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Blood Concentration of Lidocaine after Subarachnoid Administration.

Jae Kyu CHEUN ; Ae Ra KIM ; Dae Lim JEE ; Yeon Kyu KIM

Korean Journal of Anesthesiology.1993;26(2):310-313. doi:10.4097/kjae.1993.26.2.310

Ten healthy adult female patients scheduled for elective abdominal hysterectomy were evaluated for their rates and degrees of absorption following subarachnoid administration of 150 mg of 5% lidocaine in 5% dextrose solution. The mean blood concentrations of lidocaine measured at 5, 15, 30, 60 and 90 minutes after subarachnoid administration were 0.34+/-0.23, 0.78+/-0.27, 1.10+/-0.26, 1.24+/-0.24 and 1.07+/-0.19 mcg/ ml, respectively. The mean values of Cmax and Tmax obtained from these measurements were 1.30+/- 0.21 mcg/ml and 57+/-17 minutes, respectively. These results revealed that in comparison with other regional administration, absorption of lidocaine follwing subarachnoid injection is slower.
Absorption ; Adult ; Anesthesia, Spinal ; Female ; Glucose ; Humans ; Hysterectomy ; Lidocaine*

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A Comparative Study of the Prolongation of Epidural Anesthesia with 0.5 % Bupivacaine by Epinephrine and Clonidine.

Mi Kyung LEE ; Suk Min YOON ; Il Ok LEE ; Sang Ho LIM ; Nan Suk KIM ; Young Suk CHOI

Korean Journal of Anesthesiology.1993;26(2):303-309. doi:10.4097/kjae.1993.26.2.303

Epidural clonidine is reported to produce analgesia in humans. To investigate the analgesic effect and prolongation of epidural and spinal anesthesia, we mixed 0.2mg epinephrine, 150 mcg clonidine, or 1 cc normal saline with 0.5% bupivacaine and compared the hemodynamie and analgesic effects of each drug. Heart rate and blood pressure were checked before, during and after anesthesia. Sensory level was checked by pin-prick method. The results were as follows; 1) The analgesia onset time and the time to highest level of sensory loss was most rapid in the epinephrine group. 2) The two segment regression time was significantly prolonged in the epinephrine group. 3) The analgesia duration was significantly prolonged in the clonidine and epinephrine group. 4) Although the heart rate gradually decreased over 60 min. After injection of each drug, there was no significant change between the groups. 5) Blood pressure decreased over 20-30 min. After injection of each drug, but there was no significant change between the groups.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Blood Pressure ; Bupivacaine* ; Clonidine* ; Epinephrine* ; Heart Rate ; Humans

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The Measurement of Distance from Skin to the Epidural Space in Parturients.

Ae Ra KIM ; Jae Kyu CHEUN ; Sung Koo CHOI ; Jung In BAE

Korean Journal of Anesthesiology.1993;26(2):299-302. doi:10.4097/kjae.1993.26.2.299

Lumber epidural analgesia is a well established method of providing pain relief during labor. Placement of a needle in the epidural space is probably one of the more tephnically demanding procedures which are performed by anesthesiologists. Two-hundred-thirty-four women receiving epidural analgesia during labor were studied. The distance from skin to the epidural space was measured with Portex disposable epidural needle marked at 1 cm intervals. The mean distance was found to be 4.18 cm. There was no correlation between distance from skin to the epidural space and height, hut was signifieant correlation with weight(p<0.001). The epidural depths were identified most frequently at 3 to 4 cm deep and 84.2% of total cases were less than 5 cm deep. This study suggests that, if the epidural space has not been identified within a depth of 6 cm, redirection or reinsertion of the needle should be considered.
Analgesia, Epidural ; Epidural Space* ; Female ; Humans ; Labor Pain ; Needles ; Pregnancy ; Skin*

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Cardiovascular Effect of Lidocaine in Patients under Halothane , Enflurane and Diazepam Anesthesia.

Bong Ho SHIN ; Sang Hyun GWAK ; Sung Su CHUNG ; In Ho HA

Korean Journal of Anesthesiology.1993;26(2):293-298. doi:10.4097/kjae.1993.26.2.293

To evaluate the cardiovascular effect of lidocaine and serum electrolytes during inhalational or intravenous anesthesia, thirty-two healthy patients were randomly divided into three groups and measured systolic pressure, diastolic pressure, mean pressure, heart rate and serum K+ and Na+ level were measured at 30 sec, l, 3, 6, 12 minutes after intravenous injection of lidocaine(1.5 mg/kg) during halothane-N2O-O2 or enflurane-N2O-O2 or diazepam-N2O-O2 anesthesia. In all 3 groups, the values of hemodynamic and serum electrolytes were not changed by 2% lidocaine. These results indicate that intravenous injection of lidocaine(1.5 mg/kg) to prevent undesirable reflexes and to prevent intracranial hypertension is a safe method without depression of hemodynamics.
Anesthesia* ; Anesthesia, Intravenous ; Anesthetics ; Anesthetics, Local ; Blood Pressure ; Depression ; Diazepam* ; Electrolytes ; Enflurane* ; Halothane* ; Heart Rate ; Hemodynamics ; Humans ; Injections, Intravenous ; Intracranial Hypertension ; Lidocaine* ; Reflex

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Effects of Vecuronium, Pancuronium, and Succinylcholine on the Oculocardiac Reflex in Children.

Yong Suk LEE ; Hoon KANG ; Seong Deok KIM ; Kwang Woo KIM

Korean Journal of Anesthesiology.1993;26(2):285-292. doi:10.4097/kjae.1993.26.2.285

Oculocardiac reflex occurs frequently during strabismus surgery in children. The most common arrythmia is bradycardia, with resolution after traction of extraocular muscle is withdrawn. However, the reflex is potentially fatal as it can cause cardiac arrest. This study was undertaken to compare the effect of three muscle relaxants, succinylcholine, pancuronium and vecuronium on the oculocardiac reflex, and to determine which could prevent it during strabismus surgery in children. We compared the change of heart rate and systolic blood pressure in each muscle relaxant group before and after traction of extraocular muscle in unpremedicated children between 3 to 15 years old with atropine or glycopyrrolate undergoing strabismus surgery. The incidences of oculocardiac reflex were 31.6% in vecuronium group, 14.0% in pancuronium group and 18.4% in succinylcholine group. Overall incidence was 20.1%. Heart rate decreased significantly in vecuronium and succinylcholine group, but systolic blood pressure was unchanged. In pancuronium group, changes in heart rate and systolic blood pressure were not significant. From the above results, the use of pancuronium which does not decrease heart rate will be more protective in preventing the oculecardiac reflex during strabismus surgery in children.
Adolescent ; Arrhythmias, Cardiac ; Atropine ; Blood Pressure ; Bradycardia ; Child* ; Glycopyrrolate ; Heart Arrest ; Heart Rate ; Humans ; Incidence ; Pancuronium* ; Reflex ; Reflex, Oculocardiac* ; Strabismus ; Succinylcholine* ; Traction ; Vecuronium Bromide*

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The Effect of Succinylcholine on the Duration of Action of Pancuronium.

Hyeun KIM ; Myung Ha YOON ; Woong Mo IM

Korean Journal of Anesthesiology.1993;26(2):278-284. doi:10.4097/kjae.1993.26.2.278

For the assessment of the effect of succinylcholine(SCh) on pancuronium, 62 adult patients undergoing elective surgery under gerieral anesthesia were subjected tc this study in which the EMG response(twitch hight) of the hand to TOF stimulation(0.2 Hz) of ulnar nerve was monitored and recorded with Datex Relaxograph. According to the amount and mode of the drugs administered, the patients were divided into four experimental groups: 1) Group I, a bolus intravenous injection of pancuronium in dose of 0.05 mg/kg. 2) Group II, intravenous injection of pancuronium 0.1 mg/kg, a double dose of group I. 3) Group III, intravenous injection of pancuronium(0.05 mg/kg) after 25 to 50 recovery of initial twitch height from twitch height depression induced by SCh(1 mg/kg). 4) Group IV, mixed intravenous injection of SCh(1 mg/kg) and pancuronium(0.05 mg/kg). Followings were the results. 1) Mean onset time of the effect of pancuronium, was 15.6+/-1.1 minutes in group I and 13.8+/-1.5 minutes in group II, to 2,9+/-0.4 and 1.3+/-0.1 minutes in group III and IV respectively, and decreased(p< 0.001). 2) Duration of action of pancuronium was 47.1+/-4.5 minutes in group I and 87.7+/-7.4 minutes in group II, the prolongation of the latter being significantg<0.001). It was, however 48.3+/-5.2 minutes in group III, indicating that SCh showed a little effect, while it was 21.2+/-1.9 minutes in group IV, being significantly shorter than those of group I and III(p<0.001), 3) Potency of pancuronium expressed by the percentage changes of initial twich height was 34.3+/-6.0% in group I and it was noted to decrease significantly to 4.0+/-1.0% in group II and 0% in group IV(p<0.001). This pattern of decrease was almost similar to group II. 4) Presence of pancuronium(0.05 mg/kg) in group IV did not have any effect on the intensity of fasciculation induced by SCh. These results indicate that succinylcholine could potentiate the onset time and action potency of pancuronium by facilitating quick action on the receptor, but it have an antagonistic effect on the duration of action of pancuronium.
Adult ; Anesthesia ; Depression ; Fasciculation ; Hand ; Humans ; Injections, Intravenous ; Pancuronium* ; Succinylcholine* ; Ulnar Nerve

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Assessment of Facial Nerve Stimulation Methods to Determine the Optimal Time for Tracheal Intubation after Vecuronium Injection.

Kyo Sang KIM ; Jeong Uk HAN ; Jong Hun JUN ; Jae Chul SHIM ; Kyoung Hun KIM ; Dong Ho LEE ; Jung Kook SUH ; Hee Koo YOO ; Ik Sang SEUNG ; Se Ung CHON

Korean Journal of Anesthesiology.1993;26(2):272-277. doi:10.4097/kjae.1993.26.2.272

Absence of response to train of four(TOF) and single twitch stimulation at ulnar nerve did not guarantee ided intubation conditions after vecuronium. The double burst stimulation (DBS) introduced by Viby-Mogensen, made it easier to evaluate postoperative residual neuromuscular blockade manually than did the use of the TOF method. The purpose of this study was to examine which will be the best stimulus among DBS, TOF and single twitch stimulation(STS) for an indicator of the optimal time for tracheal intubation. One hundred and nine healthy patients were randomly allocated to three groups in which DBS(n=34), TOF(n=38) and STS(n=37) group. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained 1% enflurane until intubation. Neuromuscular block was induced by intravenous vecuronium0.1 mg/kg, and applied facial nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher and Paykel Co.) continuously. The complete relaxation time of orbicularis oculi muscle was closely observed with authors naked eyes. Tracheal intubation was performed immediately by the author after disappearance of the response to stimuli. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cords opening, coughing reflex and response to laryngoscopy attempts. The intubation time was 195.9+/-74.7(90-390) seconds in DBS group, 180.9+/-49.8(100-290) seconds in TOF group and 167.7+/-37.9(90-270) seconds in STS group and there were no statistically significant difference. There were also no significance on vocal cords opening and response to laryngoscopy attempts in three groups but DBS group was statistically less cough reflex than TOF group and STS group(p<0.05). With the above results the authors concluded that DBS on the facial nerve with the orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation and the time was about l96 seconds after vecuronium.
Anesthesia ; Cough ; Enflurane ; Facial Nerve* ; Humans ; Injections, Intravenous ; Intubation* ; Laryngoscopy ; Muscle, Skeletal ; Neuromuscular Blockade ; Reflex ; Relaxation ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide* ; Vocal Cords

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Effect of Cooling & Lidocaine on Propofol Induced Vascular Pain.

Jun Seok CHOI ; Cheol Seung LEE ; Won Tae KIM ; Chan Jin PARK

Korean Journal of Anesthesiology.1993;26(2):266-271. doi:10.4097/kjae.1993.26.2.266

Propofol containing solvents such as soybean oil, egg phosphatide, glycerol, is known to arouse pain on intravenous injection in most patients. The study was undertaken to evaluate the efficacy of the two methods in preventing pain during injection of propofol on induction of anesthesia. Patients were allocated randomly into three groups. The one to receive unmodified propofol as control, the other to have injection of propofol with lidocaine added O.l mg/kg and another to have administration of propofol cooled in 0-4 degrees C. The results showed that propofol with lidocaine mixed and propofol cooled in 0-4 degrees C significantly lowered the incidence of pain during the intravenous injection of the drug and that addition of lidocaine and cooling had no untoward effect on the cardiovascular system.
Anesthesia ; Cardiovascular System ; Glycerol ; Humans ; Incidence ; Injections, Intravenous ; Lidocaine* ; Ovum ; Propofol* ; Solvents ; Soybean Oil

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Clinical Effects of Propofol According to Dosage.

Tae Hun AN ; Nam Soo CHO ; Byung Sik YU ; Gyung Joon LIM ; Chong Dal CHUNG ; Yong Il KIM

Korean Journal of Anesthesiology.1993;26(2):257-265. doi:10.4097/kjae.1993.26.2.257

Propofol(Diprivan, England ICI) is a new intravenous anesthetic agent chemically unrelated to barbiturates or other intravenous anesthetic agents. It was found to produce rapid onset of anesthesia and early recovery similar to that Obtained with pentothal sodium. The purpose of the present study is to compare the cardiovascular and respiratory effect of propofol with the cardiovaseular and respiratery effeet of pentothal sodium. Sixty patients of ASA class l or 2 scheduled to undergo gynecological, orthopedic and abdominal procedures were classified randomly into 3 Groups. Group A were injected with pentothal sodium 5.0 mg/kg and Group B, C received propofol 2.0 mg/kg, 2.5 mg/kg respectively. The results were as follows, 1) Change of the systolic arterial pressure. Propofol 2.5 mg/kg produced the greatest decrease in systolic blood pressure when compared with other groups. 2) Change of the heart rate. Change of the heart rate was minimal after both doses of prepofol when compared with pentothal sodium. 3) Respiratory effect. Respiratory measurement in 20 unpremedicated surgical patients who received an induction dose of propofol 2.5 mg/kg showed significant respiratory depression. 4) Side effect. Excitatory effects and pain on injection were more frequent in propofol group than pentothal sodium group. Nausea, vomiting were more frequent in pentothal sodium group than propofol group.
Anesthesia ; Anesthetics ; Arterial Pressure ; Barbiturates ; Blood Pressure ; England ; Heart Rate ; Humans ; Nausea ; Orthopedics ; Propofol* ; Respiratory Insufficiency ; Sodium ; Thiopental ; Vomiting

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Vital Sign Changes to an iv Test Dose of Epinephrine and Lidocaine with and without Glycopyrrolate Pretreatment.

Sang Chul LEE ; Byung Moon HAM ; Hoon KANG

Korean Journal of Anesthesiology.1993;26(2):250-256. doi:10.4097/kjae.1993.26.2.250

In order to decrease complications of local anesthetic, early detection of intravascular injection of local anesthetics is inevitable. However, heart rate response to intravenous(iv) epinephrine test dose injection may result in false-positive or false-negative result. Besides, glycopyrrolate pretreatment may enhance heart rate response to epinephrine test dose. We allocated randomly 30 ASA physical status 1 and 2 patients to two groups, to receive glycopyrrolate 0.2 mg(n=15) or same volume of saline(n=15). Five minutes after glycopyrrolate pretreatment, patients received iv test dose of 2% lidocaine 3 ml with epinephrine 15 pg at a rate of 1 ml/sec. Two groups were similar with respect to basal heart rate. Heart rate and mean arterial pressure increased significantly in both groups at 1, 2, 3 and 4 minutes after epinephrine test dose injection. After 5 minutes, heart rate and mean arterial pressure normalized in both groups. Thus we might suggest that glycopyrrolate pretreatment has no influence on the sensitivity of the test dose containing 2% lidocaine 3 ml and epinephrine 15 ug to detect intravascular injection of local anesthetics.
Anesthetics, Local ; Arterial Pressure ; Epinephrine* ; Glycopyrrolate* ; Heart Rate ; Humans ; Lidocaine* ; Vital Signs*

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