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Although neuromuscular blockade can influence the bispectral index (BIS) during anesthesia, there have been contradictory reports regarding its effects. The purpose of this study was to investigate whether a muscle relaxant affected the level of BIS during propofol anesthesia. Methods: Forty-eight healthy patients undergoing elective surgery under general anesthesia were enrolled in this prospective, randomized, double-blind study. All patients received an effect-site targeted concentration of propofol via a TCI system that was titrated until loss of consciousness occurred. The patients then received either an injection of vecuronium (relaxant group, n = 24) or normal saline as a placebo (placebo group, n = 24) at 3 minutes after loss of consciousness. The BIS and electromyogram (EMG) activity were recorded from anesthetic induction to 4 minutes after injection of the vecuronium or placebo. Results: The BIS significantly decreased after injection in both groups (P ＜ 0.05), however, the decrease in the BIS was larger in the relaxant group than in the placebo group (P ＜ 0.05). The decrease of EMG activity was not significantly different between the two groups after administration of vecuronium or placebo. Conclusions: During propofol induction of anesthesia, a muscle relaxant decreased BIS significantly without decreasing the EMG activity.

Background: Thoracic epidural anesthesia (TEA) combined with general anesthesia is commonly used in major upper abdominal surgery. The advantages of this method is the suppression of the perioperative stress response, the improvement in endocardial perfusion, and the reduction of myocardial oxygen consumption, postoperative morbidity and mortality. In particular, this method reduces the level of postoperative ileus and intestinal anastomosis leakage during gastrointestinal surgery. However, there is the possibility of severe cardiovascular depression using this combination method. This study evaluates the cardiovascular effects of extensive TEA combined with sevoflurane general anesthesia. Methods: Fifty patients scheduled subtotal gastrectomy were enrolled in this study. After administering a bolus injection of 20 ml of 0.375% ropivacaine through an epidural catheter during sevoflurane general anesthesia, mean arterial pressure, heart rate, stroke volume, cardiac output, and systemic vascular resistance measured by Hemosonic (HemoSonicTM 100, Arrow, USA) every 5 minutes over a 30-minute period after the injection. Results: All the data showed a significant decrease from 5 minutes after the epidural bolus injection except for the stroke volume, but that was not important clinically. Conclusions: A thoracic epidural injection of 20 ml of 0.375% ropivacaine can be used safely during sevoflurane anesthesia without severe cardiovascular complications during upper abdominal surgery.

Background: Breast cancer is the most common cause of tumors in Korean women. Until recently, oncologic breast surgery was performed by using general inhalation anesthesia. However, this anesthetic method is associated with incomplete postoperative pain control and significantly more postoperative nausea and vomiting (PONV). Therefore, this study examinated the value of thoracic epidural anesthesia (TEA) for a mastectomy, and evaluated the effects of a continuous epidural infusion on postoperative pain control and the PONV, which is known to be a better method than general anesthesia with intravenous patient controlled analgesia (IV PCA). Methods: Sixty five patients scheduled for a mastectomy were randomly assigned and divided into two groups. The GA group underwent general anesthesia using O2-N2O-sevoflurane with IV PCA. The TEA group was injected with 20 ml of 0.375% ropivacaine with fentanyl 50μg at T4－5. After surgery the visual analogue scale (VAS) score of postoperative pain and nausea was checked. Results: The postoperative pain intensity was significantly (P ＜ 0.05) lower in the TEA group at the postoperative period and during 6 hours compared with the GA group. Postoperative nausea intensity was significantly (P ＜ 0.05) lower in the TEA group during 6 hours. Conclusions: These results suggest that TEA is a method suitable of regional anesthesia for a mastectomy and a continuous epidural catheter infusion is more effective on postoperative pain control than general anesthesia with IV PCA. In addition, it is a good method for decreasing the PONV to a similar level as IV PCA with antiemetics. (Korean J Anesthesiol 2007; 52: 396~402)

Background: The present study was undertaken to determine the effect-site concentration of remifentanil for blunting hemodynamic responses to tracheal intubation during total intravenous anesthesia (TIVA) using propofol. Methods: In this prospective, randomized, double-blind study, a total of 126 patients, aged 18-60 (ASA I or II), having undergone elective surgery under TIVA using propofol were investigated. Anesthesia was induced using propofol (target effect-site concentration 4μg/ml) and rocuronium (0.9 mg/kg). Remifentanil was infused at target effect-site concentrations of 0, 2, 4, 6 ng/ml: groups R1, R2, R3 and R4, respectively. The systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and heart rate (HR) were measured pre-induction, and before and after tracheal intubation. Results: After intubation, the SAP, DAP and HR increased significantly (P ＜ 0.05) in all groups compared to the pre-intubation values. Compared with pre-induction values, the SAP and DAP in groups R1 and R2 increased significantly after intubation (P ＜ 0.05), but those in group R3 remained constant until 1 min after intubation. The SAP and DAP in group 4 however, decreased significantly (P ＜ 0.05) for 3 min after intubation. The HR increased significantly after intubation in groups R1, R2 and R3 compared to the values before intubation (P ＜ 0.05), but that in group R4 being remained constant. Conclusions: We suggest that the optimal target effect-site concentrations of remifentanil for blunting hemodynamic responses to tracheal intubation were 4 or 6 ng/ml during TIVA using propofol.

Background: The present study was undertaken to determine the effect of remifentanil on the bispectral index (BIS) during intubation under TIVA (total intravenous anesthesia) using propofol. Methods: In this prospective, randomized, double-blind study, 80 healthy patients aged 18�� 60 years undergoing elective surgery were investigated. Anesthesia was induced using propofol (target effect-site concentration 4μg/ml). After the loss of consciousness, rocuronium (0.9 mg/kg) and remifentanil was infused. The patients in the R group were infused with remifentanil using a target effect-site concentration of 4 ng/ml, and patients in the P gro up were infused with saline. The BIS value, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, before remifentanil infusion and before and after tracheal intubation. Results: The BIS value remained constant after intubation in the two g roups. The MAP and HR increased significantly after intubation in the two groups, but the degree of increase of MAP and HR was less in group R than in group P significantly. Conclusions: We suggest that the BIS value is not affected by the administration of remifentanil during intubation under TIVA using propofol. (Korean J Anesthesiol 2007; 53: 695∼9)

Background: The measurement of cardiac output (CO) is an important part of anesthetic practice in patients undergoing major surgery. The thermodilution method (TDM), using a pulmonary artery catheter, is still accepted as the standard procedure. However, the use of the method is associated with several limitations and severe complications. The use of a transesophageal Doppler ultrasound monitor (EDUM; Hemosonic 100 TM ) is less invasive and calculates CO from a simultaneous measurement of blood flow velocity and diameter of the descending aorta. The aim of this study was to compare the cardiac output measured by the use of the TDM and an EDUM. Methods: In 20 patients undergoing major abdominal surgery, CO and other hemodynamic profiles were measured simultaneously by the use of the TDM and an EDUM. Results: The cardiac output, cardiac index, and the systemic vascular resistance monitored by both devices were highly correlated (correlation coefficients range from 0.63 to 0.88). Bland and Altman analysis showed a consistently negative mean bias for an EDUM and the TDM. This finding indicates an overestimation of the hemodynamic profile by the use of an EDUM. Conclusions: Although Bland and Altman analysis showed a significant bias, the use of an EDUM results in cardiac output, cardiac index, and total systemic vascular resistance measurements that are considerably similar to those obtained using the TDM, and a strong correlation exists for the use of the two methods. (Korean J Anesthesiol 2007; 53: 689∼94)

Background: Segmental high thoracic epidural anesthesia and analgesia is now accepted as a popular technique for thoracic and breast surgeries, as well as post operative pain relief. However, a high thoracic epidural puncture is technically difficult, which can cause neurological complications. Having prior knowledge of the distance from the skin to the thoracic epidural space may be helpful for the prevention of complications during this procedure. This study was undertaken to evaluate the distance from the skin to the thoracic epidural space and the insertion angle of the Tuohy needle, as measured using a protractor, and to determine any potential relationship between a patient's height, weight and BMI (body mass index) with the calculated distance on the preoperative chest CT and the distance from the skin to the epidural space in 50 women undergoing a mastectomy. Methods: In the sitting position, using a mid-line approach, the T4-5 epidural depth was measured in 50 mastectomy patients after the block had been successfully confirmed. The patient's age, height, weight and BMI, as well as the calculated distance on the preoperative chest CT were then checked. Results: The distance from the skin to the thoracic epidural space at the T4-5 intervertebral level and insertion angle were 5.59 ± 1.26 cm and 54.40 ± 12.12 o , respectively. A significant correlation was found between the epidural depth and, the weight, BMI and calculated distance on the preoperative chest CT. Conclusions: The distance from the skin to the thoracic epidural space showed significant relationships with the weight, BMI and calculated distance on the preoperative chest CT. (Korean J Anesthesiol 2007; 53: 589∼92)

Background: The purpose of this study is to evaluate the patients' general perception about the analgesics and the effects of the preoperative education about analgesics and patient-controlled analgesia (PCA). Methods: One hundred patients scheduled for elective gastrectomy were randomly allocated into two groups. In control group (n = 50), patients were given conventional preanesthetic visit with questionnaire survey on PCA one day before operation. In study group (n = 50), patients were sufficiently explained about postoperative analgesia and PCA by anesthesiologist and given precise explanation sheet about PCA. Total amounts of drug used in PCA as well as rescue analgesics, the pain scores, and side effects were compared. Results: 62.2% of patients had much information from various sources that analgesics effects positively in the recovery phase, but actually 73.7% of patients considered that analgesics do not seem to have any influence on the recovery after operation. There was no difference between the amounts of total PCA used, rescue analgesics, and the pain scores. However, the educated patients complained less dizziness at postoperative days (POD) one. Also, the number of patients excluded from study due to the PCA discontinuation secondary to related side effects was less in educated patients (P = 0.025). Conclusions: Preoperative education about analgesics and PCA failed to demonstrate significant decrease in the amount of analgesics and of pain scores. However, it lowered the incidence of PCA discontinuation due to side effects.

Background: Vancomycin is frequently used as a prophylactic antibiotic in patients undergoing cardiac and orthopedic surgical procedures. However, the interactions of vancomycin with non-depolarizing muscle relaxant have not yet been reported on. Therefore, we studied the effects of vancomycin on the neuromuscular block of vecuronium, rocuronium and atracurium in vitro. Methods: Square wave, 0.1 Hz supramaximal stimuli were applied to the phrenic nerve-hemidiaphragm preparation of the rat and the twitch height response was recorded. We measured cumulative concentration response curves of vecuronium, rocuronium or atracurium, respectively, and also those of the rats that were pretreated with vancomycin (20/ml). The and of these muscle relaxants alone and those of the rats pretreated with vancomycin were calculated with using an inhibitory sigmoid Emax model. Results: Vancomycin alone did not depress the twitch height. The pretreated vancomycin (20/ml) did not affect the and of vecuronium or rocuronium, but it significantly reduced the and of atracurium (P ＜ 0.05). Conclusions: Vancomycin itself does not have neuromuscular blocking properties. Vancomycin does not affect the neuromuscular blockade induced by vecuronium or rocuronium, but it significantly enhances the neuromuscular blockade induced by atracurium.

Background: Segmental thoracic epidural anesthesia (sTEA) is commonly used for postoperative pain control in chest or upper abdominal surgery. But it is not commonly used for the purpose of pure regional anesthesia. Therefore we investigated the usefulness of sTEA for mastectomy and evaluated the effects of sTEA on respiration and hemodynamics. Methods: Twenty patients scheduled for mastectomy were randomly assigned. Under sitting position, epidural catheter was inserted at T3-4 or T4-5. 20 ml of 0.375% ropivacaine with fentanyl 50g was injected to maintain anesthesia. The targeted sensory anesthetic dermatomal levels were determined by pinprick and measured at 5 min intervals for the first 15 min after injection of the drugs. If sensory block was not adequate, subsequent 5 ml doses of ropivacaine was injected. Supplemental oxygen (3-6 L/min) was administered through a face mask. After dermatomal level was checked, propofol infusion for sedation was started. Arterial blood sampling was taken for ABGA. Results: Average sensory anesthetic dermatomal levels is C5.5 1.9 - T8.9 2.7. During surgery, hypotension was noted in 25% of patients. It was treated with ephedrine 6 mg i.v. Average is 47.9 7.7 mmHg. Conclusions: Above results suggest that sTEA is suitable for mastectomy as a method of regional anesthesia.

Background: Postoperative vomiting (POV) is a common complication after pediatric strabismus surgery. The aim of this study was to evaluate the prophylactic antiemetic effects of a combination of ondansetron with dexamethasone after strabismus surgery in children. Methods: In this prospective, randomized, double-blind, placebo-controlled study, 126 healthy children, aged 3-10 years, who underwent strabismus surgery under general anesthesia using sevoflurane were examined. The patients were divided randomly into three groups: Patients who received 100g/kg ondansetron with 100 g/kg dexamethasone (OD group, n = 42); 100g/kg ondansetron (O group, n = 42); and saline as placebo (P group, n = 42) after the induction of anesthesia. The incidence of vomiting, the patient's distress due to vomiting, the need for rescue antiemetics and parental satisfaction during the first 24 h after surgery were evaluated. Results: The incidence of vomiting in group OD (5%) and group O (17%) during the first 24 h after surgery were significantly lower than in group P (40%) (P

Background: The aim of the study was to evaluate the prophylactic effect of ondansetron on the postoperative nausea and vomiting (PONV) after a laparoscopic cholecystectomy (LC). Methods: In this prospective, randomized, double-blind, placebo-controlled study, 77 healthy female patients, who underwent a LC under general anesthesia using sevoflurane were investigated. Patients were randomly divided into two groups; the ondansetron group (n = 39) was administered 4 mg ondansetron, and the placebo group (n = 38) 2 ml of normal saline before the end of surgery. The incidence and severity of PONV, and the need for rescue antiemetics during the first 6 h and 24 h after surgery were evaluated. Results: The incidence of nausea in the ondansetron was significantly lower than in the placebo group during the 0-6 h (early nausea, P

Ramosetron Compared with Granisetron for the Prevention of Postoperative Nausea and Vomiting following General Anesthesia for Breast Mass Excision Ji Eun Kim, M.D., Chang Bong Lee, M.D., Sun Chong Kim, M.D., Soon Im Kim, M.D., and Si Young Ok, M.D. Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, Seoul, Korea Background: Women undergoing general anesthesia for breast mass excision have a high risk for postoperative nausea and vomiting (PONV). We therefore evaluated the efficacy of ramosetron versus granisetron for preventing PONV. Methods: One hundred twenty women scheduled for breast mass excision received, in a randomized allocated, double-blind manner, an intravenous placebo (P group), granisetron 40/kg (G group) or ramosetron 6 /kg (R group) at the end of surgery. Emetic episode and side effects were assessed. Results: The incidence and severity of nausea in G and R group was less than P group (P ＜ 0.05) during the first 24 hrs. The incidence of vomiting in R group was less than P group (P ＜ 0.05) during the first 6 hrs. However there was no significant difference in the incidence of PONV between G and R group. Conclusions: Our results showed that both granisetron and ramosetron significantly decreased the occurrence of PONV compared to placebo. However, any different efficacy for preventing PONV was not revealed between granisetron and ramosetron.

Background: A prospective study was performed to evaluate the preventive effect of intravenous (IV) ondansetron on postoperative nausea and vomiting (PONV) due to epidural morphine for postoperative pain control after major abdominal surgery. Methods: One hundred patients undergoing elective major abdominal surgery were randomly devided into two groups, group O (n = 50) receiving IV ondansetron and group C (n = 50) receiving IV saline. After bolus epidural morphine were injected to all patients thirty minutes before the end of surgery, group O received ondansetron 8 mg and group C received normal saline intravenously. Incidence and severity of nausea, episodes of vomiting, patient´s satisfaction, side effects such as pruritus, headache, dizziness related to epidural morphine were checked at 6, 24 hours after operation. Results: The incidence and severity of nausea were significantly decreased in group O than group C during the first 24 hours after surgery. There were no significant differences in postoperative pain scores and patient´s satisfaction between groups. The patients who didn´t experienced PONV were significantly more satisfied than those who experienced PONV after surgery. Conclusions: Ondansetron decrease the incidence and severity of nausea in patients receiving epidural morphine for postoperative pain control after major abdominal surgery.

Background: Hypotension associated with spinal anesthesia for cesarean delivery is most common and serious adverse effect despite the use of uterine displacement and volume preload. This study evaluated the role of ephedrine and fluid preload for prevention of hypotension during spinal anesthesia. Methods: Sixty healthy women undergoing elective cesarean delivery under spinal anesthesia at term were allocated randomly to receive ephedrine 10/kg/min followed by 4 mg bolus IV (E group, n = 20); ephedrine 10/kg/min followed by 4 mg bolus IV and rapid administration of 500 ml hydroxyethyl starch solution (EH group, n = 20); and ephedrine 10/kg/min followed by 4 mg bolus IV and rapid administration of 500 ml lactated Ringers solution (ER group, n = 20). Heart rate, blood pressure, hypotension incidence, and total ephedrine administration were checked after spinal anesthesia. Umbilical blood gas analysis and APGAR score were checked after delivery. Results: Maternal blood pressure, maternal heart rate, APGAR score were similar in three groups. But umbilical blood and is significantly low in hypotensive group than normotensive group (P /kg/min) with or without 500 ml colloid or crystalloid infusion is not effective for blood pressure maintenance. Once the maternal hypotension induces the umbilical blood low oxygen tension, it is necessary for anesthesiologists to concentrate more on the maintenance of the blood pressure.

Aprotinin is a serine protease inhibitor and a powerful antifibrinolytic agent, derived from the inhibition of plasmin and kallikrein. Therefore, it is widely used in cardiopulmonary bypass surgery or major surgery for reducing bleeding and blood transfusion requirements. Aprotinin is rapidly eliminated from the circulation by glomerular filtration and is actively reabsorbed in the renal tubular system, where it is stored, metabolized, and eliminated over the following 5-6 days. Because of this metabolism, concerns have been raised regarding the possibility that aprotinin may impair renal function due to a toxic effects on proximal tubular cells. We report three cases of postoperative renal failure after aprotinin had been used during surgery. Two patients, Jehovah's Witnesses who refused blood transfusion, required hemodialysis. One patient, who underwent spinal orthopedic surgery, was administered aprotinin to reduce intraoperative blood loss, and developed acute renal dysfunction. The patient recovered after supportive therapy.

Background: The present study was undertaken to investigate whether the transcutaneous electrical stimulation of the P6 acupoint prevents postoperative nausea and vomiting (PONV) after minor breast surgery. Methods: In this prospective, randomized, double-blind and placebo-controlled study, we investigated ASA I or II female patients who underwent minor breast surgery under general anesthesia using sevoflurane. We used a ReliefBanddevice (NSTTM 600, Woodside Biomedical Inc, USA) for the transcutaneous electrical stimulation of the P6 acupoint. The patients were randomly divided into two groups; in the P6 group (n = 33) the activated ReliefBandwas placed at the P6 acupoint; in the placebo group (n = 33) the inactivated ReliefBandwas placed at the P6 acupoint. The ReliefBandwas applied 10 min before the end of surgery and it remained in place for 24 h. We evaluated the incidence and severity of PONV, and the need for palliative antiemetics during the first 6 h and 24 h after surgery. Results: The incidence of nausea was significantly lower in the P6 group (33%) than in the placebo group (67%) during the first 24 h after surgery. The severity of nausea was also significantly lower in the P6 group than in the placebo group. However, the incidence of vomiting and the need for palliative antiemetics was not different between the two groups. Conclusions: Transcutaneous electrical stimulation of the P6 acupoint significantly reduced the incidence and severity of nausea, but not the incidence and severity of vomiting, for female patients undergoing minor breast surgery during the first 24 h after surgery.

Background: The aim of the present study was to investigate the effect of preemptive gabapentin on postoperative pain and opioid consumption in patients undergoing mastectomy. Methods: In a randomized, double-blind study, 41 patients received a single dose of oral gabapentin 900 mg with routine premedicantion (GABA group, n = 21) or only routine premedication without gabapentin (control group, n = 20) 1 h before surgery. Patients received intravenous patient-controlled analgesia using fentanyl for postoperative analgesia. VAS scores for pain at rest and during movement, sedation scores, side effects, and fentanyl consumptions were assessed at 6 and 24 h after surgery. Results: No significant differences were found between the two groups in terms of pain scores, side effects, or fentanyl consumptions for 24 h postoperatively. However, patients in the GABA group were more sedated at 6 h postoperatively than patients in the control group (P

Background: Ondansetron, a receptor antagonist, is widely used for the prevention of postoperative nausea and vomiting. However, the interaction of ondansetron with non-depolarizing muscle relaxants have not been reported until now. Therefore we studied the effects of ondansetron on the neuromuscular block of vecuronium, rocuronium or atracurium in vitro. Methods: A square wave 0.1 Hz supramaximal stimuli was applied to the phrenic nerve-hemidiaphragm preparation of a rat, and the twitch height response was recorded mechanomyographically. We measured cumulative concentration response curves of vecuronium, rocuronium or atracurium alone and after pretreating with ondansetron (1/ml). We also measured the effects of ondansetron. The 's and EC's of these muscle relaxants alone and after pretreatment with ondansetron were calculated using an inhibitory sigmoid Emax model. Results: Ondansetron depressed the twitch height in a dose-dependent manner, and its potency was lower than the muscle relaxants. The and of ondansetron were 14.7/ml and 33.4/ml, respectively. Pretreated ondansetron (1/ml) significantly reduced the EC's and EC's of vecuronium, rocuronium and atracurium (P

Background: It is believed that stimulation of the P6 acupoint minimizes nausea and vomiting and has been used to prevent and treat nausea and vomiting in vario us situations. T he present study was undertaken to investigate whether the transcutaneous electrical stimulation of the P6 acupoint prevents postoperative nausea and vomiting (PONV in female patients undergoing laparoscopic cholecystectomy. M ethods: In this prospective randomized double-blind placebo-controlled study we investigated 59 ASA I or II female patients who underwent laparoscopic cholecystectomy under general anesthesia using isoflurane or enflurane. We used a ReliefBand u nit (NST TM 600 Woodside Biomedical Inc USA for the transcutaneous electrical stimulation of the P6 acupoint. Patients were randomly divided into two groups; in the P6 group (n = 29 the activated ReliefBand w as placed at the P6 acupoint; and in the placebo group (n = 30 the inactivated ReliefBand was placed at the P6 acupoint. The ReliefBand was applied 10 min before the end of surgery and remained in place for 24 h. We evaluated the incidence and severity of PONV and need for rescue antiemetics during the first 6 h and 24 h after surgery. Results: No differences in age weight previous PONV history or duration of anesthesia were present between groups. The incidence of PONV was significantly lower (34% in the P6 group than in the placebo group (63% during the first 24 h after surgery. The severity of nausea and vomiting was also significantly lower in the P6 group than in the placebo group. However the need for rescue antiemetics was similar in the two groups. Conclusions: Transcutaneous electrical stimulation of the P6 acupoint significantly reduces the incidence and severity of PONV in female patients undergoing laparoscopic cholecystectomy during the first 24 h after surgery. (Korean J Anesthesiol 2003; 44: 853～859

Background: The primary objective of this study was to determine the effect of fentanyl, esmolol, and lidocaine on arterial blood pressure (BP) and heart rate (HR) following endotracheal intubation (ETI) and during an operation in patients with chronic renal failure (CRF) undergoing an arteriovenous fistula (AVF). Methods: Sixty CRF patients who underwent creation of an AVF were analyzed for this study. Before ETI, the patients were randomly placed in a control group (CONT, n = 15), fentanyl group (FENT, 2/kg, n = 15), esmolol group (ESM, 1 mg/kg, n = 15), or lidocaine group (LID, 1 mg/kg, n = 15) and then each drug was administered before ETI. HR and BP were measured before intubation (baseline), after intubation, immediately after surgical incision (A-Inc), 15 min (A-Inc15) and 30 min (A-Inc30) after surgical incision. Mean arterial pressure was controlled between 20% of the pre-intubation value with the control of inspired fraction of isoflurane, and with ephedrine or clonidine. Results: The HR was not different among groups. The elevation of BP following ETI in FENT was less than in CONT. BP was lower in FENT at A-Inc, A-Inc15, and A-Inc30 than in CONT, ESM, or LID. The administered dose of clonidine was not different among groups, but that of ephedrine was larger in FENT than in CONT. Conclusions: In CRF patients undergoing an AVF, esmolol 1 mg/kg and lidocaine 1 mg/kg could not prevent the elevation of BP and HR following ETI. The elevation BP after ETI was blunted by fentanyl 2/kg, but it decreased BP during the operation and increased the requirement of ephedrine. It is concluded that further studies must be made about the adminstration of a shorter acting opioid and of a larger dose of esmolol and lidocaine for preventing elevation of BR and HR in CRF patients undergoing an AVF.

Background: β-Bungarotoxin irreversibly changes the presynaptic membrane, hexamethonium acts on the presynaptic nicotinic receptor, and verapamil blocks the ion channels on the presynaptic membrane. The effect of these drugs on twitch height and train of four (TOF) ratio were investigated, as well as the reversal effects of neostigmine, pyridostigmine or 4-aminopyridine (4-AP) on the partial neuromuscular blockade induced by these drugs. Methods: Square wave, 0.1 Hz supramaximal stimuli or 2 Hz, 0.2 ms train of four stimuli, was applied to the phrenic nerve-hemidiaphragm preparation of the rat, and the twitch height response was recorded mechanomyographically. The cumulative concentration effects and TOF ratios at each point of twitch depression after β-bungarotoxin, hexamethonium or verapamil were measured. TOF ratios were observed at 75, 50 and 25% of the control twitch height value during observation of the concentration effect. The EC50 and EC95 of β-bungarotoxin, hexamethonium or verapamil were calculated using an inhibitory sigmoid Emax model. The reversal effect of some doses of neostigmine, pyridostigmine or 4-aminopyridine to the partial neuromuscular block produced by EC50 of βbungarotoxin, hexamethonium or verapamil was determined. Results: The EC50 and EC95 of β-bungarotoxin, hexamethonium and verapamil were 0.0695 and 0.1160μg/ml, 1267.0 and 2033.5μg/ml and 29.45 and 37.99μg/ml respectively. TOF fade was marked with hexamethonium or verapamil but small with β-bungarotoxin. Neostigmine or pyridostigmine did not reverse the partial neuromuscular block induced by β-bungarotoxin, hexamethonium or verapamil. However, 4-AP produced a dose-dependent recovery of the twitch response (P < 0.05). Conclusions: β-Bungarotoxin, hexamethonium and verapamil produced different degree of TOF fade, and this may be due to different sites of action of these drugs. 4-AP reversed effectively the partial

Background: Lidocaine, verapamil or a lidocaine-verapamil mixture was effectively applied for blunting extubation during recovery from anesthesia. However, these drugs can enhance neuromuscular blockade and cardiovascular depression. We investigated the neuromuscular and the cardiovascular effect of lidocaine, verapamil or a lidocaine-verapamil mixture before extubation in the recovery from anesthesia. Methods: We studied ninety nine healthy adult patients (ASA class I or II), excluding the patients with cardiovascular diseases and with factors affecting neuromuscular function. Induction of anesthesia was performed with thiopental sodium 5 mg/kg and fentanyl 0.1 mg, and maintained with O2-N2O (50%)-enflurane (2%). Supramaximal single twitch stimuli (0.1 Hz) were applied to the ulnar nerve and the twitch response of the adductor pollicis was recorded by the Gould TA 240 recorder via a 2 kg Load Cell Strain Gauge modification. After stabilization of the twitch response, mivacurium (0.16 mg/kg) or vecuronium (0.1 mg/kg) was administered intravenously and endotracheal intubation was performed. Twitch heights were spontaneously recovered without a reversal agent from the neuromuscular blockade as a spontaneous group. Pyridostigmine 10 mg and glycopyrrolate 0.2 mg were administered intravenously around the time of 10% recovery of baseline twitch height as a reversal recovery group. At the time of 100% recovery of twitch height, train of four (TOF) stimuli was applied and then lidocaine, verapamil or a lidocaine-verapamil mixture was administered intravenously in both groups. Maximum depression of twitch height and the TOF ratio at this point, recovery index (RI) measured, and mean arterial pressure and pulse rates were measured before and at 2, 5, 10, 20 and 30 min. after the lidocaine-verapamil mixture administration. Results: Twitch heights were depressed slightly after lidocaine, verapamil or a lidocaine-verapamil mixture administration; however, there were no significant differences to compare with the control. TOF

Background: α-Bungarotoxin, decamethonium or lidocaine has a neuromuscular blocking effect. The aim of this study was to evaluate the pharmacodynamic properties of these drugs at the neuromuscular junction and the reversal effects of antagonists in vitro. Methods: The effects of evoked twitch tension response have been studied on the isolated phrenic nerve hemidiaphragm preparation of the rat, using a single twitch (0.1 Hz) and the train of four (TOF; 2 Hz for 2 s) stimulation. The cumulative concentration effect and TOF ratio at each point of twitch depression after α-bungarotoxin, decamethonium or lidocaine were measured mechanomyographically. The EC50 and EC95 of α-bungarotoxin, decamethonium or lidocaine were calculated using an inhibitory sigmoid Emax model. The reversal effects of various doses of neostigmine, pyridostigmine or 4-aminopyridine (4-AP) to the partial neuromuscula r block produced by EC50 of α-bungarotoxin, decamethonium or lidocaine were determined. Results: The EC50 and EC95 of α-bungarotoxin, decamethonium or lidocaine were 0.179 and 0.320μg/ml, 17.07 and 26.84μg/ml or 76.80 and 105.70μg/ml. TOF fade was produced by α-bungarotoxin or decamethonium but not by lidocaine. Neostigmine or pyridostigmine did not reverse the partial neuromuscular block induced by α-bungarotoxin, decamethonium or lidocaine. However, 4-AP produced a dose-dependent recovery of the twitch response (P < 0.05). Conclusions: α-Bungarotoxin, decamethonium or lidocaine produced different degree of TOF fade, and it means that this may be due to different site of action of these drugs. 4-AP reversed effectively the partial neuromuscular block induced by α-bungarotoxin, decamethonium or lidocaine, whereas neostigmine or pyridostigmine did not. (Korean J Anesthesiol 2001; 40: 763∼772) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Background : Postoperative nausea and vomiting remain troublesome problems, especially in women receiving the opioid analgesics. This study was performed to assess the antiemetic efficacy of ondansetron in patients using an intravenous patient-controlled analgesia (IV-PCA) after gynecologic surgery. Methods : In this randomized placebo-controlled study, forty healthy gynecologic surgical patients received ondansetron 4 mg or placebo at the end of surgery. Patients in the recovery room received fentanyl by PCA which provided a bolus dose of 20μg, a lockout time of 6 minutes, and a basal infusion of 20μg/hr. We assessed the occurrence of nausea, vomiting, and the need for rescue antiemetics during the first 24 hours after operation. Results : During the first 24 hr after operation, 40% of patients experienced no nausea or vomiting in the ondansetron group compared to 30% of patients in the placebo group. There was no significant difference in the incidence of nausea between groups (70% in placebo group vs 60% in ondansetron group). However, ondansetron reduced the incidence of vomiting from 50% to 15%, and the need for rescue antiemetics significantly from 25% to 0% (P＜ 0.05). Conclusions : Ondansetron in a dose of 4 mg does not prevent postoperative nausea during the first 24 hours after operation when used with fetanyl PCA. However, ondansetron significantly reduces the chance of postoperative vomiting and rescue antiemetics. (Korean J Anesthesiol 1999; 37: 1089∼1094)

Background : The aim of the present study is to evaluate the effect of propofol on the incidence of postoperative nausea and vomiting (PONV) during the first 24 hours after minor orthopedic surgery using general anesthesia. Methods : We studied 66 healthy female patients (aged 20∼67 years old). The patients were randomly divided into the two groups: (i) Group P (n=33): Anesthesia was induced with propofol and fentanyl, and maintained with continuous infusion of propofol. (ii) Group E (n=33): Anesthesia was induced with thiopental and fentanyl, and maintained with enflurane. We compared the incidence and severity of PONV at 6 and 24 hours after the operation between the two groups. Results : The incidence and severity of PONV in Group P was significantly lower than in Group E during the first 6 hours after the operation (p＜0.05). However, after 6 hours, there was no significant differences between the two groups. Conclusion : In the early postoperative period, the use of propofol prevents PONV. (Korean J Anesthesiol 1999; 36: 402∼406)