The Effect of Cervical Sympathetic Nerve Block on Blood-brain Barrier Disruption with Mannitol Infusion in Rats / 대한구급학회지

BACKGOUND: The barrier can be altered by a number of insults to the brain (e.g., hypertension, freezing, trauma, drug). But the effect of the blood brain barrier distruction immediately after the neural change is unknown. In the present study, we focused on the BBBD after cervical sympathetic chain block. METHODS: 13 male Sprague-Dawley rats were divided into 2 groups. Group 1 (N=7) was blocked with 0.5% bupivacaine on the right cervical sympathetic chain and group 2 (N=6) was blocked with 0.5% bupivacaine on the bilateral cervical sympathetic chain. All rats received 37degrees C, 25% mannitol (1.75 g/kg) via right carotid artery and then, the effect of cervical sympathetic chain block on blood-brain barrier disruption of four cerebral compartment using 99mTc-human serum albumin and Evans blue was evaluated. RESULTS: Both groups showed blood-brain barrier disruption and there was no significant difference between group 1 and group 2 in the anterior and posterior hemisphere of the right side brain. But group 2 showed significant blood-brain barrier disruption than group 1 in anterior and posterior hemisphere of the left brain (p<0.01). CONCLUSIONS: This results suggest that cervical sympathetic chain block can increase the degree of mannitol-induced blood-brain barrier disruption via neural arch or blood flow change.

Pneumomediastinum and Subcutaneous Emphysema Complicating Tonsillectomy and Ademoidectomy / 대한마취과학회지

The causes of pneumomediastinum during perioperative period are trauma to the airway from intubation or other manipulation, raised airway pressure during anesthesia, rupture of a bleb or other intrapulmonary lesion, upper airway damage during neck surgery, infiltration of the tonsillar fossa or adenoid bed with air under pressure, increased airway pressure after nausea and vomiting, and coughing during awakening. This paper is represents and discusses a case of pneumomediastinum, pneumothorax, extensive subcutaneous and retroperitoneal emphysema which occurred suddenly a few minute after several times of bucking and straining in the intubated state with oxygen catheter after tonsillectomy and adenoidectomy at recovery room. The complieation was thought to be a infiltration of air through tonsillar fossa under pressure or alveolar rupture due to increased airway pressure after coughing. The patient was treated with high concentration of oxygen and recoverd uneventfully.

Dosage Titration of Protamine using a Heparin Dose Response Curve and Evaluation of the Factors affecting ACT during Open Heart Surgery / 대한마취과학회지

Dosage titration of protamine using a heparin dose response curve for the reversal of heparinization after cardiopulmonary bypass and the factors which affect. ACT were investigate. This study included 170 patients undergoing surgery for congenital or acquired heart diseases. Patients were randomly allocated to 6 griyos according to a protamine dosage of either 0.8, 1.0, 1.3, or 1.5 times the residual heparin amounts, or protamine 3mg/kg. The factors affecting ACT which we investigated were the differences between arterial and venous blood, between men and women, between a hematocrit value less of greater than 40%, and between less or more than 2 hours duration of bypass time. The results are as follows: 1) There were no significant differences in postprotamine ACT among the 5 groups. 2) ACT of arterial blood was more prolonged than that of venous blood(139.85+/-4.77 vs 111.50+/-2.36 sec). 3) ACT in men was more prolonged than in women(638.81+/-32.10 vs 559.08+/-14.33 sec). 4) ACT in which the hematocrit value was less than 40% was more prolonged than that in which it was above 40%. 5) Although there was no difference between less and more than 2 hours duration of bypass time in ACT, additional protamine was needed in latter group.

Effect of Preanesthetie Cimetidine on Gaatric pH / 대한마취과학회지

The effect of preanesthetic administration of glycopyrrolate and cimetidine on gastric fluid pH and volume were studied. Forty patients scheduled for elective surgery were fandomly placed into two groups. Patients in group 1 were given glycopyrrolate intramuscularly (0.003 mg/kg) 30-60 minutes before induction of anesthesia, while group 2 patients received glycopyrrolate intramuscularly and 200mg of cimetidine intravenouly 2 hours before induction of anesthesia. Nasogastric tubes were placed and gastric pH and volume were measured. The results showed that patients in group 1 hade a medn gastric pH of 2.428+/-1.378. Twenty five percent of these patients had gastric contents with a pH of 2.428+/-1.378. Twenty five percent of these patients had gastric contents with a pH above 2.5 and a volume greater than 25ml. In contrast, group 2 patients had a mean gastric pH of 5.566+/-1.969, 85 percent had a ph above 2.5 and 15 percent had a volume greater than 25ml. These findings demonstrate that cimetidine markedly increases gastric pH. The authors recoment that patients reciving general anesthesia be given cimetidine preoperatively.