Hepatic Ischemic Preconditioning Provides Protection Against Distant Renal Ischemia and Reperfusion Injury in Mice

We previously demonstrated that there are acute and delayed phases of renal protection against renal ischemia and reperfusion (IR) injury with renal ischemic preconditioning (IPC). This study assessed whether hepatic IPC could also reduce distant renal IR injury through the blood stream-mediated supply of reactive oxygen species (ROS). Male C57BL/6 mice were randomly divided into four groups: group I, sham operated including right nephrectomy; group II (IR), left renal ischemia for 30 min and reperfusion injury; group III (IPC-IR), hepatic ischemia for 10 min followed by 10 min of reperfusion before left renal IR injury; group IV (MPG - IPC + IR), pretreated with 100 mg/kg N-(2-mercaptopropionyl)-glycine (MPG) 15 min before hepatic IPC and left renal IR injury. Renal function, histopathologic findings, proinflammatory cytokines, and cytoprotective proteins were evaluated 15 min or 24 hr after reperfusion. Hepatic IPC attenuated the expression of proinflammatory cytokines, tumor necrosis factor alpha, intercellular adhesion molecule 1, and induced inducible nitric-oxide synthase, and the phosphorylation of Akt in the murine kidney. Renal function was better preserved in mice with hepatic IPC (group III) than groups II or IV. Hepatic IPC protects against distant renal IR injury through the blood stream-delivery of hepatic IPC-induced ROS, by inducing cytoprotective proteins, and by inhibiting inflammatory reactions.

Low dose ketamine reduces the induction of ERK1/2 and CREB signaling protein in a neuropathic pain model of rats / 대한마취과학회지

BACKGROUND: In addition to causing the loss of voluntary sensory and motor function, spinal cord injury (SCI) often creates a state of central neuropathic pain. Rats given SCI display increases in the activated form of transcription factors ERK 1/2 MAPK and CREB in the spinal cord, which correspond to allodynia in a model of neuropathic pain. This study was conducted to determine if low dose ketamine had an effect on the activation of ERK 1/2 and CREB in the development of neuropathic pain. METHODS: This study was conducted to evaluate ERK 1/2 and CREB protein in a sham operated (control) group, neuropathic pain and normal saline (NP + NS) group and neuropathic pain and ketamine (NP + Keta) group. To accomplish this, male Sprague-Dawley rats were anesthetized and then subjected to L5-L6 spinal nerve ligation (SNL, neuropathic rats). The total amounts of ERK 1/2 and CREB protein were then assessed by western blot analysis. In addition, changes in the amounts of ERK 1/2 and CREB mRNA were evaluated by RT-PCR. RESULTS: There was a significant increase in the amount of ERK 1/2 and CREB in the NP + NS group when compared with the sham group. However, the amount of ERK 1/2 and CREB protein induced due to SNL were significantly reduced by continuous infusion with ketamine in the NP + Keta group. CONCLUSIONS: The results of this study revealed a positive linkage between NMDA receptors and the ERK-CREB signaling pathway. Therefore, NMDA receptors could be the target of future therapeutic approaches. Additionally, the results of the present study provide additional evidence that low dose ketamine effectively prevents and treats central neuropathic pain following SNL.

Neural Stem Cell Harvest and Culture using the High Speed Centrifugation from Rat Brain / 대한마취과학회지

BACKGROUND: During recent two decades of crucial revision of some cornerstone concepts has opened new horizons in neurosciences. Modern basic viewpoints include the idea of high CNS plasticity which means not only rearrangement of neurons and their interconnections, but also the formation of new neural cells in humans and animals during their whole life span. The purpose of this study is to harvest neural stem cell from the adult rat brain using the high speed centrifugation method and study the characteristics of these cell. METHODS: 60 rats (Fisher 344, 150-160 g) brain were saved under inhalation anesthesia and dissect the subventricular zone under the microscope. The brain tissue was digested with enzyme to make a cell suspension. The cell suspension was processed high speed centrifugation to separate the neural stem/progenitor cells according to the buoyancy. After 2 weeks culture, immuno-staining (O4, GFAP, Nestin, beta-tubulin III and DAPI) were performed and replated the cultured cells. RESULTS: The 2 weeks culture cells were positive 92.8% in Nestin, 91.5% in O4 and 87.6% in Gal-C. But only positive 1.4% in beta-tubulin III and 5.5% in GFAP. And replated cell culture shows similar results compared to the primary culture. CONCLUSIONS: With this high speed centrifugation method, authors can harvest neural stem/progenitor cells from the adult rat brain. Although we have many limitations using these cell in clinical trial, but we can afford to next step on neural stem cell research.

Comparison of TIVA and VIMA for Endocrine Stress Response and Anesthesia Characteristics / 대한마취과학회지

BACKGROUND: Anesthetic procedures are major potent stimulus for the neuroendocrine hormonal axis, which results in release of the stress hormone. It is important to know the influence of specific anesthetic procedures on those host responses. We compared endocrine stress response and anesthesia characteristics for TIVA (total intravenous anesthesia) and VIMA (volatile induction and maintenance of anesthesia). METHODS: Forty patients scheduled for elective total abdominal hysterectomy were randomly assigned to TIVA or VIMA group. The patients in TIVA group (n = 20) received target controlled infusion (TCI) of propofol and fentanyl TCI with Stelpump software, and the patients in VIMA group (n = 20) received sevoflurane-nitrous oxide for induction (6%) and maintenance (1.5%) of anesthesia. Blood sampling was done 5 minutes before induction (baseline blood sample, BBS), just after intubation (intubation blood sample, IBS), just after extubation (extubation blood sample, EBS), and at arrival in recovery room (recovery room blood sample, RBS). Plasma concentration of glucose, cortisol, epinephrine, norepinephrine were measured. Bispectal Index (BIS) and systolic, diastolic blood pressure, heart rate, induction and recovery profiles were also measured. RESULTS: In both groups, there was significant increase of the blood cortisol and glucose level in EBS and RBS. But only in VIMA group, there was significant increase of the blood cortisol level in IBS. There was no change of the blood epinephrine and norepinephrine in both groups at EBS and RBS, but only in VIMA group, there was significant increase of epinephrine and norepinephrine at IBS. Blood pressure and heart rate increased significantly at IBS in VIMA group, compared with TIVA group. CONCLUSIONS: In VIMA group, there was significant increase of stress response and hemodynamic change only during induction of anesthesia. However, in TIVA group, there was no significant increase of stress response and hemodynamic change during induction, maintenance and recovery of anesthesia.

Comparison of TIVA and VIMA for Endocrine Stress Response and Anesthesia Characteristics / 대한마취과학회지

BACKGROUND: Anesthetic procedures are major potent stimulus for the neuroendocrine hormonal axis, which results in release of the stress hormone. It is important to know the influence of specific anesthetic procedures on those host responses. We compared endocrine stress response and anesthesia characteristics for TIVA (total intravenous anesthesia) and VIMA (volatile induction and maintenance of anesthesia). METHODS: Forty patients scheduled for elective total abdominal hysterectomy were randomly assigned to TIVA or VIMA group. The patients in TIVA group (n = 20) received target controlled infusion (TCI) of propofol and fentanyl TCI with Stelpump software, and the patients in VIMA group (n = 20) received sevoflurane-nitrous oxide for induction (6%) and maintenance (1.5%) of anesthesia. Blood sampling was done 5 minutes before induction (baseline blood sample, BBS), just after intubation (intubation blood sample, IBS), just after extubation (extubation blood sample, EBS), and at arrival in recovery room (recovery room blood sample, RBS). Plasma concentration of glucose, cortisol, epinephrine, norepinephrine were measured. Bispectal Index (BIS) and systolic, diastolic blood pressure, heart rate, induction and recovery profiles were also measured. RESULTS: In both groups, there was significant increase of the blood cortisol and glucose level in EBS and RBS. But only in VIMA group, there was significant increase of the blood cortisol level in IBS. There was no change of the blood epinephrine and norepinephrine in both groups at EBS and RBS, but only in VIMA group, there was significant increase of epinephrine and norepinephrine at IBS. Blood pressure and heart rate increased significantly at IBS in VIMA group, compared with TIVA group. CONCLUSIONS: In VIMA group, there was significant increase of stress response and hemodynamic change only during induction of anesthesia. However, in TIVA group, there was no significant increase of stress response and hemodynamic change during induction, maintenance and recovery of anesthesia.

One-lung Ventilation in a Pediatric Patient: A case report / 대한마취과학회지

We successfully managed one-lung ventilation in a 5-yr-old boy who underwent thoracoscopic removal of an emphysematosed right lower lobe. We used a 5-French 70 cm balloon-tipped Fogarty embolectomy catheter as a bronchial blocker. Its single lumen, which ends blindly, contains a guidewire and is used to inflate a spherical balloon. First, we threaded the distal end of the blocker through the Murphy hole of a 5.5 cuffed endotracheal tube. The tip of the blocker was adjusted to the end of the endotracheal tube, and the remainder of the blocker was attached closely to the outer wall of the tube and fixed once at the neck of the tube with tape. The tube and catheter were intubated as a set. After intubation, a bronchoscope was introduced through the tube. Under bronchoscopic view, Fogarty catheter was drawn back by 1 2 cm to withdraw the catheter tip from the Murphy hole and then advanced until the balloon tip reached the right main bronchus. With balloon inflation, we were able to achieve satisfactory one-lung ventilation.

Dose-Related Prolongation of Ropivacaine Epidural Anesthesia by Epidural Ketamine / 대한통증학회지

BACKGROUND: Besides its general anesthetic effect, ketamine interacts with sodium channels in a local anesthetic-like fashion, including the sharing of binding sites with those commonly used by clinical local anesthetics. This study evaluated the dose related effects of ketamine during epidural anesthesia with 0.5% ropivacaine. METHODS: Sixty ASA physical status I-II patients, scheduled for minor elective surgery under epidural anesthesia using 0.5% ropivacaine, were randomly divided into three groups (n = 20 each). The patients initially received either 0.5% ropivacaine (group 1), ketamine (0.1 mg/kg) in addition to the epidural 0.5% ropivacaine (group 2) or ketamine (0.2 mg/kg) in addition to the epidural 0.5% ropivacaine (group 3). The regression of sensory block was assessed by transcutaneous electric stimulation (TES), equivalent to a surgical incision. Motor block was assessed using the Modified Bromage's scale. Episodes of bradycardia, hypotension and sedation were also recorded. RESULTS: There were no significant differences among the three groups in the maximal levels of sensory block or the times taken for these levels to be reached. The mean times for the block to regress to two and four segments below the maximal level were significantly prolonged by epidural ketamine. CONCLUSIONS: Epidural ketamine prolongs the duration of ropivacaine epidural anesthesia. These results suggest that ketamine has local anesthetic-like actions.

Changes in Osteopontin Expression in the Rat Lumbar Spinal Cord Following the Avulsion of Lumbar Nerve Roots / 대한해부학회지

This study investigated the expression of osteopontin (OPN) in rat lumbar spinal cords after lumbar nerve root avulsion, using in situ hybridization histochemistry, immunocytochemistry and western blot analysis. Cells expressing OPN were motoneurons and interneurons in the ventral horn, but no signals were observed in neurons in the dorsal horn of the normal lumbar spinal cord. From day 1 after avulsion injury, OPN mRNA-labeled neurons increased in the ventral horn and the intermediate zone. By day 3, relatively strong OPN mRNA signals were found throughout the gray matter of the injured side of the spinal cord with OPN mRNA-labeled cells scattered in the superficial dorsal horn. By day 7, the labeling patterns for OPN mRNA were similar to those on day 3, but the numbers of OPN mRNA-labeled cells in the ventral horn and the intermediate zone peaked. At this point, these labeled cells were also more densely packed and the intensity of signals was stronger. Interestingly, these labeled cells were neurons, but not glial cells such as astrocytes or microglia. This OPN mRNA-labeled cell profile in the dorsal horn had nearly disappeared by day 14 after avulsion injury, and the labeling pattern became similar to that on day 1. By day 28, after avulsion injury, the numbers of OPN mRNA-labeled cells decreased further below control values. These results suggest that increased expression of OPN in the rat lumbar spinal cord after avulsion injury might play an important role in the pathogenesis of damaged neurons.

The Effects of Thoracic Sympathetic Ganglion Block and Gabapentin in a Patient with Myokymia and Neuropathic Pain after a Thoracotomy / 대한마취과학회지

Myokymia is one of involuntary movement, which is characterized by undulatory muscle spasm, similar to the worm's crawl. Sometimes muscle pain, itchy sensation, dysautonomia and other symptoms are associated with it. Derangement of the peripheral or central nervous system after nerve or tissue damage is suspected as the source of impulse generators causing this symptom. We encountered a patient with neuropathic pain and myokymia after thoracotomy. Although several medications and nerve blocks have been applied, all have failed to provide symptom relief. We experienced improvement of the pain and involuntary movement with a thoracic sympathetic ganglion block and gabapentin.

The Effect Site Concentration of Propofol Comparable to BIS 50 and Awakening in Pediatric Patients / 대한마취과학회지

BACKGROUND: Propofol offers the advantages of rapid onset of action and recovery. However, the pharmacokinetics of propofol in children is different from that of adults. Therefore, infusion of propofol by target-controlled infusion (TCI) has same difficulties in use. Also, bispectral index has shown a close relationship with plasma concentration of propofol. In this study, we measured the effect site concentration comparable to Bispectral index (BIS) 50 during induction and the awakening concentration. Furthermore, we tried to demonstrate age-related differences. METHODS: Forty five premedicated (atropine 0.02 mg/kg) children (ASA class I) scheduled for elective surgery were assigned to one of three groups (Group 1: 1-5 years, Group 2: 6-10 years, Group 3: 11-15 years). After intravenous injection of lidocaine 0.5 mg/kg, a propofol infusion was started at a target concentration of 6 microgram/ml by using a Stelpump. Anesthesia was maintained with propofol 4-6 microgram/ml and 67% nitrous oxide in oxygen. During anesthesia induction, we checked the effect site concentration comparable to BIS 50 and plasma/effect concentration for awakening during an emergence period. RESULTS: The effect site concentrations comparable to BIS 50 were 5.7 +/- 0.5 microgram/ml (group 1), 4.9 +/- 0.8 microgram/ml (group 2) and 3.8 +/- 1.1 microgram/ml (group 3), so there are significant differences among the groups (P < 0.05)(Table 2). At the moment of awakening, the current/effect site concentration in group 1 (2.0 +/- 0.1 microgram/ml, 2.6 +/- 0.2 microgram/ml) was significantly higher than those of group 3 (1.6 +/- 0.2 microgram/ml, 2.0 +/- 0.30 microgram/ml). CONCLSIONS: The effect site concentration comparable to BIS 50 showed significantly age-related differences and was higher in younger children. The current/effect site concentration at awakening was highest in group 1.

The Effects of Midazolam and Droperidol Pretreatment on the Cardiac Toxicity of Bupivacaine in Rabbits / 대한마취과학회지

BACKGROUND: Unintended intravenous injection of bupivacaine causes severe cardiovascular complication, which is known for its difficulty in resuscitation. This study was performed to evaluate the effects of pretreatment with midazolam and droperidol in the cardiac toxicity caused by intravenous infusion of bupivacaine. METHODS: Thirty rabbits were divided into three groups; saline- as a control, midazolam, and droperidol pretreated group. We observed the time intervals for the arrhythmia, 25% and 50% reduction in baseline mean arterial blood pressure, and arrest. We also checked the dose of infused bupivacaine to be required for arrest during continuous intravenous infusion of bupivacaine at the rate of 1 mg/kg/min. RESULTS: The onset of dysrhythmia and the time to 50% reduction in baseline mean arterial blood pressure and arrest were significantly more delayed in the midazolam group than the control group (P < 0.05). With respect to the time to 25%, 50% reduction in baseline mean arterial blood pressure and arrest, the data of the droperidol group was significantly shorter than that of the control group (P < 0.05). CONCLUSIONS: Droperidol pretreatment hastened bupivacaine induced cardiac arrest in rabbits. Midazolam pretreatment exerted protective effects on arrhythmia and cardiac arrest. Thus midazolam would be a preferable agent as a supplement for regional anesthesia using bupivacaine.

The Effects of Propofol on Cardiac Toxicity of Intravenous Bupivacaine in Rabbits / 대한마취과학회지

BACKGROUND: Propofol is an intravenous anesthetic agent, which has a protective effect on cardiovascular and CNS toxicity of local anesthetics compared with an inhalational agent. Also lipids have a has protective effects on local anesthetic cardiovascular toxicity. So, we had questioned that the protective effect on local anesthetic toxicity comes from the lipid solvent of propofol or propofol itself. METHODS: Eighteen healthy rabbits, weighing 3.0 Kg, were divided into three groups during continuous intravenous infusion of bupivacaine: the control group received normal saline (n = 6), the propofol group received propofol (n = 6), and the intralipid group received intralipid (n = 6). The changes in mean arterial pressure, heart rate and the electrocardiogram were observed during the continuous intravenous infusion of bupivacaine. RESULTS: The onset time of QRS widening and dysrhythmia was significantly prolonged in the propofol group compared with the control and intralipids group. The time required for 25% and 50% decrease in mean arterial pressure and heart rate during bupivacaine infusion was significantly prolonged in experimental groups compared with the control group. In the propofol group compared with the intralipids group, the time required for a 25% and 50% decrease in mean arterial pressure and heart rate were prolonged. CONCLUSIONS: This study suggests that infusion of propofol protection on cardiac toxicity of intravenous infusion by an bupivacaine, the dosage for sedation without cardiovascular adverse effects, is more profound than intarlipids.

The Optimal Concentrations of Propofol at Eye Opening and Orientation after Propofol-fentanyl TCI in Koreans / 대한마취과학회지

BACKGROUND: We evaluated the optimal concentrations of eye opening and orientation after propofol- fentanyl TCI by CSDT of the pharmacokinetic model using DiprifusorTM in adults retrospectively. Furthermore, we tried to compare those data with the cases of using propofol TCI alone that had been reported. METHODS: After obtaining informed consent and IRB approval, 124 patients of ASA class I or II scheduled for elective surgery were allocated into 3 groups according to age. Three groups were group 1 (n = 40): 18 - 29 years, group 2 (n = 42): 30 - 39 years, group 3 (n = 42): 40 - 54 years. Propofol infusion was started at a propofol target concentration (CT) of 6 microgram/ml by using DiprifusorTM. Anesthesia was mostly maintained with propofol CT 3.5 microgram/ml and fentanyl CT 1.5 ng/ml using a Stelpump and 67% nitrous oxide in oxygen. We estimated the average concentrations of propofol at eye opening and orientation in each group with DiprifusorTM, and we also evaluated the correlation coefficient. RESULTS: Total requirements of propofol in cases of propofol-fentanyl TCI were decreased by 18-26% than in propofol TCI alone. The average concentrations of propofol at eye opening and orientation after surgery were 1.2 - 1.4 microgram/ml. The times to show eye opening and orientation after surgery from stopping of nitrous oxide and infusion were 10.4 - 14.5 min in the propofol-fentanyl group compared with 7.5 - 11 min using propofol TCI alone. CONCLUSIONS: We concluded that the optimal concentrations of propofol at eye opening and orientation after surgery in cases of combination with fentanyl were 1.2 - 1.4 microgram/ml instead of 1.4 - 1.6 microgram/ml with using propofol alone.

Anesthetic Management of Patient with Cis A2B3 Blood Group: A case report / 대한마취과학회지

The inheritance of ABO blood type group is actually determined by triple allelic gene, A, B and O. Transmission of blood group AB by a single chromosome, instead of by two separate chromosomes, was reported and called cis AB. The anesthesiologists, who meet many cases of the transfusions, may anesthetize cis AB patients for surgery. Recently the authors have experienced one case of patient with cis AB blood type undergoing emergency craniotomy and removal of hematoma. We transfused the patient with Rh+O packed red blood cell without any significant transfusion reactions.

Anesthetic Management of Laparoscopic Surgery in Infant with Congenital Megacolon: A case report / 대한마취과학회지

Many benefits are reported after laparoscopy. As experience, equipment, and techniques have improved, minimally invasive laparoscopic surgery is being applied to younger children. With the advent of this new surgical approach, specific modifications become necessary in anesthetic techniques. During laparoscopy, the pneumoperitoneum performed by peritoneal insufflation of CO2 may induce intraoperative ventilatory and hemodynamic changes that complicate anesthetic management. We present a case of laparoscopic Duhamel operation in a 10-month-old infant weighing 10 kg. After induction with thiopental sodium and vecuronium, anesthesia was maintained with enflurane and 50% nitrous oxide in oxygen. Rapid hypercarbia developed about 5 minutes after introduction of pneumoperitonium, so we gave intermittent manual hyperventilation to avoid hypercarbia untill we finished the surgery. In children, CO2 absorption may be more efficient due to the physiological properties of the immature peritoneum. The functional residual capacity (FRC) is low in children. During laparoscopy, FRC is decreased further due to a variety of factors. In spite of the changes in FRC, arterial oxygenation has not been shown to deteriorate in normal infants. In our case, the changes in end-tidal CO2 tension (PETCO2) during laparoscopy did not influence the hemodynamic change. But insufflation of CO2 induced a significant increase in PETCO2, and produced a fast reaction time of PETCO2.

The Effects of Steroid and Lidocaine on Inflammatory Responses in the Rabbit Lung of Induced Endotoxemia / 대한마취과학회지

Background: It has been reported that steroid and lidocaine reduce inflammatory responses to endotoxin. The aim of this study is to compare the effects of lidocaine with those of steroid on inflammatory responses to Escherichia coli endotoxemia in the rabbit lung. Methods: Twenty four animals were randomly assigned to one of four groups. Group I (endotoxemic group; control, n=6): They were received E. coli endotoxin (500 microg/kg) intravenously through the ear vein and followed by saline infusion at 20 ml/kg/hr for 4 hours. Group II (steroid treated group, n=6): They were treated with steroid (30 mg/kg) intravenously just after endotoxin injection and then saline was given at 20 ml/kg/hr for 4 hours. Group III (lidocaine treated group, n=6): They were received same as the endotoxemic group and lidocaine (3 mg/kg IV bolus, then continuous infusion at the rate of 2 mg/kg/hr) was administered with saline at 20 ml/kg/hr for 4 hours. Group IV (steroid & lidocaine treated group, n=6): They were received same as the endotoxemic group and after endotoxin infusion, steroid (30 mg/kg) and lidocaine (3 mg/kg IV bolus, then continuous infusion at the rate of 2 mg/kg/hr) was administered intravenously with saline. Numbers of neutrophils and monocytes in the samples of peripheral blood and lung tissue were counted and compared to evaluate the anti-inflammatory effect of drugs. Results: The group II, III, and IV showed significant attenuation of inflammatory responses compared to group I in the rabbit lung(P<0.05). But there were no significant differences among group II, III, and IV. There was no additive effect between steroid and lidocaine. Conclusion: These results suggest that lidocaine could be used as an alternative drug to steroid for its anti-inflammatory effects and cost-effectiveness.

Hyperthermia during General Anesthesia: A case report / 대한마취과학회지

The fulminant malignant hyperthermia (MH) is now encountered less frequently because of increased awareness of the condition by anesthesiologist and better use of mornitoring facilities. Thus there is also an increase in the number of aborted cases, in which anesthesia is stopped and treatment instituted as soon as MH is thought to be likely. We presented a case of an abortive MH in 18 years old male patient during the discectomy on the third and fourth lumbar intervertebral spaces. Anesthesia was induced with thiopental sodium and succinylcholine and then maintained with nitrous oxide, oxygen and enflurane. After induction, there were persistent tachycardia, elavation of end-tidal CO2 tension on capnography, spontaneous tachypnea, body temperature elevation up to 38.2oC, respiratory acidosis and highly level of CPK, myoglobulin in serum and urine. Under the suspicion of MH, all anesthetics were discontinued and vigorous emergency treatment was attempted including ventilation with high flow of 100% oxygen (8 l/min), changing all anesthetic circuits, and cooling measurements such as chilled intravenous solution infusion, gastric lavage with cold saline, alcohol and ice water pack over the body. Fourtunately, he recovered well and discharged without complications.

Morphine and Meperidine Analgesic Effect Using Intravenous PCA of Intramuscular Diclofenac after Cesarean Section / 대한마취과학회지

BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvants for postoperative pain management with opioid sparing effect. The effect of diclofenac on postoperative opioid analgesia of morphine and meperidine was evaluated in 180 women after cesarean section. METHODS: One hundred eighty parturients were randomly allocated to four groups and each group had 45 women. The parturients were given loading dose of morphine in M group and meperidine in D group using intravenous patient controlled analgesia (PCA) device for up to 48 hours when the parturients awoke and complained abdominal pain. The parturients received diclofenac 75 mg every 12 hours intramuscularly followed by loading dose of morphine in MV group and meperidine in DV group. We evaluated the postoperative opioid requirement, numerical rating pain score, delivery/demand ratio, patient's satisfaction and side effects including respiratory depression, itching, nausea, urinary retention and dizziness. RESULTS: Diclofenac decreased over 40% of morphine or meperidine requirement and also pain score at 1, 2, 3, 6, 12, 24 and 48 hours in the use of PCA morphine and at 6, 12 and 24 hours in the use of PCA meperidine. And the incidence of sedation and itching decreased in MV and DV group. CONCLUSION: We concluded that diclofenac as adjuvant of opioid for postoperative pain after cesarean section could decrease requirement of morphine and meperidine, increase pain relief and decrease sedation and itching.

The Evaluation of Myocardial Contractile Reserve Using Low Dose Dobutamine under Transesophageal Echocardiography to Coronary Artery Bypass Graft / 대한마취과학회지

BACKGROUND: Intraoperative low dose dobutamine test with transesophageal echocardiography may offer a simple, cost effective and widely available mean of detecting contractile reserve in coronary artery disease. The purpose of this study was to determine the effect of low dose dobutamine infusion on ventricular function in patients undergoing coronary artery bypass graft and to predict the post-pump response of dysfunctional myocardial segments to surgical revascularization. METHODS: This study was performed in 23 patients undergoing coronary artery bypass graft. After transesophageal echocardiographic images of transgastric left ventricular short axis view at mid-papillary muscles level were obtained, the percentage of systolic wall thickening(PSWT) was evaluated. The ejection fraction by modified Simpson's method and hemodymic changes were measured simultaneously. RESULTS: The clinical accuracy of intraoperative low dose dobutamine test for PSWT was followed; Sensitivity-76%, specificity-94.7%, positive predictive value-95%, negative predictive value-75% and overall accuracy-84.1%. Ejection fraction increased from 49.0 13.1% to 56.3 11.5%(dobutamine infusion) and 59.5 12.1%(post-pump) significantly(P<.05). During dobutamine infusion and post-pump, cardiac index increased significantly(P<.01). CONCLUSIONS: Intraoperative low dose dobutamine by transesophageal echocardiography is a potentially useful test for prediction of the post pump response of regional systolic function and global ventricular function to coronary revascularization.

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.