BACKGROUND: The saddle block with heavy bupivacaine is confinal to the lower lumbar and sacral dermatomes. We reduced the infusion dose of bupivacaine to confine the blocked area to the perineum, and evaluated intrathecal bupivacaine with intrathecal bupivacaine and tramadol or clonidine for their anesthetic and analgesic effect in patients undergoing hemorrhoidectomy. METHODS: Sixty patients (ASA I - II, aged 20 to 55) scheduled for hemorrhoidectomy were divided into three groups. We gave a 0.2 ml placebo (0.9% normal saline) in the control group (n = 20), 0.2 ml tramadol (10 mg) in the tramadol group, and 0.2 ml clonidine (50 microgram) in the clonidine group (n = 20) intrathecally 1 minute after saddle block with 0.5% heavy bupivacaine 2 mg. We compared the effects of the sensory and motor blocks by using the analgesic time and the degree of anal relaxation and the side effects. RESULTS: The analgesic time was greater in the tramadol group than is the control group (P < 0.05), and in the clonidine group if was group then in the tramadol group (P < 0.05) and the control group (P< 0.01). Anal relaxation for hemorrhoidectomy in the tramadol group and the clonidine group was better than that of the control group. The incidence of paresthesia of the foot in the clonidine group (n = 16) was higher than in tramadol group (n = 3) and the control group (n = 1) (P < 0.01). The incidence of patients with urinary retention was significantly lower in the control group than in the tramadol group (n = 3) and the clonidine group (n = 4). CONCLUSIONS: Both bupivacaine 2 mg with tramadol and clonidine were efficient in hemorhoidectomy provided good conditions for hemorhoidectomy.
Bupivacaine* ; Clonidine* ; Foot ; Hemorrhoidectomy ; Humans ; Incidence ; Paresthesia ; Perineum ; Relaxation ; Tramadol* ; Urinary Retention

BACKGROUND: The saddle block with heavy bupivacaine is confinal to the lower lumbar and sacral dermatomes. We reduced the infusion dose of bupivacaine to confine the blocked area to the perineum, and evaluated intrathecal bupivacaine with intrathecal bupivacaine and tramadol or clonidine for their anesthetic and analgesic effect in patients undergoing hemorrhoidectomy. METHODS: Sixty patients (ASA I - II, aged 20 to 55) scheduled for hemorrhoidectomy were divided into three groups. We gave a 0.2 ml placebo (0.9% normal saline) in the control group (n = 20), 0.2 ml tramadol (10 mg) in the tramadol group, and 0.2 ml clonidine (50 microgram) in the clonidine group (n = 20) intrathecally 1 minute after saddle block with 0.5% heavy bupivacaine 2 mg. We compared the effects of the sensory and motor blocks by using the analgesic time and the degree of anal relaxation and the side effects. RESULTS: The analgesic time was greater in the tramadol group than is the control group (P < 0.05), and in the clonidine group if was group then in the tramadol group (P < 0.05) and the control group (P< 0.01). Anal relaxation for hemorrhoidectomy in the tramadol group and the clonidine group was better than that of the control group. The incidence of paresthesia of the foot in the clonidine group (n = 16) was higher than in tramadol group (n = 3) and the control group (n = 1) (P < 0.01). The incidence of patients with urinary retention was significantly lower in the control group than in the tramadol group (n = 3) and the clonidine group (n = 4). CONCLUSIONS: Both bupivacaine 2 mg with tramadol and clonidine were efficient in hemorhoidectomy provided good conditions for hemorhoidectomy.
Bupivacaine* ; Clonidine* ; Foot ; Hemorrhoidectomy ; Humans ; Incidence ; Paresthesia ; Perineum ; Relaxation ; Tramadol* ; Urinary Retention

Background: Post-dural puncture headache (PDPH) is one of the well-known complication of spinal anesthesia. Epidural blood patch is the treatment of choice for PDPH but is rarely used for the prevention of PDPH after spinal anesthesia. The purpose of this study is to observe the effectiveness of epidural blood patch for prevention of PDPH and to evaluate the complications after epidural blood injection. Methods: Three hundred patients (ASA I or II) receiving spinal anesthesia were studied. They were randomly devided into two groups. Patients in Group I, the control group, were maintained in a supine position for 24 hour after spinal anesthesia. Patients in Group II, the study group, received 3 ml of autologous blood in the epidural space after spinal anesthesia. PDPH was evaluated for 5 days. The incidence, location, onset, and duration of headache in the patients presenting with PDPH were measured for 5 days, and the complications following epidural blood patch in Group II were observed for 2 weeks. Results: The incidence of PDPH in group I was 11%, but 0% in group II. There were no specific complications following epidural blood patch in Group II. Conclusions: This study suggest that the 3 ml epidural autologous blood patch is an useful method for the prevention of PDPH in patients with spinal anesthesia.
Anesthesia, Spinal* ; Blood Patch, Epidural ; Epidural Space ; Headache ; Humans ; Incidence ; Post-Dural Puncture Headache ; Punctures* ; Supine Position

BACKGROUND: Ropivacaine and levobupivacaine, both single S-enantiomers, show less toxicity on the central nervous and cardiovascular system than racemic bupivacaine. Earlier studies have shown that levobupivacaine and bupivacaine are almost equipotent while ropivaciane was 60% less potent than bupivacaine. The aim of this prospective, double blinded study was to compare the clinical efficacy and safety of epidural anesthesia produced by 0.5% levobupivacaine and 0.5% ropivacaine for a cesarean section. METHODS: Sixty-two parturients undergoing an elective cesarean section were randomized to receive either epidural levobupivacaine 0.5% 20 ml (n = 31) or epidural ropivacaine 0.5% 20 ml (n = 31). Surgery was commenced when the sensory block had reached the dermatome level, T6. The onset, duration, quality of the sensory and motor block and abdominal muscle relaxation were evaluated. The blood pressure and heart rate of the mother and neonatal outcome, as assessed by the Apgar score and umbilical pH, were also recorded. RESULTS: There was no difference in the onset time, the segmental spread of sensory block and analgesic supplement between the two groups. However, levobupivacaine produced a longer duration of sensory block than ropivacaine (levobupivacaine 224.1 +/- 66.6 min, ropivacaine 176.5 +/- 32.8 min, P < 0.05). The onset time (except Bromage scale 2), intensity and duration of the motor block and muscle relaxation were similar in both groups. There was no difference in the maternal and neonatal outcomes between the two groups. CONCLUSIONS: 0.5% levobupivacaine and 0.5% ropivacaine produced equivalent efficacy and safety in epidural anesthesia for a cesarean section, but levobupivacaine resulted in a longer duration of sensory block.
Abdominal Muscles ; Anesthesia, Epidural* ; Apgar Score ; Blood Pressure ; Bupivacaine ; Cardiovascular System ; Cesarean Section* ; Female ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Mothers ; Muscle Relaxation ; Pregnancy ; Prospective Studies ; Relaxation

No abstract available.

The authors experienced a case of myoglobinuria accompanied by generalized myalgia and mild fever that developed 3 hours 30 minutes after general anesthesia. Tracheal intubation was done smoothly 5 minutes after injection of thiopental sodium(275 mg) and pancuronium bromide(6 mg), and anesthesia was maintained with ethrane/N2O/O2(1.5-2%/21/21/min). There was no specific event except tachycardia and fluctuation of blood pressure throughout operation. In this case, we assume that the myoglobinuria is a presentation of the sign of an abortive type of malignant hyperthermia. However, it was not confirmed. We had good patient outeome with the supportive measures of hydration and diuresis. The patient was discharged twenty three days after operation without any complication.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Diuresis ; Fever ; Humans ; Intubation ; Malignant Hyperthermia ; Myalgia ; Myoglobinuria* ; Pancuronium ; Tachycardia ; Thiopental

A 62-year-old female patient was scheduled for emergent explo-laparotomy under general anesthesia because of traffic accident. Preoperative checked chest x-ray showed multiple fractures of the ribs but didn't show the sign of pneumothorax or hemothorax. she had no dyspnea. Compared with previous value(PaO2; 210.5 mmHg), Arterial PO2 value(PaO2; 143.0 mmHg) was reduced significantly two hours after starting general anesthesia. Chest x-ray was taken in the operating room, which showed pneumothorax in the right side lung. The patient was treated with immediate closed thoracostomy. She recovered uneventfully three days later with complete resorption of the pneumothorax.
Accidents, Traffic ; Anesthesia, General* ; Dyspnea ; Female ; Hemothorax ; Humans ; Lung ; Middle Aged ; Operating Rooms ; Pneumothorax* ; Ribs ; Thoracic Injuries* ; Thoracostomy ; Thorax*

BACKGROUND: The aim of the present study was to evaluate the effect of sevoflurane with or without nitrous oxide compared with propofol on the incidence of postoperative nausea and vomiting after gynecologic laparoscopy. METHODS: One hundred and forty patients of ASA status I or II, undergoing gynecologic laparoscopy were studied. Patients were allocated randomly to one of four groups: (I) GROUP 1 (n = 35): Anesthesia was induced and maintained with propofol using a computer controlled infusion system in combination with 60% nitrous oxide in oxygen. (II) GROUP 2 (n = 35): Anesthesia was induced and maintained with sevoflurane in combination with 60% nitrous oxide in oxygen. (III) GROUP 3 (n = 35): Anesthesia was induced with sevoflurane with 100% oxygen and maintained with sevoflurane in combination with 60% medical air in oxygen. (IV) GROUP 4 (n = 35): Anesthesia was induced with propofol 2 mg/kg intravenously and maintained with sevoflurane in combination with 60% nitrous oxide in oxygen. The incidence of postoperative nausea and vomiting and requests for antiemetic rescue medication were assessed 2 and 24 hours after surgery. RESULTS: In group 1 (compared with groups 2, 3, and 4), the incidences of postoperative nausea and vomiting (9% compared with 31%, 29%, and 37%) within the first 2 hours after surgery, were significantly lower. However, there were no statistical differences among the four groups in the 2 to 24 hours after surgery with respect to the incidences of postoperative nausea and vomiting. Conclusion: For gynecologic laparoscopy, the use of propofol for induction and maintenance is more effective at preventing postoperative nausea and vomiting than sevoflurane with or without nitrous oxide within the first 2 hours of surgery, This study found no statistically significant difference between the postoperative incidence of nausea and vomiting, whether 60% N2O or medical air was used with sevoflurane.
Anesthesia ; Humans ; Incidence ; Laparoscopy* ; Nausea ; Nitrous Oxide ; Oxygen ; Postoperative Nausea and Vomiting* ; Propofol ; Vomiting

BACKGROUND: Rocuronium administration is associated with a severe burning pain during injection in 50-80% patients. The purpose of this study was to evaluate mixtures of saline, lidocaine, sodium bicarbonate (NaHCO3) and lidocaine-NaHCO3 with rocuronium to reduce injection pain and withdrawal movement. METHODS: One hundred and twenty patients were randomly assigned to one of four groups in a double blinded, prospective study; Group S (0.9% normal saline 5 ml mixed with rocuronium 50 mg/5 ml, n = 30), Group L (2% lidocaine 5 ml mixed with rocuronium 50 mg/5 ml, n = 30), Group B (8.4% NaHCO3 5 ml mixed with rocuronium 50 mg/5 ml, n = 30) and Group LB (4% lidocaine 2.5 ml and 8.4% NaHCO3 2.5 ml mixed with rocuronium 50 mg/5 ml, n = 30). After all patients had received an intubating dose (0.6 mg/kg) of premixed rocuronium over 5 seconds, we investigated the incidence and severity of pain and withdrawal movement. We measured the onset and duration of muscle relaxation using train-of-four (TOF) and the pH values and osmolalities of each mixture. RESULTS: The incidence and severity of pain during injection were significantly reduced in Groups B and LB compared with Group S. The withdrawal movement was observed 8 patients (26.7%) in Group S, but in no patient in Groups B or LB. No significant difference in the incidence of pain or withdrawal response was observed between Groups S and L. CONCLUSIONS: We conclude that premixed NaHCO3 with rocuronium is effective at reducing injection pain and withdrawal movement whereas the addition of lidocaine has little effect.
Burns ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Lidocaine* ; Muscle Relaxation ; Osmolar Concentration ; Prospective Studies ; Sodium Bicarbonate

BACKGROUND: Every practitioner, however skilled, will encounter patients who are unexpectedly difficult to intubation. The incidence of difficult laryngoscopy appears to be approximately 0.5% to 2%. So many methods are used to intubate the trachea, but endotraheal intubation by them is not always possible. The purpose of the this study is to evaluate the effectiveness of magnet on the endotracheal intubation. METHODS: Twenty patients(aged 30 to 59yr, ASA physical status 1) required general anesthesia with an endotracheal tube. Anesthesia was induced with thiopental sodium and succinylcholine, ventilation was controlled with 100% O2. The tip of the epiglottis was exposed wtih a No.3 MacIntosh laryngoscope. A catheter with ferrous stylet was placed behind epiglottis close to tracheal lumen and a magnet was placed over the cricoid cartilage allowing the stylet to be pulled. Endotraheal tube was guided into the trachea over the stylet. The time to intubation, the blood pressure and heart rate of pre- and postintubation, and the difficulty of intubation were recorded and the complications of the endotracheal intubation such as bronchial spasm, oral and tracheal mucosal trauma, and sore throat, were observed. RESULTS: The mean time to intubation was 31.2+/- 8(18 to 50)sec. There were statistically signigicant increase in blood pressure and heart rates following intubation. The incidence of excellent and good intubating condition were 14 and 6 respectively. Seventeen and three intubations were successful on the 1st and 2nd attempts respectively. There were no differences in incidence of complications of endotracheal intubation compared to other reports. CONCLUSIONS: Though magnet guided technique has some limitations to use in case of difficult laryngoscopy, it can be used with merits such as simplicity and cheapness when other methods are not available.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Bronchial Spasm ; Catheters ; Cricoid Cartilage ; Epiglottis ; Heart Rate ; Humans ; Incidence ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes ; Laryngoscopy ; Pharyngitis ; Succinylcholine ; Thiopental ; Trachea ; Ventilation