Ik Soo Chung

Effects of epidural injection on spinal block during combined spinal and epidural anesthesia for cesarean delivery

Background and Objectives Epidural injection has been known to enhance spinal anesthesia in combined spinal and epidural (CSE) anesthesia. Saline and local anesthetics have been reported to have a volume effect, elevating sensory level when supplementing a volume into the epidural space. We evaluated the effects of epidural injection when using the CSE technique for cesarean delivery. Methods Sixty-six parturients were allocated randomly into group C (control, n = 21), S (saline, n = 21), or B (bupivacaine, n = 24): epidural injections of 10 mL saline and 0.25% bupivacaine were given in groups S and B, respectively, 10 minutes after they received 8 mg of 0.5% hyperbaric bupivacaine intrathecally, and no injection was given in group C. The sensory level at 10 minutes, the maximal level and the time to reach it, and degree of motor block and muscle relaxation were compared. We also investigated intraoperative side effects and postoperative findings in the postanesthesia care unit. Results Epidural injection raised the sensory level significantly in groups S and B, but the maximal height of sensory block and degree of muscle relaxation did not differ among the groups. Fewer patients complained of intraoperative pain in group B than in the other groups (P < .001). Conclusions We could not achieve satisfactory surgical analgesia with 8 mg of hyperbaric bupivacaine injected into the subarachnoid space using the needle-through-needle technique in cesarean deliveries. An epidural saline injection elevated the sensory level, which did not improve the spinal block, whereas an epidural injection of 10 mL of 0.25% bupivacaine enhanced the spinal block and sustained the block postoperatively.

Effect of preoperative skull block on pediatric moyamoya disease

OBJECT Stable hemodynamics, normocapnia, and adequate pain relief are considered important factors in the reduction of neurological complications in pediatric patients undergoing encephaloduroarteriomyosynangiosis (EDAMS) operations for the treatment of moyamoya disease. A preoperative skull block may reduce hemodynamic fluctuations and hypo- or hyperventilation due to emergence delirium or oversedation and provide adequate pain relief, thereby reducing postoperative morbidity. METHODS Pediatric patients (age 3-13 years) undergoing EDAMS surgery for moyamoya disease were randomly divided into a nerve block (NB) group (18 cases) or control group (21 cases). The treatment group patients received a preoperative NB (0.25% 5-8 ml bupivacaine mixed with 20-40 mg methylprednisolone) targeting the supraorbital, supratrochlear, auriculotemporal, and posterior auricular nerves. Patients in the control group did not receive NB. General anesthesia with sevoflurane was induced in both groups. RESULTS In the NB group, stable hemodynamic parameters were obtained with a lower sevoflurane concentration than in the control group. For delirious awakening, the odds ratio in the control group was 4.9 compared with the NB group. Pain and analgesic requirement were higher in the control patients than in the NB-treated patients during the postanesthesia care unit stay. However, the arterial CO(2) tension in the postanesthesia care unit did not differ between the 2 groups. The odds ratio in the control group for the rate of morbidity (cerebral infarction and reversible ischemic neurological deficits) during the first 24 hours following the operation was 3.2 compared with the NB group. CONCLUSIONS The use of skull block during EDAMS surgery provided easy hemodynamic control, calm awakening, and better pain relief and may be related to the reduced postoperative morbidity.

The comparison of complications on the endovascular and surgical treatment in elderly cerebral aneurysm patients

BACKGROUND The aim of this study was to compare intraoperative and postoperative complications and clinical outcome of endovascular coiling (EVT) with neurosurgical clipping (NST) under general anesthesia in the cerebral aneurysm patients older than 60 years. METHODS We retrospectively reviewed the charts, operative reports of patients who underwent EVT or NST at our hospital between January 2006 and August 2008. A total of 181 patients (EVT = 78, NST = 103) were included in this study. RESULTS The rate of intraoperative event was higher in EVT than in NST but postoperative complication and Glasgow outcome scale (GOS) at 6 months did not show statically significance in both groups. Preoperative aneurysm rupture, age and the World Federation of Neurological Surgeons grade (WFNS) were the influencing factors for outcome in both groups. Anesthetic agents, body temperature and vasoactive drugs were significantly different between the two groups but the effects of these on the outcome of patients were insignificant. CONCLUSIONS In EVT and NST, the variables related to the postoperative complications were preoperative aneurysm rupture, age and WFNS. When the elderly patients get these procedures, more close care should be considered postoperatively.