No abstract available.
Anesthetics, Local

No abstract available.
Anesthetics, Local* ; Epinephrine*

Levobupivacaine is the oure S(-)-enantiomer of racemic bupivaciane but is less toxic to the heart and central nervous system. Previous studies have shown that it is of equal potency with Bupivacaine in terms of onset of motor blockade, duration of sensor and motor blockade but a significant delay in the onset motor blackade (21 min versus 10 min). one study was done where aspirated CSF was used instead of adding sodium bicarbonate to adjust the pH-adjusted Levobupivacaine0.5% for spinal anesthesia. Thirty patients undergoing elective minor surgery received either 15mg of Levobupivacaine 0.5% isobaric or solution of 15mg of Levobupivacaine 0.5% isobaric with 1:1 mixture of aspirated CSF. Time of motor block onset and pH level were measured in both groups. Results showed faster motor block onset for pH-adjusted Levobupivacaine (1.87 +/- 0.65min versus 18.70 +/-3.26min) and pH level was also higher (7.12 +/-0.05 versus 6.04 +/-0.28). we conclude that the alkalinization by addition of CSF to Levobupivacaine 0.5% via 1:1 mixture speeds the onset motor block. Time to reach a Bromage score from 0 to 3 was shorter and pH level was more basic from the pH-adjusted Levobupivacaine, which may explain the faster onset since pH of the solution was closer to the pKa of Levobupivacaine.
Human ; LEVOBUPIVACAINE ; ANESTHETICS, LOCAL ;

BACKGROUND: Recent studies suggest the hypothesis that blockade of nociceptive input with local anesthetics before surgery can decrease pain beyond the immediate postoperative period. The purpose of this study was to determine if the preincisional infiltration with local anesthetics affected postoperative pain relief. METHOD: Among 30 patients having tonsillectomy, 15 patients(group 1) given peritonsillar infiltration using lidocaine with epinephrine(1 : 200,000) were compared with 15 patients(group 2)given peritonsillar infiltration using saline with epinephrine(1 : 200,000). Following general anesthesia with a mixture of O2-N2O(50%) and enflurane(1-2vol.%), peritonsillar infiltration were performed 5 minutes before surgery. Constant incisional pain and pain on swallowing were assessed using a visual analogue scale at 4 hour, 1, 2, 3 and 4 days postoperatively. The time to emergence and behaviour of patient at 0.5, 1 and 4 hour were recorded postoperatively. RESULT: Preincisional infiltration with lidocaine resulted in a significant decrease in postoperative pain during 4 days after surgery and smoother emergence. CONCLUSION: There were significant difference in pain scores between lidocaine group and saline group during 4 days after surgery. Preincisional lidocaine infiltration seemed to have analgesic activity beyond the residual anesthetic period. The results of this study support the theory of pre-emptive analgesia.
Analgesia ; Anesthesia, General ; Anesthetics ; Anesthetics, Local ; Child* ; Deglutition ; Humans ; Lidocaine* ; Pain, Postoperative ; Postoperative Period ; Tonsillectomy

Voltage-gated sodium channels are large glycoproteins that permit selective sodium ion conduction in excitable cells such as neurons. They generate upstroke of action potential and transmit depolarizing impulses through the neuronal network including pain pathway. They are composed of core forming alpha-subunit and one or more auxiliary beta-subunits. Local anesthetics bind in the inner pore of the sodium channel. They block sodium currents and generation of action potential. Amino acid residues which contribute to the drug binding site have been identified by mutational analysis. Also, blockade of sodium ion currents has been investigated as a possible mechanism of general anesthetics. But it is not sufficient to explain the major mechanism of action of general anesthetics.
Action Potentials ; Anesthesia ; Anesthetics, General ; Anesthetics, Local ; Binding Sites ; Glycoproteins ; Neurons ; Sodium ; Sodium Channels

BACKGROUND: This study was performed to compare anesthetic agents and adjuvants for general anesthesia or regional anesthesia between university hospitals, resident-training general hospitals and hospitals without training program of residents. METHODS: We surveyed university hospitals, resident-training hospitals and hospitals without training program of residents and divided randomly each hospital groups to become twenty hospitals. We compared the use frequency of inhalation anesthetics, muscle relaxants, induction agents, reversing agents, local anesthetics, premedicants, cardiovascular drugs and plasma expanders. RESULTS: Enflurane was most commonly used inhalation anesthetic in all hospital groups. Isoflurane was less commonly used inhalation anesthetic in hospitals without training program of residents. Pancuronium was most commonly used muscle relaxant in university hospitals. Midazolam, ketamine, fentanyl, propofol were commonly used induction agents during induction in university hospitals and resident-training general hospitals. Differences of use frequency of local anesthetics among hospital groups were not significant, but epinephrine mixing with local anesthetics was more frequent in university hospitals and resident-training general hospitals. Midazolam as a premedicant and norepinephrine, phenylephrine, amrinone, esmolol, pentastarch were less used in hospitals without training program of residents. CONCLUSIONS: These results suggest that university hospitals and resident-training general hospitals didn't show difference in anesthestics or adjuvants but hospitals without training program of residents used less commonly isoflurane, atracurium, midazolam, ketamine, propofol, fentanyl, cardiovascular drugs and pentastarch.
Amrinone ; Anesthesia, Conduction ; Anesthesia, General ; Anesthetics* ; Anesthetics, Inhalation ; Anesthetics, Local ; Atracurium ; Cardiovascular Agents ; Education ; Enflurane ; Epinephrine ; Fentanyl ; Hospitals, General* ; Hospitals, University* ; Hydroxyethyl Starch Derivatives ; Inhalation ; Isoflurane ; Ketamine ; Midazolam ; Norepinephrine ; Pancuronium ; Phenylephrine ; Plasma ; Propofol

PURPOSE: Anesthesia and surgery commonly cause hypothermia, and this caused by a combination of anesthetic-induced impairment of thermoregulatory control, a cold operation room environment and other factors that promote heat loss. All the general anesthetics markedly impair normal autonomic thermoregulatory control. The aim of this study is to evaluate the effect of two different types of propofol versus inhalation anesthetic on the body temperature. MATERIALS AND METHODS: In this randomized controlled study, 36 patients scheduled for elective laparoscopic gastrectomy were allocated into three groups; group S (sevoflurane, n=12), group L (lipid-emulsion propofol, n=12) and group M (micro-emulsion propofol, n=12). Anesthesia was maintained with typical doses of the study drugs and all the groups received continuous remifentanil infusion. The body temperature was continuously monitored after the induction of general anesthesia until the end of surgery. RESULTS: The body temperature was decreased in all the groups. The temperature gradient of each group (group S, group L and group M) at 180 minutes from induction of anesthesia was 2.5+/-0.6degrees C, 1.6+/-0.5degrees C and 2.3+/-0.6degrees C, respectively. The body temperature of group L was significantly higher than that of group S and group M at 30 minutes and 75 minute after induction of anesthesia, respectively. There were no temperature differences between group S and group M. CONCLUSION: The body temperature is maintained at a higher level in elderly patients anesthetized with lipid-emulsion propofol.
Aged ; Aging ; Anesthesia, General/*methods ; Anesthetics, Combined/administration & dosage ; Anesthetics, Inhalation/*administration & dosage ; Anesthetics, Intravenous/*administration & dosage ; Body Temperature/*drug effects ; Body Temperature Regulation/drug effects ; Fat Emulsions, Intravenous ; Female ; Humans ; Male ; Methyl Ethers/*administration & dosage ; Middle Aged ; Propofol/*administration & dosage

BACKGROUND: Propofol is a new, short-acting intravenous sedative-hypnotic anesthetics for induction and maintenance. Awakening craniotomy for resection of seizure focus is performed when the area to be excited is too close to an eloquent area to be mapping accurately. This study was performed to evaluate the efficacy and the hemodynamic effects of Pofol(R) in comparison with Diprivan(R) for the maintenance of total intravenous anesthesia (TIVA) in epilepsy surgery. METHODS: This procedure is carried out under what has been euphemistically called local anesthesia or monitored anesthesia care (MAC). For induction, 2 mg/kg in bolus was administered in both groups, and the usual maintaining dose was 100 mcg/kg/min. Surgical procedures are divided in 6 stage (I: Craniotomy, II: Electrocorticography (ECoG), III: Functional mapping, IV: Cortical resection, V: Post-resection EEG, VI: Craniotomy closure). RESULTS: Arterial blood gases and vital signs of Pofol(R) group and Diprivan(R) group were analysed. But, awakening time was slightly rapid in Pofol(R) group (8.9+/-2.64 min.) compared with Diprivan(R) group (10.6+/-3.22 min.). And there were no statistically significant differences between the two groups. CONCLUSIONS: We concluded that both Pofol(R) and Diprivan(R) are the ideal total intravenous anesthetics for long time epilepsy surgery. However, Pofol(R) group is more helpful in intraoperative ECoG and functional brain mapping because of its slightly rapid awakening time.
Anesthesia* ; Anesthesia, Intravenous ; Anesthesia, Local ; Anesthetics ; Anesthetics, Intravenous ; Brain Mapping ; Craniotomy ; Electroencephalography ; Epilepsy* ; Gases ; Hemodynamics ; Propofol* ; Seizures ; Vital Signs

Epidural administration of opioid and/or local anesthetics during general anesthesia is widespread method for postoperative pain control. Despite of its availability, inadvertent administration of non-epidural medications into epidural space can be associated with serious neurologic sequelae. We report a case of accidental epidural atracurium injection.
Anesthesia, General ; Anesthetics, Local ; Atracurium* ; Epidural Space ; Lidocaine* ; Pain, Postoperative

OBJECTIVETo investigate the effect of epidural ropivacaine in combination with fentanyl for labor analgesia on the clinical outcome of labor.

METHODSA retrospective study was conducted involving 281 healthy primiparas, including 106 undergoing spontaneous labor who received epidural 0.15% ropivacaine in combination with fentany (1microg/ml) and 175 without epidural analgesia. The active phase duration, durations of each labor stages, delivery modes, management of labor, postpartum hemorrhage, incidence of fetal distress and asphyxia neonatorum were recorded in the two groups. The visual analogue scale (VAS) was used to assess the pain of uterine contraction, and modified Bromage scoring system applied to evaluate the lower limb motor block.

RESULTSThere were no significant differences in the duration of the first, third or the total labor stages between the two groups, but the second labor stage was prolonged in the labor analgesia group. The ratio of spontaneous labor, assisted vaginal delivery, and incidence of asphyxia neonatorum were higher, whereas the duration of the active stage was shortened in the analgesia group.

CONCLUSIONEpidural ropivacaine in combination with fentanyl in labor can decrease the incidence of cesarean section, and the duration of the active stage can be shortened with application of ocytocin.

Adult ; Amides ; administration & dosage ; therapeutic use ; Analgesia, Epidural ; methods ; Analgesia, Obstetrical ; methods ; Anesthetics, Combined ; Anesthetics, Intravenous ; administration & dosage ; therapeutic use ; Anesthetics, Local ; administration & dosage ; therapeutic use ; Female ; Fentanyl ; administration & dosage ; therapeutic use ; Humans ; Labor Pain ; drug therapy ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies