Sae Yeon Kim

The effect of sub-tenon lidocaine injection on emergence agitation after general anaesthesia in paediatric strabismus surgery

Background and objective Sevoflurane is widely used for paediatric anaesthesia. However, many cases of emergence agitation after sevoflurane anaesthesia have been reported and pain was suggested as a major contributing factor. The purpose of this study was to evaluate the effect of sub-Tenon lidocaine injection on emergence agitation in children receiving sevoflurane or propofol–remifentanil anaesthesia. Methods We enrolled 260 children, aged 4–10 years, who were scheduled for strabismus surgery, and randomized them to one of four groups: group SS, SL, BS, and BL. Anaesthesia was maintained with sevoflurane (SS, SL) or propofol–remifentanil infusion (BS, BL). At the end of surgery, the surgeon injected into the sub-Tenon space 1 ml of isotonic saline (SS, BS) or 2% lidocaine (SL, BL). Emergence behaviour was assessed in the post-anaesthesia care unit using a 5-point scoring scale (score 1, asleep; 2, awake and calm; 3, irritable or consolable crying; 4, inconsolable crying; and 5, severe restlessness). We defined a score of 4 or 5 as emergence agitation. The incidence of emergence agitation was analysed using χ2 and Fishers exact test. Results The incidence of emergence agitation in group SL and BL was significantly lower compared to group SS and BS, respectively (P = 0.011, 0.019). The lidocaine-injected group showed significantly lower occurrence of emergence agitation (10.4%) than isotonic saline-injected group (27.2%; P = 0.001). Emergence agitation was significantly higher following sevoflurane (25.0%) than balanced anaesthesia (13.1%; P = 0.023). Conclusion The frequency of emergence agitation is significantly reduced by sub-Tenon lidocaine injection regardless of the modality of anaesthesia used.

The optimal volume of 0.2% ropivacaine required for an ultrasound-guided stellate ganglion block.

Background This study was performed to find the optimal volume of local anesthetics needed for a successful ultrasound-guided stellate ganglion block (SGB) to treat head and neck pathology. Methods Fifteen female and fourteen male sensory-neural hearing loss patients received 4 times SGBs with 0.2% ropivacaine in volumes of 6, 4, 3 and 2 ml at 1 to 3 day intervals. Using the transverse short-axis view of the neck that showed Chassaignacs tubercle at the C6 level, a 25-gauge, and 4 cm needle was inserted via the lateral paracarotid approach with out-of-plane targeting between the prevertebral fascia and the ventral surface of longus colli muscle (subfascial injection). A successful block was confirmed with the onset of ptosis (Horners syndrome). Results There were no significant statistical differences between the presence of Horners syndrome and the volume of local anesthetics given. However, Horners syndrome was present in all trials for the 4 ml and 6 ml groups. Six (20.7%) and three out (10.4%) of twenty-nine trials in the 2 ml and 3 ml groups, respectively, failed to elicit Horners syndrome. The duration of action was significantly different in the 2 ml group compared to that of the 6 ml group, but there was no significant difference between the other groups, including the 4 ml vs. 6 ml groups. The side effects were not different between the groups. Conclusions This data suggests that the optimal volume of 0.2% ropivacaine for ultrasound-guided SGB to treat the head and neck pathology in daily practice is 4 ml.

The effect of intravenous labetalol administration on hemodynamic responses during desflurane inhalation

Background Inspired concentrations of desflurane ≥ 1 minimum alveolar anesthetic concentration (MAC) have been related to sympathetic stimulation such as hypertension and tachycardia. The current study examined whether labetalol, an α1 and β-adrenergic antagonist would blunt these hemodynamic responses. Methods Fifty-four ASA physical status I patients, aged 20-60 years, were enrolled in this study. The patients were randomly divided into 2 groups. The breathing circuit was primed with an end-tidal desflurane concentration of 1.2 MAC in 6 L/min O2. Normal saline 5 ml or labetalol 0.3 mg/kg was injected into groups S and L respectively. After 5 minutes, anesthesia was induced with intravenous etomidate 0.2 mg/kg and vecuronium 0.1 mg/kg. Each patient inhaled desflurane through a tight fitting facemask. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and end-tidal concentration of desflurane (et-des) were measured at 5 minutes after saline or labetalol injection (baseline) and every 1 minute for 5 minutes after desflurane inhalation and for 2 minutes after intubation. Results In the saline injection group (group S), desflurane inhalation increased heart rate and blood pressure, while labetalol 0.3 mg/kg attenuated the heart rate and blood pressure increase in group L. After tracheal intubation, heart rate and blood pressure were significantly lower in group L than in group S. Conclusions These results demonstrate that administration of intravenous labetalol is effective in attenuating tracheal intubation and desflurane-induced hemodynamic responses.

Anesthetic management of non-cardiac surgery with adult onset type of cor triatriatum sinister: A case report

A 45-year-old woman with cor triatriatum sinister was admitted for laparoscopic resection of an ovarian tumor. Her medical history was benign with the exception of a single episode of syncope one year ago. A 1.5-cm membrane fenestration was found on echocardiography, but there were no other cardiac structural anomalies. General anesthesia was established with etomidate, sevoflurane, and remifentanil; no notable events occurred during the anesthesia. As cor triatriatum shows a clinical picture of mitral stenosis (MS), careful anesthetic management is required.