Effect of Diltiazem on Pancuronium - and Vecuronium - induced Neuromuscular Blockade / 대한마취과학회지

The effects and interactions of pancuronium and vecuronium with diltiazem on the electri- cally-evoked twitch response, train-of-four and tetanic stimulation were studied in the isolated rat hemi-diaphragm preparation. Pancuronium(3 X 10(-7) -10(-5) M) and vecuronium(3 X 10(-6)-15 X 10(-6) M) decreased the electrically evoked(nerve stimulation, 0.1Hz, 0.5ms, 10V) twitch response, train-of-four and tetanus ratio in a dose-related fashion and pancuronium was more potent than vecuronium. The inhibitory effects of pancuronium and vecuronium were potentiated by pretreatment with 5 & 10 uM diltiazem, a Ca++-channel blocker, in which the concentration of diltiazem has no obvious effects on the twitch response itself. Furthermore, it is noteworth that the inhibitory effects of pancuronium and vecuronium were markedly potentiated by 150 uM hemicholinium pretreatment. In cases of the direct(muscle, 0.1 Hz, 5 ms, 10 V) stimulation, pancuronium and vecuronium decreased the electrically evoked twitch response dose dependently, but the amplitudes of inhibition were less than those in indirect(nerve) stimulation. The inhibitory effects were not affected by diltiazem pretreatment except low doses of vecuronium. On the basis of these findings, the result of the present study suggests that the muscle relaxation by pancuronium and vecuronium is mediated by pre- and post-junctional receptor blockade, and that diltiazem intensifies neuromuscular blockade produced by muscle relaxants. The potentiating effect of diltiazem may be due to blocking influx of calcium and/or release of acetylcholine from presynaptic nerve terminals.

Effect of Diltiazem on Pancuronium - and Vecuronium - induced Neuromuscular Blockade / 대한마취과학회지

The effects and interactions of pancuronium and vecuronium with diltiazem on the electri- cally-evoked twitch response, train-of-four and tetanic stimulation were studied in the isolated rat hemi-diaphragm preparation. Pancuronium(3 X 10(-7) -10(-5) M) and vecuronium(3 X 10(-6)-15 X 10(-6) M) decreased the electrically evoked(nerve stimulation, 0.1Hz, 0.5ms, 10V) twitch response, train-of-four and tetanus ratio in a dose-related fashion and pancuronium was more potent than vecuronium. The inhibitory effects of pancuronium and vecuronium were potentiated by pretreatment with 5 & 10 uM diltiazem, a Ca++-channel blocker, in which the concentration of diltiazem has no obvious effects on the twitch response itself. Furthermore, it is noteworth that the inhibitory effects of pancuronium and vecuronium were markedly potentiated by 150 uM hemicholinium pretreatment. In cases of the direct(muscle, 0.1 Hz, 5 ms, 10 V) stimulation, pancuronium and vecuronium decreased the electrically evoked twitch response dose dependently, but the amplitudes of inhibition were less than those in indirect(nerve) stimulation. The inhibitory effects were not affected by diltiazem pretreatment except low doses of vecuronium. On the basis of these findings, the result of the present study suggests that the muscle relaxation by pancuronium and vecuronium is mediated by pre- and post-junctional receptor blockade, and that diltiazem intensifies neuromuscular blockade produced by muscle relaxants. The potentiating effect of diltiazem may be due to blocking influx of calcium and/or release of acetylcholine from presynaptic nerve terminals.

Clinical Study of the Patient with Traumatic Head Injury / 대한마취과학회지

Clinical analysis was done of 284 head injured patients admitted to the hospitals in the Chonbuk area from January to December 31, 1984. The results were the following. 1) Head injury occureed mostly in the 3rd and 4th decade and male patients were 3.7 times as friquent as the female patients. 2) The main cause of head injury was traffic accidents(79%) Other causes were blunt traums, falls, and gunshot in that orer. Many of the traffic accidents involved motorcycles. 3) The accidents were prevalent between 6 and 12 P.M. on Wednesday and Thursday, and in spring and autumn. 4) There was close relation between the level of the consciousness and the death rate of the victims. That is, everyone who was clear or in a stuporous mental state at the time of operation survived, while most of the patients who were semi-or fully comatose died. 5) The time lag between the accident and the surgical operation was 1 to 3 hours. 6) 71% of the injuries were epidural and subdural hematomas, and the rest of the injuries were compressed skull fracture, hemorrage inside the brain parenchyme, in that order. 7) The anesthesia was induced mostly with thiopental sodium and maintained with halothane-N2O-O2 sequence(91.5%). NLA was used in the rest ofr anesthesia(9.1%). 8) Total anesthesia time lapsed for the operation was 2~3 hour in 38%, 3~4 hour in 25% and less than 1 hour in 1.7%.

Clinical Analysis of Anesthesia for Emergency Operations / 대한마취과학회지

We have made a clinical analysis of emergency operations which were performed from January to December 1983 at the Chonbuk National University Hospital. The Clinical analysis compared sex and age distribution, physical status, frequency of emergency operation, department, anesthetic method, time, and seasonal distribution. The results were as follows: 1) About forty-eight percent of emergency patients were between 20 to 40. 2) Emergency operative cases were about forty-one percent of all anesthetized patients. 3) About forty-three percent of emergency operations were performed by the Department of General Surgery and the most common surgical operation was appendectomy. 4) Emergency operations in the winter were significantly less common than those of other seasons. 5) About forty percent of emergency operations were performed during daytime office hours.

Celiac Plexus Block for the Management of Intraabdominal Pain / 대한마취과학회지

Celiac plexus block with neurolytic agents is widely recommended for the management of intraabdominal pain due to malignant disease as a simple, asafe and effective method. We performed neurolytic celia: plexus block with 60% ethanol in lidocaine in 8 patients: with gastric cancer(4), hepatoma(2), pancreatic cancer(1), and chronic pancreatitis(1). Good to excellent pain relief was obtained in the 2 hepatoma cases, 1 pancreatic cancer, and a gastric cancer patient. In one patient with gastirc cancer, analgesia lasted for about 3 months but the second block was entirely unsatisfactory. The result was uncertain in one patient with chronic pancreatitis because the pain was non-specific and responded even to saline solution(placebo). In the remaing 2 patients, the result was entirely negative and eventually, epidural morphine was given periodically through an indwelling catheter.