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: 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: 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: 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: This study was performed to compare responses to the insertion of an intubating laryngeal mask airway (ILMA) and to the intubation of an endotracheal tube according to insertion time when used with sevoflurane and without muscle relaxant. METHODS: We used 50% N2O-O2-8% sevoflurane and a 10% topical lidocaine spray. Forty-eight patients were randomized into four groups according to insertion time (each, n = 12). The ILMA was inserted at 3, 4, 5, and 6 minutes after sevoflurane induction and intubation was performed at 1 minute after ILMA insertion. Responses to intubation, such as vital signs, jaw relaxation, coughing, biting, movements, and laryngospasm were compared according to ILMA insertion time. RESULTS: At 3 minutes, overall responses to insertion and intubation were worse than at 4, 5, and 6 minutes (P < 0.05). At 4, 5, and 6 minutes, responses to the insertion of the ILMA and the intubation of endotracheal tube were satisfactory. CONCLUSIONS: Insertion of ILMA at 4 minutes after sevoflurane induction proved satisfactory, and this could be applied in clinical practice.
Cough ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngeal Masks* ; Laryngismus ; Lidocaine ; Relaxation ; Vital Signs

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: In patient-controlled analgesia (PCA), ketorolac tromethamine has been mixed with nalbuphine HCL in the same PCA balloon or syringe. The compatibility of mixed drugs is an important factor in determining the effects of the administered drugs, so we examined the compatibility of the mixed solution of the both drugs in various dilutions. METHODS: Ketorolac tromethamine (K1, 3, 7, 19 group; n = 10/group) or nalbuphine HCl (N1, 3, 7, 19 group; n = 10/group) was diluted 1: 1, 3, 7, or 19 with normal saline and then the other drug was added. The presence of precipitates, turbidity by visual and spectrophotometric methods, and the pH of the mixed solutions were evaluated 0, 1, 6, 12 and 24 hours later. RESULTS: Precipitates were observed in all studied solutions except in solutions of nalbuphine HCl diluted 1 : 19 with normal saline plus ketorolac tromethamine at the observed intervals. Turbid changes were observed in N1, 3, K1, 3, and 7, but significantly decreased from 6 hours after mixing. The pH of the K groups were significantly lower than those of the N groups. CONCLUSIONS: The mixed solutions of ketorolac tromethamine with nalbuphine HCl were visually incompatible in almost all studied cases, so careful considerations are needed in mixing ketorolac tromethamine with nalbuphine HCl.
Analgesia, Patient-Controlled ; Hydrogen-Ion Concentration ; Ketorolac Tromethamine* ; Ketorolac* ; Nalbuphine* ; Passive Cutaneous Anaphylaxis ; Syringes

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