Showing papers in "Korean Journal of Anesthesiology in 1995"

Unilateral Phrenic Nerve Block after Supraclavicular Brachial Plexus Block

Abstract: The incidence of phrenic nerve block following brachial plexus block, performed above clavicle, have varied widely. However, respiratory difficulty due to unilateral phrenic nerve block is rare complication of brachial plexus blocks, We experienced a case of symptomatic unilateral phrenic nerve block after supraclavicular approsch in thirty-four-year old woman. For brachial plexus block, 30 ml of 1.5% lidocaine and 0.2 mg of epinephrine were injected. Twenty five minutes after injection, she complained of respiratory difficulty. At recovery room, she complained sharp chest pain at apex of heart and epigastrium. We diagnosed her case as right phrenic nerve block because her right diaphragm was normal contour but was markedly displaced upward in portable chest X-ray. Respiratory difficulty was recovered 5 hours after injection and her chest pain was recovered 9 hours after injection.(Korean J Anesthesiol 1995; 2% 750~754)

Pre-emptive Infiltration of Lidocaine Reduces Formalin Pain Behavior in Rat

Abstract: Surgical tissue damage induces dual phenomenon of peripheral and central sensitization. Postoperative pain could be partially explained by neuronal hyperexcitability. As a postoperative pain model, formalin test, subcutaneous injection of formalin in the rat hind paw, results in initial vigorous flinching(phase 1), depends on acute chemical stimulation, followed by cessation of activity, and then resumption of flinching(phase 2), which depends on central sensitization. Pre-emptive analgesia, given before the onset of a painful stimuli, reduces or ptevents postoperative pain by preventing this central sensitization. This study was performed to evaluate the effect of local infiltration of lidocaine as a pre-emptive analgesia in the formalin test. Forty experimental rats were divided four groups; CONTROL group(without any treatment), POST group(0.04 mL of 1% lidocaine injection 5 min after formalin injection), PRE group(0.04mL of 1% lidocaine 5 min before formalin injection), and SHAM group(injection of normal saline 5 min before formalin injection). All animals received inhalation anesthesia for 15 min before and 5 min after formalin injection. Under halothane inhalation anesthesia, all were injected subcutaneously 0.04 mL of 5% formalin in the distal plantar area of right hind paw. After recovery of anesthesia, the formalin-induced flinching behavior was observed during only the phase 2 period(10-60 min) after formalin injection. The time to first flinching, the mean number of flinches per min, and the mean number of total flinches during phase 2 expressed as a percent of the values of the CONTROL group were compared between the groups with an t-test or an ANOVA. The first flinching was appeared before recovery of anesthesia in CONTROL and SHAM groups. The time to first flinching after formalin injection was 21.2±3.4, 16.6±3.1 min respectively in PRE and POST groups. It was significantly longer in PRE group than in POST group(P<0.05), despite of 10 min earlier injeetion of lidocaine in PRE group. The mean number of flinches per min was significantly lower in PRE and POST groups(P<0.05) until 25 min after formalin injection, and after that time the difference between PRE group and POST group was significant(P<0.05). The means of the total number of flinches during phase 2, expressed as a percent of the values of the CONTROL poup, were 100±17.2%, 31.8±13.1%, 76.9±14.5% respectively in SHAM, PRE and POST groups. Those in PRE and POST groups were significantly lower than that of CONTROL group(P<0.001), and the difference between PRE group and POST group was significant(P<0.05). In summary, pre-emptive infiltration of lidocaine on formalin test prolongs the duration of analgesia and reduces the severity of formalin pain in rat. Therefore, the infiltration of lidocaine before formalin test is really provided pre-emptive analgesia.(Korean J Anesthesiol 1995; 29: 790~797)

Temperature Maintenance during General Anesthesia for a Patient with Cold Agglutinin Hemolytic Anemmia

Abstract: Cold hemagglutinin disease is a form of immune hemolytic anemia caused by cold-reactive immunoglobulins Cold agglutinins are autoantibodies, usually of the IgM type, that cause red blood cell agglutination at reduced temperatures When the agglutinated antibody-covered red blood cells return to the central circulation, the classical complement pathway is activated Complement components combine with the antibody-covered red blood cells, inducing membrane changes that result in intravascular hemolysis Clinical manifestations of cold hemagglutinin disease, which occur only on cold exposure include acrocyanosis, purpura, Raynauds phenomenon, acral gangrene, immune complex nephritis, and hemolytic anemia We experienced a case of 66-year-old woman with cold agglutinin disease, gastric cancer and gall bladder stone Preoperative plasmapheresis and intraoperative forced air convective warming to minimize red blood cell agglutination and hemolysis were performed The operating room was prewarmed to 31~32℃ The patient had her lower body and the upper extremities covered with warming blankets Inspired gases were humidified at 37℃ and intravenous fluids were warmed with a blood warmer Peripheral body temperature was maintained above 365℃ throughout the procedure Subtotal gastrectomy and cholecystectomy were done successfully without complication It can be concluded that the maintenance of central and peripheral body temperature above the thermal aetivity of the cold agglutinin is required during the perioperative period(Korean J Anesthiol 1995; 29: 740~745)

The Effects of the Body Positions and the Durations of CO2 Pneumoperitoneum to the PaCO2 and PETCO2 during Laparoscopy

Abstract: During laparoscopic surgery with carbon dioxide (CO2) pneumoperitoneum, PaCO2 (arterial CO2 gas tension) and P(ET)O2 (end-tidal CO2 gas tension) will be affected by the durations of CO2 pneumo-peritoneum and the body positions. PaCO2 and P(ET)CO2 were investigated 5 minutes after induction of general anesthesia(control value), 10 minutes, 30 minutes and 60 minutes after CO2 gas insufflation, and 15 minutes after CO2 gas excretion. Seventy-two patients undergoing laparoscopic surgery under general anesthesia were allocated to two study groups: group I, laparoscopic appendectomy under the Trendelenburg position; group II, laparoscopic cholecystectomy under the reverse Trendelenburg position. In results, PaCO2 and P(ET)CO2 were significantly increased during laparoscopic surgery that associated with times of CO2 pneumoperitoneum. PaCO2 and P(ET)CO2 at 60 minutes after CO2 gas insufflation were increased from P(ET)CO2 control value 35.8±4.2 mmHg, P(ET)CO2 . control value 34.0±3.6 mmHg to P(ET)CO2 . 39.98.0 mmHg, P(ET)CO2 42.3±4.7 mmHg(p<0.05). PaCO2 and PO in group I were more increased compared with group II. PaCO and P(ET)CO2 in group I were increased from PaCO2 control value 35.9±4.8 mmHg, P(ET)CO2 control value 34.9±3.7 mmHg to PaCO2 45.7±2.5 mmHg, P(ET)CO2 48.0±3.6 mmHg(p<0.05), in group II from PaCO control value 35.7±3.2 mmHg, P(ET)CO2 control value 32.8±3.0 mmHg to PaCO2 38.4±8.3 mmHg, P(ET)CO2 40.4±3.2 mmHg(p<0.05). In conclusion, to minimize the risk of a carbon dioxide retension during laparoscopy especially under the Trendelenburg position, we recommend that ventilation should be adjusted to to the normal range of PaCO2 and P(ET)CO2 .(Korean J Anesthesiol 1995; 29: 490-494)

A Comparison of Midazolam and Propofol on Hemodynamic Changes and Postanesthetic Recovery as Hypnotics for Total Intravenous Anesthesia(TIVA)

Abstract: Total intravenous anesthesia(TIVA) is a anesthetic technique where hypnosis, analgesia and muscle relaxation are provided solely by intravenously administered drug without the use of anesthetic vapors or gases including nitrous oxide. For TIVA, midazolam and propofol have been used as hypnotics because of their relatively short elimination half life. Hemodynamic function during induction of anesthesia, the fentanyl and naloxone requirements, and speed of recovery from TIVA with midazolam/fentanyl(group M, n=20) or prapofol/fentanyl (group P, n=20) were compaired in patients undergoing surgery. Forty patients were randomly assigned to receive either 0.2 mg/kg midazolam in 5 min followed by 0.4 mg/kg/hr for 20 min, 0.3 mg/kg/hr for next 20 min, 0.05~0.2 mg/kg/hr until 10~15 min before skin closure, or 2 mg/kg propofol in 5 min followed by 9 mg/kg/hr for 30 min and 4.5 mg/kg/hr until 10~15 min before skin closure. Simultaneously, a variable rate infusion of fentanyl was given. Patients were intubated with an aid of vecuronium and ventilated with 40% oxygen in air. In both groups, mean arterial pressure decreased significantly(P 0.05). The total dose, duration and rate of infusion of fentanyl was similar in both groups. 16 patients in group M and 9 patients in gmup P needed naloxone for recovery of respiration and 10 patients in group M needed flumazenil for recovery of consciousness. Recovery as judged by scoring system(sedation score, comprehension score, orientation score) was shorter in group P than group M. Among side effects, resedation was more frequent in group M(9 pts) than P group(0 pt). In conclusion, both midazolam and propofol were useful hypnotics for TIVA. But, group M showed more stable hemodynamics than group P during induction period and P group showed earlier recovery than group M. We concluded that the selection of hypnotics between midazolam and propofol for TIVA depends on situation such as better hemodynamics during induction period or earlier recovery.(Korean J Anesthesiol 1995; 29: 671~679)