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Background: Remifentanil appears to have a pharmacologic profile similar to other potent mu agonists, but with exceptionally short lasting pharmacokinetics. It is likely to make it a very useful opioid for clinical practice. The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. The purpose of this study is to compare sedative and cardiovascular effects of remifentanil and fentanyl during target controlled infusion (TCI) of propofol by monitoring BIS and hemodynamics. Methods:Fifty-two patients undergoing total abdominal hysterectomy were randomly assigned to remifentanil group and fentanyl group with 26 cases in each group. Anesthesia was induced with propofol (4μg/ml) and either remifentanil (0.5μg/kg) or fentanyl (1.5μg/kg) and was maintained with inhalation of 50% nitrous oxide and 50% oxygen mixture and a continuous infusion of either remifentanil (0.2μg/kg/min) or fentanyl (0.03μg/kg/min). Depth of anesthesia, hemodynamic changes and adverse reactions were observed.Results: The number of patients exhibited light depth of anesthesia during tracheal intubation and maintenance in the remifentanil group was significantly lesser than that in the fentanyl group (P ＜ 0.05). During intubation, skin incision, maintenance of anesthesia and extubation, remifentanil group shows lesser fluctuation of hemodynamic value than those in the fentanyl group (P ＜ 0.05). BIS was significantly decreased both groups during infusion of propofol, but no difference was found between the two groups. There was no significant difference between the two groups in the aspect of adverse reactions.Conclusions: Remifentanil with propofol TCI based anesthetic can prevent the fluctuation of heart rate and mean arterial pressure during the operation especially, during intubation.

The pain associated with acute herpes zoster is neuropathic. In this case report, we describe acute herpes zoster patients with severe pain, allodynia, and hyperesthesia over the T1 to T8 dermatomes. Patients received continuous epidural administration of ketamine at a dose of 20 mg with 0.125% bupivacaine at a dose of 110 ml for 2 days. Their acute herpes zoster pain was controlled without any sign of side effects. This case report, epidural blocks with ketamine, an antagonist of the N-methyl-D-aspartic acid receptor and bupivacaine effectively in treated acute herpes zoster pain, when applied soon after the onset of the acute phase of the disease. (Korean J Anesthesiol 2003; 45: 664∼667) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

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