Moon Seok Chang

Lidocaine does not prevent bispectral index increases in response to endotracheal intubation

We investigated the effect of IV lidocaine on the hemodynamic and bispectral index responses to induction of general anesthesia and endotracheal intubation. Forty patients (ASA I) were randomly allocated into 2 groups of 20 to receive normal saline or lidocaine 1.5 mg/kg IV 30 s after induction. Ninety seconds later, endotracheal intubation was performed. Systolic blood pressure, heart rate, and bispectral index were measured at baseline, 1 min after induction, at preintubation, and every minute until 5 min after endotracheal intubation. Bispectral index at 1 min after induction and preintubation in the lidocaine group were significantly lower compared with the control group (P < 0.05). Systolic blood pressure increased significantly at 1 and 2 min after intubation in the control group compared with the baseline value (P < 0.05) but did not increase significantly in the lidocaine group. Heart rate increased at 1 to 3 min in both groups (P < 0.05), but there was no significant difference between the two groups. One patient in the control group had recall of the procedure. We conclude that the administration of IV lidocaine (1.5 mg/kg) does not suppress the hypnotic response to endotracheal intubation.

Effect of Nicardipine on Haemodynamic and Bispectral Index Changes following Endotracheal Intubation

We investigated the effect of IV nicardipine on haemodynamic and bispectral index responses to the induction of general anaesthesia and intubation. Forty patients were randomly allocated to two groups of 20 to receive normal saline or nicardipine 15 μg/kg IV 30 s after induction. Ninety seconds later, tracheal intubation was performed. Systolic blood pressure, heart rate and bispectral index were measured at baseline, 1 min after induction, pre-intubation, and every minute until 5 min after endotracheal intubation. Rate–pressure product values were calculated. In the nicardipine group, systolic blood pressure decreased compared with the control group, and heart rate increased compared with the control group. Bispectral index and rate–pressure product showed no differences between the two groups. In conclusion, the administration of 15 μg/kg nicardipine IV does not affect anaesthetic depth in response to the induction of general anaesthesia and intubation.

The Effects of Midazolam on the Bispectral Index after Fetal Expulsion in Caesarean Section under General Anaesthesia with Sevoflurane

The effects of midazolam used with low concentration inhaled anaesthetics on the bispectral index (BIS) was investigated after fetal expulsion during caesarean section. Forty-five patients undergoing caesarean section received either normal saline (control, n = 15), or an intravenous bolus of 0.03 mg/kg (n = 15) or 0.05 mg/kg (n = 15) midazolam. Changes in BIS and maternal haemodynamics were monitored before induction, on intubation, at uterine incision, on delivery, at 3, 5 and 10 min after fetal expulsion, at subcutaneous tissue closure, at skin closure, on eye opening and at extubation. BIS values in the group that received 0.05 mg/kg midazolam were significantly lower than in the other two groups at 3, 5 and 10 min after fetal expulsion, and at subcutaneous tissue closure and skin closure. Values of BIS < 60 could only be maintained with 0.05 mg/kg midazolam and there was no delay in maternal emergence or recovery.

Anesthetic management for a pediatric patient with joubert syndrome − A case report −

Joubert syndrome is a rare autosomal recessive condition in which there is complete or partial agenesis of the cerebellar vermis. The clinical features are hypotonia, ataxia, mental retardation, abnormal ocular movements, typical facial features and episodic tachypnea with alternating apnea. The abnormal respiratory pattern and hypotonia may be exacerbated by anesthetics, and especially, the apneic episodes may be prolonged by administering opioids. Joubert syndrome has been associated with various airway abnormalities such as a high and arched palate, a large or protruding tongue, laryngomalacia, a variable epiglottis and micrognathia. These abnormalities may cause difficulty with tracheal intubation. In this present case, direct laryngoscope-assisted, fiberscopic guided intubation was performed. This case is the first report of anesthetic management in a patient with Joubert syndrome and who underwent palatoplasty in Korea.