Massive Diffuse Alveolar Hemorrhage Caused by the Aspiration of Gastric Contents during Induction of Anesthesia in Patients with Adhesive Ileus: A Case Report / 대한구급학회지

Aspiration pneumonitis is best defined as an acute lung injury, following the aspiration of regurgitated gastric contents. Major cause of pulmonary aspiration, during anesthesia, is gastric contents. Pulmonary aspiration can present symptoms of wheezing, coughing, dyspnea, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute respiratory distress syndrome (ARDS). However, there was no report of massive alveolar hemorrhage associated with aspiration pneumonitis. A 63-year-old man, who had undergone a total gastrectomy and received adjuvant chemotherapy, four months ago, was scheduled for adhesiolysis of the small bowel. The patient occurred aspiration of gastric contents, during induction of anesthesia, and subsequently, hypoxia developed during surgery. The patient moved to an intensive care unit (ICU), without extubation. Mechanical ventilation with PEEP was performed in an ICU. However, the patient died by ARDS and massive alveolar hemorrhage.

The Effects of Remifentanil, Lidocaine, Nicardipine and Nitroglycerin on Hemodynamic Changes during Tracheal Intubation / 대한마취과학회지

BACKGROUND: This study was conducted to compare the effects of remifentanil, lidocaine, nicardipine and nitroglycerin used in conjunction with thiopental-sevoflurane on hemodynamic changes induced by direct laryngoscopy and tracheal intubation. METHODS: Seventy-five ASA class I or II patients scheduled for elective surgery were randomly divided into 5 groups. After induction of anesthesia with thiopental, sevoflurane and rocuronium, they were administered an intravenous bolus of either saline (Group S), remifentanil 1microgram/kg (Group R), lidocaine 1.5 mg/kg (Group L), nicardipine 20microgram/kg (Group N) or nitroglycerin 2microgram/kg (Group G). Tracheal intubation was then conducted 90 seconds after the drug was administered. The systolic blood pressure, diastolic blood pressure and heart rate were measured prior to the administration of anesthesia, before intubation, at 1 min after intubation and at 3 min after intubation for each patient. RESULTS: The systolic blood pressure, diastolic blood pressure and heart rate at 1 min after intubation were significantly lower in Group R than in Group S. In addition, the systolic blood pressure and diastolic blood pressure prior to intubation were significantly lower in Group N than in Group S. CONCLUSIONS: Remifentanil 1microgram/kg was most effective at controlling hemodynamic changes induced by direct laryngoscopy and tracheal intubation when compared with lidocaine, nicardipine and nitroglycerin.

The Effectiveness of Labetalol for Treating Esmolol-resistant Tachycardia in a Patient Who was Under General Anesthesia : A case report

Esmolol is a cardioselective beta-blocker with a very rapid onset of action and a short half-life. Labetalol is a combined alpha- and beta-adrenoceptor blocking agent. It is a nonselective antagonist at beta-adrenoceptors and a competitive antagonist of postsynaptic alpha 1-adrenoceptors. A 51 year old female patient was transferred to the operating room for performing spinal fusion under general anesthesia. She had no operation and medication history. The initial heart rate was 150 beats/min. Despite administering several bolus injections of esmolol, the heart rate was not decreased to under 130 beats/min. But the heart rate was decreased to 100 beats/min after the administration of labetalol 5 mg and this rate was maintained without an additional injection. The vital signs were stable until the operation was finished and the patient recovered uneventfully in the recovery room. The postoperative laboratory findings revealed that she had hyperthyroidism. We report here on an anesthetic experience of effective labetalol treatment for esmolol-resistant tachycardia in a patient who was under general anesthesia.

The Effect of Acute Hemodilution on Carotid Blood Flow, Arterial Blood Gas Analysis and Acid-Base Balance in Rabbits / 대한마취과학회지

BACKGROUND: Hemodilution is known to increase cerebral blood flow, but it is not known why it is. We tried to investigate about these question like above. METHODS: Blood flow were checked on carotid artery after hemodilution by using electromagnetic blood flow-meter in 10 rabbits. Hemodilution was induced as 15 ml of lactated Ringers solution (LR) was infused after removing 5 ml of blood. Hemodilution was done 5 times in each rabbit. At 15 minutes after each hemodilution procedure, blood flow was checked and arterial blood gas analysis, and they compared with control data. The Sigma STAT and one way repeated measured ANOVA in Bonfferoni correction and regression analysis with DBSTAT PC application were used for statical analysis. RESULTS: Hemoglobin concentration and hematocrit in blood according to each hemodilution step decreased. At the same time, carotid blood flow increased following hemodilution. Though PaO2 level was not changed, CaO2 and pH, bicarbonate, and base excess in accordance with hemodilution were decreased. Also carotid blood flow calculated as increase 2.5 ml/min whenever hematocrit decreased 1%. CONCLUSIONS: We concluded as follow. Carotid blood flow increased to 2.5 ml/min (4.7%) whenever hematocrit decreased 1% by hemodilution. Whenever 15 ml of L/R solution was infused for acute hemodilution, carotid blood flow increased, on the contrary, hematocrit and arterial oxygen content decreased. Metabolic acidosis was induced by the large amount of L/R solution and it may be affected to carotid blood flows.

Pulmonary Embolism Detected in the General Ward after Operation: A Case Report / 대한구급학회지

Pulmonary embolism is a common medical complication following major orthopedic procedures of the lower extremities and a leading cause of morbidity and mortality. However, the clinical manifestations of pulmonary embolism are nonspecific and it may be difficult to diagnose. An 82 years old female with severe restrictive pulmonary disease received the elective operation for the fracture of left femur neck under combined spinal-epidural anesthesia. During the operation, we sometimes gave her oxygen via face mask and maintained oxygen saturation of more than 80% which was measured by a pulse oxymeter. The operation and anesthesia was performed uneventfully. On the seventh postoperative day, she showed tachycardia suddenly and cardiac arrest later on the electrocardiogram. After cardiopulmonary resuscitation, she was transferred to intensive care unit and checked by a computed tomography and echocardiography. She was diagnosed with pulmonary embolism and deep vein thrombosis and treated with heparin and urokinase. But she did not improve and died.

Effects of Lactated Ringer's Solution on Acid-Base and Serum Electrolyte Levels during Liver Surgery in Cirrhosis Patients / 대한마취과학회지

BACKGROUND: Changes in acid-base balance and serum electrolytes by infusion of lactated Ringer's solution in liver cirrhosis patienst during liver surgery are poorly characterized. In this study, we evaluated the effects of infusing large amount of lactated Ringer's solution on acid-base and serum electrolytes during liver surgery in cirrhosis patients. METHODS: Thirty-two patients were divided into two groups. Group I (n = 21) was made up of patients who had received liver lobectomy without cirrhrosis. Group II (n = 11) was made up of patients who had received liver lobectomy with cirrhosis above a moderate level. Arterial blood gas and serum electrolyte levels were checked 4 times during the study in each patient: just after the operation start, after infusing 3,000 ml and 6,000 ml of lactated Ringer's solution during operation, and 30 minutes after arrival at the postanesthesia care unit. RESULTS: pH and base excess decreased according to the amount of lactated Ringer's solution used in both groups and these results were significant. Serum electrolyte levels were not changed and only Ca2+ levels were significantly different in the two groups. The cause of changing of Ca2+ levels found out by intravenous infusion of Ca2+ solution. CONCLUSIONS: In liver surgery patients with or without liver cirrhosis decreased pH and base excess in serum by increased amount of used lactated Ringers solution during liver surgery but in serum electrolytes and others acid-base parameters, CVP, changes on there were not any statistical significant. When a large amount of LR solution is used in liver surgery, we recommend regular arterial blood gas analyses for acid-base balance and an infusing speed of 20 ml/kg/h.

Effectiveness and Side Effects of Postoperative Pain Control Methods in Stomach and Colorectal Cancer Patients

PURPOSE: The goal of postoperative pain management is to provide safe, continuous, effective analgesia, free from unwanted side effects. In doing so, it is hoped that postoperative morbidity is reduced, facilitating recovery, and hasten discharge from hospital. However, the effects of patient-controlled analgesia (PCA) and complications after a major gastrointestinal operation are currently unclear. METHODS: Fifty four and 31 patients who had undergone an elective gastrectomy due to stomach cancer and elective colorectal surgery due to colorectal cancer, respectively, between August 2002 and April 2003 at the Hanyang University Hospital, were allocated to one of two groups; One received patient-controlled analgesia (PCA group), the other received preoperative fentanyl patch appliment (Patch group). The kind and amount of additional analgesics demanded, pain scale, clinical course, and side effects were analyzed. RESULT: After the stomach cancer surgery, the average postoperative pain scores (numeric scale+pain face scale) in the PCA and patch groups were 9.44 and 10.76, respectively (P=0.0325). After the colorectal cancer surgery, the average postoperative pain scores in the PCA and patch groups were 6.44 and 9.22, respectively (P=0.0072). The amount of additional analgesic agent required after gastrointestinal surgery was variable and unpredictable, but IV PCA resolved this problems and markedly reduced the need for additional analgesic agents. The clinical courses of the PCA and patch groups did not differ in terms of gas passing and resumption of diet. The complication rates of the two groups were similar. CONCLUSION: IV PCA after gastrointestinal surgery for stomach and colon cancers is better for the management of postoperative pain than other pain control methods, with similar complication rates.

Effects on Renal Functions of Low Dose Dopamine in Partial Hepatectomy Patients / 대한마취과학회지

BACKGROUND: Low dose dopamine is widely used during the perioperative period to preserve renal perfusion. Low dose dopamine (3-5 microgram/kg/min) was administrated to partial hepatectomy patients and BUN, creatinine in serum were measured to determine the effects of low dose dopamine on renal function. METHODS: Liver group (n = 28) were administered low dose dopamine (3-5 microgram/kg/min) and the stomach group (n = 23) were not administered any vasoactive drugs during the operation. Perioperative plasma BUN, and creatinine, creatinine clearance, BUN/creatinine ratio, serum Na+ and K+, and central venous pressure (CVP) were checked 3 times, just after starting operation, 4 hours after starting the operation, and at PACU for both groups. We also evaluated intravascular volume status using the CVP and the BUN/creatinine ratio. Changes in BUN, and creatinine level during the operation in both group were compared. All the patients in this study were confirmed as having euvolemia by CVP and BUN/creatinine ratio. RESULTS: Urine volume increased significantly in the liver group with low dose dopamine compared to the stomach group (P < 0.05). The BUN level in the liver group increased significantly versus the stomach group (P < 0.05). In both groups, the creatinine level increased significantly (P < 0.05) and the plasma Na+ level decreased significantly (P < 0.05). CONCLUSIONS: We confirmed that low dose dopamine significantly increases urine volume in euvolemia status cases during liver surgery. But we were unable to determine why increased diuresis by the administration of low dose dopamine during operation and has a renal protective effect.

The Effects of Peripheral mu and kappa Opioid Receptor Agonists on the Thermal Injury Induced Hyperalgesia in the Rat / 대한마취과학회지

BACKGROUND: Previous reports have described that the local administration of opioid receptor agonist can attenuate the nociceptive responses induced by a variety of inflammatory states. This study evaluated the effects of mu or kappa opioid receptor agonists peripherally administered at a site of injury on the state of thermal hyperalgesia induced by mild burn injury. METHODS: Thermal injury was induced after briefly anesthetizing with halothane, by applying the left hindpaw to a hot plate (52.5 degree C) for 45 seconds. Paw withdrawal latency of the hindpaw was determined using an underglass thermal stimulus, which allowed the response latency of the injured paw to be obtained. In this work, the mu receptor agonist, morphine (10, 30, 100 microgram), or the kappa receptor agonist, U50,488H (10, 30, 100 microgram), was administered respectively at the injured site on the right hindpaw in rats. To compare the systemic effects of the drug, the same drug was administered at the normal left hindpaw site with mild burn injury. Naloxone (40 microgram/kg) was administered at the injured site or at the normal site to determine the reversibility of the opioid used. RESULTS: Mild burn injury produced thermal hyperalgesia manifested as reduced paw withdrawal latency. Administration of either morphine (10, 30, 100 microgram) or U50,488H (10, 30, 100 microgram) at the injured site attenuated hyperalgesia in a dose-dependent manner. But the administration of drugs at the normal site had no effect on hyperalgesia at the injured site. In addition, naloxone had the effect of morphine and U50,488H reversed significantly. CONCLUSIONS: These results suggest that peripheral mu or kappa opioid receptor administration at an injured site may play an important role in the hyperalgesia induced by mild burn injury.

Neuromuscular Blockade of Mivacurium Following the Duration of Isepamicin Intramuscular Injection in Rabbits / 대한마취과학회지

BACKGROUND: Isepamicin, a new aminoglycoside antibiotic, was usually administered to patients for prophylactic use. Mivacurium has a short duration of action. The current study was undertaken to evaluate the neuromuscular blockade of mivacurium following the duration of an intramuscular injection of isepamicin 20 mg/kg/d in rabbits. METHODS: In the first study, the dose-response relations of mivacurium were studied in forty rabbits during thiopental anesthesia. Rabbits were randomly assigned to four groups; group 1: normal saline 2 ml/d IM for 7 days; group 2: isepamicin 20 mg/kg/d IM for 1 day; group 3: isepamicin 20 mg/kg/d IM for 3 days; group 4: isepamicin 20 mg/kg/d IM for 7 days. They received mivacurium 10, 20 and 30ng/kg in groups 1, 2 and 3; mivacurium 20, 30 and 40ng/kg in group 4, respectively. In the second study, time courses of action of mivacurium 0.18 mg/kg in forty rabbits were evaluated in each group. RESULTS: The calculated ED50 for mivacurium in groups 1, 2, 3 and 4 were 19.2 +/- 3.1ng/kg, 15.4 +/- 3.7ng/kg, 20.1 +/- 3.5ng/kg and 31.2 +/- 4.4ng/kg, respectively and corresponding ED95 was 29.9 +/- 3.7ng/kg, 22.1 +/- 4.5ng/kg, 30.1 +/- 5.9ng/kg and 43.4 +/- 5.1ng/kg, respectively. There were significant differences between group 4 and the others (P < 0.05). In the second study, the times after mivacurium 0.18 mg/kg until 95% twitch recovery in groups 1, 2, 3 and 4 were 35.1 +/- 5.1 min, 42.2 +/- 6.2 min, 32.8 +/- 4.9 min and 24.9 +/- 3.6 min, respectively. There were significant differences between group 2 and others, and between group 4 and group 1 or 3, respectively (P < 0.05). CONCLUSIONS: Mivacurium when used as a bolus isepamicin therapy, has both an increased potency and a longer duration of action, but when used during concurrent isepamicin therapy, has both a decreased potency and a shorter duration of action.

Changes in Hemodynamics and Local Myocardial Perfusion in the Acute Phase of Coronary Reperfusion by Using Nicardipine in Korean Mongrel Dogs / 대한마취과학회지

BACKGROUND: The measurement of perfusion is very important to understanding the physiology in the ischemic and reperfused tissue. However, no studies have been reported using a beating heart with a real time-continuous perfusion measurement system (QFlow(TM)400) to check local tissue perfusion so far. In this study, the changes in hemodynamics and local myocardial perfusion (LMP) after coronary reperfusion with nicardipine (a calcium channel blocker) administration were evaluated. METHODS: A total of 10 mongrel dogs were divided into two groups; group I (control group, n = 5), group II (nicardipine group, n = 5). After femoral arterial, pulmonary arterial and left ventricular catheterization, a left thoracotomy was performed. Next, the left anterior descending coronary artery (LAD) was exposed, and a thermal diffusion microprobe was inserted in the myocardium to measure LMP. RESULTS: In group II, blood pressure and systemic vascular resistance after LAD reperfusion were significantly decreased compared to group I. Cardiac output and stroke volume were more rapidly increased in group II, while left ventricular stroke work was decreased in group II. In group I, the LMP after LAD reperfusion did not recover to the baseline level, but the LMP did recover 20 minutes after LAD reperfusion and was increased more compared to the baseline level at 30 minutes after LAD reperfusion in group II. There were no significant differences in dP/dt between the two groups. CONCLUSIONS: We found that the LMP did not recover to the baseline level in the early state of LAD reperfusion; however, nicardipine administration increased the LMP after the early reperfusion period. Cardiac output and stroke volume were also more rapidly increased when nicardipine was administrated.

Changes Induced by the Infusion of Normal Saline in Arterial Blood Gas Analysis, Serum Electrolytes and Central Venous Pressure during Renal Transplantation / 대한마취과학회지

BACKGROUND: The changes in acid-base balance and serum electrolytes after infusion of 0.9% normal saline during renal transplantation are poorly characterized. In this study, the relationships between the infusion of fluids and the changes in arterial blood gas analysis, serum electrolytes and central venous pressure during renal transplantation were determined. METHODS: Sixty-seven patients undergoing elective renal transplantation were divided into two groups: group I (n = 33) was made up of patients who received a living related renal transplantation, while group II (n = 34) was made up of those who received a living unrelated renal transplantation. Blood gas analysis, central venous pressure and serum electrolytes were evaluated just after the beginning of the operation, just before reperfusion (unclamping of the renal artery and vein), just after reperfusion and 20 minutes after arriving in the recovery room. RESULTS: pH, base excess, HCO3 and Na+ concentration were decreased, but PaCO2 was not changed during the operation. Central venous pressure and K+ concentrations were elevated during the operation. CONCLUSIONS: The results of this study suggest that 0.9% normal saline and mannitol leads to dilutional acidosis. If a lot of fluids are required during transplantation, we need to consider that 0.9% normal saline can aggravate acidosis in a renal transplantation patient.

Study of Acid-Base in Arterial and Central Venous Blood during / 대한마취과학회지

BACKGROUND: Although pulmonary artery catheters are useful to monitor hydration, these devices may be associated with severe morbidity and are not routinely used in kidney transplantation. A central venous pressure (CVP) catheter is preferred rather than a pulmonary artery catheter. Noninvasive continuous blood pressure monitors may substitute for intraarterial catheters, thereby preserving the radial artery in kidney transplantation patients should it be needed later to create an arteriovenous fistula. If there is a relationship between central venous and radial arterial blood for acid-base (pH, BE, HCO3(-)), we can use the blood sample from a CVP catheter instead of arterial blood from aradial artery catheter for testing acid-base and it can help patients. METHODS: A central venous catheter and radial artery catheter was inserted in 67 patients while undergoing kidney transplantation. To assess arteriovenous differences in acid-base status at operation start, before reperfusion of the transplanted kidney, after reperfusion, we measured the pH, BE and HCO3(-) simultaneously from the arterial and central venous circulation. RESULTS: Aacid-base using arterial and central venous samples at operation start, before reperfusion and after reperfusionb was evaluated. We found the relationship as follows: pH between arterial (pHa) and central venous blood (pHcv) in each: linear regression equation; pHcv = 0.668 + (0.906 X pHa), pHcv = 0.225 + (0.965 X pHa), pHcv = 0.646 + (0.908 X pHa), determination coefficient; 0.908, 0.926, 0.888, P values < 0.001 in each period. Base excess (BE) between BEa and BEcv in each period: linear regression equation; BEcv = 0.483 + (0.952 X BEa), BEcv = 0.032 + (0.939 X BEa), BEcv = 0.008 + (0.954 X BEa), determination coefficient; 0.844, 0.954, 0.962 P values < 0.001 in each period. HCO3(-) concentration between HCO3(-)a and HCO3(-)cv in each period: linear regression equation; HCO3(-)cv = 2.434 + (0.937 X HCO3(-)a), HCO3(-)cv = 2.093 + (0.942 X HCO3(-)a), HCO3(-)cv = 1.755 + (0.954 X HCO3 a), determination coefficient; 0.950, 0.925, 0.932 P values < 0.001 in each period. CONCLUSIONS: The acid base status of arterial blood is similar to that of central venous blood. Central venous blood gas values (pH, BE, HCO3(-)) may be an acceptable alternative to arterial blood gas values in kidney transplantation patients.

The Effect of Fentanyl and Ketorolac in Intravenous Patient-Controlled Analgesia on Postoperative Nausea and Vomiting and the Effect of Prophylactic Ondansetron / 대한마취과학회지

BACKGROUND: This study was performed to assess the effect of fentanyl and ketorolac in intravenous patient-controlled analgesia (IV-PCA) on postoperative nausea and vomiting and the antiemetic effect of prophylactic ondansetron after a total abdominal hysterectomy. METHODS: Of 115 women having general anesthesia for a total abdominal hysterectomy, a non-PCA group (n = 52) didn't receive IV-PCA and a PCA group (n = 39) and ondansetron group (n = 24) received IV fentanyl 1 - 1.5 microgram/kg and IM ketorolac 30 mg as a loading dose and IV-PCA with a mixture of 60 ml with fentanyl 25 - 30 microgram/kg and ketorolac 4 - 5 mg/kg. In addition, the ondansetron group received IV ondansetron 4 mg before an IV-PCA was started. We assessed nausea, vomiting and the need for rescue antiemetics during the first 24 hours postoperation. RESULTS: During the first 24 hours postoperation, there were no significant differences in the incidence of nausea, vomiting and the need for rescue antiemetics among the groups. CONCLUSIONS: Intravenous patient-controlled analgesia with fentanyl and ketorolac didn't increase postoperative nausea, vomiting and the need for rescue antiemetics during the first 24 hours postoperation. Also, prophylactic ondansetron didn't significantly reduce the chance of postoperative nausea, vomiting and rescue antiementics.

Lumbar Nerve Root Sleeve Injections in Painful Disorders of the Lumbar Spine: Short Term Results / 대한마취과학회지

BACKGROUND: Nerve root sleeve injection has become popular in the treatment of lumbar radicular complaints. However reported data on nerve root sleeve injection is more of a technical nature. The present study was designed to evaluate the therapeutic success of a fluoroscope guided nerve root sleeve injection of local anesthetics and corticosteroids. METHODS: Fifty seven patients who had persistent radicular pain and/or low back pain that is resistant to conservative treatment were treated with fluoroscope guided injection therapy. 0.125% bupivacaine 2.5 ml and triamcinolone 40 mg were injected at intervals of 2 - 4 weeks. Before and after treatment and at follow up, a visual analogue scale (VAS) was measured. Treatment success was evaluated on a ratio based on the visual analogue scale (post-treatment VAS/pre-treatment VAS) and categorized as following (good improvement = > 70%, moderate improvement = 70 50%, no improvement = < 50%). RESULTS: Short-term good and moderate improvement was observed in 46% of the patients with radiating pain and/or lower back pain, and in 43% of patients with lower back pain only. CONCLUSIONS: Results indicated that nerve root sleeve injections of corticosteroids done under fluoroscopic guidance as an outpatient procedure was effective and safe in our study and may deserve to be used as part of the conservative management of lumbar radiculopathy before resorting to more invasive methods.

Neuromuscular Blocking and Vagolytic Effects of Atracurium, Cisatracurium, and Mivacurium in the Anesthetized Cat / 대한마취과학회지

BACKGROUND: Atracurium is a benzylisoquinolium nondepolarizing neuromuscular blocking drug. It releases histamine upon the rapid administration of more than 2 x ED95. Cisatracurium is about three to four times more potent than atracurium, less likely to release histamine, and has weaker cardiovascular or autonomic effects. Mivacurium releases histamine to about the same degree as atracurium at the same dose. This study was undertaken to reevaluate the experimental model for the evaluation of effects on the autonomic nervous system, and to determine the neuromuscular blocking profiles and the vagolytic effects of atracurium, cisatracurium and mivacurium in cats. METHODS: Cats, either sex, anesthetized with pentobarbital, were used. Neuromuscular blocking effects were assessed using the effects on the anterior tibialis muscle twitch evoked with supramaximal stimuli (0.2 ms-duration, 0.1 Hz). Inhibition of the parasympathetic nervous system was assessed in response to bradycardia to vagal nerve stimulation with ten-second trains of square-waves (0.5 ms-duration, 20 Hz). The dose-response curves for both neuromuscular blocking and vagolytic actions were determined for each animal. The dose-response curves were constructed in cumulative fashion. The response for vagal stimuli was measured two minute after each dosing. Vagal ID50 (The doses that produced 50% inhibition of the response to vagus nerve stimulation) were determined. RESULTS: NMB ED95 and NMB ED50, respectively, were 102.0 +/- 28.3 and 143.7 +/- 40.5 microgram/kg for atracurium, 81.4 +/- 13.3 and 110.7 +/- 18.8 microgram/kg for cisatracurium, and 56.8 +/- 17.4 and 74.2 +/- 25.0 microgram/kg for mivacurium. Vagal ID50 was 2,654 +/- 1,651 microgram/kg for atracurium, 655 +/- 389 microgram/kg for cisatracurium, and 606 +/- 182 microgram/kg for mivacurium. The vagal ID50/NMB ED95 and vagal ID50/NMB ED50 were 18.5 and 26.0 for atracurium, 5.9 and 8.1 for cisatracurium, and 8.2 and 10.7 for mivacurium. CONCLUSIONS: Atracurium has a wider margin of safety only for vagal stimulation as compared with cisatracurium and mivacurium. However, we couldn't exclude that either sympathetic stimulation or histamine release might contribute to heart rate.

Effects of Amrinone on the Vascular Tension of the Isolated Rabbit Pulmonary Artery / 대한마취과학회지

BACKGROUND: Amrinone is a noncatecholamine, nonglycoside compound, which is known to possess both cardiac inotropic and vasodilatory actions. This drugs has been increasingly used in clinical practice for the management of low cardiac output syndrome during anesthesia, particularly for patients associated with right heart failure and pulmonary hypertension. The aim of this study was to explore the direct vasoactive effect of amrinone and its action mechanisms in the isolated rabbit pulmonary artery. METHODS: The rabbits' pulmonary arteries were dissected free and cut into rings (3 4 mm) and mounted for isometric tension in a tissue chamber. The effects of amrinone (5 10 6 5 10 4 M) on the vascular tension were assessed in the by KCl (40 mM)- or norepinephrine (NE, 10 6 M)- precontracted pulmonary arterial rings with or without endothelium. Also effects of K channel blockers (tetraethyl ammonium 20 mM, glybenclamide 2.5 10 5 M, 4-aminopyridine (4-AP) 5 10 4 M), protein kinase A & G inhibitor (H8), L-NAME, methylene blue and indomethacin on the amrinone- induced vascular responses were investigated. Also studied was effects of amrinone on the Ca2 influx through voltage operated channel (VOC) and receptor operated channel (ROC) of the vascular cells. RESULTS: Amrinone produced vasorelaxation of KCl- or NE-precontracted pulmonary artery in a dose-dependent fashion. The amrinone-induced vasorelaxation was not affected by the denudation of the endothelium. Pretreatment with L-NAME and methylene blue did not affect the vasodilatory effect of amrinone, suggesting that nitric oxide is not involved. Following pretreatment with indomethacin (a cyclooxygenase inhibitor) or K channel blockers, the amrinone-induced vasorelaxation was not altered. After exposure to Ca2 free solution, amrinone attenuated the KCl- or NE-induced contraction even in the presence of Ca2 , implying that VOC and ROC are blocked by amrinone. On the other hand, protein kinase A blocker (H8) completely abolished the amrinone-induced relaxation in the KCl-precontracted pulmonary artery. CONCLUSIONS: These findings suggest that the amrinone-induced vasorelaxations result from inhibition of VOC and ROC as well as from the activation of protein kinase A in the isolated rabbit pulmonary artery.

Nausea and Vomiting after Tympanomastoidectomy: Effect of Small Dose of Fentanyl / 대한마취과학회지

BACKGROUND: Nausea and vomiting are among the most common postoperative complaints. There is high incidence of emesis after middle ear surgery and opioids increase the prevalence of postoperative nausea and vomiting. METHODS: Sixty six adult patients undergoing routine tympanomastoidectomy under general anesthesia were divided into two groups to study the incidence and effect of intraoperative fentanyl as supplements on postoperative nausea and vomiting. Patients in group 1 received medical air instead of N2O about 15 minutes before grafting, while patients in group 2 received not only medical air instead of N2O, but also intravenous fentanyl (1~1.5 microgram/kg). RESULTS: The incidences of nausea and vomiting in the group 1 and 2 were 19.4% and 22.9%, respectively. There was no significant difference of postoperative nausea and vomiting between the group 1 and group 2 (P=0.73). CONCLUSION: The incidence of nausea and vomiting after tympanomastoidectomy in adult was not higher than comprehensive that of recent other reports and a small dose of fentanyl, given intraoperatively for supplementation, did not increase the prevalence of nausea and vomiting.

Nausea and Vomiting after Tympanomastoidectomy: Effect of Small Dose of Fentanyl / 대한마취과학회지

BACKGROUND: Nausea and vomiting are among the most common postoperative complaints. There is high incidence of emesis after middle ear surgery and opioids increase the prevalence of postoperative nausea and vomiting. METHODS: Sixty six adult patients undergoing routine tympanomastoidectomy under general anesthesia were divided into two groups to study the incidence and effect of intraoperative fentanyl as supplements on postoperative nausea and vomiting. Patients in group 1 received medical air instead of N2O about 15 minutes before grafting, while patients in group 2 received not only medical air instead of N2O, but also intravenous fentanyl (1~1.5 microgram/kg). RESULTS: The incidences of nausea and vomiting in the group 1 and 2 were 19.4% and 22.9%, respectively. There was no significant difference of postoperative nausea and vomiting between the group 1 and group 2 (P=0.73). CONCLUSION: The incidence of nausea and vomiting after tympanomastoidectomy in adult was not higher than comprehensive that of recent other reports and a small dose of fentanyl, given intraoperatively for supplementation, did not increase the prevalence of nausea and vomiting.

Severe Hyperkalemia without Typical Electrocardiographic Manifestations: A case report / 대한구급학회지

Severe hyperkalemia can induce life threatening cardiac rhythm disturbances, and usually produce classic electrocardiographic (EKG) manifestations. We report a case of severe hyperkalemia in which the EKG did not reveal the expected alterations. The patient was a 57-year-old man with adenocarcinoma of stomach. There were no significant abnormal findings in laboratory analysis, chest X-ray and EKG. His preoperative medications for hypertension consisted of furosemide, amiloride and enalapril. The tests for serum potassium concentration ([K ]) were performed on 20 and 7 days before the operation and the results were 4.5 and 4.9 mEq/l, respectively. Just after induction of anesthesia, we tried the blood gas and electrolyte analysis and the result revealed high [K ] of 8.5 mEq/l, but EKG did not show typical phenotype of hyperkalemia at that time. His intraoperative and postoperative courses were not eventful.