BACKGROUND: Caudal anesthesia is considered a safe and reliable anesthetic technique for many pediatric surgical procedures. It is well known that extradural clonidine produces analgesia in adult. The purpose of this study is to assess its efficacy in children. METHODS: We randomized 45 pediatric patients aged under 10 years, weighted under 25 kg presented for lower abdominal surgery with duration of operation would be shorter than 2 hours, into three groups of 15 each. After sedation with the use of intravenous thiopental sodium, caudal anesthesia was performed with the use of 1 mL/kg of 0.25% bupivacaine. We allocated randomly the patients who received no additional medication in 0.25% bupivacaine (group I), with epinephrine 1/200,000 (group II), and with 1 mcg/kg of clonidine (group III). The degree of postoperative analgesia was evaluated using the Broadman ""Objective Pain/discomfort Scale"" (OPS) at hourly intervals for 24 hours. RESULTS: Duration of sleep in the recovery room was significantly longer in group III than in group I and group II, and statistical significant difference was found between the group I and group II. Duration of analgesia was significantly longer in group III than in group I and group II. Overall hourly OPS scores were lower in group III than in group I and group II. CONCLUSION: Duration of postoperative analgesia with caudal bupivacaine was increased by addition of 1 mcg/kg of clonidine.
Adult ; Analgesia ; Anesthesia, Caudal* ; Bupivacaine ; Child ; Clonidine* ; Epinephrine ; Humans ; Recovery Room ; Thiopental

BACKGROUND: High dose fentanyl for cardiac surgery in neonates, infants and children can cause severe bradycardia and chest wall rigidity that result in decreased cardiac output and oxygen desaturation due to fixed stroke volume in pediatric patients. To ameliorate the effects of fentanyl, it is common to administer neuromuscular blocking drugs with wanted cardiovascular side effects. This study was designed to compare the cardiovascular variables and oxygen saturation among different muscular relaxants in high dose fentanyl anesthesia. METHODS: Thirty pediatric cardiac patients were allocated randomly into three muscle relaxant groups treated with 0.2 mg/kg pancuronium (n=10), 0.2 mg/kg vecuronium (n=10) or 0.2 mg/kg pipecuronium (n=10) after receiving an initial bolus dose of 25 g/kg of fentanyl. Changes of heart rate (HR), mean arterial blood pressure (MAP), rate-pressure-product (RPP) and oxygen saturation (SpO2) were observed. The same cardiovascular variables were also observed 1 and 2 minutes after the second bolus dose of 25 g/kg fentanyl and compared to the results among muscle relaxants. RESULTS: HR, MAP and RPP decreased significantly (p<0.05) 1 and 2 minutes after injection of the 1st fentanyl, which returned to levels above the control value after administration of pancuronium, vecuronium or pipecuronium. Among muscle relaxants, pancuronium caused the most rapid and significantly high level compared to the control value in HR and MAP. Next was pipecuronium and then vecuronium. In clinical setting, SpO2 was decreased after the 1st fentanyl injection and increased after the injection of muscle relaxants, but not significant statistically. CONCLUSION: In view of hemodynamic changes, pancuronium is most efficient and rapid in returning the hemodynamic variables that was decreased after high dose fentanyl anesthesia in neonates, infants and children whose cardiac output was dependent on HR due to relatively fixed stroke volume.
Anesthesia* ; Arterial Pressure ; Bradycardia ; Cardiac Output ; Child* ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Infant* ; Infant, Newborn* ; Neuromuscular Blockade ; Oxygen ; Pancuronium* ; Pipecuronium* ; Stroke Volume ; Thoracic Surgery ; Thoracic Wall ; Vecuronium Bromide*

Background: Hyperglycemia during cardiopulmonary bypass may increase the incidence and severity of neurologic deficits that may result from cerebral ischemia. Moderate hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery despite measures such as eliminating dextrose from the CPB clear pump priming solution and from the intra-operative iv fluids. To ameliorate the hormonal and hemodynamic stress responses during cardiac surgery in neonates, infants and children, high dose fentanyl anesthesia is widely used. The authors wished to determine prospectively whether fentanyl dosage is associated with reduced blood glucose or not in pediatric patients undergoing cardiac surgery. METHODS: Twenty four pediatric patients undergoing cardiac surgery were allocated randomly into 3 groups who received 25 g/kg fentanyl, 50 g/kg fentanyl or 75 g/kg fentanyl before CPB. The changes of plasma glucose and insulin levels were observed after sternotomy, on bypass, 30 min after bypass, off bypass, and the end of the operation. RESULTS: Blood glucose levels were not increased after sternotomy, but significantly increased at bypass to the end of the operation in all fentanyl dosage groups. Plasma insulin level increased, but statistically not significant. Different fentanyl dosage (25~75 g/kg) is not associated with differences in blood glucose level. CONCLUSION: At a dosage of 25~75 g/kg fentanyl anesthesia during pediatric open heart surgery were associated with no differences and below 250 mg/dl of blood glucose level and no significant changes in insulin level.
Anesthesia ; Blood Glucose* ; Brain Ischemia ; Cardiopulmonary Bypass ; Child ; Fentanyl* ; Glucose ; Heart* ; Hemodynamics ; Humans ; Hyperglycemia ; Incidence ; Infant* ; Infant, Newborn* ; Insulin* ; Neurologic Manifestations ; Plasma ; Prospective Studies ; Sternotomy ; Thoracic Surgery*

BACKGROUND: Recent evidence suggest that noxious surgical trauma may induce prolonged changes in central neural function that later contribute postoperative pain. So, postoperative pain may be eliminated or reduced if surgical afferent barrages are prevented with local anesthetics or opioid before they reach to the CNS. We studied the preemptive analgesic effect of continuous epidural analgesia under general anesthesia after radical gastrectomy. METHODS: Forty four patients scheduled for radical gastrectomy were investigated. After general anesthesia induction, patients of preemptive group (n=25) were given 40 ml of 0.125% bupivacaine, 0.1 mg/kg of morphine and 75 microgram of clonidine epidurally as a bolus and followed by 10 ml/hour of 0.125% bupivacaine and 0.2 mg/hour of morphine continuously for 10 hours. Patients of non-preemptive group (n=19) were given the same drugs according to the same way after finishing the operations. The effect of preemptive analgesia was assessed by visual analogue pain scale (VAPS) score, and evaluated the time to first analgesic request, and total amount of used analgesics. Side effects were recorded. RESULTS: Postoperative VAPS scores were not different between two groups. Time to first analgesic request were significantly more prolonged and total amount of used analgesics were significantly less in preemptive group than in non-preemptive group. The incidence of side effects except respiratory depression were similar between two groups. CONCLUSIONS: We concluded that despite preemptive analgesic effect was seen in preemptive group, but it was not prominent. Further studies are needed to prove more prominent preemptive effect in major abdominal operation.
Analgesia ; Analgesia, Epidural* ; Analgesics ; Anesthesia, General ; Anesthetics, Local ; Bupivacaine ; Clonidine ; Gastrectomy* ; Humans ; Incidence ; Morphine ; Pain Measurement ; Pain, Postoperative* ; Respiratory Insufficiency

Immunohistochemical studies of the molecules associated with gastric tumor progression and metastasis were done to evaluate their relationship with known prognostic factors and their usefulness in assessment of the progression of gastric carcinoma in 127 gastric carcinoma tissues. The 4 antibodies used in this study were CD44H, CD44v6, erbB-2, and p53. The CD44H expression was detected in 76 (59.8%), CD44v6 in 63 (49.6%), erbB-2 in 18 (14.2%), and mutant p53 in 98 (77.2%) out of 127 cases of gastric carcinomas. There was no significant correlation between the expression rates of each four proteins. The expression rates of all 4 proteins were not significantly correlated with age and sex of the patients and lymph node metastasis, but the correlation between CD44v6 expression and the depth of tumor invasion and tumor stage was significant (p<0.05). These results suggest that CD44v6 is closely associated with tumor invasion, and high levels of CD44H, erbB-2 and p53 are associated with tumorigenesis of the stomach as they are highly expressed in early as well as in advanced gastric carcinomas. The findings also support the conclusion that the loss of control of alternative CD44 mRNA splicing resulted in production of CD44v6 splicing variant in tumor cell facilitates tissue invasion by increased adherence of the tumor cell to an extracellular matrix or by tumor cell migration. It can be expected that CD44v6 overexpression in tumor cells appears to be an important prognostic indicator for gastric tumor progression.
Neoplasm Metastasis ; Cell Transformation, Neoplastic ; Stomach Neoplasms

To relieve intractable upper abdominal cancer pain using 75% alcohol, Celiac Plexus Blocks (C.P.B.) were performed by means of the classic two needle technique in 7 cases and by single needle transaortic method in 3 cases under fluroscopic guidance. Both methods relieved the pain effectively and there was no significant hemorragic, neurologic and other complications. The degree of pain relief estimated by Graphic Rating Scale (GRS) and the incidence of complication were similar between two methods but the single needle transaortic method was more simple, easier and effective with just one third of alcohol used in the classic method.
Celiac Plexus* ; Incidence ; Needles

We have studied the effect of thiopental sodium, propofol, midazolam and ketamine on systemic vascular resistance(SVR) during cardiopulmonary bypass with constant pump flow in 20 patients undergoing elective open heart surgery. SVR decreased about 13(+/-3.42)% of control values after thiopental sodium 4 mg/kg, about 10 (+/-5.30)% of control after propofol 2 mg/kg and about 8(+/-3.72)% of control after midazolam 0.2 mg/kg; it returned to control values about 2 min 30 sec(+/-1 min 20 sec) after administration of thiopental sodium and about 4 min 30 sec(+/-2 min 15 sec) after administration of propofol. It remained under control values after 10 min after administration of midazolam. Ketamine showed no significant changes on SVR. Analysis of variance showed that there were no significant differences in the changes in SVR between the groups. Change of SVR after administration of thiopental sodium did not have statistical significance(P< 0.05).
Anesthetics, Intravenous* ; Cardiopulmonary Bypass ; Humans ; Ketamine ; Midazolam ; Propofol ; Thiopental ; Thoracic Surgery ; Vascular Resistance*

After abdominal surgery, it is well known that a significant decrease in ventilatory function, arterial oxygenation, and coughing ability occurs and this may lead to retainment of bronchial secretions and eventually atelectasie. The author selected 32 patients who received abdominal surgery under general anesthesia. A small dose of morphine was administered intrathecally before induction of general anesthesia, in an attempt to relive postoperative pain. The development of pain was observed until it was sufficient enough to require intramusclar or intravenous injections of analgesics. The results of this study were as follows: 1) A small dose of intrathecally injected morphine did not affect postoperative arterial blood pressure and respiratory rate of the patients. 2) Fifty percent of the patients required no analgesics for pain control within 24 hours of postoperative periods. Intrathecal dose of morphine from 0.1 to 0.3 mg had the similar effect for the postoperative pain control. 3) Central nevous system depression was not noted, but side effects such as nausa(44%) and pruritus(19%) were commonly observed.
Analgesics ; Anesthesia, General* ; Arterial Pressure ; Cough ; Depression ; Humans ; Injections, Intravenous ; Morphine* ; Oxygen ; Pain, Postoperative* ; Postoperative Period ; Respiratory Rate

The preanesthetic management of preschool children is rather difficult. They worry about separation from their parents, the strange hospital environment, surgery, and are not always amenable to reasoned explanation. Therefore, the preoperative sedation is necessary to reduce anxiety and minimize psychologic trauma to children. To determine which type of intrarectal administration is the most effective in preanesthetic sedation, 90 children were randomly assigned to three groups. Group I was administered with intrarectal midazolam (0.5 mg/kg), group II, intrarectal ketamine (5 mg/kg), and group III, intrarectal midazolam (0.5 mg/kg) with ketamine (5 mg/kg). Most of children separated easily from their parents 30 minutes after intrarectal administration (above 80%). In all groups, the loss of consciousness were below 40% and sedation states were above 80%. But in group III, the loss of consciousness and the sedation states were much better than those of the other two groups. The anxiety level of group III was lower than that of the other groups (p<0.05) and the sedation level of group I and III were better than that of group II (p<0.001). Complications and recovery time were similar among each group. Following intrarectal administration of 0.5 mg/kg of midazolam with 5 mg/kg of ketamine, reliable sedation was obtained 20-30 min after intrarectal administration. Therefore we believe that intrarectal midazolam with ketamine is a useful teehnique for the reliable preoperative sedation in children.
Anxiety ; Child* ; Child, Preschool ; Humans ; Ketamine* ; Midazolam* ; Parents ; Premedication* ; Unconsciousness

BACKGROUND: Even when patients agree that anesthesia is indispensable for a safe and comfortable operation, they are reluctant to experience the side effects of conventional general and regional anesthesia. We investigated whether monitored anesthetic care (MAC) using propofol, ketamine, fentanyl, and ketolorac can be substituted for conventional anesthesia in minor surgery. METHODS: One hundred forty six healthy adult patients who received minor surgery were studied. All were fasted, premedicated, and monitored according to conventional general anesthesia. Fentanyl 2 microgram/kg, propofol 1 mg/kg, ketamine 0.2 mg/kg, and ketorolac 30 mg were given intravenously and propofol was maintained at 3 4 mg/kg/h. Before local anesthetics infiltration at the incision site, ketamine 5 mg and propofol 20 mg were added intravenously. During the procedure, fentanyl 25 microgram plus propofol 20 mg were added whenever involuntary movements appeared. We observed vital signs, complications, time to eye opening to verbal command, time to regain orientation, satisfaction with anesthesia, postoperative pain scores, and analgesic consumption. RESULTS: Blood pressure and heart rate were reduced at the beginning of anesthesia, but were not clinically significant. Intraoperatively, respiratory depression (40.4%), SpO2 < 90% (25.3%) were observed, but no patients needed tracheal intubation. Postoperatively, dizziness (29.5%), pain (20.5%), and nausea (15.8%), were observed. The time to eye opening and to regaining of orientation were 57.3+/-119.4 sec, and 8.0+/-4.7 min respectively. Satisfaction with anesthesia was remarkable; surgeon (76.7%), patients (91.8%). Postoperative pain scores were low; 59.6% of patients did not need analgesics for the first 24 h. CONCLSIONS: If careful monitoring and instantaneous management for respiratory depression by anesthesiologist is provided, MAC using PKFK is an excellent and readily applicable method for minor surgery.
Adult ; Analgesics ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthetics, Local ; Blood Pressure ; Dizziness ; Dyskinesias ; Fentanyl* ; Heart Rate ; Humans ; Intubation ; Ketamine* ; Ketorolac* ; Nausea ; Pain, Postoperative ; Propofol* ; Respiratory Insufficiency ; Surgical Procedures, Minor* ; Vital Signs