High lead exposure in two leaded bronze ingot foundry workers

BACKGROUND: Awareness about lead poisoning in South Korea has increased; however, occupational exposures occurring in small-scale businesses have not been thoroughly investigated. We report two cases of high lead exposure in a leaded bronze ingot foundry. CASE PRESENTATION: Two employees, a 54-year-old primary operator and a 46-year-old assistant, at a small-scale metalworking company who had been employed for 18 years and 1 month, respectively, showed elevated blood lead levels (61.1 mug/dL and 51.7 mug/dL, respectively) at an occupational health checkup. Neither worker complained of abnormal symptoms nor signs related to lead poisoning. Health assessment follow-ups were conducted and biological exposure indices of lead were calculated every four weeks. After the initial follow-up assessment, both workers were relocated from the foundry process to the metalworking process. In addition, a localized exhaust system was installed after the second follow-up. CONCLUSIONS: Foundry workers in a small-scale businesses might be at high risk of lead exposure because these businesses might be vulnerable to poor industrial hygiene. Therefore, regular occupational health checkups are required.

Postoperative nausea and vomiting after total thyroidectomy: sevoflurane combined with prophylactic ramosetron vs. propofol-based total intravenous anesthesia / 대한마취과학회지

BACKGROUND: The frequent and distressing adverse events (AEs) of postoperative nausea and vomiting (PONV) are of major concern in 63-84% of adult patients undergoing thyroidectomy. We conducted this prospective study to compare two prophylactic strategies; sevoflurane combined with ramosetron and propofol-based total intravenous anesthesia in a homogenous group of non-smoking women undergoing total thyroidectomy. METHODS: In the current prospective study, we enrolled a consecutive series of 64 female patients aged between 20 and 65 years with an American Society of Anesthesiologists physical status of I or II who were scheduled to undergo elective total thyroidectomy under general anesthesia. Patients were randomized to either the SR (sevoflurane and remifentanil) group or the TIVA group. We evaluated the incidence and severity of PONV, the use of rescue anti-emetics and the severity of pain during the first 24 h after surgery. RESULTS: There were no significant differences in the proportion of the patients with a complete response and the Rhodes index, including the occurrence score, distress score and experience score, between the two groups. In addition, there were no significant differences in the proportion of the patients who were in need of rescue anti-emetics or analgesics and the VAS scores between the two groups. CONCLUSIONS: In conclusion, TIVA and ramosetron prophylaxis reduced the expected incidence of PONV in women undergoing total thyroidectomy. In addition, there was no significant difference in the efficacy during the first 24 h postoperatively between the two prophylactic regimens.

Anesthetic requirements and stress hormone responses in chronic spinal cord-injured patients undergoing surgery below the level of injury: nitrous oxide vs remifentanil / 대한마취과학회지

BACKGROUND: Nitrous oxide (N2O) and remifentanil both have anesthetic-reducing and antinociceptive effects. We aimed to determine the anesthetic requirements and stress hormone responses in spinal cord-injured (SCI) patients undergoing surgery under sevoflurane anesthesia with or without pharmacodynamically equivalent doses of N2O or remifentanil. METHODS: Forty-five chronic, complete SCI patients undergoing surgery below the level of injury were randomly allocated to receive sevoflurane alone (control, n = 15), or in combination with 67% N2O (n = 15) or target-controlled infusion of 1.37 ng/ml remifentanil (n = 15). Sevoflurane concentrations were titrated to maintain a Bispectral Index (BIS) value between 40 and 50. Measurements included end-tidal sevoflurane concentrations, mean arterial blood pressure (MAP), heart rate (HR), and plasma catecholamine and cortisol concentrations. RESULTS: During surgery, MAP, HR, and BIS did not differ among the groups. Sevoflurane concentrations were lower in the N2O group (0.94 +/- 0.30%) and the remifentanil group (1.06 +/- 0.29%) than in the control group (1.55 +/- 0.34%) (P < 0.001, both). Plasma concentrations of norepinephrine remained unchanged compared to baseline values in each group, with no significant differences among groups throughout the study. Cortisol levels decreased during surgery as compared to baseline values, and returned to levels higher than baseline at 1 h after surgery (P < 0.05) without inter-group differences. CONCLUSIONS: Remifentanil (1.37 ng/ml) and N2O (67%) reduced the sevoflurane requirements similarly by 31-39%, with no significant differences in hemodynamic and neuroendocrine responses. Either remifentanil or N2O can be used as an anesthetic adjuvant during sevoflurane anesthesia in SCI patients undergoing surgery below the level of injury.

Effects of inspired oxygen fraction in discriminating venous from arterial blood in percutaneous central venous catheterization under general anesthesia / 대한마취과학회지

BACKGROUND: A low fraction of inspired oxygen (FiO2) increases venous deoxygenated hemoglobin concentrations, making the color of the blood darker. The present study was aimed to determine the effects of FiO2 on the ability to discriminate venous from arterial blood. METHODS: One-hundred and sixty surgical patients undergoing percutaneous central venous access of the internal jugular vein were randomly assigned to receive an FiO2 of 0.2, 0.4, 0.6, or 1.0 (n = 40 each) for at least 20 min prior to central line placement under general anesthesia. Vascular access was achieved with a 22-gauge needle; 2 ml of blood was withdrawn and shown to three physicians including the operator. Each of them was asked to identify the blood as 'arterial', 'venous' or 'not sure'. Simultaneous blood gas analysis of the samples was performed on blood taken from the puncture site and the artery after visual comparison to confirm blood's origin and hemodynamic measurements. RESULTS: Lowering FiO2 progressively increased venous deoxygenated hemoglobin concentrations (2.24 +/- 1.12, 3.30 +/- 1.08, 3.66 +/- 1.15, and 3.71 +/- 1.33 g/dl) in groups having an FiO2 of 1.0, 0.6, 0.4 and 0.2, respectively (P < 0.001), thereby facilitating the 'venous' blood identification (P < 0.001). Neither heart rate nor mean arterial pressure differed among the groups. None developed hypoxemia (percutaneous hemoglobin oxygen saturation < 90%) in any group during the study period. CONCLUSIONS: A low FiO2 increases venous deoxygenated hemoglobin levels, thereby facilitating the recognition by clinicians of its venous origin in percutaneous central venous catheterization under general anesthesia.

Bioequivalence Study of Two Orally Disintegrating Risperidone Formulations, Risperdal OD(R) Tablet 1mg and Risperdal Quicklet(R) Tablet 1mg in Healthy Korean Volunteers

BACKGROUND: Risperidone is one of the atypical antipsychotic drugs that have effectiveness in the management of a range of psychiatric illnesses. Orally disintegrating (OD) formulations of risperidone that rapidly dissolve in the mouth, prior to swallowing without water have been developed to overcome any problems related to swallowing and improve acceptability. The goal of this study was to evaluate the bioequivalence of Risperdal OD(R) tablet 1mg and Quicklet(R) tablet 1mg. METHODS: This randomized, open-label, 2-way crossover trial was conducted in 36 healthy male volunteers that received OD risperidone tablet, either the reference formulation (Risperdal Quicklet(R) tablet 1mg), or the test formulation (Risperdal OD(R) tablet 1mg), each in a single administration. Blood samples were obtained during a 24-hour period after dosing. Plasma was analyzed for risperidone by a validated LC-MS/MS. Adverse events were monitored by safety assessments including clinical interview by clinician. Pharmacokinetics were calculated by noncompartmental analysis and compared between two formulations. RESULTS: A total of 36 male volunteers (mean age, 24.2 years; height 174.5 cm; weight 67.6 kg) completed the study. The ANOVA showed no significant effect of sequence, formulation and period of Ln (AUClast) and Ln (Cmax). The 90% confidence intervals for the mean treatment ratios of the Ln (AUClast) and Ln (Cmax) were Ln 0.96 ~ Ln 1.12, Ln 0.97 ~ Ln 1.16, respectively. No serious adverse events were caused by both formulations. CONCLUSION: In this study, a single administration of Risperdal OD(R) tablet 1mg was bioequivalent to a single administration of Risperdal Quicklet(R) tablet 1mg.

Postoperative nausea and vomiting after mastoidectomy with tympanoplasty: a comparison between TIVA with propofol-remifentanil and balanced anesthesia with sevoflurane-remifentanil / 대한마취과학회지

BACKGROUND: There is growing interest in the anesthetic approach using total intravenous anesthesia (TIVA) with propofol and remifentanil for the prevention of postoperative nausea and vomiting (PONV). The aim of this study was to compare between the two anesthetic techniques for preventing PONV in the patients undergoing mastoidectomy with tympanoplasty. METHODS: After obtaining informed consent, 62 patients aged between 20 to 60 years undergoing elective mastoidectomy and tympanoplasty were randomized into two equal study groups: group P/R (n = 31) included patients undergoing TIVA with propofol and remifentanil, and group S/R (n = 31) included patients undergoing balanced anesthesia with sevoflurane and remifentanil. The incidences of PONV and complete response (no PONV, no rescue) were assessed at 1 and 24 h after surgery, using the Rhodes Index. Also, the usage of rescue antiemetics and pain intensity were recorded. RESULTS: The Rhodes Index including the occurrence score, distress score and experience score was significantly lower in the P/R group compared to that in the S/R group during the study period (P < 0.05), and the incidence of complete response was significantly higher in the P/R group compared to that in the S/R group, during the first 24 h after surgery. 4 patients in the S/R group requested antiemetics during the first 1 h after surgery. There were no significant differences in pain intensity among groups. CONCLUSIONS: Compared to balanced anesthesia with sevoflurane and remifentanil, TIVA with propofol and remifentanil was followed by significantly lower incidence and severity of PONV.

The effect of priming injection of different doses of remifentanil on injection pain of microemulsion propofol premixed with lidocaine / 대한마취과학회지

BACKGROUND: The injection pain of microemulsion propofol is frequent and difficult to prevent. This study examined the prevention of pain during microemulsion propofol injection by pretreatment with different doses of remifentanil or saline, and premixing of lidocaine. METHODS: One hundred sixty ASA physical status 1-2 adult patients scheduled for elective surgery were enrolled into one of four groups (n = 40, in each). The patients received saline (group LS), remifentanil 0.3 microg/kg (group LR 0.3), remifentanil 0.5 microg/kg (group LR 0.5), or remifentanil 1.0 microg/kg (group LR 1.0), and after 90 seconds received an injection of 2 mg/kg microemulsion propofol premixed with lidocaine 40 mg. Pain was assessed on a four-point scale during microemulsion propofol injection. RESULTS: The incidence of microemulsion propofol-induced pain was significantly lower in the LR 0.3, LR 0.5 and LR 1.0 groups than in the LS group (37.5%, 12.5% and 10% vs 65%, respectively). The LR 0.5 and LR 1.0 groups showed significantly less frequent and intense pain than the LR 0.3 group. However, both incidence and severity of pain were not different between LR 0.5 and LR 1.0 groups. CONCLUSIONS: The combination of remifentanil and lidocaine is effective in alleviating pain associated with a microemulsion propofol injection compared with just lidocaine. Remifentanil 0.5 microg/kg had a similar analgesic effect compared to the 1.0 microg/kg dose.

Maternal and neonatal effects of remifentanil used during induction of general anesthesia in preeclamptic patients undergoing cesarean delivery / 대한마취과학회지

BACKGROUND: Endotracheal intubation elicits cardiovascular and arousal responses. The present study was aimed to determine whether remifentanil affects these responses in patients with preeclampsia. METHODS: Thirty preeclamptic women who were scheduled to undergo cesarean delivery under general anesthesia were randomly assigned to receive either remifentanil 1 microgram/kg (n = 15) or saline (n = 15) before induction of anesthesia. Systolic arterial pressure (SBP), heart rate (HR) and bispectral index (BIS) value as well as plasma catecholamine concentrations were measured. Neonatal effects were assessed using Apgar score and umbilical cord blood gas analysis. RESULTS: Induction with thiopental caused a reduction in SBP and BIS (P < 0.01) in both groups. Following the tracheal intubation SBP and HR increased in both groups, the magnitude of which was lower in the remifentanil group. BIS values also increased, of which magnitude did not differ between the groups. Norepinephrine concentrations increased significantly following the intubation in the control, while remained unaltered in the remifentanil group. The neonatal Apgar scores (5 min), and umbilical gas values were similar in the two groups except for higher incidence of Apgar score < 7 at 1 min in the remifentanil group. CONCLUSIONS: Remifentanil 1 microgram/kg effectively attenuates hemodynamic and catecholamine but not BIS responses to tracheal intubation in preeclamptic patients undergoing cesarean delivery. However, remifentanil may cause mild neonatal depression and thus should be used when adequate facilities for neonatal resuscitation are available.

Hemodynamic Changes according to the Remifentanil Effect Site Concentration for Patients under Total Intravenous Anesthesia during Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Laryngeal microscopic surgery directly stimulates an airway via endotracheal intubation and insertion of a suspension laryngoscope, and this can result in acute elevation of the blood pressure and heart rate. Therefore, an anesthesia that can maintain a sufficient depth of anesthesia and simultaneously makes awakening and recovery possible in a short period is required. We wanted to present the effect site concentration of remifentanil for achieving the best anesthesia by observing the hemodynamic changes according to the effect site concentration of remifentanil. METHODS: 36 patients, who corresponded with the ASA physical status classification 1 and 2 and who were from 20 to 70 years old, were the subjects of this study. They were randomly classified into three groups according to the effect site concentration of remifentanil. Propofol 4microgram/ml was infused continuously, and remifentanil was continuously infused for each group to achieve an effect site concentration of 4 ng/ml, 6 ng/ml, and 8 ng/ml, respectively. Rocuronium 0.5 mg/kg was used. The arterial blood pressures and heart rates were measured before induction of anesthesia, before endotracheal intubation, after endotracheal intubation and after insertion of a suspension laryngoscope. RESULTS: In comparison with the other groups, the 4 ng/ml remifentanil group was able to prevent acute elevation of blood pressure and heart rate. CONCLUSIONS: For total intravenous anesthesia using propofol and remifentanil, 4 ng/ml of remifentanil is proposed to be the effect site concentration that is able to stably maintain blood pressure and heart rate during laryngeal microscopic surgery.

Comparison of Anesthetic Techniques for Preventing Postoperative Nausea and Vomiting Undergoing Thyroidectomy / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the anesthetic techniques for preventing postoperative nausea and vomiting (PONV) in the patients undergoing thyroidectomy. METHODS: Sixty patients of ASA status I or II, undergoing thyroidectomy were studied. Patients were allocated randomly to one of three groups. Group 1 (n = 22): anesthesia was induced by propofol (2 mg/kg) and maintained with desflurane and 50% nitrous oxide in oxygen. Group 2 (n = 22): anesthesia was induced and maintained propofol and alfentanil using a computer controlled infusion system in 60% medical air in oxygen. Group 3 (n = 16): anesthesia was induced propofol using computer controlled infusion system in combination 50% nitrous oxide in oxygen. The incidence of PONV was assessed at 6 and 24 hours after the surgery and standardized by Rhodes index of nausea, vomiting and retching (RINVR) score. RESULTS: In group 3, the incidence of PONV within the first 6 hours after surgery, was significantly lower as P < 0.05. But, there was no statistical differences among the three groups in the 6 to 24 hours' RINVR score after surgery. CONCLUSIONS: The use of propofol for induction and maintenance with combination 50% N2O is the most effective technique at preventing PONV among the three groups within the first 6 hours after thyroidectomy. This study found no statistically significant difference between the RINVR score, using desflurane-N2O and propofol-alfentanil.

Re-expansion Pulmonary Edema after Chest Tubing: A Case Report / 대한구급학회지

Re-expansion pulmonary edema (RPE) is a rare complication associated with the treatment of collapsed lung caused by pneumothorax, atelectasis, pleural effusion in which a large amount of air or effusion fluid is evacuated. In general RPE is resulted from more than 3 days of lung collapse and application of high negative intrapleural pressure. However, it is reported that RPE could be developed despite the collapse period is short and negative pressure suction is not performed. It also has been known that the rate of reexpansion is more important than amount of evacuated air, or collapse period in the development of RPE. Seventeen-year-old female was undergone suture hemostasis for liver laceration, in which RPE was occurred after closed thoracostomy for pleural effusion on postoperative-27 day. We present a case report with review of related articles.

Effects of a Combination of Nicardipine and Alfentanil on Hemodynamic Response after Endotracheal Intubation / 대한마취과학회지

BACKGROUND: The present study was designed to examine the effect of a combination of nicardipine and low dose alfentanil on hemodynamic response following endotracheal intubation. METHODS: Thirty patients (20-65 yr) were assigned randomly to receive nicardipine (N: 20microgram/kg) or a combination of nicardipine and low dose of alfentanil (NA: nicardipine 10microgram/kg and alfentanil 5microgram/kg). Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured at 1, 2 min after anesthetic induction, and every minute for 5 min after intubation. RESULTS: The magnitude of increases in SBP and DBP were non-significantly smaller in the NA group than in the N group, and increase in HR were significantly lower in the NA group. CONCLUSIONS: These results indicate that the nicardipine with alfentanil combination was more effective than nicardipine alone at attenuating blood pressure and heart rate increases following intubation.

Effect of Zaprinast, a Phosphodiesterse Inhibitor, on Formalin-induced Nociception and Hemodynamics in the Rat Spinal Cord / 대한마취과학회지

BACKGROUND: Cyclic guanosine monophosphate (cGMP) is involved in antinociception and vascular relaxation. The effects of zaprinast, which increases the level of cGMP by inhibiting phosphodiesterase, in the spinal cord have not been reported. The aims of this study were to evaluate the effects of intrathecal zaprinast on stimulus evoked by formalin injection, and to observe hemodynamic change in the absence of formalin stimulation. METHODS: Rats were implanted with lumbar intrathecal catheters. Intrathecal zaprinast was administered 10 min before formalin injection. After formalin injection, formalin-induced nociceptive behavior (flinching response) was observed for 60 min. Mean arterial pressure (MAP) and heart rate (HR) were measured after intrathecal delivery of zaprinast for a period of 60 min. RESULTS: Intrathecal administration of zaprinast produced a dose-dependent suppression of flinches in both phases. Zaprinast had no evident effects on baseline MAP or HR. CONCLUSIONS: Zaprinast, a phosphodiesterase inhibitor, is active against the nociceptive state evoked by formalin stimulus without affecting resting MAP or HR. Accordingly, spinal zaprinast may be useful in the management of tissue-injury induced pain.

Hypertrophic Scar with Chronic Pain after Acute Herpes Zoster: A case report / 대한통증학회지

The most common and cumbersome complication of herpes zoster is postherpetic neuralgia, which typically presents as neuropathic pain. However, the painful symptoms of the postherpetic period might be associated with other causes, such as skin lesions of the herpes zoster. We report a case of a hypertrophic scar that developed in the lesion of an acute herpes zoster patient and was accompanied by pain.

Cardiovascular Responses to Endotracheal Intubation in Patients with Acute and Chronic Spinal Cord Injuries / 대한마취과학회지

BACKGROUND: We investigated whether the cardiovascular responses to intubation change as a function of the time elapsed in patients with spinal cord injury. METHODS: One hundred and fifty eight patients with traumatic complete spinal cord injury were grouped according to the time elapsed after injury (less than and more than 4 wks) and the level of injury (above C7, T1-T4, and below T5). There were six groups: acute quadriplegia (n = 28), chronic quadriplegia (n = 29), acute high paraplegia (n = 8), chronic high paraplegia (n = 11), acute low paraplegia (n = 29) and chronic low paraplegia (n = 53). Twenty-five patients with no spinal cord injury served as controls. Systolic arterial blood pressure (SAP), heart rate, and plasma concentrations of catecholamines were measured. RESULTS: The intubation did not affect SAP in acute and chronic quadriplegics, but significantly increased SAP in the other groups. The magnitude of peak increase was less in acute high paraplegics (P<0.05), but comparable in chronic high paraplegics, and acute and chronic low paraplegics to that of the controls. Heart rates were significantly increased in all groups. However, the magnitude of this increase was smaller in acute quadriplegics and in acute high paraplegics than in the controls (P<0.05). Plasma concentrations of norepinephrine increased in all groups except in acute quadriplegics (P<0.05). The magnitude of this increase was attenuated in chronic quadriplegics, accentuated in acute low paraplegics, and similar in acute and chronic high paraplegics and in chronic low paraplegics versus the controls. CONCLUSIONS: The cardiovascular and plasma catecholamine responses to endotracheal intubation may differ according to the time elapsed and the affected level in patients with complete spinal cord injuries.

Considerations of Adequate Inspiratory Sevoflurane Concentrations in General Anesthesia for Caesarean Section / 대한마취과학회지

BACKGROUND: In cases that receive inhalation anesthesia for cesarean section, there is a high risk of recall. So the bispectral index (BIS) is useful for measuring the depth of anesthesia. This study was designed to determine optimal inspiratory sevoflurane concentrations and BIS index values during cesarean section. METHODS: We randomized 30 patients scheduled for elective cesarean section to receive inspiratory sevoflurane 1.0 vol% (group 1, n = 10), inspiratory sevoflurane 1.5 vol% (group 2, n = 10), inspiratory sevoflurane 2.0 vol% (group 3, n = 10) in a 50% nitrous oxide oxygen mixture. Each group was assessed for BIS, blood pressure, heart rate, and end tidal sevoflurane concentration at the point of preinduction, skin incision, uterine incision, delivery, and at 1, 2, 3, 5 and 10 minutes after delivery. Responsiveness to verbal commands using the Tunstall isolated forearm technique, was detected throughout the study period. Neonatal effect was assessed using Apgar scores at 1 and 5 minutes. RESULTS: The BIS index was lower in group 3 than in group 1 from the point of delivery (P<0.05) and the BIS index in group 2 was lower than in group 1 from 1 minute after delivery (P<0.05). However blood pressures, heart rates, and Apgar scores were not significantly different among the groups. No awareness was observed any subject. CONCLUSIONS: We found that the use of inspiratory sevoflurane 2.0 vol% (endtidal 1.2 vol%) maintained a BIS index of under 60.

Correlations between the Modified Observer's Assessment of Alertness/Sedation Scale, Bispectral Index and Propofol Effect Site Concentrations in Sedated Elderly Patients under Regional Anesthesia / 대한마취과학회지

BACKGROUND: To maintain an adequate sedation level in elderly patients (over 65 years) under regional anesthesia, we evaluated the correlations between the modified observer's assessment of alertness/sedation (OAA/S) scale, bispectral index (BIS), propofol effect site concentrations. METHODS: In elderly patients (over 65 years) scheduled for transurethral resection of a bladder tumor or prostate, we measured BISs and started propofol infusion using the target controlled infusion (TCI) method to sedate patients after regional anesthesia. OAA/S composite scores, measured BISs propofol effect site concentrations and vital signs were determined. RESULTS: When the OAA/S composite score was 5, mean BIS was 97.2 +/- 1.1; when the OAA/S was 4, mean BIS was 84.3 +/- 4.6 and mean propofol effect site concentration was 0.8 +/- 0.3microgram/ml; when the OAA/S was 3, mean BIS was 78.4 +/- 4.3 and mean propofol effect site concentration was 1.2 +/- 0.3microgram/ml; and when the OAA/S was 2, mean BIS was 73.2 +/- 5.9 and mean propofol effect site concentration was 1.5 +/- 0.4microgram/ml. The OAA/S scale was found to be well correlated with BIS (Pearson's r = 0.973) and the propofol effect site concentration (Pearsons's r = -0.968). BIS was also well correlated with propofol effect site concentration (Pearson's r = -1.0). CONCLUSIONS: BIS was found to be a good tool for monitoring sedation level in elderly patients under regional anesthesia with propofol sedation.

Vocal Cord Paralysis after the Coronary Artery Bypass Graft: A Case Report / 대한구급학회지

Surgical trauma has long been recognized as the most common cause of unilateral and bilateral vocal cord paralysis. We experienced a case of bilateral vocal cord paralysis after off-pump coronary artery bypass graft. The patient was repeated intubation and extubation after operation in surgical intensive care unit. Fiberoptic bronchoscopy revealed bilateral vocal cord paralysis in the patient. The patient recovered after permanent tracheotomy. We reported a case of vocal cord paralysis after coronary artery bypass graft.

Effects of Alfentanil on Hemodynamic and Catecholamine Responses to Laryngoscopy and Endobronchial Intubation in the Elderly / 대한구급학회지

BACKGROUND: Endobronchial intubation should elicit significant circulatory responses. We examined the effects of alfentanil on hemodynamic and catecholamine responses to endobronchial intubation in elderly patients. METHODS: A total of 60 patients aged over 60 years requiring endobronchial intubation were randomized into three groups of 20 patients each. Anesthesia was induced with thiopental 4~6 mg/kg followed by saline (placebo) or alfentanil 10 or 30microgram/kg given as a bolus over 30 s. Succinylcholine 1 mg/kg was given for neuromuscular block. Laryngoscopy and intubation were performed 1 min later. RESULTS: The intubation significantly increased systolic arterial pressure and heart rate. The maximum pressure changes from pre-intubation values in both alfentanil groups (58+/-27 and 33+/-30 mm Hg in 10 and 30microgram/kg, respectively) were significantly lower compared with that of 83+/-35 mm Hg in the control group. The tachycardiac response was not significantly affected by alfentanil 10microgram/kg, but attenuated by alfentanil 30microgram/kg. The plasma norepinephrine concentrations were increased, which was not affected by alfentanil 10microgram/kg, but was significantly attenuated by alfentanil 30microgram/kg. Both doses of alfentanil abolished the increase of plasma epinephrine concentrations. Three patients in the 30microgram/kg group received ephedrine for hypotension. CONCLUSIONS: This study showed that endobronchial intubation elicited significant pressor response, and that alfentanil 30microgram/kg is more efficacious in attenuating the hemodynamic and catecholamine responses, although potential hypotension warrants a caution of its use, in elderly patients.

Influence of Collapse and Re-ventilation of Lung on the Development of Pulmonary Edema / 대한구급학회지

BACKGROUND: This study was to clarify the influence of collapse and re-ventilation of lung on the development of pulmonary edema in rabbit. METHODS: Animals were randomly assigned to one of three groups: Sham group receiving two lung ventilation (n=14), Collapse group receiving collapse of right lung (n=14), Reventilation group receiving collapse of right lung for 3 hours followed by reventilation of collapsed right lung for 3 hours (n=14). The lung of rabbits were ventilated with 50% oxygen through the tracheostomy. Right main bronchus was secured by thoracotomy in all animal. Collapse and reventilation were performed using by bulldog forcep. Mean arterial pressure, heart rate, arterial oxygen tension (PaO2), peripheral blood leukocyte and platelet counts were recorded at 0, 1, 2, 3, 4, 5 and 6 hour after the start of experiment. The wet to dry (W/D) weight ratio of lung, lung injury score and leukocyte counts, percentage of polymorphonuclear leukocyte (PMNL), concentration of albumin, and interleukin-8 (IL-8) in bronchoalveolar lavage fluid (BALF) were measured 6 hour after the start of experiment in both lung. RESULTS: W/D weight ratio of lung, lung injury score and leukocyte counts, percentage of PMNL, concentration of albumin and IL-8 in BALF were significantly increased in both lung of reventilation group. And the degree of increases is more significant in right than left lung. CONCLUSIONS: These findings suggest that reventilation of collapsed lung causes the bilateral pulmonary edema in rabbit mainly by activating neutrophil and IL-8 responses, which may play a central role in non cardiogenic pulmonary edema.