Vasopressin ameliorates hypotension induced by beach chair positioning in a dose-dependent manner in patients undergoing arthroscopic shoulder surgery under general anesthesia / 대한마취과학회지

BACKGROUND: The beach chair position (BCP) is associated with hypotension that may lead to cerebral ischemia. Arginine vasopressin (AVP), a potent vasoconstrictor, has been shown to prevent hypotension in BCP. It also improves cerebral oxygenation in different animal models. The present study examined the effect of escalating doses of AVP on systemic hemodynamics and cerebral oxygenation during surgery in BCP under general anesthesia. METHODS: Sixty patients undergoing arthroscopic shoulder surgery in BCP under general anesthesia were randomly allocated to receive either saline (control, n = 15) or three different doses of AVP (0.025, 0.05, or 0.075 U/kg; n = 15 each) 2 minutes before BCP. Mean arterial pressure (MAP), heart rate (HR), regional cerebral oxygen saturation (SctO2), and jugular venous oxygen saturation (SjvO2) were measured after induction of anesthesia and before (presitting in supine position) and after BCP. RESULTS: AVP per se given before BCP increased MAP, and decreased SjvO2, SctO2, and HR in all patients (P 20% SctO2 decrease from the baseline value) with no differences in SjvO2 and the incidence of SjvO2 < 50% or SjvO2 < 40% among the groups. CONCLUSIONS: AVP ameliorates hypotension associated with BCP in a dose-dependent manner in patients undergoing shoulder surgery under general anesthesia. However, AVP may have negative effects on SctO2 before and after BCP and on SjvO2 before BCP.

Cardiovascular and arousal responses to single-lumen endotracheal and double-lumen endobronchial intubation in the normotensive and hypertensive elderly / 대한마취과학회지

BACKGROUND: Endotracheal intubation usually causes transient hypertension and tachycardia. The cardiovascular and arousal responses to endotracheal and endobronchial intubation were determined during rapid-sequence induction of anesthesia in normotensive and hypertensive elderly patients. METHODS: Patients requiring endotracheal intubation with (HT, n = 30) or without hypertension (NT, n = 30) and those requiring endobronchial intubation with (HB, n = 30) or without hypertension (NB, n = 30) were included in the study. Anesthesia was induced with intravenous thiopental 5 mg/kg followed by succinylcholine 1.5 mg/kg. After intubation, all subjects received 2% sevoflurane in 50% nitrous oxide and oxygen. Mean arterial pressure (MAP), heart rate (HR), plasma catecholamine concentration, and Bispectral Index (BIS) values, were measured before and after intubation. RESULTS: The intubation significantly increased MAP, HR, BIS values and plasma catecholamine concentrations in all groups, the peak value of increases was comparable between endotracheal and endobronchial intubation. However, pressor response persisted longer in the HB group than in the HT group (5.1 +/- 1.6 vs. 3.2 +/- 0.9 min, P < 0.05). The magnitude of increases in MAP and norepinephrine from pre-intubation values was greater in the hypertensive than in the normotensive group (P < 0.05), while there were no differences in those of HR and BIS between the hypertensive and normotensive groups. CONCLUSIONS: Cardiovascular response and arousal response, as measured by BIS, were similar in endobronchial and endotracheal intubation groups regardless of the presence or absence of hypertension except for prolonged pressor response in the HB group. However, the hypertensive patients showed enhanced cardiovascular responses than the normotensive patients.

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.

The Effect of Doxapram Hydrochloride on the Ventilation Responses during Total Intravenous Anesthesia by Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: Intravenous anesthetics causes depression of ventilatory response to hypercapnea. Doxapram stimulates ventilation via peripheral and central chemoreceptors. This study was aimed to evaluate the effect of doxapram on ventilation during total intravenous anesthesia (TIVA). METHODS: 60 patients undergoing operation under spontaneous ventilation via laryngeal mask airwaywere randomly divided into 3 groups: Control group received 5% dextrous infusion, D-2 group received doxapram injection of 1 mg/kg followed by continuous infusion of 2 mg/kg/hr, and D-4 group received doxapram injection of 2 mg/kg followed by continuous infusion of 4 mg/kg/hr. Anesthesia was induced and maintained with propofol and remifentanil. Respiratory rate, tidal volume (VT) and arterial carbon dioxide tension (PaCO2) were measured before and 15 min after induction of anesthesia, 0(15 min after start of operation), 1, 2, 3, 5, 15, 30, 45, and 60 min after start of doxapram infusion during TIVA. RESULTS: VT was significantly increased 1 min after start of doxapram infusion and returned to the value of pre-doxapram infusion immediately. In D-4 group, VT was significantly (P < 0.05) increased again 5 min after doxapram infusion compared with the value of pre-doxapram infusion and control group. PaCO2 was decreased 1 min after start of doxapram infusion and then increased again 2 min after doxapram infusion. In D-4 group, the degree of increase of PaCO2 was significantly (P < 0.05) less than those of D-2 group. CONCLUSIONS: Doxapram injection of 2 mg/kg followed by continuous infusion of 4 mg/kg/hr improved the depression of ventilatory response during TIVA.

Effects of Nitrous Oxide and Desflurane on Cardiovascular Responses to Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Endotracheal intubation often results in hypertension and tachycardia. Desflurane and nitrous oxide (N2O) are known to augment the sympathetic nervous activity. We examined whether N2O and desflurane affect the cardiovascular responses to the intubation. METHODS: One hundred-fifty patients were assigned randomly to receive one of six treatment regimens (n = 25 each): 2% sevoflurane (control), 6% desflurane or 12% desflurane with and without 75% N2O, respectively. General anesthesia was induced with intravenous thiopental (5-7 mg/kg), and tracheal intubation was facilitated with intravenous vecuronium (0.12 mg/kg). N2O was started 3 min before and desflurane soon after the intubation. Systolic arterial blood pressure (SAP), heart rate (HR), and plasma catecholamine concentrations were determined. RESULTS: The intubation increased SAP and HR in all groups within 1 min. A second increase was noted with 12% desflurane at 3 to 5 min after the intubation. N2O did not affect the tachycardiac response, but attenuated the pressor response to both intubation and 12% desflurane. The plasma concentrations of norepinephrine increased significantly at 1 min after the intubation in all groups with more pronounced rise in N2O groups, and increased further at 5 min in the 12% desflurane groups. CONCLUSIONS: A biphasic increase of SAP and HR was noted with 12% desflurane. The first increase may be related with the mechanical stimulus of the tracheal intubation and the second with the desflurane itself. Although N2O did not affect the tachycardiac responses and augmented norepinephrine release, it suppressed the pressor responses.

Hemolytic Uremic Syndrome Occurred after Esophagectomy: A Case Report / 대한구급학회지

Hemolytic uremic syndrome is an unusual and uncommon disease in adults but more common in children, which is defined by the triad of acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. We report a 64-year-old man who developed hemolytic uremic syndrome after esophagectomy and esophagogastrostomy due to esophageal cancer. We treated him using continuous renal replacement therapy and plasmapheresis with large volume fresh frozen plasma transfusion for 9 days. We could not find the cause of hemolytic uremic syndrome, and so finally concluded that it is idiopathic. Bleeding continuously without a particular reason after an operation, it needs an early diagnosis and treatment with considering a possibility of the hemolytic uremic syndrome.

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.

Comparison of the Effects on Increase of Heart Rate and Blood Pressure between Tracheal Intubation and Desflurane Inhalation during Propofol Anesthesia / 대한마취과학회지

BACKGROUND: This study was undertaken to compare the hemodynamic effects between desflurane inhalation and endotracheal intubation, and to evaluate the intensity of airway irritation by desflurane inhalation of high concentration. METHODS: Twenty adult patients with ASA 1 were enrolled in this study. Radial artery was catheterized and heart rate (HR) and mean arterial pressure (MAP) were measured throughout the study. Anesthesia was induced by propofol and effect site concentration of propofol was maintained at 4microgram/ml using target controlled infusor (TCI). Peak HR and MAP following tracheal intubation were recorded and inhalation of 12 vol% desflurane was started after HR and MAP had been returned to pre-intubation value. The HR, MAP, inspiratory (Fi) and end-tidal fraction (Et) were observed after desflurane inhalation for 10 minutes. RESULTS: The HR and MAP were significantly increased after tracheal intubation and desflurane inhalation, and the peak hemodynamic change after desflurane inhalation was significantly delayed as compared to tracheal intubation. The maximal HR change from baseline after tracheal intubation or desflurane inhalation was not different, but maximal MAP change was significantly lower during desflurane inhalation compared with tracheal intubation. The maximal change of HR and MAP when end-tidal fraction of desflurane had been reached 6 vol% was lower than that of tracheal intubation or desflurane inhalation. CONCLUSIONS: Despite of propofol administration required for general anesthesia, the HR and MAP were significantly increased during desflurane inhalation of high concentration. In particular, the extent of HR increase during desflurane inhalation was similar to that by tracheal intubation.

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.

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.

The Effect of Lidocaine on Propofol-induced Hemodynamic Changes during Induction of Anesthesia in Elderly Patients / 대한마취과학회지

BACKGROUND: Propofol has a high incidence of pain when administered by intravenous injection. Among the many different methods available, lidocaine is used most frequently to minimize this pain. Propofol also has a depressant action on hemodynamics, especially in the elderly. The present study was aimed to examine whether lidocaine affects hemodynamic changes associated with propofol injection and endotracheal intubation, and whether it attenuates propofol-induced pain. METHODS: Eighty patients, over 60 years old, ASA physical status I and II, were randomly divided into four groups of 20 each according to lidocaine dosage mixed with 2 mg/kg of propofol given over 30 seconds during the induction of anesthesia; 0 mg (control group), 20 mg, 40 mg and 80 mg. Mean arterial blood pressure (MAP), heart rate (HR), and bispectral index scale (BIS) were measured before anesthetic induction (baseline value), 1 minute after the start of induction, immediately before endotracheal intubation, and then every minute for 5 minutes. Injection pain was scored as none, mild, moderate, or severe. RESULTS: MAP decreased significantly following the propofol injection and then increased after endotracheal intubation in all four groups, the magnitude of this decrease did not differ among the groups. HR increased after the propofol injection and then decreased. It increased again after intubation in all four groups. BIS was decreased by the induction of anesthesia, but was not affected by endotracheal intubation in any group. The three lidocaine groups had a lower incidence and severity of propofol-induced pain than the control group, and the effect were comparable among the lidocaine-treated groups. CONCLUSIONS: Our results indicate that lidocaine 20, 40 or 80 mg mixed with propofol does not affect the hemodynamic changes associated with propofol and endotracheal intubation, but that they similarly attenuate the injection pain associated with propofol.

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.

Antinociceptive Effects of Intrathecal Metabotropic Glutamate Receptor Compounds and Morphine in Rats / 대한통증학회지

BACKGROUND: Spinal metabotropic glutamate receptors (mGluRs) and opioid receptors are involved in the modulation of nociception. Although opioid receptors agonists are active for pain, the effects of the compounds for the mGluRs have not been definitely investigated at the spinal level. We examined the effects of the intrathecal mGluR compounds and morphine in the nociceptive test, and then we further clarified the role of the spinal mGluRs. In addition, the nature of the pharmacological interaction after the coadministration of mGluRs compounds with morphine was determined. METHODS: Catheters were inserted into the intrathecal space of male SD rats. For the induction of pain, 50microl of 5% formalin solution or a thermal stimulus was applied to the hindpaw. An isobolographic analysis was used for the evaluation of the drug interaction. RESULTS: Neither group I mGluR compounds nor group III mGluR compounds produced any antinociceptive effect in the formalin test. The group II mGluR agonist (APDC) had little effect on the formalin-induced nociception. The group II mGluR antagonist (LY 341495) caused a dose-dependent suppression of the phase 2 flinching response on the formalin test, but it did not reduce the phase 1 response of the formalin test nor did it increase the withdrawal latency of the thermal stimulus. Isobolographic analysis revealed a synergistic interaction after the intrathecal delivery of a LY 341495-morphine mixture. CONCLUSIONS: These results suggest that group II mGluRs are involved in the facilitated processing at the spinal level, and the combination of LY 341495 with morphine may be useful to manage the facilitated pain state.

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.

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 Amrinone and Dobutamine on Regional Myocardial Function and Oxygen Balance in Normal and Stunned Myocardium in Dogs / 대한구급학회지

BACKGROUND: We examined the effects of amrinone and dobutamine on regional mechanical function, coronary blood flow (CBF), and myocardial oxygen consumption (MVO2) in normal and stunned myocardium in an open-chest canine model. METHODS: Dogs were instrumented to measure aortic and left ventricular pressures, pulmonary and left anterior descending (LAD) coronary blood flows, and subendocardial segment length in the region supplied by LAD. Incremental doses of either amrinone (2~10microgram/ml of LAD flow, n=13) or dobutamine (0.05~0.375microgram/ml of LAD flow, n=14) were directly infused into a coronary artery before (normal) and after a 15 min of LAD occlusion and subsequent 30 min-reperfusion (stunned). Percent segment shortening (%SS) and percent post-systolic shortening (%PSS) were evaluated. Myocardial extraction of oxygen (EO2) and lactate (Elac) was calculated. RESULTS: Amrinone or dobutamine in the normal myocardium caused dose-dependent increases in %SS that were comparable (range, 20~40%) but had no effect on %PSS. MVO2 increased in parallel with %SS for both amrinone and dobutamine. With amrinone, CBF increased more than MVO2, resulting in a modest decrease in EO2, whereas with dobutamine, CBF increased in proportion to MVO2, resulting in no change in EO2. After the ischemia and reperfusion, %SS and Elac were reduced, but similar %SS and CBF responses to both agents were observed, except that both agents caused progressive reductions of %PSS. CONCLUSIONS: These results indicate that both amrinone and dobutamine exert positive inotropic effects in normal and stunned canine myocardium. It is also indicated that amrinone causes direct coronary vasodilation, which is not affected by ischemia and reperfusion, while dobutamine has no direct effect on coronary vascular tone in either normal or stunned myocardium.

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.

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.

Cardiovascular Responses to Endotracheal Intubation in Patients Receiving Desflurane Anesthesia for Anesthetic Induction / 대한마취과학회지

BACKGROUND: Desflurane is known to augment central and systemic sympathetic nervous activity. The present study was aimed at examining the effects of desflurane on cardiovascular responses to intubation. METHODS: Seventy-five ASA physical status I patients (aged 35-60 yr) were assigned randomly to receive one of three treatment regimens (n = 25 each): 1 minimum alveolar concentration (MAC) of sevoflurane, 1 MAC of desflurane or 2 MAC of desflurane. Anesthesia was induced with IV thiopental (5 mg/kg), while patients were ventilated with 100% oxygen. Tracheal intubation was facilitated with IV vecuronium (0.12 mg/kg). After intubation, patients received each anesthetic gas in oxygen via a semiclosed anesthesia circuit. Systolic arterial blood pressure (SAP), heart rate (HR) and rhythm, and plasma catecholamine concentrations were measured. RESULTS: The intubation resulted in immediate increases of SAP and HR in all groups; peak effects occurred within 1 min of the intubation. In addition, 2 MAC desflurane elicited a secondary hemodynamic effect at 3 to 5 min after the intubation. The plasma concentrations of norepinephrine increased significantly when measured at 1 min after intubation in all groups, and returned to preintubation values at 5 min in the 1 MAC desflurane groups, but showed further increases at 5 min in the 2 MAC group. CONCLUSIONS: These results show that 2 MAC desflurane elicits a biphasic hemodynamic response along with an augmented norepinephrine release, where the first appears within 1 min and the second at 3 to 5 min after intubation.

Results of Multilevel Lumbar Fusion for Degenerative Disorder of the Lumbar Spine / 대한척추외과학회지

PURPOSE: To investigate the causative factors of the complications and clinical results of 82 patients that underwent multilevel fusion due to degenerative lumbar disease. MATERIALS AND METHODS: This was a retrospective study, between October 1994 and July 2001, of 101 patients that had undergone spinal fusion at more than 3 levels, due to degenerative lumbar disease, and excluding 19 patients, which included 8 revisions, 1 postop infection and 10 lost to follow-up. The average age of the 82 patients was 61, ranging from 49 to 81 years. There were 22 men and 60 women, with an average follow up of 35, ranging from 12 to 79 months. Inclusion in the study required a minimum of 1 year of radiographic follow-up, where the lumbar lordotic angle, lateral sagittal angle of the fusion segments, problems associated with instrumentation (screw loosening, breakage and rod breakage), nonunion, fusion level, extension to sacrum, medical comorbidities and their influences on the clinical results were evaluated. Evaluation of the clinical results were quantified using Kirkaldy-Willis'criteria. T-test, Chi-square test and Pearson correlation tests were performed to evaluate the statistical significance, using SPSS version 10.0. RESULTS: 12, 35, 20 and 15 of the 82 patients declared their outcomes to be excellent, good, fair and poor, respectively. The clinical results were statistically associated with the difference between the postoperative and final sagittal angle in the fusion segments (p<0.05). The more fusion segments involved, the more problems associated with the instrumentation occurred. The number of fusion levels affected the clinical results. CONCLUSION: It seems to be difficult to reach satisfactory results in the case of multilevel spinal fusion, which was mostly associated with problems of instrumentation and nonunion, which showed poorer clinical results. Maintenance of the sagittal angle in the fusion segments was challenging when the number of fusion levels was increased.