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Background: Currently, sevoflurane and remifentanil are utilized frequently for the inhalation induction of anesthesia. However, there is currently an insufficient amount of clinical data regarding the inhalation induction of sevoflurane after the administration of remifentanil. Methods: 80 patients undergoing elective surgery were allocated randomly to four groups. Group A inhaled only sevoflurane at 8 vol%. Other groups were administered 3 ng/ml of remifentanil and inhaled sevoflurane at 8 vol% (group B) or 6 vol% (group C) or 4 vol% (group D). All groups also received 0.6 mg/kg of rocuronium. The blood pressure and heart rate were measured at pre-induction, and before and after tracheal intubation. After operation, the patients` levels of satisfaction with the inhalation induction were evaluated. Results: The time to loss of consciousness was substantially longer in group D than in the other groups, but no significant differences were noted among the groups in terms of satisfaction scores. The HR in groups B, C and D increased significantly after pre-intubation as compared to baseline in group A. The HR decreased significantly during induction as compared to group A. The MAP in groups B, C and D decreased significantly at 1 and 2 minutes after tracheal intubation as compared to group A. In group D only, we noted no significant differences in the MAP as compared to baseline at 1, 2 minutes after tracheal intubation. Conclusions: 4 vol% sevoflurane was a more appropriate concentration for the inhalation induction of anesthesia when coupled with 3 ng/ml of remifentanil. (Korean J Anesthesiol 2009;57:170∼5)
Background: Propofol and ketamine are believed to reduce airway resistance. The aim of the present study was to compare the effect of propofol and ketamine on respiratory mechanics after endotracheal intubation in children. Methods: Forty pediatric patients were assigned randomly to two groups: propofol (n = 20) and ketamine (n = 20). Patients were anesthetized with propofol (2 mg/kg) or ketamine (2 mg/kg). All patients were paralyzed with rocuronium (0.8 mg/kg) and intubated and ventilated mechanically (ETCO2: 30-40 mmHg, tidal volume: 10 ml/kg, respiratory rate: 15-25 time/min). Peak inspiratory pressure (PIP), respiratory resistance (Rr), dynamic compliance (Cdyn) and expiratory tidal volume (Vte) measurements were recorded at five time points; 0.5 min after intubation without sevoflurane (baseline), following 2.5 min, 5 min, 7.5 min and 10 min of ventilation with 2% sevoflurane- 50% nitrous oxide. Results: Rr at 0.5 min after intubation was 27.4 ± 12.7 cmH2O/L/s in the propofol group, and 30.0 ± 13.5 cmH2O/L/s in the ketamine group. Cdyn at 0.5 min after intubation was 28.0 ± 9.9 ml/cmH2O in the propofol group, and 25.1 ± 10.6 ml/cmH2O in the ketamine group. There was no significant difference in the response of PIP, Rr, Cdyn and Vte between two groups and within groups. Conclusions: We suggest that the effects of propofol and ketamine on respiratory mechanics were similar during anesthetic induction in children. (Korean J Anesthesiol 2006; 51: 690~4)
충북대학교병원은 개원이래 그 동안 충북지역의 의료 중심기관으로 지속적인 성장을 거듭해 왔다. 개원후 5년동안 본 충북대학교병원 중앙수술실에서는 많은 수술이 행하여 졌는데 마취과학교실에서는 그 동안의 수술들이 어떠한 특성을 가졌는지 알아보기 위해 개원(1991년 7월)후부터 1995년 12월까지의 수술환자들의 마취예를 분석하였다. 5년간의 총 마취예는 10,562건이었고 이를 연령별, 과별, 응급 혹은 정규수술여부, 수술전 환자의 상태별 및 수술후 중환자실 이송 등에 따라 비교 분석하였다. 해마다 수술환자수는 50례 이상씩 증가하였고 21∼40세의 연령군이 대부분을 차지하였으며, 타병원과 비교하여 71세 이상 고령층의 비율이 특히 높았다. 전체 수술예중 일반외과 수술이 제일 많았으며, 응급수술의 경우는 신경외과와 일반외과가 많은 비율을 차지하였다. 수술전 환자의 상태는 미국 마취과학회 신체등급 분류상 1군에 해당되는 환자가 가장 많았으며 수술을 받고 중환자실로 이송된 환자는 연평균 7.2%였다. Chungbuk University Hospital has played a leading role in medical service for the people Chungbuk province since it was established in 1991. To get a basic clinical and statistical data we statistically analyzed the 10,562 anesthetic cases that was practiced from July, 1991 to December, 1995. Total numbed of the anesthetic cases was 10,562 and it had increased annually. According to the age category, the third to fourth decades of life occupied the largest portion(35.3%) of the anesthetic cases. Clinical characteristics of the anesthetic cases were very similar to those of other centers, but the elderly(over 71 years of age) cases were significantly common in comparison to those of other centers. Among the departments, General Surgery accounted more portion than any other department in the elective operation while Neurosurgery accounted more in the emergency operation. Recording the preoperative ASA physical status, class I was dominant in both elective and emergency cases. Patients transferred to ICU after operation were accounted for 7.2% annually.
Background : Effects of epinephrine on the cardiovascular toxicity of intravenously injected bupivacaine and mixture of tetracaine and lidocaine were studied in fifty rats. Vasoconstrictors such as epinephrine are frequently used with local anesthetics to prevent rapid vascular absorption and/or to prolong the duration of local anesthetic action. Epinephrine is also believed to antagonize the cardiovascular depressive effects induced by local anesthetics. Methods : To determine whether the addition of epinephrine to local anesthetics protects from cardiovascular toxicity induced by intravenously administerd local anesthetics, bupivacaine, the mixture of tetracaine and lidocaine, and epinephrine were administerd to anesthetized rats with thiopental sodium i.p. For the injection of local anesthetics and epinephrine, a femoral vein was cannulated, and baseline blood gas analysis was measured. Fifty rats were randomly allocated to one of five group to receive commercially available bupivacaine(0.5%) at 4 mg/1kg(group 1), the mixture of tetracaine(0.2%) and lidocaine(0.8%) at 0.8 ml/Kg(group 2). Epinephrine(1 : 200,000) was added to group 1 for group 3, and to group 2 for group 4, respectively.In group 5, normal saline (0.8 ml/kg) and epinephrine (1 : 200,000) were administerd. Rats were classified as survivors and non-survivors. Rats with severe bradycardia, ventricular fibrillation and ventricular tachycardia were considered dead. And we measured the times to circulatory arrest in each group. Results: Rats given epinephrine and bupivacaine showed the larger numbers of death than those given bupivacaine alone. Mean survival time and time to circulatory arrest were shortest in rats given bupivacaine and epinephrine. Only one rat was dead among those given normal saline and epinephrine, suggesting that epinephrine itself was not toxic. Conclusions: This study demonstrated that concomitantly administered i.v. epinephrine doesn't protect rats from local anesthetics-induced cardiovascular toxicity in spite of its non-toxic effect as shown in rats given normal saline with epinephrine. (Korean J Anesthesiol 1997; 32: 879∼886)