BACKGROUND: The use of laparoscopic techniques in general surgery has gained increasing popularity. The small, limited incisions are well accepted by patients and there is the benefit of a faster recovery. But the contribution of N2O to nausea and vomiting is still controversial. This study was undertaken to evaluate the effect of N2O for airway pressure, blood gas and postoperative emesis in laparoscopic cholecystectomy. METHODS: Twenty ASA physical status I, II patients for elective laparoscopic cholecystectomy were randomly divided into two groups. First group (n=10) of patients was anesthetized with isoflurane(0.5~1.5 vol%)-O2 (2 l/min)-air (2 l/min). Second group (n=10) of patients was anesthetized with isoflurane (0.5~1.5 vol %)-O2 (2 l/min)-N2O(2 l/min). After induction of anesthesia, ventilation was controlled with tidal volume 10 ml/kg and respiratory rate 11/min and not changed throughout the operation. After measuring of control value of PaCO2, pH and airway pressures before CO2 insufflation, repeatedly measured at 20 min, 40 min after CO2 insufflation and 10 min after CO2 exsufflation. We observed the patients concerning nausea and vomiting for postoperative period. RESULTS: There were no significant intraoperative differences between the both groups with respect to PaCO2, pH and airway pressures. In the both groups, PaCO2 and airway pressure throughout the operation are significantly increased in comparison to control values. The pH is significantly decreased in comparison to control values. The incidence of postoperative nausea and vomiting was similar in both groups. CONCLUSIONS: N2O had no clinically apparent effects on airway pressure, blood gas and postoperation emesis during laparoscopic cholecystectomy.
Anesthesia ; Anesthetics ; Blood Pressure* ; Cholecystectomy, Laparoscopic* ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Insufflation ; Isoflurane ; Nausea ; Postoperative Nausea and Vomiting* ; Postoperative Period ; Respiratory Rate ; Tidal Volume ; Ventilation ; Vomiting

Clonidine, an 2 agonist, has been shown to be effective as preanesthetic medication in adults. To evaluate the effects of clonidine on the sedation and cardiovascular changes induced by intubation, we administered clonidine (2.0-2.5g/kg, 4.5-5.0g/kg, peros) 90-120min before induction of anesthesia. We measured heart rate, systolic pressure and diastolic pressure before premedication, before induction, after intubation and 5, 10, 15, 20 and 30 min after intubation and evaiuated sedative sction before induction. The results are as follows: 1) Before intubation heart rate decreased significantly in both clonidine groups compared with diazepam group (P<0.05). 2) Before intubation clonidine 4.5-5.0g/kg group produced a significant reduction in systolic pressure compared with diazepam group (P<0.05). 3) After intubation systolic and diastolic blood pressure increased in all group but the increasing rate was significently less then in clonidine 4.5-5.0g/kg group (P<0.05). 4) After intubstion the increase in heart rate in both clonidine groups were significsntly less than in diazepam group (P<0.005). 5) Sedative actions were not significantly different in all groups.
Adult ; Anesthesia ; Blood Pressure ; Cardiovascular System* ; Clonidine* ; Diazepam ; Heart Rate ; Humans ; Intubation ; Preanesthetic Medication ; Premedication

The combination of intra-articular morphine and bupivacaine has been suggested as an ideal analgesic after arthroscopy. We performed a randomized double-blind controlled study in patients undergoing elective knee arthroscopy to investigate the analgesic effect of intra-articular morphine and bupivacaine. Sixty ASA physical status 1~2 patients were randomized into one of three treatment groups. All patients received general anesthesia with N2O, O2 and inhalational agents. The drugs were given by intra-articular injection by the surgeon before tourniquet release at the end of the operation. According to the mode of the drugs administered, the patients were divided into three groups; 1) Groupl (n=20) received 0.25% bupivacaine 2) Group2 (n=20) received morphine 1 mg in saline 3) Group3 (n=20) received morphine 1 mg in 0.25% bupivacaine. The injected volume was 25 ml, and all solutions contained 1:250,000 epinephrine. Additional postoperative analgesia was provided with intramuscular diclofenac sodium. The visual analogue pain scores in the recovery room(0.5 h) and 2, 4, 8, 12 and 24 h after surgery, time to first analgesic use, and total 24 h additional analgesic requirements were recorded. The results were as follows; 1) Visual analogue pain scores were lower in group 1 and 3 at 1~8 h. 2) Visual analogue pain scores were lower in group 2 and 3 at 24 h. 3) Additional analgesic requirements were lower for the first 12 h in group 1 and 3, but no difference was seen between groups over the 24 h study period. We conclude that, after elective knee arthroscopy, intra-articular morphine 1 mg in 0.25% bupivacaine 25 ml, with 1: 250,000 epinephine, may provide superior postoperative analgesia up to 24 h than bupivacaine or morphine alone.
Analgesia ; Anesthesia, General ; Arthroscopy* ; Bupivacaine* ; Diclofenac ; Epinephrine ; Humans ; Injections, Intra-Articular ; Knee* ; Morphine* ; Tourniquets

Epidural clonidine produces analgesia via non-opioid mechanism and it may be used as an adju-vant to local anesthetics in obstetric analgesia. To evaluate the effects of epidural clonidine and bupivacaine for post-cesarean section analgesia, we designed a double-blind study. Sixty patients scheduled for elective cesarean section were divided into three groups. Group 1 (n=20) received 0.125% bupivacaine 2 ml/hour epidurally for 2 days. Group 2 (n=20) received 150 ug clonidine bolus, followed by 0.125% bupivacaine 2 ml/hour and clonidine 10 ug/hour for 2 days. Group 3 (n=20) received 150 ug clonidine bolus, followed by 0.125% bupivacaine 2 ml/hour and clonidine 20 ug/hour for 2 days. At the end of the cesarean section, above drug was administered epidurally. Postoperative analgesia was assessed by recording VAS(visual analogue scales) at 1, 2, 4, 8, 16, 32 and 48 postoperative hours. Sedation score, heart rate and systolic and diastolic blood pressure were also checked. The results were as follows: 1) VAS were significantly decreased in group 2 at 1~16 hours and in group 3 at 1~32 hours compared with group 1, They were decreased in group 3 compared with group 2 at 1~48 hours but no significance was seen between two groups. 2) The changes of systolic and diastolic blood pressures & sedation scores were not significantly different between any two groups. In summary, co-administration of clonidine and bupivacaine epidurally provided more profound analgesia compared with bupivacaine alone after cesarean section.
Analgesia ; Analgesia, Epidural ; Analgesia, Obstetrical ; Anesthetics, Local ; Blood Pressure ; Bupivacaine* ; Cesarean Section* ; Clonidine* ; Double-Blind Method ; Female ; Heart Rate ; Humans ; Pregnancy