The Comparison of Measured Hypnotic Levels among Propofol, Sevoflurane and Desflurane Anesthesia by Using EEG-entropy and Bispectral Index

BACKGROUND: Sevoflurane has been reported to associate with epileptiform activity during a rapidly increasing concentration, but desflurane isn't associated. This study was designed to compare the measured hypnotic levels by using EEG-entropy and bispectral index (BIS) among propofol target-controlled infusion (TCI), sevoflurane and desflurane anesthesia. METHODS: Sixty-five patients undergoing total hysterectomy were studied. Thirty patients were anesthetized with propofol TCI, twenty patients with sevoflurane, and fifteen patients with desflurane anesthesia. BIS, response entropy (RE), state entropy (SE), and hemodynamic variables were collected on the effect site concentrations of 1.5-10.0micro/ml for propofol TCI group. On the other hand, those data were collected on the end-tidal concentrations of 1.0-6.0 vol% for sevoflurane group and, 1.0-13.0 vol% for desflurane group. RESULTS: In propofol TCI group, there was a strong correlation between the measured hypnotic levels and the effect site concentrations of 1.5-10.0micro/ml. Furthermore, the measured values were significantly lower than previous corresponding values on 3.0-4.0 and 8.0micro/ml of the effect site concentrations. In sevoflurane group, the measured hypnotic levels increased paradoxically on the end-tidal concentration of 2.0-5.0 vol%. In desflurane group, the measured hypnotic levels showed ceiling effect in the concentration ranges of 3.0-12.0 vol%. CONCLUSIONS: The measured values by using EEG-entropy and BIS with propofol TCI were considered as useful indices of hypnotic level because of showing a strong correlation. However, those values didn't reflect real clinical hypnotic levels well partly with sevoflurane anesthesia because the measured hypnotic levels increased paradoxically. And it should be considered that those values showed ceiling effect from 3.0 vol% onward with desflurane anesthesia.

The Comparative Effects of Dopamine and Dobutamine on Hemodynamics and Gastrointestinal Perfusion in Resuscitation of Hemorrhagic Shock / 대한마취과학회지

BACKGROUND: Preservation of intestinal perfusion is considered the goal of resuscitation because derangement of gut perfusion is the major factor in multi-organ dysfunction. Gut intramucosal pH measured by tonocap, has been proven to be the sensitive monitor of gut mucosal perfusion. The effects of vasoactive agents on regional blood flow and cellular metabolism remain unclear. This study was done to examine the effects of dopamine or dobutamine on systemic hemodynamics and splanchnic perfusion assessed by gastric intramucosal pH (pHi) during resuscitation of hemorrhagic shock. METHODS: Thirty anesthetized dogs were bled to 30 40 mmHg of mean arterial pressure (MAP) and maintained at the shock state for 90 minutes. Cardiac output and arterial and mixed venous blood gas data was measured for the global assessment of circulation and oxygenation. Gastric intramucosal pH (pHi) and CO2 tension (PrCO2) and the difference of arterial and gastric intramucosal CO2 tension (CO2 gap) were measured for the assessment of splanchnic perfusion. Dogs were resuscitated with shed blood and a crystalloid solution at the maintenance dose (control group, n = 10). Dopamine (4microgram/kg/min, dopamine group, n = 10) or dobutamine (7microgram/kg/min, dobutamine group, n = 10 ) was added from the start of volume replacement and maintained for a follow-up period of 180 minutes. RESULTS: Cardiac index and global oxygen delivery and consumption were increased after resuscitation in all groups. These parameters were significantly higher in the dopamine or the dobutamine groups than in the control group (P< 0.05), and significantly higher in the dopamine group than in the dobutamine group (P< 0.05). The pHi, PrCO2 and CO2 gap were not improved from the values of shock state after volume resuscitation in the control group. The pHi, PrCO2 and CO2 gap were significantly improved from the values of shock state after resuscitation in the dopamine group (P< 0.05), but not differentfrom the control group. The pHi, PrCO2 and the CO2 gap were significantly improved from the value of shock state after resuscitation in the dobutamine group and maintained significantly higher than in the control group for the follow-up period (P< 0.05). Compared to the dopamine group, the pHi increased early and was higher in the dobutamine group (P< 0.05). CONCLUSIONS: We conclude that dobutamine is effective in improving gut mucosal oxygenation during early resuscitation of hemorrhagic shock. Dopamine has little effect on the restoration of gut mucosal oxygenation. Considering the better recovery of cardiac index and global oxygenation parameters in the dopamine group, this finding could be explained by the redistribution of cardiac output or imbalance of oxygen metabolism occuring in the dopamine group.

Anesthetic Experience of the Patient with Nemaline Myopathy: A case report / 대한마취과학회지

Nemaline rod myopathy is an autosomal dominant disease characterized by nonprogressive symmetric skeletal muscle weakness affecting principally proximal skeletal muscles. Anesthesia of the patient with this disease is known to present some problems:difficult intubation due to facial dysmorphism, delayed onset of succinilcholine, reduced vital capacity on pulmonary function test and skeletal deformity. We anesthetized 19 year old male patient with nemaline myopathy for the operation of cryptochidism. Because of the possibility of difficult intubation, we produced epidural anesthesia with 20 G Tuohy needle at L5-S1 intervertebral space successfully. There were no problems in the course of operation and recovery except transient airway obstruction due to sedative.

The Effect of Acute Hypervolemic Hemodilution on Blood Loss and Mononuclear Cell Counts during Bone Marrow Harvesting / 대한마취과학회지

BACKGROUND: Hypervolemic hemodilution (HHD) seems to be a good alternative to acute normovolemic hemodilution to reduce transfusion requirements because it requires less time and effort. In a prospective study in healthy donors, we studied the effects of HHD on blood loss and mononuclear cell counts of aspirated bone marrow which were transplanted. METHODS: After induction of anesthesia and positioning to prone, donors of the HHD group (n = 25) were administered 7.5 ml/kg of pentastarch and the same amount of Hartmann's solution prior to aspiration, but those of the control group (n = 25) were administered only 2 ml/kg/h of Hartmann's solution. Bone marrow was aspirated at the iliac spine and blood loss was replaced with pentastarch and Hartmann's solution for both groups. Hemoglobins and hematocrits were counted after induction, after hemodilution and the end of aspiration. Hemoglobins and mononuclear cell counts of aspirated bone marrow were also counted. RESULTS: HHD decreased hemoglobin from 13.2 +/- 1.1 g/dl to 10.7 +/- 1.0 g/dl significantly (P < 0.01). Even though hemoglobins of both groups at the end of aspiration were not different (9.3 +/- 2.3 g/dl at control vs 9.5 +/- 1.1 g/dl at HHD), calculated blood loss based on body weight through aspirated bone marrow was less in the HHD group (18.0 +/- 1.8% at control vs 16.3 2.0% at HHD, P < 0.05). There was no difference in counted mononuclear cell counts between the two groups (1.8 +/- 0.7 x 10(7)/ml at control vs 1.8 +/- 0.7 x 10(7)/ml at HHD). CONCLUSIONS: During bone marrow harvesting in healthy donors, HHD reduced blood loss through aspirated bone marrow, but does not affect transplanted bone marrow mononuclear cell counts.

Multiple Intradural Schwannomas of the Cauda Equina in the Absence of Neurofibromatosis

A case of multiple intradural schwannomas of the cauda equina is reported without evidence of any other manifestations of neurofibromtosis. The patient had symptoms of cauda equina compression. Following a diagnosis of multiple intradural tumors of the cauda equina, based on lumbar spine MRI with contrast enhancement, the tumors at the L1 body, L3 body, L3-L4 intervertebral space level were removed completely, involving two rootlets. After the operation, the patient is asymptomatic apart from left S3 dermatome hypesthesia.

Bronchial Cuff Volume of Univent Tube for One Lung Ventilation / 대한마취과학회지

BACKGROUND: The univent tube is an endotracheal tube with a movable bronchial blocker for one lung ventilation. The purpose of this study was to measure the appropriate cuff volume sealing the mainstem bronchus by three different techniques. METHODS: This study was performed in 60 adult patients undergoing thoracotomy. 1) The negative pressure was applied to the end of blocker causing loss of volume in the breathing system. The blocker cuff volume was measured at the point of the bag ceased to deflate. 2) The blocker cuff volume was measured when breathing sound is not heard on blocked lung. 3) Then the capnometer was applied to the blocker and the cuff volume was measured at the point of the CO2 wave ceased abruptly. The bronchial blocker volumes from these three methods were compared with the volume which was measured when the lung was completely collapsed in operation field. RESULTS: Left bronchial sealing volume was 2.7+/-?0.8 ml with negative pressure technique, 3.5+/-0.8 ml with auscultation, 3.2?1.2 ml with CO2 technique and 3.0+/-0.7 ml with complete lung collapse at operation field. Right bronchial sealing volume ranged 3.5+/-0.9 ml with negative pressure technique, 4.6+/-1.0 ml with auscultation, 3.9+/-0.6 ml with CO2 technique and 4.2+/-0.9 ml with complete lung collapse at operation field. CONCLUSIONS: We concluded that right bronchial blocker volume was 4.2+/-0.9 ml and left bronchial blocker volume was 3.0+/-0.7 ml. The right bronchial blocker volume was larger than the left.

Effects of Inhalation Anesthetics on Lymphocyte Transformation / 대한마취과학회지

Anesthesia and operation may impair the immune system so that bacterial growth and tumor cells spread can occur more rapidly and host response to transplanted tissue may be altered. In order to evaluate the influence of inhalation anesthetics on immune function, mitogen induced lymphocyte transformation and colony formation of T lymphoctye of peripheral blood in rats were studied. The experimental animals were divided into 4 groups according to inhaled anesthetics such as control, 0.8% halothane, 1.65% enflurane and 1.05% isoflurane 6 hours inhaled group. One day after inhalation of anesthetics, 5 ml of blood was sampled from inferior vena cava and the lymphocytes were isolated and cultured. Spontaneous and phytohemagglutinin (PHA) or pokeweed mitogen (PWM) induced lymphocte transformation were measured by the titration of H-thymidine uptake and the number of colony forming unit-T lymphocyte (CFU-TL) were counted. The results were as follows: Spontaneous lymphocyte transformation was increased by halothane and decreased by enflurane significantly but not differed by isoflurane compared with the control group. Lymphocyte transformation were decreased significantly before and after PHA stimulation in all of the anesthetic groups respectively compared with the control group. 3) Lymphocyte transformation by PWM stimulation also decreased in all of the anesthetic groups. 4) The numbers of CFU-TL cluster and colony decreased in all of the anesthetic groups compared with the control group. In conclusion, inhalation anesthetics such as halothane, enflurane and isoflurane decreased immune competence and that halothane was the most, isoflurane was the least immunosuppressive among these three inhalation anesthetics.

Folinic Acid Protection Against Hematopoietic Cell Depression Induced by Nitrous Oxide in Rats / 대한마취과학회지

The degree of hematopoietic depression and spontaneous recovery of depressed cells with 50% nitrous oxide inhalation for 6 or 12 hours were studied in 120 Sprague-Dawley rats. Immediately after, 1 day, 3 days and 1 week after nitrous oxide inhalation, precursor cells of granulocyte-monocyte and T lymphocyte in bone marrow and blood were sampled and cultured. After one week of culture period, the numbers of colony forming unit-granulocyte monocyte (CFU-GM) and colony forming unit-T lymphocyte (CFU-TL) were counted. There was no change in the number of colony immediately after inhalation of nitrous oxide, but was significant decrease in number of colony 1 day and 3 days after inhalation of nitrous oxide (p<0.001). One week after cessation of nitrous oxide inhalation, spontaneous recovery of number of colony developed without any treatment. To evaluate the protective effect of folinic acid (Rescuvolin) against hematopoietic depression, Rescuvolin 0.1 mg/0.3 ml were injected intraperitoneally at 12 hours and 1 hour before, 1 hour before and immediately after nitrous oxide inhalation, respectively. The data of each group were compared with that of the animals which have inhaled nitrous oxide for 6 hours without folinic acid. Folinic acid injected groups showed significant increase in numbers of colony (p<0.001) especially in 12 and 1 hour before nitrous oxide inhalation. In conclusion, the longer the duration of nitrous oxide inhalation, the faster and severer hematopoietic depression developed. The pretreatment of folinic acid may prevent the bone marrow depression by a long-term and repeated use of nitrous oxide. In clinical anesthesia, it is recommended to avoid to use nitrous oxide for the patients with bone marrow depressed disease such as leukemia and aplastic anemia.