Effect of vitamin C on plasma total antioxidant status(TAS) in patients with paraquat intoxication / 대한내과학회지

BACKGROUND: This study was undertaken to evaluate the effect of plasma concentration of vitamin C is on the plasma total antioxidant status(TAS) in patients with paraquat intoxication. METHODS: As a preliminary research for this study, we measured plasma vitamin C levels, uric acid, TAS, and bilirubin from 100 healthy Koreans aged between 25-55 years. Various concentrations of vitamin C were constructed in vitro with normal pooled plasma between 1mg/dl and 100 mg/dL and TAS was measured. Both vitamin C concentrations and TAS were measured from the blood samples, taken at 0.5, 1, 2, 3, 5, 7, 9 hours after a bolus injection of vitamin C(50 mg/kg) from 7 volunteers who had been recruited from medical students at our hospital. Various amounts of vitamin C were given to 10 patients with paraquat intoxication for 5 consecutive days in the morning : first day ; 100 mg single dose, second day; 500 mg single dose, third day ; 1,000 mg single dose, fourth day : 3,000 mg single dose, and fifth day ; 3,000 mg three times every 8 hours. RESULTS: The mean value of TAS and vitamin C measured in 100 healthy Korean adults was 2.22 +/-0.16 mmol/L and 0.48+/-0.10 mg/dL. Age and sex do not influence these levels(p> 0.05, data are not presented). A direct correlation was observed between TAS and vitamin C concentrations of 1 mg/dL and 100 mg/dL both in vivo and vitro. As the vitamin C concentration was increased gradually 5 consecutive days, the TAS values increased in the same way as follows : first day(vitamin C 100 mg) 2.26+/-0.98 mmol/L, second day(vitamin C 500 mg) 2.76+/-0.78 mmol/L, third day(vitamin C 1.000 mg) 2.81+/-0.68 mmol/L, fourth day(vitamin C 3.000 mg) 3.18 mmol/L. On the fifth day when 3.000 mg of vitamin C was given by bolus intravenous injection 3 times(every 8 hours for a day), the TAS values measured one hour after the injection was 3.58+/-0.37 mmol/L. CONCLUSION: When vitamin C is used as a free radical scavenger, the loading dose and maintenance dose should be around 2278 mg intravenous bolus and 146 mg/hour. High doses of vitamin C are effective and safe for patients with acute paraquat intoxication.

The Clinical Assessment of the Efficacy and Safety of the Intubating Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: The intubating laryngeal mask airway (ILMA) was introduced recently as an effective ventilatory device and intubation guide. The following study was designed to assess not only efficacy but also safety of the ILMA. METHODS: Sixty adult patients who were randomly assigned in 3 groups (Group 1, 2, 3), ASA class 1 or 2, undergoing elective surgery were induced with intravenous injection of fentanyl, thiopental sodium, vecuronium, lidocaine and inhalation of O2, N2O, enflurane. In Group 1 (n=20), the patients were intubated with Macintosh curved blade and endotracheal tube. In Group 2 (n=20), blind tracheal intubation using an ILMA was attempted. In Group 3 (n=20), we applicated the ILMA to a fiberoptic bronchoscope-aided tracheal intubation. Then we decided success rates for blind and fiberoptic-guided passage of an endotracheal tube via the ILMA. We measured systolic, diastolic arterial pressure and heart rate before administration of induction agent, 1 and 5 minutes after induction, just after intubation, 1, 2, 3 and 5 minutes after endotracheal intubation. RESULTS: The success rates for blind (Group 2) and fiberoptic-guided (Group 3) passage of an endotracheal tube via the ILMA were 70% and 100% respectively. There were no statistically significance in the systolic, diastolic arterial pressure and heart rate when compared to value of any other groups at any time but higher in all groups when compared to preinduction value of each group just after intubation. CONCLUSIONS: Though the ILMA may be an effective intubation guide, it doesn't blunt hemodynamic changes effectively than standard laryngoscopic intubation.

Comparison of Midazolam-Ketamine with Midazolam for Sedation during Retrobulbar Block in Cataract Surgery / 대한마취과학회지

BACKGROUND: Many ophthalmic procedures can be performed using a retrobulbar regional anesthetic technique. However, retrobulbar block is painful and most of patients express anxiety about the procedure. In addition, several life-threatening complications may occur. We compared the effects of midazolam and midazolam-ketamine as a sedative during retrobulbar block in cataract surgery. METHODS: Thirty patients undergoing cataract surgery were randomly allocated into two groups, group I (n=15) was received midazolam and group II (n=15), midazolam-ketamine. Mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) were compared before administration of drugs and 1, 2, 3, 4, 5, 10, 20, and 30 min after administration of drugs. Patients' movement requiring restraint were also checked. In the recovery room, postoperative nausea and vomiting, recall, delirium and/or hallucinations, and ocular complications were recorded. RESULTS: There were no significant differences in MAP and SpO2 between groups but heart rates were significantly increased at 1, 2, 3, 4, and 5 min than baseline in group II. Movement score was significantly lower in Group II than in Group I during the block (p<0.05). Recall during performance of the nerve block occured more often in Group I than in Group II (p<0.05). CONCLUSION: Low-dose midazolam-ketamine sedation sequence was superior to a midazolam technique regarding patients' movement and recall.

Caudal Epidural Morphine for Postoperative Analgesia in Children / 대한마취과학회지

BACKGROUND: The use of caudal morphine for postoperative analgesia has been increased in popularity since 1981. The purpose of this study was to compare the effect of analgesia and incidence of side effects of a mepivacaine-morphine mixture with mepivacaine alone. METHODS: Forty patients were randomly divided into two groups. In group 1, caudal block was performed with 1% mepivacaine 1 ml/kg alone. In group 2, caudal block was performed with 1% mepivacaine 1ml/kg-morphine 0.03 mg/kg mixture. Postoperative five-point pain scores and side effects were measured. RESULTS: There were no significant differences in sedation dose, incidence of side effects and supplemental analgesics. Pain scores were significantly lower at postoperative 2 and 3 hours in mepivacaine-morphine mixture group. CONCLUSIONS: Caudal epidural mepivacaine-morphine (0.03 mg/kg) mixture is effective in children for control of postoperative pain without significant side effects.

The Relationships between Administration Time of Pyridostigmine and the Recovery of Vecuronium-induced Neuromuscular Blockade / 대한마취과학회지

BACKGROUND: The timing of administration may be an important factor in order to obtain maximal antagonizing effect of anticholinesterase on neuromuscular blockade. The objective of this study is to seek for the optimal administration time of pyridostigmine for reducing the recovery time of vecuronium. METHODS:Thirty patients were devided into three groups,who were receiving intravenously pyridostigmine (0.2 mg/kg) at 10% (group 1), 20% (group 2) and 25% (group 3) recovery of T1. The recovery indices (RI: time taken for T1 to recover from 25 to 75% of control) and recovery time (time taken for T1 to recover from 5% to 20, 25, 50 & 75%) in vecuronium (0.1 mg/kg) neuromuscular blockade were checked and compared between 3 groups using train of four stimulation with Relaxograph(Datex co., Finland). RESULTS: The recovery time (T5-20, T5-25, T5-50, T5-75) was significantly faster in the group 1 than the group 3. But there were no significant differences in recovery indices (RI) between 3 groups. CONCLUSIONS: Provided there is a slightest evidence of spontaneous recovery, early administration of anticholinesterse will reduce the recovery time of nondepolarizing neuromuscular block. But it can not affect the dissociation rate of vecuronium (KD) and there were no significant differences in recovery indices.

Heart Failure and Pulmonary Edema in Patient with Graves` Disease during Cesarian Section / 대한마취과학회지

We report a case of heart failure and pulmonary edema in patient with Graves disease during recovery from general anesthesia for cesarean section. A 34-year-old multigrivida, at 35 weeks gestation underwent emergency cesarian section for preterm labor, twin pregnancy and polyhydramnios. She has been treated with Graves' disease for 5 years. After premedication with propranolol and glycopyrrolate, anesthesia was induced with thiopenthal and maintained with O2 -N2 O-enflurane. At the end of skin closure, heart failure and pulmonary edema were developed. On auscultation, systolic murmur was audible at the left sternal border and immediate echocardiography revealed mitral valve prolapse accompanied with mitral regurgitation. After proper treatment, she was discharged without complication at 14 days after surgery.

Heart Failure and Pulmonary Edema in Patient with Graves` Disease during Cesarian Section / 대한마취과학회지

We report a case of heart failure and pulmonary edema in patient with Graves disease during recovery from general anesthesia for cesarean section. A 34-year-old multigrivida, at 35 weeks gestation underwent emergency cesarian section for preterm labor, twin pregnancy and polyhydramnios. She has been treated with Graves' disease for 5 years. After premedication with propranolol and glycopyrrolate, anesthesia was induced with thiopenthal and maintained with O2 -N2 O-enflurane. At the end of skin closure, heart failure and pulmonary edema were developed. On auscultation, systolic murmur was audible at the left sternal border and immediate echocardiography revealed mitral valve prolapse accompanied with mitral regurgitation. After proper treatment, she was discharged without complication at 14 days after surgery.

Comparison of Train - of - four Fade during Spontaneous Recovery of Various Nondepolarizing Neuromuscular Blockades / 대한마취과학회지

Train-of-four (TOF) fade is a characteristic of the nondepolarizing neuromuscular blocking agents, but the degree of TOF fade has been shown to vary for different nondeplarizing relaxants. In the present study we measured the degree of fade of four nondepolarizing muscle relaxantsatracurium, vecuronium, pancuronium, and d-tubocurarine-during spontaneous recovery of neuromuscular blockade. Forty ASA class 1 or 2 adult patients were studied. All patients were premedicated with glycopyrrolate 0.2 mg and nalbuphine 10 mg IM, 1 hour before induction. After induction with pentothal sodium 5-6 mg/kg IV, neuromuscular monitoring was carried out by stimulaton of the ulnar nerve at the wrist with supramaximal stimuli at a frequency of 2 Hz repeated every 20 seconds using an ABM (Anesthesia and Brain activity Monitor, Datex Co.). The electromyographic response of hypothenar muscles was recorded. Following stabilization of control twitch height, the nondepolarizing relaxant was injected as a bolus dose, and tracheal intubation was performed when the first twich height of the train (T(1)) was 5% of the control. Anesthesia was maintained with O2-N2O (50%) -enflurane. Patients were divided into four groups according to use of relaxant: atracurium 0.4 mg/kg (n=10: group A), vecuronium 0.08 mg/kg (n=10; group V), pancuronium 0.08 mg/kg (n=10; group T), and d-tubocurarine 0.4 mg/kg (n= 10: group T). T(4) ratios at T(1) of 25, 50 and 75% recovery of T(1) and recovery index in each group were measured. The results were as follows: 1) The T(4) ratio was decreased significantly in P and T groups, as compared to A and V group. There were no significant differences between P and T groups, and between A and V groups (except 25% recovery of T(1)). 2) The recovery index was 14.8+/-2.36 min in A group, 16.4+/-1.85 min in V group, 51.2+/-4.17 min in P group, and 93.4+/-7.31 min in T group.

Plasma Cholinesterase Activity and Reaction of Succinylcholine in Late Pregnancy / 대한마취과학회지

Plasma cholinesterase (ChE), an enzyme produced by the liver, rapidly hydrolizes succinylcholine. In the presence of low enzymatic activity, the rate of destruction of succinylcholine is diminished and it may result in an undesirably long duration of paralysis following succinylcholine administration. There are many reports that a significant fall in plasma ChE activity was shown to occur during pregnancy and in the immediate postpartum period. The present study was designed to compare the plasma ChE activity and the reaction of succinylcholine in 27 healthy nonpregnant women with that in 30 pregnant women undergoing elective caesarean section. Before induction of anesthesia, venous blood was taken for the measurement of plasma ChE activity, which was assayed by a colorimetric method, and the duration of action, recovery index and TOF ratio of succinylcholine were measured using ABM (Anesthesia and Brain activity Monitor, Datex Co.). The results were as follows: 1. Plasma ChE aetivity in pregnant women was lower than in nonpregnant women but was not statistically significant. 2. With respect to the duration of action, recovery index and TOF ratio on the 25 and 75% recovery of first twitch height, there were no significant differences between pregnant and nonpregant women.