Effects of Thiopental Sodium, Midazolam, Propofol and Ketamine on Endothelial Nitric Oxide in Rat Thoracic Aortic Rings / 대한마취과학회지

BACKGROUND: Compared to inhalation and local anesthetics, little is known about the mechanisms of vascular effects of intravenous anesthetics. So we studied the effects of thiopental sodium, midazolam, propofol and ketamine on the endothelial nitric oxide-cGMP pathway and also on the membrane cyclooxygenase pathway. METHODS: After isolating ring strips of rat thoracic aorta, we measured the relaxation ED50 values of the four intravenous anesthetics from the maximally contracted using phenylephrine 10(-5)M. Then using L-NAME and methylene blue, we studied the effects of the drugs upon the NO-cGMP system. In addition, another pathway of vasodilation through membrane prostaglandin metabolism was examined using the membrane cyclooxygenase inhibitor, indomethacine. RESULTS: The following results were obtained. 1. Thiopental sodium (10(-5)M) did not have any effect on the PE induced contractions of aortic rings but midazolam (10(-6)M), propofol (10(-4)M) and ketamine (10(-3)M) significantly (P < 0.05) inhibited the PE induced contractions of aortic rings. 2. Midazolam 10(-6)M and propofol 10(-4)M induced relaxation of aortic rings were recovered with L-NAME pretreatment but ketamine induced relaxation was not recovered with L-NAME. 3. Midazolam 10(-6)M induced relaxation was not recovered with methylene blue pretreatment, but propofol 10(-4)M induced relaxation was recovered with methylene blue. 4. Indomethacine pretreatment induced further relaxation of midazolam or propofol induced relaxation of aortic rings. CONCLUSIONS: Midazolam, propofol and ketamine, but not thiopental sodium, relax rat thoracic aortic rings, and these relaxation effects of midazolam and propofol are endothelium dependent. Cyclooxygenase inhibition is related at least in part to midazolam or propofol induced relaxation, and guanylate cyclase to propofol induced relaxation.

Effect of Hymn and Sutra-Chanting on the Preanesthetic Patient Anxiety in the Operating Room / 대한마취과학회지

BACKGROUND: Most surgical patients experience preoperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contribute to postoperative pain. Music has been recognized as a way to reduce anxiety and fear. The effect of hymn and sutra-chanting on the preanesthetic patient's anxiety in the operating room were studied. METHODS: 98 patients were divided into two groups according to the religionist or atheism. Group I(n=50, religionist) and Group II(n=48, atheism) listened to hymn or sutra-chanting according to the patient's religion and choice. At ward, hemodynamic variables including systolic and diastolic blood pressure and pulse rate were measured as control values. Hemodynamic variables and measurements of anxiety score with Hamilton anxiety rating scale were made at pre-music and post-music in the operating room. Also, patient's response to the music was measured on the postoperative 5-6th day. RESULTS: There were no difference between ward, pre-music, and post-music in terms of systolic pressure, diastolic pressure and pulse rate except the systolic pressure at pre-music that is grater than that of controls in both groups. Both group, anxiety score at post-music was significantly lower than that of pre-music (10.2+/-3.4 vs 4.4+/-2.9, 11.0+/-3.2 vs 5.7+/-3.1). At post-music, anxiety score in Group I showed significant reduced compaired with Group II (p<0.05). Patients showed relatively good satisfaction with music in both groups. CONCLUSION: The results suggest that music with hymn and Sutra-chanting were effective to reduce preanesthetic anxiety in both religionist group and atheism group.

The Effect of Pretreated Pyridostigmine on the Change of Blood Pressure and Heart Rate Following Intrathecally Injected Clonidine in Cats / 대한마취과학회지

Intrathecal clonidine injection induces analgesia without significant respiratory depression, but decreases blood pressure and causes sedation. Injection of spinal cholinesterase inhibitor alone increases blood pressure in animals, and enhances clonidine induced analgesia. To evaluate the effect of pretreated pyridostigmine on the change of blood pressure and heart rate, clonidine was injected intrathecally in cats. We divided fifteen cats into three groups and administered saline(0.5 cc) to group 1, pyridostigmine(0.5 cc, 2.5 mg) to group 2, pyridostigmine(0.5 cc, 2.5 mg) and glycopyrrolate(0.5 cc, 0.1 mg) to group 3 before 20 minute of clonidine injection and measured mean arterial pressure, heart rate, P CO2 and central venous pressure. The results were as follows: 1)After clonidine injection, all mean arterial pressure values were significantly reduced in group 1, but in group 3, 20, 30 and 40 minutes values were significantly reduced, and 10, 40 minutes values after clonidine injection were not reduced significantly in group 2 compared to group 1. 2)After clonidine injection, heart rates were significantly reduced in all groups, but there was no significant difference between group 1, group 2 and group 3. 3)There was no significant difference of central venous pressure in any groups. 4)There was no significant difference for reversal of pyridostigmines effect by glycopyrrolate. Based on these results, these data suggest that pyridostigmine pretreatment counteracts clonidine induced hypotension, but further study of spinal az adrenergic-cholinergic combination for pain therapy is needed before clinical application.

Cardiac Arrest following Epidural Block for Postoperative Pain Control / 대한마취과학회지

The continuous epidural anesthesia is an effective method for postoperative pain control and improvement of pulmonary function. A 39-year-old man was scheduled for postoperative intestinal obstruction. After adhesiolysis under the general anesthesia, epidural anesthesia was done for postoperative pain control. Because an accidental dural puncture was noticed, the adjacent interspace of epidural anesthesia was tried and catheter was inserted. Respiratory depression, hypotension, loss of consciousness and cardiac arrest were developed about 20 minutes after the first injection of 1% lidocain 10ml. Endotracheal intubation was performed and the respiration was controlled using 100% oxygen. Self respiration and alert mentality returned after 180 minutes. No CSF leakage, delayed onset time, severe hypotension, complete recovery may be the result of subdural anesthesia and postoperative hypoxia. But radiological examination was not performed.

Dose - response for Glycopyrrloate and Heart Rate in Children Anesthetized with Halothane and Nitrous Oxide / 대한마취과학회지

The dose-response for glycopyrrolate and heart rate in anesthetized children has not heen defined. We determined the dose-response for glyeopyrrolate and heart rate in 50 children, ASA physical status l and 2, anesthetized with halothane and nitrous oxide. Anesthesia was induced with 60-70% nitrous oxide in oxygen and halothane(1.5-2.0 vo1%). After induction of aneethesia, glycopyrrolate in a dose of 4, 6, 8, 12 or 16ug Xkg(-1) was administered by rapid infusion to each subject. The effects of glycopyrrolate on heart rate, heart rhythm and systolic blood pressure were compared among dosage groups, and dose-response curve for peak heart rate was constructed, Glycopyrrolate increased the heart rate in a dose-related manner upto 12 ug X kg(-1) except 16 ugX kg(-1). Fifty percent maximal response corresponded to 6.1 ug X kg(-1), and 95% maximal response corresponded to 11.1 ug X kg(-1) . None of the patients had nonsinus rhythm after glycopyrrolate injection. Except for glycopyrrolate given at 4 ug x kg(-1), the systolic blood pressure increased significantly after all other doses. Glycopyrrolate in doses greater than or equal to 6 ug X kg(-1) increased the heart rate and systolic blood pressure in children anesthetized with halothane and nitrous oxide.

Blood pressure monitoring with UV-101 noninvasive beat to beat finger blood pressure monitor / 대한구급학회지

No abstract available.

End - tidal Carbon Dioxide Measurements in the Pediatric Patients : A Comparison of End - tidal PCO2 Sampled from the Proximal and Distal Ends of Pediatric Uncuffed Tracheal Tube / 대한마취과학회지

To determine the accuracy of end-tidal PCO2(PetCO2) measurement analysed with Ohmeda 5210 capnometer in the pediatric patients whose jung were ventilated with Ohio infant Circle Absorber and Ohio Ventilatior 7200, we compared PetCO2, measurements sampled from the proximal(PetCO2-p) and distal(PetCO2-d) ends of the tracheal tube to arterial PCO2(PaCO2) in 22 healthy pediatric patients between 6.8 to 18.5kg. The results were as follow: 1) Proximal PetCO2 and distal PetCO2 correlated with PaCO2(r=0.76%, SEE=2.79, r=0.70:SEE=3.01, respectively)(p<0.05). 2)Arterial to end-tidal PCO2 difference(delta(a-et)PCO2) was significantyly greater with distal(3.53+/-4.68 mmhg) than proximal(0.35+/-2.72 mmhg) sampling(p<0.05). 3) In subgroup of patients whose proximal to distal concentration of nitrous oxide difference was more than 2%, the delta(a-et)PCO2 using distal sampling(7.90+/-5.15 mmhg) was also significantly greater then it was using proximal sampling(-1.73+/-2.39 mmhg)(p<0.05).. We conclude that distal estimates of PetCO2-P can not provide accepatbale estimate of PaCO2 in healthy pediatric patients who are intubated with pediatric uncuffed tracheal tube.

The Clinical Evaluation of Atracurium Besylate for Endotracheal Intubation for Cesarean Section / 대한마취과학회지

The need for a short-acting non-depolarizing neuromuscular blocking agent to replace succinylcholine chloride(succinylcholine) is recognized widely and attempts to find such a drug have been numerous. Atracurium besylate(atracurium) is one of the new series of neuromuscular blocking agents with little cardiovascular effect and is not dependent on hepatic and renal function for terminating its action because of its self-destroying mechanism. Because succinylchline may occasionally be contraindieated for intubation in parturients we studied the use of atracurium in 23 patients having cesarean section. All patients received 0. 5 mg/kg atracurium for intubation and neuromuscular relaxation. Hemodynamic changes, the time from the injection of atracurium to maximal twitch suppression, the time between atracurium administration and the return to 10% of control twitch height were recorded and observed the degree of vocal cord relaxation and conditions of intubation and evaluated the Apgar scores. 1) Mean arterial pressure and heart rate increased significantly after intubation compared with that of control and just before intubation but there were no significant changes in 5 minutes after intubation. 2) The 90% twitch suppression following atracurium administration was 75.6+/-20.9 seconds. 3) The return of 10% of control twitch height was 2449.3+/-1114.0 seconds. 4) Intubation conditions were excellent for 19 patients. 5) The Apgar scores of 20 neonates were high. These data suggest that the use of atracurium may be a useful alternative for induction for Cesarean section when succinylcholine is contraindicated.

The Effects of Metocurine Iodine and Vecuronium Bromide on Intraocular Pressure with the Priming Principle / 대한마취과학회지

We measured the intraocular pressure changes in forty female patients (aged from 20 to 50) without a history of ocular or cardiovascular disease who were classified physical status 1 and 2, and scheduled for elective surgery. They were divided into 4 groups. Group l (n=10); metocurime 0.03 mg/kg as a priming dose and metocurine 0.27 mg/ kg as a intubating dose. Group 2 (n= 10); vecuronium 0.008 mg/kg as a priming dose and vecuronium 0.072 mg as a intubating dose. Group 3 (n=10); vecuronium 0.008mg/kg as a priming dose and metocurine 0.27 mg/kg as a intubating dose. Group 4 (n=10); metocurine 0.03mg/kg as a priming dose and vecuronium 0.072 mg/kg as a intubating dose. In this study, metocurine and vecuronium were used with the priming principle. We also measured changes in blood pressure, pulse rate and T1% of Train of four stimulation and evaluated the discomfort after the administration of the priming dose and the difficulties of intubation. The results were as follows, 1) Compared with the control value, there was no increse in intraocular pressure following intubation in all four groups and intraocular pressure of 2 and 4 minutes following intubation decreased significantly in all four groups. The greatest decrease was seen in group 3, but it was not significant when compared to the other three groups. 2) While a transient increase in blood pressure was seen in all four groups, the lowest increase was seen in group 3 as compared to the control value. Blood pressure 4 minutes following intubation decreased significantly in grop 3. 3) A significant decrease in the T1% of the Train of four stimuli at one minute after administration of the intubating dose was seen in group 3 compared to the other three groups. 4) Group 3 showed the lowest number of difficult intubation. In conclusion, the combination of vecuronium and metoeurine with the priming principle provide optimal conditions for smooth and rapid intubation with no elevation of intraocular pressure, blood pressure and heart rate changes for ocular surgery.

A Comparison of Nalbuphine, Morphine and Placebo as Premedication Agents / 대한마취과학회지

Nalbuphine hydrochloride is a new analgesic structurally related to naloxone, a widely used narotic antagonist, and oxymorphone, a potent narcotic analgesic. Multiple clinical trials have verified the efficacy of nalbuphine in the relief of moderate to severe pain. In general, nalbuphine appears equal to morphine in both medical and surgical use at the same dosage levels and route of administration, although nalbuphine has a slightly longer duration of action. The purpose of this study was to assess the efficacy and side effects of nalbuphine in preoperative medication. Morphine and normal saline as placebo were included for comparison purpose. Eighty four patients who were scheduled to have an elective operation were included in this randomized, double-blind study. The patients received 0.17mg/kg of nalbuphine, 0.12mg/kg of morphine or 1 ml of normal saline respectively. by intramuscular injection one hour before arriving at operation room. Sedation, level of anxiety, emesis, subjective rating on the effect of premedication and side effects were evaluated. The results were as follows: 1) The sedation score was significantly lower in nalbuphine group than placebo group. 2) The level of anxiety was significantly lower in nalbuphine and morphine group than placebo group. 3) The frequency of emesis was not significantly different among three groups. 4) In the subjective rating on the effect of premedication, nalbuphine group was significantly more favorable than placbo group. 5) The side effects such as headache and dizziness were observed, and there were no significant differences in the frequency among three groups. The results indicate that nalbuphine may be recommended as an dffective premedication agent in those situation where opiods are considered as premedication agents.

Myoglobinuria Following General Anesthesia / 대한마취과학회지

The authors experienced a case of myoglobinuria accompanied by generalized myalgia and mild fever that developed 3 hours 30 minutes after general anesthesia. Tracheal intubation was done smoothly 5 minutes after injection of thiopental sodium(275 mg) and pancuronium bromide(6 mg), and anesthesia was maintained with ethrane/N2O/O2(1.5-2%/21/21/min). There was no specific event except tachycardia and fluctuation of blood pressure throughout operation. In this case, we assume that the myoglobinuria is a presentation of the sign of an abortive type of malignant hyperthermia. However, it was not confirmed. We had good patient outeome with the supportive measures of hydration and diuresis. The patient was discharged twenty three days after operation without any complication.

The Effect of Metoclopramide on the Time from Disapprearance of 1 Hz Single Twitch Height to Reappearance of that following injection of Succinylcholine / 대한마취과학회지

Although it has been accepted that metoclopramide provides the effects of antiemetics, enhance- ment of intestinal motility and acts as antagonist on dopamine receptor, there is still controversy over inhibitory action of plasma cholinesterase. We examined the effect of preoperative intravenous administration of metoclopramide 10mg (group 2,4) on the duration of neuromuscular block induced by an intubating dose (1 mg/kg) of succinylcholine. Forty female adult patients were devided into four groups, scheduled for cesarean section (group 3,4) or other elective operations (group 1,2). The 1 H2single twitch height of the adductor pollicis muacle was recorded on paper to 1 H2single twitch stimulus by a nerve stimulator (Accelograph). The patients in group 2 and 4 received metoclopramide 10 mg i.v followed by succinylcholine 1mg/kg, and the patients in group 1 and 3 received succinylcholine 1mg/kg alone. The time from disappearance of 1 H, single twitch height to reappearance of that did not significantly differ between group l and 3. However, there was significant prolongation of the time from disappearance of 1H2single twitch height to reappearance of that in patients who received metoclopramide followed by succinylcholine in group 2 and 4. Also, we examined the effect of preoperative intravenous administration of metoclopramide 10mg on the duration of neuromuscular block by 0.5mg/kg of succinylcholine in twenty female patients for elective operations (group 5,6). There was no significant prolongation of the time from disappearance of 1 H, single twitch height to reappearance of that.