Young Jhoon Chin

Intrathecal fentanyl added to hyperbaric ropivacaine for cesarean delivery

Background and Objectives Hyperbaric ropivacaine produces adequate spinal anesthesia for cesarean delivery. Addition of opioid to local anesthetics improves spinal anesthesia. We assessed the effect of fentanyl added to hyperbaric ropivacaine for spinal anesthesia for cesarean delivery. Methods Fifty-nine healthy, full-term parturients scheduled for elective cesarean delivery under spinal anesthesia were randomly assigned in a double-blind fashion to receive either fentanyl 10 μg or normal saline 0.2 mL added to 0.5% hyperbaric ropivacaine 18 mg. Characteristics of spinal block, intraoperative quality of spinal anesthesia, side effects, complete analgesia (time to first feeling of pain), and effective analgesia (time to first request of analgesics) were assessed. Results Duration of sensory block was prolonged in the fentanyl group (P < .05). Duration of motor block was similar in both groups. The quality of intraoperative analgesia was better in the fentanyl group (P < .05). Incidence of side effects did not differ between groups. Duration of complete analgesia (143.2 ± 34.2 minutes v 101.4 ± 21.4 minutes; P < .001) and effective analgesia (207.2 ± 32.2 minutes v 136.3 ± 14.1 minutes; P < .001) were prolonged in the fentanyl group. Conclusions Adding fentanyl 10 μg to hyperbaric ropivacaine 18 mg for spinal anesthesia for cesarean delivery improves intraoperative anesthesia and increases the analgesia in the early postoperative period.

Effect of Acute Normovolemic Hemodilution on Homologous Blood Saving during Off-Pump CABG

Background: Acute normovolemic hemodilution (ANH) is accepted to be the easiest and most economical method of autotransfusion. This study was performed to investigate the clinical usefulness of ANH in patients undergoing off-pump CABG. Methods: Thirty patients were randomly divided into two groups. In the ANH group, 753.3 51.6 ml of fresh autologous whole blood were sequestrated from a pulmonary artery catheter following induction of anesthesia with simultaneous infusion of colloids and crystalloid solution from a separate line. Perioperative changes of hemoglobin, hematocrit level, platelet counts, prothrombin time, cardiac output, transfusion requirement and the amount of postoperative drainage were compared between the two groups. Results: Perioperative changes of platelet counts and PT showed no significant differences between the two groups. Less allogenic blood was used in the ANH group (0.27 0.46 unit) than in the control group (1.27 0.80 unit) in the operation room. Conclusions: ANH can decrease the transfusion requirement in off-pump CABG.