Sixty parturients scheduled for elective cesarean section at term under epidural anesthesia were randomly divided into one of two groups. Group 1 patients were given a prepared 2% lidocaine solution with 1:200,000 epinephrine plus 1ml of normal saline per 10ml of lidocaine; the solution pH was 2.45. Group 2 patients were given a prepared 2% lidocaine solution with 1:200,000 epinephrine plus 1ml(lmEq) NaHCO3 per 10ml of lidocaine; the solution pH was 7.20. Just before injection, either 2ml normal saline(group 1)or 2ml(2mEq) 8.4 % NaHCO3 solution(group 2) was added to 20ml 2% lidocaine hydrochloride with 1:200, 000 epinephrine. The time to onset of the T5 sensory block (time between completion of injection and loss of cold sensation at T5 dermatome) was significantly more rapid in the group 2 that received the pH adjusted solution. The mean onset time was 4.9+/-1.3 min in the group 2 and 6.4+/-2.0 min in the group 1. The time to peak level was also significantly more rapid in the group 2 at 10.5+/-2.7 min and group 1 at 13.3+/-4.0 min. But the peak level was not statistically signifieant between the two groups. The spread of sensory blockade was significantly more rapid in the pH-adjusted group at 5, 10 and 15 min after epi- dural injection. Incidence of maternal hypotension during the operation did not differ signifi- cantly between the two groups. The time from end of injection to Bromage scale 0 did not differ significantly between the two groups.
Anesthesia, Epidural ; Cesarean Section* ; Epinephrine ; Female ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Incidence ; Lidocaine* ; Pregnancy ; Sensation ; Sodium Bicarbonate

BACKGROUND: The aim of this study is to compare duration of analgesia and incidence of adverse effects between two doses of intrathecal morphine in patients after elective ceasrean section. METHODS: Group 1 (n = 31) received morphine 0.1 mg and group 2 (n = 28) received morphine 0.2 mg in addition to intrathecal dose of 2.0 ml of 0.5% bupivacaine in 8% dextrose and fentanyl 15ng. RESULTS: In both groups 1 and 2, excellent postoperative analgesia with long duration was obtained (19.4 +/- 10.1 and 20.5 +/- 11.3 hours, respectively). Fourteen patients (45.2%) in group 1 and 12 patients (42.9%) in group 2 developed mild pruritus that did not require treatment except one patient in group 2 who received nalbuphine 5 mg iv. Incidences of postopertaive nausea or vomiting were not significantly different between the two groups. CONCLUSIONS: Both small doses intrathecal morphine of 0.1 mg and 0.2 mg provided adequate analgesia and patient satisfaction postoperatively with same incidences of side effects.
Analgesia* ; Bupivacaine ; Cesarean Section ; Female ; Fentanyl ; Glucose ; Humans ; Incidence ; Morphine* ; Nalbuphine ; Nausea ; Patient Satisfaction ; Pregnancy ; Pruritus ; Vomiting

Most obstetric anesthesiologist now consider epidural anesthesia to be the preferred anesthetic technique for patients with preeclampsia. In the severe preeclampsia effective ciirculatory volume is usually low, so appropriate preanesthetic hydration is essential feature of safe management. We performed CVP monitoring before epidural anesthesia in nine severe preeclamptic patients undergoing cesarean section. Mean CVP of them was 2+/-1 mm Hg which was not significantly different from normal term parturient. In four patients whose CVP was less than 2 mmHg, preanesthetic hydration with Hartman's solution 500~700 rrd was performed under the monitoring of CVP until it became to rise 2~3 mmHg. Five patients out of nine whose systolic blood pressure dropped below 100 mmHg during anesthesia were IV injected ephedrine 4 mg immmediately and three of them needed repeat injection of ephedrine 4 mg. With the monitoring of CVP, the operations of all the nine severe preeclamptic patients were completed successfully without any problem during and after anesthesia. lt is important to reaUze the limitation of central venous pressure monitoring : but if used with caution in proper circumstance it can provide clinically useful information with minimal risk to the patient.
Anesthesia ; Anesthesia, Epidural* ; Blood Pressure ; Central Venous Pressure* ; Cesarean Section ; Ephedrine ; Female ; Humans ; Pre-Eclampsia* ; Pregnancy

Recently several reports have described the usefulness of meperidine as the sole agent for spinal anesthesia. In this study, meperidine 50mg mixed with 10% dextrose 0.5ml was used for the spinal anesthetic agent for Cesarean section in 182 cases. The subarachnoid injection of meperidine resulted in anesthesia similar to that noted with the intrathecal administration of local anesthetics. Sensory and motor blockades in all patients with meperidine spinal anesthesia were obtained. Prolonged analgesic effect (453.7 +/- 158.1 minutes) and rapid motor recovery (75.9 +/- 17.2 minutes) were obtained. Side effects included nausea (49 patients), hypotension (95 patients) and pruritus (30 patients). Hypotension was easily treated with rapid hydration and ephedrine. Eighteen patients complained of mild pain during the last period of operation. At birth, all newborns cried immediately and the mean Apgar scores were 9.8 +/- 0.4 at one minute and 10 at 5 minutes. It is concluded that meperidine, which has advantages such as rapid motor recovery, prolonged postoperative analgesia, and mild complications which may be easily treated, can serve as a good alternative agent for spinal anesthesia for Cesarean section.
Adult ; *Anesthesia, Epidural ; *Anesthesia, Obstetrical ; *Cesarean Section ; Female ; Humans ; Infant, Newborn ; Injections, Spinal ; Meperidine/*administration & dosage/adverse effects ; Middle Aged ; Pregnancy

BACKGROUND: To reduce the disadvantages with both epidural and spinal block, a combined spinal epidural(CSE) technique was introduced by Brownridge in 1981. The effect of the combined spinal-epidural block was compared with the spinal block for elective cesarean section. METHODS: Fifty healthy parturients were randomly divided into a spinal(n=20) group and a CSE(n=30) group. In the spinal group, 0.5 ml of 5% meperidine(25 mg) mixed with 40~50 mg of 5% hyperbaric lidocaine was injected into the subarachnoid space . In the CSE group, 0.5 ml of 5% meperidine also was injected into the subarachnoid space through a long 26-gauge Quincke needle, which was introduced through an 18-gauge Tuohy needle. An epidural catheter was then inserted and 1.5% lidocaine 7~9 ml was given. RESULTS: 1) The mean time interval from the end of drug injection to T4 sensory block was 3.6?1.0 min in the CSE block and 3.6?1.2 min in the spinal block. The mean level of peak sensory block was T3.3?0.6 in the CSE block and T3.5?0.5 in the spinal block. The time interval between the end of drug injection and Bromage scale 0 of the CSE block(62.1?27.9 min) was significantly (p<0.0001) shorter than the spinal block(102.1?24.0 min). Hypotension ocurred in 14 patients(47%) of the CSE block and 10 patients(50%) of the spinal block. The surgical analgesia was exellent or good in both groups. CONCLUSIONS: The CSE block using meperidine and hyperbaric lidocaine for cesarean section resulted in rapid onset, good surgical analgesia and rapid motor recovery. And incidence of hypotension of the both groups was not significantly different.
Analgesia ; Anesthesia, Epidural* ; Catheters ; Cesarean Section* ; Female ; Hypotension ; Incidence ; Lidocaine* ; Meperidine* ; Needles ; Pregnancy ; Subarachnoid Space

Epidural anesthesia has been greatly substitued for spinal anetshesia because epidural aneshtesia can eliminate the most common and agonizing problems of headache and other neurologic sequelae resulting from spinal anesthesia. Many anesthetists are reluctant to give spinal anetshesia to the patients for gynecologic surgery because of the high incidence of postspinal headache in the middle age group of women. On the contrary, epidural anesthesia provides several advantages compared to spinal anetshesia such as eliminating complications of dural puncture and easy management of postoperative pain control. This investigation was primarily undertaken to observe the effectiveness of epidural anesthesia as well as postoperative pain controllability in gynecologic surgery. Out of total 526 cases who had gynecologic surgery, We had 275 cases (53%) who received epidural anesthesia during the last year. 2% lidocaine 400-500 mg, with 4 mg of morphine were used epidurally for total abdominal hysterectomies, ovarian cystectomies, and some cases of tuboplasty, and 2% lidocaine 300-400 mg, with 3 mg of morphine was used for vaginal hysterectomies. Continuous epidural anesthesia in association with general anesthesia was used for tubal anastomosis and radical hysterectomy, and 4 mg morphine was given through the catheter at the end of surgery. The results are as follows: 1) The duration of postoperative analgesic effect was 21.1+/-5.5 hours. 2) The adverse effects from epidural morphine administration showed 42 (15%) patients had nausea and/or vomiting and 58 (21%) patients had itching. 3) Complications of epidural anesthesia were dural puncture-4 cases (1.4%), convulsion-1 case (0.3%), backache-48 cases (17%), and hypotension-44 cases (16%). The results of this study suggest that epidural anesthesia with 3-4 mg of epidural morphine can be satisfactory for gynecologic surgery and postoperative pain control.
Anesthesia, Epidural* ; Anesthesia, General ; Anesthesia, Spinal ; Catheters ; Cystectomy ; Felodipine ; Female ; Gynecologic Surgical Procedures* ; Headache ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Incidence ; Lidocaine ; Middle Aged ; Morphine ; Nausea ; Pain, Postoperative* ; Pruritus ; Punctures ; Vomiting

Interest in cardiac arrhythmia during surgery has increased in korea because the number of patients with cardiac diseases has increased and cardiac arrhythmia can be a warning that the patient is physiologic or anesthetic distress and that rapid remedial action is necessary. Our institution since 1975 has atarted a routine pre-operative ECG order on the patients over the age of 40. During the year of 1982, out of 5,800 cases of various surgeries, 252 patients were found to haveabnormal ECG findings. They were LVH, myocardial abnormality, RBBB, sinus arrythmia, PVC, AF, 1st A-V block, LBBB and myocardial infarction in this order of incidence. The significance of pre-operative ECG record was emphasized, and the intra-operatve ECG monitoring, dysrrhythmia, cardiac abnormality and its management are described.
Anesthesia* ; Arrhythmias, Cardiac ; Electrocardiography* ; Heart Diseases ; Humans ; Incidence ; Korea ; Myocardial Infarction

Continuous epidural analgesia for labor has become a very popular procedure in the Unites States. However it has not been introduced enough to the laypeople in Korea because of economic problems, lack of availabel anesthesiologists and traditional prejudice about anesthesia for delivery. This report is to present our clinical experience of 250 cases of continuous epidural analgesia for labor and delivery which was done at the Dong San Medical Center during the period of January to May 1985. An epidural puncture was made at the level between L3-4 with the same technique as used for an ordinary epidural anesthesia. The catheter was thereaded through an 18GTuohy epideral needle. The epidural catheter was fixed and tapped to the patient's right side. During the first stage of labor, 6~8ml of 1% lidocaine mixed with eqinephrine 1:300,000 was injected through the catheter when the cervix was 5~6cm dilated in primipara and 4~5cm dilated in multipara. After the initial injection, the same dose 1% lidocaine was repeated as needed when the pain recurred. The injections were usually repeated 3 to 4 times in primipara and once or twice in multipara. For the second stage of labor, 10~12 ml of 1.5% lidocaine was used. As a result of this experience, we have come to the conclusion that continuous epidural analgesia for labor is beneficail to most of the parturients and is highly useful for practice in Korea.
Analgesia, Epidural* ; Anesthesia ; Anesthesia, Epidural ; Catheters ; Cervix Uteri ; Female ; Korea ; Lidocaine ; Needles ; Patient Rights ; Prejudice ; Punctures

Recently several reports have described the usefulness of meperidine as a sole agent for spinal anestaeaia. In this study, meperidine mixed with a 10% dextrose solution was used for a spinal anesthetic agent for Cesarean sections in twenty cases. The results from the meperidine spinal anesthesia were compared with lidocaine spinal anesthesia. The specific gravity was 1.043 with 5% lidocaine solusion and 1.029 with meperidine solution. Both were hyperbaric and very similar in baricity. Hypotension over 20% decre-ase in systolic blood pressure due to spinal aneshesia was found in nine out of 20 cases in the lidocaine group and eleven out of 20 cases in the meperidine group. A dose of ephed- rine used for hypotension was 14.+/-3.mg in the lidocaine group and 20.6+/-10.2mg in the meperidine group. The Apgar score was 10 in both groups at 5 minutes. The duration from the administration of the drug until the development of severe pain postoperatively was checked as 481.8+/-197.8 minutes in the meperidine group and 89.0+/-21.8 minutes in the lidocaine group (P<0.001) . As a result of thin study, it was concluded that meperidine can serve as an alternative agent for spinal anesthesia for a Cesarean section. The motor recovery from meperidine spinal anesthesia is shorter than lidocaine and the postoperative analgesic effect was very efficient and much longer than lidocaine, and no clinical signs of fetal depression with a good Apgar score were observed.
Anesthesia, Spinal* ; Apgar Score ; Blood Pressure ; Cesarean Section* ; Depression ; Female ; Glucose ; Hypotension ; Lidocaine ; Meperidine* ; Pregnancy ; Specific Gravity

BACKGROUND: Pregnancy induced hypertension (PIH) is a common cause of maternal morbidity and death in late pregnancy. Pulmonary edema, although infrequently encountered, may cause death in severe cases of PIH. However, the mechanisms that account for pulmonary edema have not been clarified. Mobilization of peripheral edema, excess fluid intake, myocardial dysfunction, and reduced plasma protein concentration are factors that have been postulated as contributing to the development of pulmonary edema in this syndrome. Colloid osmotic pressure is a principal regulator of capillary fluid exchange. METHODS: In a study of 50 normotensive and severe PIH patients who underwent cesarean section, peripartum plasma colloid osmotic pressure, serum albumin, and total serum protein were compared. RESULTS: Both groups exhibited significantly lower plasma colloid osmotic pressure in the postpartum period than that measured antepartum (p<0.05). The mean antepartum plasma colloid osmotic pressure in severe PIH patients was significantly lower than in normotensive subjects (p<0.05). CONCLUSIONS: We believe that serial COP measurments may be helpful to guide optimal fluid management in severe PIH patients.
Capillaries ; Cesarean Section ; Colloids* ; Edema ; Female ; Humans ; Hypertension, Pregnancy-Induced ; Osmotic Pressure* ; Peripartum Period ; Plasma ; Postpartum Period ; Pregnancy* ; Pulmonary Edema ; Serum Albumin