The Effect of Labetalol on the Hemodynamic Response to Endotracheal Intubation / 대한마취과학회지

Transient increases in blood pressure and heart rate following laryngoscopy and endotra- cheal intubation are common. These stress responses are greatly exaggerated in patients with hypertension and cardiovascular diseases and can lead to cardiac arrhythmia, pulmo- nary edema, and cerebral hemorrhsge. Many approaches have been tried to attenuate these potentially adverse circulatory responses but none has been satisfactory. This study was made to evaluate the hemodynamic responses to tracheal intubation using combined alpha-and beta-adrenoreceptor blocking agent, labetalol. We intravenously administered labetalol or placebo prior to laryngoscopy and tracheal intubation in adult patients with ASA class 1, or 2. Sixty patients were randomly assigned to one of three treatment groups. Group 1 patients (control group,n=20) received normal saline 3ml, Group 2 patients (n=20) received labetalol 0.3mg/kg, and Group 3 patients (n= 20) received labetalol 0.6mg/kg intravenously. These drugs were injected 3 minutes before induction with thiopental sodium (5mg/kg). Succinylcholine chloride 1.0mg/kg i.v. was used to facilitate endotracheal intubation. After the completion of intubation, nitrous oxide/oxygen with enflurane or isoflurane was administered. The blood pressure and heart rate were measured upon arrival in the operating room (baseline), immediately before intubation, immediately after intubation, 1 minutes after intubation and at 2, 3, 5, 7, 10 minutes after intubation. There were no significant differences in preinduction values of blood pressure and heart rate. A significant reduction in heart rate was observed in the group 3, group 2 in that order compared with the group 1. Similarly, systolic, diastolic and mean arterial pressure de- creased in labetalol groups, but was not significantly different in all groups. None of the patients experienced any untoward side effects, such as hypotension, aignificant bradycardia, bronchospasm or electrocardiographic ehanges. In conclusion, in patients with no history of hypertension or significant cardiac disease, labetalol 0.3 or 0.6mg/kg i.v. is better suited to blunting tachycardia than to blunting hypertension to laryngoscopy and intubation.

Study about Hypothermic - anesthesia during Intraperitoneal Hyperthermo - chemotherapeutic Perfusion Combined with Surgery in Far - advanced Stomach Cancer / 대한마취과학회지

Intraperitoneal hyperthermic perfusion(IPHP) is gaining popularity in the world as a method of prevention and treatment of peritoneal metastasis following gatrointestinal cancer. The procedure presents significant problems to the anesthegiologist with regard to tempera- ture control, fluid and electrolyte balance, acid-base change and postoperative care. During IPHP, there is a potential for heat gain from the peritoneal cavity. Several workers have reported a significant increase in core temperature. Therefore, it is true that accurate monitoring of temperature is essential. We studied that acid-base balance, electrolyte balance, level of blood suger following core temperature change in Intraperitoneal Hyperthermo-chemotherapeutic Perfusion patients.

Changes in End Tidal CO2 before and After Release of Tourniquet / 대한마취과학회지

In 24 healthy adult patients having orthopedic surgical procedures requiring the use of a tourniquet under general anesthesia with controlled mechanieal ventilation, we have deter- mined ehanges in end tidal CO2(PetCO2) and arterial blood gas values before and after release of tourniquet. After deflation of tourniguet, PETCO and PaCO2 increased significantly with the maximal elevation occuring within two minutes. The pH level decreased significantly and maximally within three minutes. There was statistically significant linear correlation between PCO and PaCO2 Sugesting prediction of the PaCO2, level by monitoring the PetCO2 level. On these findings, hyperventilation may be indicated to facilitate the return of PaCO2 and pH to baseline just before and for several minutes after tourniquet release, especially in patients with increased intracranial pressure. In conclusion, we recommend noninvasive monitoring of the PetCO2 level instead of invasive measure-ment of the PaCO2 level.