Acute unilateral anesthesia mumps after hysteroscopic surgery under general anesthesia: a case report / 대한마취과학회지

Acute unilateral parotid gland swelling after general anesthesia, anesthesia mumps is rare and when occurred, it is associated with the patient's position and with long-lasting surgery. The exact mechanism or etiology has not been fully established but stasis of gland secretion, blockage of Stensen's duct by direct compression, or retrograde flow of air by increased the oral cavity pressure are suspicious reasons. We experienced a case of soft tissue swelling in the left preauricular and submandibular regions in a 40-year-old female patient after short-lasting, hysteroscopic myomectomy performed in the lithotomy position with no suspicious predisposing factor. It is required to pay attention on the fact that even with the usual face mask ventilation can lead to the development of anesthesia mumps.

Quality improvement for reducing intravenous patient-controlled analgesia self-discontinuation rate / 대한마취과학회지

No abstract available.

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.

Renal Protective Effects of Opposite Renal Ischemic Preconditioning against Renal Ischemic Reperfusion Injury in Mice / 대한마취과학회지

BACKGROUND: Acute renal failure (ARF) results from renal ischemic reperfusion (IR) injury and is a major contributor to the morbidity and mortality encountered during the perioperative period. It was previously demonstrated that ischemic preconditioning (IPC) of the heart, brain, and kidney offered protection against IR injury. Therefore, this study examined whether or not distant IPC can also be effective against IR injury in other organs. METHODS: C57BL6 mice were classified into three groups, Sham group (n=7), IR group (n=7) and Cross IPC IR group (n=7). The sham group was subjected only to a right renal nephrectomy (ligation of renal pedicle with silk). The IR group was subjected to 30 min of left renal ischemia after a right nephrectomy. The cross IPC IR group was subjected to right renal IPC (two cycles of 5 min of ischemia and reperfusion) followed 15 min later by a right nephrectomy and 30 min left renal ischemia. The left kidney was harvested 24 h after surgery and the histology and blood creatinine level was analyzed. The left kidneys were isolated 15 min after right nephrectomy (sham, n=7) and right renal IPC (cross IPC, n=7), respectively, and analyzed by western blotting. RESULTS: The level of the intra-cellular signaling proteins, iNOS, Akt and ERK increased significantly as a result of the right renal IPC, and the renal functions were well preserved in the cross IPC IR group compared with the IR group. CONCLUSIONS: Cross renal IPC offers protection by elevating the iNOS, Akt and ERK levels due to the distant oxygen free radicals stream against the opposite renal IR injury in mice.

A Case of Atypical Trigeminal Neuralgia Mistaken as Glossopharyngeal Neuralgia: A case report / 대한마취과학회지

Trigeminal neuralgia (TGN) is a relatively well-known disorder with characteristic brief attacks of shooting pain in the facial regions. Atypical signs like constant pain and/or sensory abnormalities can develop as the disease progresses. Some cases begin with atypical signs and later develop all the hallmarks of TGN. The atypical forms of TGN can be misdiagnosed as other pain disorders. We present a patient with facial pain who demonstrated a transformation in signs of glossopharyngeal neuralgia into typical trigeminal neuralgia. A 71 year-old man was referred for sharp episodic pain in his right side of the face and neck. The pain was mainly in the neck, which was worsened especially by swallowing. The condition was initially diagnosed as a glossopharyngenl neuralgia. While controlling the pain conservatively with a sympathetic blockade, the neck pain disappeared suddenly and lower jaw pain triggered by speaking and chewing became prominent, which are the characteristic signs of trigeminal neuralgia.

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.

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.

Effects of Norepinephrine on the Mechanoreceptors of the Urinary Bladder in the Cat / 대한마취과학회지

BACKGROUND: Recent findings suggest that a coupling between the somatic and sympathetic nervous system is critical not only for the development but also for the maintenance of pain behavioral changes. However, studies on the effect of sympathetic efferent system on sensory receptors in the visceral organ that is more dependent on the autonomic nervous system are lacking. This study examined whether norepinephrine (NE) had an influence on the mechanoreceptors in the feline urinary bladder. METHODS: Ten adult male cats were used and anesthetized with alpha-chloralose and artificially ventilated. A cannula with the pressure transducer was inserted through the urethra to apply mechanical stimuli and monitor the pressure of bladder. A tiny cannula inserted into the bilateral side branches of vesical arteries were used as a route for a NE (10A.M 9:40 01-10-08 bilaterally) injection. Nerve fiber recordings were obtained from the distal stump of the pelvic nerve. RESULTS: After the NE injection, the response of mechanoreceptors (n = 13) to the isotonic pressure stimulus (50 - 60 mmHg) decreased significantly (p < 0.05) in terms of sensitivity (i.e., ratio of nerve activity change to urinary bladder pressure change). The responses to pressure stimuli after an injection of an alpha1 adrenoceptor blocker (terazosin) reversed the effect of NE. The responses of mechanoreceptors to isotonic pressure stimulus were not affected significantly by NE with preinjection of an alpha2 adrenoceptor blocker (yohimbine). CONCLUSIONS: These results suggest that NE may have influence on the sensitivity of mechanoreceptors in the normal feline urinary bladder via an alpha1 adrenoceptor.

Determinants of Effective Dose of Thiopental Sodium, Propofol and Etomidate in Elderly / 대한마취과학회지

BACKGROUND: Many drugs are commonly administered according to total body weight or age basis. However, drugs are primarily distributed to the lean body mass. This study was undertaken to find out the best determinant for drug requirements during induction in elderly. METHODS: Forty-five ASA 1 to 3 male and female patients older than 65 years scheduled for elective surgery were divided into 3 groups and received thiopental sodium 62.5 mg/min (group T, n = 15), propofol 25 mg/min (group P, n = 15), or etomidate 5 mg/min (group E, n = 15) respectively. Kendall's tau test for correlations was used to describe the relationship between drug requirements for induction and total body weight, lean body mass determined by Weisburg's modification of Gubner's formula, ideal body weight calculated by Devine's method, and body surface area. RESULTS: Loss of consciousness was obtained with a thiopental sodium dose of 128.4 +/- 29.3 mg, propofol 59.8 +/- 13.6 mg, and etomidate 9.8 +/- 1.4 mg. Kendall's tau correlation test showed that requirements of drugs were related to lean body mass (group T, r = 0.490*, group P, r = 0.433*, group E, r = 0.493*, global P < 0.05) and ideal body weight (group P, r = 0.426*, group E, r = 0.434*, p < 0.05), but not to total body weight or body surface area. CONCLUSIONS: Our results indicate that drug requirements for induction of anesthesia correlate better with lean body mass and ideal body weight than with total body weight or body surface area in elderly patients.

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.

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 Pediatric Patient with Pheochromocytoma: A case report / 대한마취과학회지

Pheochromocytoma is an unusual tumor in pediatric age group and there are several different aspects from adult counterparts. Children have fewer malignant, more extra-adrenal, and greater bilaterality and multiplicity of tumor. We present a case of 14-year old boy with pheochromocytoma who has symptoms such as episodic headaches, vomiting, seizure and paroxysmal hypertension which is less common in children. Although the duration of preoperative preparation was not long enough, we decided to remove the tumor because symptoms were disappeared rather rapidly after alpha and beta adrenergic blocker treatment. The patient was managed with continuous epidural block and light general anesthesia but extra use of adrenergic receptor blocker and vasodilator were demanded during tumor manipulation. The patient has remained well postoperatively but long-term follow up is essential because of the possibilities of recurrence.

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.

Anesthetic Management for a Patient with Apert's Syndrome / 대한마취과학회지

Apert's syndrome is rare autosomal dominant defect characterized by craniosynostosis, midface hypoplasia and symmetrical syndactyly. Multiple surgical procedures will be needed for the child with this syndrome. Especially surgery for craniosynostosis is most often performed between 2 and 6 months of life, a period of physiologic anemia. Perioperative complications can occur from numerous sources-massive blood loss, venous air embolism, cerebral edema, hypothermia and hazardous airway management, thus more monitoring, large bored central venous line and early transfusion are recommended. We report a case of 5 month-old female Apert patient undergoing frontal bone advancement and cranioplasty. At the end of uneventful surgery, we removed endotracheal tube in operating room and permitted early feeding because the procedure was limited above the orbital ridge. As soon as feeding the patient presented cyanosis with generalized seizure. Patient was immediately intubated, sucked out secretions and inhaled with oxygen. Blood gas showed moderate hypoxemia which was improved by oxygen therapy. Suspicious aspiration pneumonia was marked on chest film but disappered I week later. The condition was favorable thereafter and discharged without complication. Keypoints in management of Aperts syndrome are close observation, early detection and preventive treatment of possible complications in perioperative period. (Korean J Anesthesiol 1995; 29: 300~303)

Changes of Blood Glucose , Insulin and Elecrolyte during Hypothermic Cardiopulmonary Bypass / 대한마취과학회지

It has been shown that blood glucose level was risen during cardiopulmonary bypass procedure. However it is uncertain whether this alteration in carbohydrate metabolism in the result of inadequate insulin release or of an abnormality in glucose metabolism. This report concerns glucose metabolism and insulin release as well change in serum potassium concentration in patients undergoing cardiac surgery under moderate hypothermic cardiopulmonary bypass. Hyperglycemia and delayed insulin response to glucose may be due to an increase in catecholamine retion induced by the surgical trauma and hypothermic cardiopulmonary bypass. Plasma glucose, insulin, serum sodium and potassium concentrations were measured in 14 patients undergoing open heart surgery with moderate hypothermia. Patients were anesthetized with fentanyl 10~20 pg/kg, droperidol and nitrous oxide in oxygen. Priming solution of bypass was composed with heparinized whole blood, Hartmann's solution and 5% dextrose water added at the ratio of 2:1, as a result of hematocrit 28~30% during bypass A significant in blood glucose concentration occurred with bypass from the control value of 87.0+/-7.85 mg/dl to 529.8+/-67.52 mg/dl in children and from 88.8+/-10.42 mg/dl to 474.8+/-62.27 mg/dl in adults (p<0.05), partly as a result of the stress hyperglycemia and exogenous glucose load from the priming solution. Following bypass the blood glucose remained above the preanesthetic concentration at the level of 237.2+/-57.57 mg/dl in children and 210.4+/-45.29 mg/dl in adults, and this elevation persisted into the period following surgery (p<0.05). Plasma insulin concentration remained low in spite of increased glucose concentration at the level of 7.8+/-2.79 ul.U/ml in children and 10.1+/-3.84 pI.U/ml in adults and start to elevate with the start of bypass. The highest concentration at 39.6+/-13.90 ul.U/ml in children and 40.5+/-16.97 ul.U/ml in adults occurred following hypothermia and this elevation persisted during bypase procedure(p<0.05). Serum sodium and potassium concentration decreased significantly at the level of 134.0+/-3.58 mEq/ L and 3.1+/-0.40 mEq/L in children and 128.9+/-4.49 mEq/L and 3.2+/-0.37 mEq/L in adults, respeetively, following bypaas procedure (p<0.05). These observations indicated that exogenous glucose load such as glucose contained priming solution and cardioplegic solution may aggravate the stress hyperglycemia.