BACKGROUND: To know the effect of droperidol and ondansetron on nausea and sedation in postoperative patients, we studied 120 gynecological patients receiving patient-controlled analgesia (PCA) with morphine and droperidol or ondansetron. METHODS: Subjects were randomly allocated to one of four groups according to PCA regimen, morphine 0.5 mg/cc alone (group M); morphine plus droperidol 0.034 mg/morphine 1 mg (group D); morphine plus ondansetron 0.132 mg/morphine 1 mg (group O1); morphine plus ondansetron 0.066 mg/morphine 1 mg (group O2). The PCA device, WalkMed was set at basal rate 2 ml/hr (1 mg/hr), bolus dose 1 ml (0.5 mg), lockout time 10min, 1 hour maximum dose 4 mg. The severity of nausea, sedation and pain were assessed at 1h, 4h, 8h, 12h, 24h, and 48h postoperatively. RESULTS: The occurrence of nausea was not different among groups. But there were statistical differences in the nausea severity (p<0.05). The group D and group O1 had lower nausea scores, and between them there was no difference. The scores for sedation were significantly lower in the group O1 compared with group M and group D (p<0.05). Overall pain scores were not different among groups. CONCLUSIONS: Ondansetron and droperidol are effective in reducing nausea. Ondansetron is superior to droperidol in avoiding excessive sedation.
Analgesia, Patient-Controlled* ; Droperidol* ; Humans ; Morphine ; Nausea ; Ondansetron* ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting*

BACKGROUND: Intravenous patient-controlled analgesia (IV-PCA) has been widely used for pain relief after cesarean delivery under epidural anesthesia. However, IV-PCA alone has a limited effect on early postoperative pain relief. Epidural morphine injected intraoperatively could alleviate the early postcesarean pain. We evaluated the effects and side effects of intraoperative epidural morphine on postoperative IV-PCA. METHODS: Forty patients scheduled for cesarean section under epidural anesthesia were randomly assigned to one of two groups. The patients in the intravenous group (IV group, n = 20) received intravenous morphine 3 5 mg after the operation in the recovery room when patients complain of pain, and the patients in the epidural group (EPI group, n = 20) received intraoperative epidural morphine 3 mg after fetus delivery. After that, both groups received morphine IV-PCA (no basal infusion, bolus 1.0 mg, lock-out time 6 min). Analgesic efficacy, degree of patient satisfaction, drug consumption and side effects were compared at 4 and 24 hours after surgery. RESULTS: The EPI group had significantly lower VAS for pain at 4h after surgery on movement and resting than the IV group, whereas no significant difference was observed at 24h after surgery. The cumulative morphine consumptions at 4h and 24h after surgery were more in the IV group (each, P < 0.001). Fewer patients in the EPI group had drowsiness at 24h after surgery, but there were no significant differences in other side effects and degree of satisfaction between the two groups. CONCLUSIONS: We conclude that intraoperative epidural morphine was effective with less side effects for postoperative IV-PCA in the cesarean patients under epidural anesthesia.
Analgesia, Patient-Controlled* ; Anesthesia, Epidural ; Cesarean Section ; Female ; Fetus ; Humans ; Morphine* ; Pain, Postoperative ; Patient Satisfaction ; Pregnancy ; Recovery Room ; Sleep Stages

BACKGROUND: A noninvasive method for estimating cardiac output was tested in dogs. The technique is based on a differential CO2 Fick equation applied during normal ventilation and 50 seconds of partial rebreathing using additional dead space. We compared the cardiac output measured by the CO2 rebreathing method vs. the thermodilution technique. METHODS: Seven mongrel-dogs (24.6 +/- 0.4 kg) were studied, anesthesia was induced and maintained with a pentobarbital 25 mg/kg IV bolus injection followed by an infusion of 5 mg/kg/h. Mechanical ventilation was accomplished with a Servo 900C ventilator with FiO2 0.6 to maintain normocarbia. A fiberoptic pulmonary artery catheter was introduced via an external jugular vein for continuous monitoring of the cardiac output by the thermodilution method. Also cardiac output was measured by using partial CO2 rebreathing method. A continuous infusion of 0.5% bupivacaine was started at 0.5 mg/kg/min via the venous infusion port of the pulmonary catheter. Bupivacaine was infused continuously until mean arterial pressure decreased to 60 mmHg or less for at least 5 seconds. RESULTS: The total measured cardiac outputs (n = 72) were distributed over the range of 1.03-7.72 L/min by thermodilution method and 1.6-7.3 L/min by CO2 rebreathing. The correlation coefficients between both cardiac outputs was 0.6, the mean difference was 0.27 +/- 0.81 L/min. CONCLUSIONS: The cardiac output measured by CO2 rebreathing method was well correlated with cardiac output by thermodilution method.
Anesthesia ; Animals ; Arterial Pressure ; Bupivacaine ; Cardiac Output* ; Catheters ; Dogs ; Jugular Veins ; Pentobarbital ; Pulmonary Artery ; Respiration, Artificial ; Thermodilution* ; Ventilation ; Ventilators, Mechanical

BACKGROUND: One of the most important physical properties affecting the level of analgesia after intrathecal administration of a local anesthetic is baricity. This study was done to compare the distribution of 0.5% tetracaine in 5% glucose solution and in 10% glucose solution. METHODS: Tetracaine 2.6 ml (0.5% with 5% glucose or 10% glucose) added with 0.1% epinephrine 0.2 ml was administered to each of 20 patients. All patients' heights were within 160 170 cm. The cephalad spread of analgesia, the degree of motor block in the legs and hemodynamic values were assessed at 2-min intervals for the first 10 min and then at 5-min intervals until 30 min. RESULTS: In the 5% glucose and 10% glucose solutions, the maximum sensory level was T5.4 and T4.3, the maximum sensory block time was 128.1 min and 118.2 min and the time to complete motor block was 5.4 min and 5.2 min respectively. It was not statistically significant between groups. But T 8.1 (vs T 9.6 in the 5% glucose solution) of initial sensory level measured at 4 min after injection of drug was significantly higher (P < 0.05) in the 10% glucose solution. Maximum hemodynamic changes from the baseline were not different in two groups. CONCLUSIONS: Tetracaine 0.5% with 5% glucose or 10% glucose solutions showed similar distribution in the cerebrospinal fluid.
Analgesia ; Anesthesia, Spinal* ; Cerebrospinal Fluid ; Epinephrine ; Glucose* ; Hemodynamics ; Humans ; Leg ; Tetracaine*

BACKGROUND: The combination of a local anesthetic and an opioid has been shown to produce effective epidural labor analgesia. It was reported that the combination of intrathecal opioid and bupivacaine could produce labor analgesia with longer duration and less side effects. This study was done to evaluate the effect of intrathecal bupivacaine mixed with sufentanil for labor analgesia. METHODS: Eighty women requesting labor analgesia were randomly assigned to receive intrathecal 10 mcg of sufentanil (S group, n = 40) or 2.5 mg of bupivacaine plus 10 microgram of sufentanil (SB group, n = 40) diluted in a total volume of 2.2 ml with normal saline. The analgesia was performed using combined spinal-epidural technique in the lateral position. Visual analogue scales (VAS) for pain, sensory changes to cold, duration of analgesia, motor block, hypotension, fetal heart rate, pruritus, and other side effects were assessed for 30 minutes after intrathecal drug injection. RESULTS: There were no significant differences in the VAS pain scores and sensory levels at 5 minutes after intrathecal drug injection between groups. However, VAS pain scores were significantly lower and sensory levels higher in the SB group at 15 minutes and 30 minutes after intrathecal drug injection. The duration of analgesia provided by intrathecal sufentanil (n = 31) was 103.4 41.1 min, by intrathecal sufentanil plus bupivacaine (n = 29) 113.0 32.1 min (P = 0.30). Motor block assessed by a modified Bromage scale was significantly frequent in the SB group (P< 0.001). Not only adverse effects such as hypotension, fetal bradycardia, pruritus, and nausea, but also satisfaction scores were similar in both groups. CONCLUSIONS: The addition of bupivacaine to intrathecal sufentanil produced more frequent motor block and extensive sensory block, but better analgesia. However, duration of analgesia, side effects and satisfaction score did not change.
Analgesia* ; Bradycardia ; Bupivacaine* ; Female ; Heart Rate, Fetal ; Humans ; Hypotension ; Labor Pain ; Nausea ; Pregnancy ; Pruritus ; Sufentanil* ; Weights and Measures

BACKGROUND: Propofol and remifentanil are usually co-administered and have shown synergistic effect for anesthesia. However, the synergistic effect of the two drugs on hypnosis measured by bispectral index (BIS) was controversial in previous studies. The aim of this study was to identify the interaction of propofol and remifentanil on BIS and the optimal dose combinations for hypnosis under 66% N2O during surgery. METHODS: Patients (age 55-75 and American Society of Anesthesiologists [ASA] 1-2) undergoing gastrectomy were enrolled in this study. Propofol and remifentanil were co-administered incrementally at 1 : 1 potent ratio (the P1R1 group), at 1 : 2 potent ratio (the P1R2 group), or at 2 : 1 potent ratio (the P2R1 group) using effect site target-controlled infusion and BIS was measured. 66% N2O was concomitantly administered to all groups. The dose-effect curves, the 90% effective dose (EC90) for adequate hypnosis (BIS 40), isobolograms and combination index were obtained by Calcusyn program (Biosoft) to reveal the interaction of propofol and remifentanil. RESULTS: The P2R1 group showed synergistic action on BIS. However, the other groups needed larger amount of each drug than the doses of additive action. The EC90 of the P2R1 group was propofol, 3.34 microg/ml and remifentanil, 2.41 ng/ml under 66% of N2O. CONCLUSIONS: Propofol dominant co-administration is needed for dose reduction in BIS guided hypnosis.
Anesthesia ; Gastrectomy ; Humans ; Hypnosis ; Piperidines ; Propofol

BACKGROUND: Acute normovolemic hemodilution (ANH) is known as the easieat and most economical and the quality of autologous blood saved by it is the best of all methods of autotransfusion. To investigate the efficacy of ANH, we studied whether it could reduce the transfusion requirement in spinal surgery. METHODS: Forty patients were randomly divided into 2 groups. In the hemodilution group (n=20), 2 or 3 units of autologous blood were procured immediately before or after anesthetic induction while Ringer's lactate and pentastarch were infused to maintain normovolemia. All patients received deliberate hypotension induced by labetalol. Perioperative changes of hemoglobin, hematocrit and platelets, the transfusion requirement and the amount of postoperative drainage were compared between each group. RESULTS: Perioperative changes of hemoglobin, hematocrit and platelet showed no significant differences between each group. Less packed RBC were used in the hemodilution group (1.9 2.0 units) than in control group (5.9 6.8 units) (p<0.05). In the control group, 4 patients were transfused with fresh frozen plasma (mean 4.8 units), 3 patients with platelets (mean 13 units) and 1 patient with cryoprecipitate (10 units) while only one patient was transfused with 3 units of fresh frozen plasma in the hemodilution group. Postoperative drainage was significantly less in the hemodilution group (1,494 488 ml) than in the control group (2,476 1,730 ml). CONCLUSION: ANH seems to decrease the transfusion requirement in spinal surgery. Reduction of postoperative wound drainage appears to play an important role in that.
Blood Platelets ; Blood Transfusion, Autologous ; Drainage ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Hypotension ; Labetalol ; Lactic Acid ; Plasma ; Wounds and Injuries

BACKGROUND: If started with segmental block, epidural anesthesia appears to have an inadequate sacral block in the early part of cesarean deliveries. A dural puncture using the combined spinal-epidural technique making an early sacral blockade might be a solution. METHODS: A prospective, randomized, double-blinded study was performed on forty patients who were divided into two groups (C, DP; n = 20, each). An epidural infusion of 25 ml of 2% lidocaine with epinephrine was given to the group C. A dural puncture with a 27G Whitacre needle was done before the epidural infusion in the group DP. Two-way sensory levels were checked for 15 min, just before the operation. The side effects and recovery variables were also compared between the groups. RESULTS: Initial wider cephalic block (P = 0.038, 0 min) followed by more caudal block (P = 0.023, 0.013; 5, 10 min after the completion of the epidural infusion, respectively) occurred in the DP group. After 10 min, there were no differences in both block levels. The number of dermatomes blocked was bigger in the DP group at 10 min after. Fewer patients in the DP group had nausea and/or vomiting (P = 0.044). CONCLUSIONS: Early spread of the sensory blockade, initial cephalic and then caudal, was due to the dural puncture by a 27G needle. This fast onset could make the parturients more comfortable in the early part of cesarean sections.
Anesthesia, Epidural* ; Cesarean Section* ; Epinephrine ; Female ; Humans ; Lidocaine ; Nausea ; Needles* ; Pregnancy ; Prospective Studies ; Punctures* ; Vomiting

BACKGROUND: This study was designed to compare the hemodynamic changes in response to direct laryngoscopy of the McCoy blade and the Macintosh blade. METHODS: Sixty patients scheduled for elective gynecologic surgery were randomly allocated into two groups. The induction of anesthesia was done with thiopental sodium 5 mg/kg, fentanyl 2 mcg/kg, vecuronium 0.1 mg/kg. When the train of four arrived came at 0/4, the vocal cords were visualized with either the McCoy or the Macintosh laryngoscope blade for 10 seconds. Heart rate and blood pressure were recorded at 1 minute intervals for 5 minutes. RESULTS: Laryngoscopy caused significant increases in arterial blood pressure in both groups, while it had no effect on heart rate in either group. There were no significant differences in blood pressure and heart rate responses to laryngoscopy in the blades. CONCLUSIONS: The McCoy and the Macintosh blade show similar changes in heart rate and blood pressure after laryngoscopy.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics* ; Humans ; Laryngoscopes* ; Laryngoscopy ; Thiopental ; Vecuronium Bromide ; Vocal Cords

BACKGROUND: Airway pressure increases during one-lung ventilation compared to two-lung ventilation. We measured the peak inspiratory airway pressure and the actual exhaled volume during one-lung and two-lung ventilation. And then we evaluated the loss of the exhaled volume according to the increase of peak insphatory airway pressure. METHODS: Left-sided double lumen endobronchial tube (male 37 Fr., female 35 Fr.) was inserted in 62 patients and then proper position of double lumen tube was confirmed with the fiberoptic bronchoscopy. After setting the tidal volume (10 ml/kg), respiratory rate 12/min, inspiratory: expiratory ratio (1: 2) and oxygen 2 1/min, we measured exhaled volume and peak inspiratory airway pressure during two-lung and one-lung ventilation in the supine and lateral decubitus position. RESULTS: The increase of the peak inspiratory airway pressure was ranged from 33.7% to 52.1% and exhaled volume decreased 9.5% to 14.8% in one-lung ventilation compared to two-lung ventilation. CONCLUSIONS: The decrease of actual tidal volume according to the increase of peak inspiratory airway pressure during one-lung ventilation would result in carbon dioxide retention. Therefore we should readjust ventilatory setting during one-lung ventilation.
Bronchoscopy ; Carbon Dioxide ; Female ; Humans ; One-Lung Ventilation* ; Oxygen ; Respiratory Rate ; Tidal Volume ; Ventilation