia was induced with thiopental and maintained with isoflurane. Patients received meperidine on request for postoperative pain. Patients checked the VAS of spontaneous incisional pain and movement-associated pain by themselves.The time of first demand for postoperative meperidine and the amount of postoperative meperidine for the first 6 hours and 6 to 48 hours were recorded. RESULTS: At 5 hours after surgery, the postoperative VAS score of the preincisional group was lower than that of the postoperative group, and at 24 hours after surgery, the former was also lower than the latter. The first time of demand for postoperative meperidine was earlier in the postoperative group than in the preincisional group. The amount of meperidine for the postoperative first 6 hours was less in the preincisional group than in the postoperative group. CONCLUSIONS: Preincisional intravenous butorphanol reduced the intensity of spontaneous incisional pain and movement-associated pain, regarded as a preemptive effect of butorpahnol, in the early postoperative period.

Early Ambulation Reduces the Incidence of Urinary Retention after Spinal Anesthesia for Benign Anorectal Surgery / 대한마취과학회지

BACKGROUND: It has been known that bed rest after spinal anesthesia for benign anorectal surgery helps to reduce the incidence of postdural puncture headache, but the bed rest position is thought to have a negative effect on urinary retention, as a result of anxiety, anal distention, bladder distention and pain-induced reflex inhibition of the urinary bladder detrusor muscle. We investigate the effect of early ambulation after spinal anesthesia on postdural puncture headache and on urinary retention compared with bed rest for 24 hours. METHODS: One hundred and fifty-three ASA Physical Status I patients received spinal anesthesia for scheduled benign anorectal surgery. We applied hyperbaric 0.5% tetracaine 6 mg (1.2 ml) using 25 gauge Quincke needles with the cutting bevel parallel to the dural fibers at the patients' sitting position. All patients were randomly divided into an early ambulation group or bed rest group. We investigated the incidence of urinary retention and headache. The duration of operation, the perioperative intravenous fluid volume, surgical technique and postoperative pain regimen were standardized. RESULTS: The incidence of urinary retention in the early ambulation group (16/75, 21.3%) was lower than that in bed rest group (32/78, 41.0%). There was no difference in any parameters between the two groups. CONCLUSIONS: To reduce the incidence of urinary retention, early ambulation after spinal anesthesia for benign anorectal surgery is recommended over bed rest with no increase in the incidence of postdural puncture headache.

The Efficacy of PEEL Chemotherapy and Identification of Favoranble Subgroups in Patients with Carcinomas of Unknown Primary Origin / 대한암학회지

PURPOSE: In order to evaluate the efficacy of PEFL (cisplatin, etoposide, 5-fluorouracil and leucovorin) chemotherapy and to identify favorable subsets, we conducted a phase II trial of PEFL regimen for patients with carcinomas of unknown primary origin (CUPO). MATERIALS AND METHODS: A total of 38 patients was enrolled in this study between May 1995 and September 1997. CUPO was defined as the presence of metastatic cancer documented in the absence of an identifiable primary site. All entered patients were treated with PEFL combination chemotherapy (cisplatin 20 mg/m(2)/day i.v, days 1-5, etoposide 100 mg/m(2)/day i.v. days 1, 3 & 5, 5-fluorouracil 800 mg/m(2)/day continuous infusion days 1-5, and leucovorin 20 mg/m(2)/day i.v, days 1-5; repeated every 4 weeks). The end points of this study were response and survival. To identify favorable subsets, univariate and multivariate analyses were perfonned. RESULTS: Among 38 patients, 29 had measurable lesions. Three (11%) out of 27 evaluable patients had a complete response and 7 (26%) had a partial response (response rate 37%; 95% confidence interval 19~55%). The median survival of the total 38 enrolled patients was 9.1 (range; 1~21.9+) months. The median progression-free survival of the 27 evaluable patients was 5.3 (range 0~ 16.0) months. Among total 132 cycles of chemotherapy, leukopenia of grade II or more was observed in 15% and thrombocytopenia of grade I in 4%. There was no treatment-related death. Main non-hematologic toxicities were nausea/vomiting (79%), stomatitis (70%), and neurotoxicity (33%). The prognostic factor analyses identified 2 favorable subgroups; One was the patient group whose disease had poorly differentiated histology and presented in cervical lymph node. This group of patients had better response rate than other patients (response rate; 71% vs 25%, p=0.02). The other was the patient group who had normal tumor markers (CEA, CA 125 and CA 19-9). This group of patients had better survival than other patients(median survival; 14.8 vs 8.4 months, p=0.05). CONCLUSION: PEFL chemotherapy seemed to be moderately active and tolerable in patients with CUPO. Among heterogenous patients with CUPO, the subset with cervical lymph node and poorly differentiated histology responded better to the chemotherapy and those with normal tumor markers tended toward longer survival.

Angiographic Evaluation of Coronary Arterial Abnormalities in Kawasaki Disease

PURPOSE: To evaluate the coronary angiographic findings of patients with Kawasaki disease and to investigatethe natural course of aneurysms of the coronary artery. MATERIALS AND METHODS: Between June 1989 and January1996, we evaluated the coronary angiographic findings of 12 consecutive children with Kawasaki disease whosecoronary artery was abnormal. On initial study, we retrospectively analysed the size, configuration, and locationof 35 coronary aneurysms, and in five children, follow-up coronary angiography was performed at intervals of 17 to28 (mean, 23) months. Seventeen aneurysms detected on initial study were evaluated for subsequent change. RESULTS: Initial coronary angiography showed the aneurysms to be diffuse in 7 cases(20%), saccular in 7(20%), fusiform in17(49%), and tubular in 4(11%). They were large in 10 cases (29%), medium in 22(63%), and small in 3(9%) ; theirlocation in the coronary artery was proximal(71%), middle in 6(17%), and distal in 4(11%). The right coronaryartery was involved in 18 case(51%), and the left coronary artery in 17(49%). Follow-up study showed that theaneurysm had regressed in 11 cases (65%), persisted in 2(12%), and progressed to stenosis in 1(6%) and occlusionin 3(18%). Two(50%) of the four large aneurysms showed complete occlusion. On the other hand, medium and smallaneurysms showed regression in 9(82%) and in all cases, respectively. Diffuse-type aneurysms were complicated byocclusion in 2 cases (50%) and stenosis in 1(25%). On the other hand, six fusiform aneurysms (75%) and allsaccular and tubular aneurysms had regressed. CONCLUSION: In patients with kawasaki disease, informationregarding the size and configuration of coronary aneurysms may be useful for predicting the natural course andprognosis of coronary artery disease.

Radiologic Evaluation of Coronary Artery Fistula in Adult

PURPOSE: To evaluate the clinical and radiologic findings of coronary artery fistula (CAF) by reviwing adult patients in whom this condition had been diagnosed by coronary angiogram. MATERIALS AND METHODS: We retrospectively analysed the clinical findings, chest X-rays and angiographic findings of 37 adult CAF patients treated at three institutes over a period of is 15 years. RESULTS: On coronary angiogram, the origin of CAF was found to be the left coronary artery (LCA) in 20 cases (54%), the right coronary artery (RCA) in five (14%), and both in 12 (32%). By subdividing the coronary artery into four segments [RCA, left main coronary artery, left anterior descending artery(LAD), and left circumflex artery(LCX)], the origin of CAF (total 55 cases) was found to be the LAD in 23 cases (42%), the LCX in 12 (22%), the left main coronary artery in three (5%), and the RCA in 17 (31%). The draining site of CAF was the right heart [right atrium, right ventricle, and main pulmonary artery (MPA)] in 28 cases (75%) the left heart (left atrium and left ventricle) in 8 (22%), and both in one (3%). The fistula drained to the cardiac chamber in 12 cases (33%), the MPA in 23 (62%), and both in 2 (5%). Among 55 cases, the total number of fistulas to the MPA was 35, and their origin was the RCA in nine instances (26%), and the left coronary artery in26 (74%). CAF to the MPA was classified into four types : Type I (single, tortuous and not dilated) was seen in six patients (17%), type II (single, tortuous and dilated) in three (9%), type III (multiple and fine plexus) in 21 (60%), and type IV (multiple and dilated plexus) in five (14%). Eighteen cases (49%) were associated with the other cardiac disease. CONCLUSION: In these Korean adults, CAF originated most commonly from the LCA, especially from the LAD segment of this artery, and most frequently drained to the right cardic chamber, especially to the MPA. The morphology of the CAF to the MPA was mostly multiple and fine plexus. We suggest that to ensure the most suitable treatment, and for better prognosis, patients with other cardiac disease should be evaluated for the presence of CAF.

Comparison of Effects of Propofol and Thiopental as Induction Agent for Cesarean Section on Succinylcholine, Maternal Consciousness and Apgar Score / 대한마취과학회지

Since propofol was first used clinically in 1977 by Kay and Rolly, it has been widely used for the anesthesia of the short procedures and the outpatient surgery because of its rapid onset time, short action duration and minimal residual side effects. Thiopental has been considered as the routine induction agent of anesthesia for cesarean section despite of disadvantage of cardiovascular depression and some depression of fetus. Propofol might be a useful altemative to thiopental in obstetric anesthesia where rapid, smooth induction and recovery with less effect on neonates are desirable. The purpose of this study was to compare propofol with thiopental for induction of anesthesia in cesarean section with respect to affecting the time of loss of consciousness, the onset and duration of succinylcholine during induction measured by the time taking to the ratio of 0%, 25%, 50%, 75% and 100% of the control value, which were stimulated by 40mA and 1Hz single-twitch stimulation evoked by electrical peripheral nerve stimulator. Apgar scores of the neonates and the awareness during the operation were measured. The results were as follows. 1) The time from injection of the induction agent to unconsciousness by propofol was statistically shorter than that by thiopental (p<0.05). 2) There were no statistically significant differences in onset and duration of succinylcholine between both groups. 3) There were no significant differences in Apgar scores between both groups. 4) The frequency of awareness of propofol group did not differ from that of thiopental group. In conclusion, propofol appears to be a suitable alternative to thiopental as an induction agent for cesarean section beeause of its rapid loss of consciousness and similar effects on Apgar scores to thiopental.

A Case Report of Brachial Plexus Palsy after Laparascopy Assisted Vaginal Hysterectomy / 대한마취과학회지

Trendelenburg position has been used for the low abdominal and pelvic surgery or for the management of the hypotensive patients. But, various adverse effects can also occur in steep Trendelenburg position, of which brachial plexus injury has been known as the most common nerve injury during this position under the general anesthesia especiaUy when the shoulder braces are used. We experienced a case of brachial plexus palsy in a 53 year old woman who had a laparas-copy assisted vaginal hysterectomy(LAVH) under the general anesthesia for myoma uteri for four and a half hours. During the operation she was in a 30 degree-tilting Trendelenburg and combined lithotomy position with her arms tucked at her side with drawsheet and shoulder braces were placed over the acromioclavicular joints bilaterally. In the morning of the postoperative 1st day, she complained the right shouder pain and the right arm tingling sensation and weakness. After needle electromyography and nerve conduction study, it was decided that she got an intraoperative brachial plexus injury mainly involving the lateral cord of the brachial plexus, resulting from the nerve compression caused by shoulder braces in Trendelenburg position. The symptoms were improved after the physical therapy and she was recommended to take more physical therapy after discharge.

Soft tissue osteochondroma: a case report / 대한정형외과학회잡지

No abstract available.

The treatment of chronic ankle instability / 대한정형외과학회잡지

No abstract available.

Multifocal eosinophilic granuloma in 6th decade: a case report / 대한정형외과학회잡지

No abstract available.

Osteoblastoma in lumbar spine: a case report / 대한정형외과학회잡지

No abstract available.