BACKGROUND: Geriatric patients undergoing hip arthroplasty are generally considered to be at high risk for anesthesia and surgery. Thus, the evaluation of safe anesthetic methods for hip arthroplasty in geriatric patients is important and necessary. METHODS: 228 geriatrics, either sex, older than 65 years, who were performed hip arthroplasty from Mar. 1985 to Jun. 1995, were investigated for anesthetic techniques, postoperative complications and the other problems, retrospectively. According to the kinds of anesthetic techniques, the items including primary indication for operation, name of operation, blood loss, perioperative complications, time from the end of operation to the first analgesic requirement and frequency of analgesic requirements for postoperative 72 hours were analyzed. RESULTS: The mean age of the patients with caudal anesthesia was significantly higher than that with general inhalation anesthesia. The blood loss in patients with epidural anesthesia was significantly more than that in hypobaric spinal anesthesia. The most frequent perioperative complications were cardiovascular problems including hypotension, hypertension, arrythmias, and myocardial infarction. The numbers of analgesic requirement within the postoperative 72 hours was the lowest in epidural anesthesia. There was one postoperative fatal case, whose the cause of death was found to pulmonary thromboembolism by autopsy. CONCLUSIONS: This study suggested that there were many risks for anesthesia and operation in geriatric patients with hip arthroplasty, and the cardiovascular complications were the most frequent. Thus, for hip arthroplasty in geriatrics, the choice of optimal anesthetic techniques depending on the patients physical status and physicians skill should be emphasized with the proper perioperative anesthetic management.
Analgesia ; Anesthesia* ; Anesthesia, Caudal ; Anesthesia, Epidural ; Anesthesia, Inhalation ; Anesthesia, Spinal ; Arrhythmias, Cardiac ; Arthroplasty* ; Autopsy ; Cause of Death ; Geriatrics* ; Hip* ; Humans ; Hypertension ; Hypotension ; Myocardial Infarction ; Orthopedics ; Postoperative Complications ; Pulmonary Embolism ; Retrospective Studies*

The caudal epidural anesthesia has been popular due to the postoperative pain relief and the reduction of the amount of general anesthetics. It is also technically simple and safe both for inpatients and outpatients under the age of 7 Year. The aim of this study was to determine the adequate dosage and degree of postoperative pain relief according to the different local anesthetics. We have performed the caudal anesthesia in 60 patients from the age of 10 month to 7 year. All caudal blocks were performed under light general anesthesia in order to relief the fear and anxiety of operation. The patients were divided by 4 groups of each 15 children. Group 1 (control group) for 1% lidocaine 1 ml/kg, Group 2 for 1% lidocaine 0.8 ml/kg, Group 3 for 0.25% bupivacaine 0.8 ml/kg, Group 4 for 0.25% bupivacaine 0.6 ml/kg. All groups were given 1:200,000 epinephrine. The overall success rate of caudal blocks was 98%. Complication was 3 cases. As the result of this study, Group 1 (control group): There was sensory block over T4 (20%). The degree of motor block was very high(73.3%). Group 2 and 3: There was no sensory block over T4. Duration of postoperative analgesia was long enough compared to the control group (p<0.05). The degree of motor block was less than the control group. Group 4: The height of most sensory block was below T8 (80%). The degree of motor block was very low (p<0.05) and duration of postoperative analgesia was short compared to the control group (p<0.001). Therefore it is considered that caudal blocks in Group 2 & 3 were adequate dosage for the pediatric operation.
Analgesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics, General ; Anesthetics, Local ; Anxiety ; Bupivacaine ; Child ; Epinephrine ; Humans ; Inpatients ; Lidocaine ; Outpatients ; Pain, Postoperative*

Caudal anesthesia appears to be a safe and reliable technique for surgical anesthesia as well as an alternative to narcotics for postoperative analgesia for procedure below umbilicus. From January 1990 to December 1992, we examined the trend and distribution of the 1038 cases of caudal anesthesia retrospectively according to year, age, surgieal department, type of operation, operation time, local anesthetics and suecess rate. Annual numbers of caudal anesthesia increased with years and the first decade of life was the greatest number. The most common department and operation time were general surgery and 30~60 minutes. 2% or 1% lidocaine with epinephrine was the major local anesthetics used during caudal anesthesia and overall success rate was 95.5%.
Analgesia ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Conduction ; Anesthetics, Local ; Epinephrine ; Lidocaine ; Narcotics ; Retrospective Studies ; Umbilicus

Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and mtraoperative supplementation to general anesthesia for children. Caudal anesthesia was given to 63 infants and children under 15 years of age, who received lower abdominal surgery. After thiopental sodium 4-5 mg/kg IV and 1-2Vo1% halothane inhalation, caudal block was performed in the lateral position. Halothane was stopped immediately after caudal block and only 50% NO in oxygen was inhaled through the mask during operation. The patients were randomly divided into four groups: Group 1; 0.33% bupivacaine 0.7 ml/kg, Group 11; 0.33% bupivacaine 1.0 ml/kg, Group III; fentanyl 1 ug/kg combined with 0.33% bupivacaine 1.0 ml/kg, Group IV; 1.5% lidocaine 1.0 ml/kg. The time of onset, duration of analgesia, side effects during and after operation, intial voiding time, and use of analgesics in the ward were observed. The results were as follows: 1) Caudal block was successful at the 1st attempt in most cases. 2) During operation, supplementation of other inhalational anesthesies were need. 3) In all groups, surgical anesthesia could be obtained within 10 minutes. 4) Intraoperative adverse effects were not detected except for minimal movements on skin incision and spermatic cord traction in 12 cases and vomiting in 2 cases. 5) Postoperative analgetic effects were good in all groups, especially in fentanyl group. 6) In most cases, patients ean void within 6 hours without urinary catheterization. 7) Postoperative analgesics were not needed and patients parent's were highly satisfied with caudal anesthesia in all cases. From the above results, it was suggested that caudal anesthesia with 0.33% bupivacaine or 1.5% lidocaine without potent inhalational anesthetics was satisfactory for lawer abdominal surgery and l ug/kg of fentanyl had some benefits in postoperative analgesia in children.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Bupivacaine ; Child ; Fentanyl ; Halothane ; Humans ; Infant ; Inhalation ; Lidocaine ; Masks ; Oxygen ; Pain, Postoperative ; Skin ; Spermatic Cord ; Thiopental ; Traction ; Urinary Catheterization ; Urinary Catheters ; Vomiting

BACKGROUND: The advantages of addition of epinephrine to local anesthetics during caudal epidural anesthesia are core intense block, prolonged duration of anesthesia and reduction of systemic toxic effect of local anesthetics. The currently recommended concentration of epinephrine is 1 : 200,000, but absorbed epinephrines cause unwanted hemodynamic changes, so we attempted to ascertain the minimum effective concentrations of epinephrine during caudal epidural anesthesia. METHODS: Ninty patients classified ASA physical status I or II scheduled for perianal surgery were studied. These patients were divided into four groups who received 20 ml of 2% lidocaine with epinephrine concentrations of 1 : 100,000, 1 : 200,000, 1 : 400,000 or 1 : 800,000 respectively. Before and during anesthesia, patients' mean arterial pressure (MAP) and heart rate (HR) were measured. Caudal anesthesia was performed with patients in the jack-knife position. A 3 ml test dose was administered initially and then the remaining local anesthetics were injected slowly. The onset of analgesia, duration of analgesia, and other complications were observed. RESULTS: The onset of analgesia was slowest in the 1 : 800,000 group. The duration of analgesia was longest in the 1 : 100,000 group. There were no significant difference in MAP changes, but HR increased significantly in the 1 : 100,000 group compared to the 1 : 200,00 group. There were no systemic toxic symptoms for local anesthetics except that 1 patient, who was in the 1 : 100,000 group, had symptoms of palpitation and headache, considered to be the unwanted pharmacologic effects of epinephrine. CONCLUSION: We concluded that the 1 : 400,000 epinephrine concentration can be used during caudal epidural anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Caudal ; Anesthesia, Epidural* ; Anesthetics, Local ; Arterial Pressure ; Epinephrine* ; Headache ; Heart Rate ; Hemodynamics ; Humans ; Lidocaine

A case of a congenital diaphragmatic hernia was operated upon at our hospital employing a combination of light general anesthesia and epidural block, with effective results and post-operative analgesia. Cases with congenital anomalies, prematurity and neonatal respiratory distress syndrome(RDS) are at great risk during general anesthesia. To insure a good ariway and to prevent aspiration of stomach contents, tracheal intubation was done and light general anesthesia(N2-O2) administered. Unver this state candal block was done. By this method, good abdominal relaxation was obtained and the amount of inhalation anesthetics could be reduced. The author believe that in this group of patients, epidural block in combination with light general anesthesia is a good and safe method of administering anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Anesthetics, Inhalation ; Gastrointestinal Contents ; Hernia* ; Hernia, Diaphragmatic ; Humans ; Intubation ; Relaxation

The purpose of animal research in obstetric anesthesia is to find out the mechanisms of uterine contraction, to develop drugs for prevention of preterm labor, and to evaluate the effects of drugs on uterine contraction and the fetus in pregnant animals.Especially, anesthesiologists are interested in uterine contraction and fetal safety during pregnancy, labor, and cesarean section.As regional anesthesia and analgesia have come into widespread use for women in obstetric procedure, effects of local anesthetics on uterine contraction and umbilical blood flow that may be harmful to fetus are very important.A lot of animal studies about the effects of local anesthetics (e.g. lidocaine, bupivacaine, ropivacaine) on the uterine contraction and fetal safety have been carried.In addition, general anesthesia has also been still frequently utilized for cesarean delivery and nonobstetric procedure during pregnancy.A lot of animal studies about the effects of volatile and intravenous anesthetics on the uterine contraction and fetal safety have been carried.And there are many animal studies about the mechanisms of uterine contraction and effective drugs to prevent preterm labor. Animal research in obstetrics have been carried in vivo/vitro or during pregnancy/non-pregnancy.We need to study further in order to develop effective drugs for prevention of preterm labor, and also to develop neonatal extracorporeal membrane oxygenation (ECMO) or artificial placenta for achieving stable blood gas exchange and oxygen supply to the fetus.
Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Obstetrical ; Anesthetics, Intravenous ; Anesthetics, Local ; Animal Experimentation ; Animals ; Bupivacaine ; Extracorporeal Membrane Oxygenation ; Female ; Fetus ; Humans ; Lidocaine ; Obstetric Labor, Premature ; Obstetrics ; Oxygen ; Placenta ; Pregnancy ; Uterine Contraction

BACKGROUND: The requisite anesthetic concentration of sevoflurane required to obtain adequate sedation when sufficient analgesics are supplied has not been determined. The purpose of this study was to determine the requisite age-associated concentration of sevoflurane to obtain an adequate level of anesthesia during combined epidural-general anesthesia by bispectral index (BIS) monitoring. METHODS: Twenty-seven elective abdominal surgery patients (American Society of Anesthesiologists physical status I-II) were enrolled. The patients were divided into two groups of more or less than 60 years of age. We investigated the concentration of sevoflurane required to obtain an adequate sedation level during combined epidural-general anesthesia, maintaining the BIS value between 40 and 60. RESULTS: The requisite sevoflurane concentration required to keep the BIS value at 40-60 was not stable during surgery. In the younger group, the maximum concentration of sevoflurane needed during surgery was 1.95 +/- 0.14 (95% confidence interval: 1.87-2.10) vol%, while it was 1.54 +/- 0.44 (95% confidence interval: 1.27-1.80) vol% in the older group (P < 0.01). CONCLUSIONS: The requisite concentration of sevoflurane required with combined epidural-general anesthesia was 2.5 vol% for the younger group and 2.0 vol% for the older group as determined by BIS monitoring. We believe that these percentages are sufficient to avoid awareness during surgery with adequate analgesia.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Epidural ; Anesthetics, Inhalation ; Humans ; Methyl Ethers

Analgesia, Patient-Controlled* ; Anesthesia, Obstetrical*

Pediatric caudal anesthesia was done in 50 infants and children under 15 years of age, who were to undergo surgery of the inguinal region, urethra, perineum and lower extremity. All cases were given 1mg/kg body weight of 1% lidocaine solution with adrenaline 1: 200,000. The results were as follows: 1) Pediatric caudal anesthesia was simple, easy and reliable in technique and the success rate was high (94%). 2) There was one case of convulsion following lidocaine injection and it was treated immediately with thiopental, diazepam and ventilation with 100% oxygen. 3) As additional measure to provide a more cooperative state was need ed i.e. intravenous administration of 5mg/kg body weight of thiopental. 4) Anesthetic effect was judged satisfactory in 47 cases (84%). There was 2 poor anesthesia results and 1 failure. All 3 cases needed inhalation anesthesia. One failure was accidental intravenous injection of lidocaine solution. 5) The onset time of analgesia ranged from 1 to 5 minutes(average 2.5min.) after injection of lidocaine solution into sacral canal. 6) Complete analgesia was established 8~25 minutes(average 15.6min.) after injection of lidocain solution. Highest dermatome level of analgesia was T11-T4. 7) The duraion of analgesia, which was measured from maiximum analgesia to regression of analgesia of 2 dermatomes, ranged from 70 to 130 minutes(average 98.5 min.). 8) The average operation time was 70 minutes, so that pediatric caudal anesthesia is desirable in an operation lasting about 1 hour. 9) Cardiovascular and respiratory changes were minimal. 10) Theis anesthetic method was especially helpful in postoperative management because of continuous anal esic effect. From the above results, it my be concluded that caudal anesthesia in pediatric surgery is useful for the patients, anesthetists, surgeons, nurses and parents.
Administration, Intravenous ; Analgesia ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Inhalation ; Anesthetics ; Body Weight ; Child ; Diazepam ; Epinephrine ; Humans ; Infant ; Injections, Intravenous ; Lidocaine ; Lower Extremity ; Oxygen ; Parents ; Perineum ; Seizures ; Thiopental ; Urethra ; Ventilation