ABSTRACT
BACKGROUND: The issue of using phenylephrine in hemorrhagic shock treatment has been controversial because it is known that phenylephrine improves the tissue perfusion by increasing arterial blood pressure but deteriorates the myocardium by increasing afterload and decreasing myocardial oxygen delivery via coronary vasoconstriction. This study was aimed to assess the effects of phenylephrine on hemodynamic variables, cardiac performance, and myocardial oxygen balance in resuscitation from hemorrhagic shock. METHODS: Twenty anesthetized dogs were randomly divided into phenylephrine group and control group. After inducing hemorrhagic shock, resuscitation was done with phenylephrine and 0.9% normal saline respectively. We measured hemodynamic indices, blood gas parameter and cardiac enzymes which indicate myocardial demage. RESULTS: In both groups, cardiac output and hemodynamic indices improved. In phenylephrine group, the systemic oxygen delivery and consumption was much higher and the myocardial oxygen extraction ratio was maintained at the lower level than the control group. In addition, the CK-MB was higher at the early phase of resuscitation and the troponin T was also higher than the control group during the whole period of resuscitation. Creatine kinase-MB increased during early resuscitation in phenylephrine group but kept decreasing after that and there's no difference between two groups. Troponin T was higher in the phenylephrine group after resuscitation. CONCLUSIONS: We concluded that phenylephrine improves myocardial oxygen balance and contractility without serious myocardial demage during resuscitation from hemorrhagic shock.
Subject(s)
Animals , Dogs , Arterial Pressure , Cardiac Output , Creatine , Hemodynamics , Myocardium , Oxygen , Perfusion , Phenylephrine , Resuscitation , Shock, Hemorrhagic , Troponin T , VasoconstrictionABSTRACT
Perioperative cerebrovascular accidents after general anesthesia are rare but devastating, and are often fatal. We experienced a case of acute cerebral infarction found at 2 days after general anesthesia. A 64 year old, ASA physical status II, hypertensive male patient underwent radical neck dissection due to right thyroid cancer. Anesthesia was induced with propofol and succinylcholine and maintained with vecuronium-enflurane-nitrous oxide-oxygen. No special event occurred during anesthesia, except for of three hypotensive events that required ephedrine. On the second day after the operation, he complained dysarthria and left facial weakness. Brain CT and MRI revealed an infarction of the right middle cerebral artery territory. He was transferred to the department of neurology and received conservative care. Fortunately, he was discharged at 20 days after surgery with much improved symptoms.
Subject(s)
Humans , Male , Middle Aged , Anesthesia , Anesthesia, General , Anniversaries and Special Events , Brain , Cerebral Infarction , Dysarthria , Ephedrine , Infarction , Magnetic Resonance Imaging , Middle Cerebral Artery , Neck Dissection , Neurology , Propofol , Stroke , Succinylcholine , Thyroid NeoplasmsABSTRACT
When continuous seizures are refractory to conventional intravenous anticonvulsant drugs, general anesthesia has been recommended to control status epilepticus. We present the case of a 6-year-old male patient who was admitted for generalized tonic-clonic status epilepticus secondary to febrile convulsion due to an upper respiratory infection. The tonic-clonic status epilepticus was refractory to all anticonvulsant measures and drugs including, phenytoin, phenobarbital, diazepam and lorazepam. After about 32 hours of unsatisfactory seizure activity control, we started general anesthesia for the management of his status epilepticus. After discontinuing general anesthesia, the patient developed a small number of episodes of epilepsia partialis, but seizure activity was well controlled by conventional anticonvulsants. The patient was extubated after three days and was discharged from hospital as cured 12 days after general anesthesia management.
Subject(s)
Child , Humans , Male , Anesthesia, General , Anticonvulsants , Diazepam , Isoflurane , Lorazepam , Phenobarbital , Phenytoin , Seizures , Seizures, Febrile , Status EpilepticusABSTRACT
When continuous seizures are refractory to conventional intravenous anticonvulsant drugs, general anesthesia has been recommended to control status epilepticus. We present the case of a 6-year-old male patient who was admitted for generalized tonic-clonic status epilepticus secondary to febrile convulsion due to an upper respiratory infection. The tonic-clonic status epilepticus was refractory to all anticonvulsant measures and drugs including, phenytoin, phenobarbital, diazepam and lorazepam. After about 32 hours of unsatisfactory seizure activity control, we started general anesthesia for the management of his status epilepticus. After discontinuing general anesthesia, the patient developed a small number of episodes of epilepsia partialis, but seizure activity was well controlled by conventional anticonvulsants. The patient was extubated after three days and was discharged from hospital as cured 12 days after general anesthesia management.
Subject(s)
Child , Humans , Male , Anesthesia, General , Anticonvulsants , Diazepam , Isoflurane , Lorazepam , Phenobarbital , Phenytoin , Seizures , Seizures, Febrile , Status EpilepticusABSTRACT
Clinical education is difficult for actual practice of medical students. In particular, the practice in the field of obstetrics is more difficult to many students. Moreover, the education of sub-fields of obstetrics such as birth or abortion needs many materials of women's reproductive organs. However, the ordinary paper-based textbooks have some limitations for clinical education of obstetrics. The electronic textbook system based on multimedia data enables that many student, doctor, and public user overcome these difficulties, as a computer assisted learning. We developed multimedia database system which is connected with web using ODBC(Open DataBase Connectivity)and ASP(Active Server Page)/IDC(Internet DataBase Connection). Many text and multimedia data are gathered in the database. This system serves various multimedia data using internet and intranet in the student's class or home. In conclusion, providing multimedia data of obstetrics using ODBC, ASP/IDC method reduce the limitation of clinical education. This model of the electronic textbook would be a reference to develop multimedia database on the network.