Risk Factors of Acute Renal Failure after Colorectal Surgery / 영남의대학술지

BACKGROUND: Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. MATERIALS AND METHODS: Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. RESULTS: The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). CONCLUSION: Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.

Subcutaneous Emphysema and Inflammation of the Neck after Tracheal Puncture by an Intubating Stylet / 영남의대학술지

Laryngo-tracheal perforation caused by the use of a stylet during tracheal intubation is a rare complication. We present a case of subcutaneous emphysema and connective tissue inflammation after tracheal intubation. The patient was a 41-year-old male undergoing general anesthesia for an appendectomy. The intubation was difficult during laryngoscopy (Cormack-Lehane Grade III). An assistant provided an endotracheal tube with a stylet inside while the laryngoscope was in place. During intubation, a short, dull sound was heard with a sudden loss of resistance after the distal tip of the endotracheal tube passed the rima glottis. A sonogram and computerized tomography revealed subcutaneous emphysema from the neck to the upper mediastinum and fluid collection between the trachea and the thyroid. This lesion appeared to have been caused by the protruded, loose stylet. Anesthesiologists should be aware of the damage a loose stylet protruding beyond the tip of the endotracheal tube can cause.

Effects of Naloxone on Morphine Analgesia and Spinal c-fos Expression in Rat Formalin Test / 대한통증학회지

BACKGROUND: This study was performed to evaluate the dose-related effects of naloxone on morphine analgesia in the rat formalin test, and observe the correlation of pain behavior and spinal c-fos expression induced by a formalin injection. METHODS: Fifty rats were divided into five groups; control, morphine (morphine pre-treated, intra-peritoneal injection of 0.1 mg of morphine 5 min prior to formalin injection), and three naloxone groups, which were divided according to the administered dose-ratio of naloxone to morphine; 20: 1 (5microgram), 10: 1 (10microgram), and 1: 1 (100microgram) representing the low-, medium-, and high-dose naloxone groups, respectively, were injected intra-peritoneally 16 min after a formalin. A fifty ul of 5% formalin was injected into the right hind paw. All rats were observed for their pain behavior according to the number of flinches during phases 1 (2-3, 5-6 min) and 2 (1 min per every 5 min from 10 to 61 min). The spinal c-fos expression was quantitatively analyzed at 1 and 2 hours after the formalin injection using a real-time PCR. RESULTS: The morphine pre-treated (morphine and three naloxone) groups during phase 1, and the morphine, low- and medium-dose naloxone groups during phase 2, showed significantly less flinches compared to those of the control (P < 0.05). In the three naloxone groups, the numbers of flinches were transiently reduced following the naloxone injection in the low- and medium-dose groups compared to those of the morphine group (P < 0.05). The duration of the reduced flinches was longer in the medium-dose group (P < 0.05). The high-dose group revealed immediate increases in flinches immediately after the naloxone injection compared to those of the morphine, low- and medium-dose groups (P < 0.05 for each). The spinal c-fos expression showed no significant patterns between the experimental groups. CONCLUSIONS: Our data suggest that relatively low-dose naloxone (1/20 to 1/10 dose-ratio of morphine) transiently potentiates morphine analgesia; whereas, high-dose (equal dose-ratio of morphine) reverses the analgesia, and the spinal c-fos expression does not always correlate with pain behavior in the rat formalin test.

Visual Loss after Cervical Spine Surgery in the Prone Position: A case report / 대한마취과학회지

We experienced a patient with unilateral visual loss after cervical spine surgery in the prone position. During the initial postoperative period, we were not been able to identify the patient's visual loss because of severe conjunctival edema in both eyes. Three days after surgery, the patient complained of right visual loss and was examined by an ophthalmologist. Ophthalmic artery occlusion was taken to be the presumptive cause, based on fluorescein angiography (FAG) and other evidence. He had several risk factors of ophthalmic artery occlusion, such as; prone position, compression of the eye-balls, anatomic abnormality, cervical spine and a long duration operation, intraoperative bleeding, hypotension and smoking, and a diabetic history. We concluded that attention must always be paid to a patients' eyes throughout the perioperative and postoperative period to prevent such a catastrophic postoperative complication.

The Effects of Propofol on Kupffer Cells in the Rat Liver / 대한마취과학회지

BACKGROUND: Propofol has an antioxidant capacity and can be used for ischemia-reperfusion injury of the liver. However, the effects of propofol on the Kupffer cells have not been established. METHODS: Kupffer cells were isolated and cultured from male Sprague-Dawley rats. The effects of propofol on the Kupffer cells were evaluated by a phagocytosis assay, TNF-alpha gene expression, TNF-alpha production, and superoxide anion release after administering propofol in different concentrations on the cultured Kupffer cells. RESULTS: The latex bead phagocytosis by the Kupffer cells was suppressed when the Kupffer cells were exposed to propofol irrespective of concentrations. Higher propofol concentrations decreased the loss of Kupffer cells after latex bead phagocytosis. Propofol induced TNF-alpha mRNA expression in the Kupffer cells, but the mRNA expression level after 50microgram/ml of propofol decreased. The pattern of TNF-alpha mRNA expression induced by propofol was different to that induced by LPS: TNF-alpha mRNA was expressed continuously in the propofol-treated cells until 16 hours after exposure to propofol, whereas the level of TNF-alpha mRNA expression induced by LPS was evident after 2 hours and was not found thereafter. TNF-alpha production after propofol treatment was not higher than that of the control. Formazan precipitation did not show any qualitative differences between cells untreated or treated with propofol concentrations of 0.5, 5.0, and 50microgram/ml. CONCLUSIONS: These results showed that propofol might inhibit Kupffer cells. This suggests that propofol can be used for patients with ischemia-reperfusion injury of the liver.

The Effects of Intraperitoneal Instillation of Lidocaine before Pneumoperitoneum on Postoperative Pain Score and Intraoperative Changes of Blood Pressure in Patients with a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the effects of pre-emptive subdiaphragmatic instillation of lidocaine before pneumoperitoneum on postoperative pain following a laparoscopic cholecystectomy (LC) and also to evaluate it's effect on the changes of blood pressure during an operation. METHODS: Thirty-three relatively healthy patients for an LC were allocated into the two groups. after the induction of general anesthesia with sodium thiopental, vecuronium, nitrous oxide and enflurane (1-2 vol%), 0.2% lidocaine 200 ml was subdiaphragmatically instilled 10 min before pneumoperitoneum in the lidocaine group (n = 15), and normal saline in the control group (n = 18). The changes of the systolic and mean arterial pressure (SAP and MAP), postoperative pain score, and the number of analgesics used during the postoperative 24 h were compared between two groups. RESULTS: The pain scores at postoperative 1, 3, 6, 12, 18 and 24 h and the number of analgesics used were significantly low in the lidocaine group compared to the control group (P<0.01). The elevations of SAP and MAP during pneumoperitoneum were significantly attenuated in the lidocaine group (P<0.01). CONCLUSIONS: This data suggests that subdiaphragmatic instillation of lidocaine before pneumoperitoneum is effective in the control of postoperative pain following an LC and also effective to attenuate the elevation of blood pressure during pneumoperitoneum. However, further study is needed to evaluate the safety of these methods before recommendation of routine use.

On the Usefulness of Intravenous Anesthesia for Patients Undergoing Postoperative Radiologic Examination / 대한마취과학회지

BACKGROUND: In most brain operations, the endotracheal tube is kept in postoperatively for airway maintenance during radiologic examinations. But the endotracheal tube causes tracheal irritation and hemodynamic changes. Inhalation anesthetics can not be administered during transport, and minimal concentration is exhaled for several hours after the end of inhalation. The present study was designed : (1) to determine the end tidal isoflurane concentration after the end of administration ; (2) to investigate the effects of intravenous anesthetics in patients with tracheal intubation during radiologic examination postoperatively. METHODS: We selected forty adult patients who were scheduled for elective neurosurgical operation with postoperative brain CT (computerized tomography). The study was performed in 2 steps; in the step 1 (n = 10), end tidal isoflurane concentration was checked after ending inhalation. In the step 2 (n = 30), patients were divided into one of three groups according to anesthesia method; group I (using isoflurane), group P (change from isoflurane to propofol about an hour before operation end), group M (using midazolam instead of propofol, compared to group P). In each group, the frequency of bucking and incidence of hypertension were checked during postoperative radiologic examinations. RESULTS: Minimal concentrations of isoflurane were detected in exhaled gas for about 2 hours after the end of isoflurane inhalation. The frequency of bucking was significantly lower in the group P and M than in group I (P = 0.002). In group P, the incidence of hypertension was significantly reduced compared to group M and I (P = 0.031). CONCLUSIONS: These results suggest that the change of anesthetic technique (from inhalation to intravenous) in the late period of operation, provides postoperative hemodynamic stability, a more comfortable state and minimal environmental pollution in comparison to inhalation anesthesia only.

On the Usefulness of Intravenous Anesthesia for Patients Undergoing Postoperative Radiologic Examination / 대한마취과학회지

BACKGROUND: In most brain operations, the endotracheal tube is kept in postoperatively for airway maintenance during radiologic examinations. But the endotracheal tube causes tracheal irritation and hemodynamic changes. Inhalation anesthetics can not be administered during transport, and minimal concentration is exhaled for several hours after the end of inhalation. The present study was designed : (1) to determine the end tidal isoflurane concentration after the end of administration ; (2) to investigate the effects of intravenous anesthetics in patients with tracheal intubation during radiologic examination postoperatively. METHODS: We selected forty adult patients who were scheduled for elective neurosurgical operation with postoperative brain CT (computerized tomography). The study was performed in 2 steps; in the step 1 (n = 10), end tidal isoflurane concentration was checked after ending inhalation. In the step 2 (n = 30), patients were divided into one of three groups according to anesthesia method; group I (using isoflurane), group P (change from isoflurane to propofol about an hour before operation end), group M (using midazolam instead of propofol, compared to group P). In each group, the frequency of bucking and incidence of hypertension were checked during postoperative radiologic examinations. RESULTS: Minimal concentrations of isoflurane were detected in exhaled gas for about 2 hours after the end of isoflurane inhalation. The frequency of bucking was significantly lower in the group P and M than in group I (P = 0.002). In group P, the incidence of hypertension was significantly reduced compared to group M and I (P = 0.031). CONCLUSIONS: These results suggest that the change of anesthetic technique (from inhalation to intravenous) in the late period of operation, provides postoperative hemodynamic stability, a more comfortable state and minimal environmental pollution in comparison to inhalation anesthesia only.

Comparison of the Peripheral Analgesic Effects of Morphine, Meperidine and Fentanyl using the Formalin Test in Rats / 대한마취과학회지

BACKGROUND: Recently there have been several contradictory reports about the analgesic effects of opioids applied to peripheral tissues. To confirm the peripheral analgesic effects of opioids, this study compared the analgesic effects by observing the pain behavior in rats using the formalin test following infiltration of the commonly used opioids: morphine, meperidine and fentanyl. Furthermore, to confirm the mechanism of this analgesia, it also contrasted the differences of the analgesic effects between local infiltration and intraperitoneal injection of each opioid, and the reversal of peripheral analgesia of morphine by the administration of naloxone. METHODS: One hundred rats were divided into ten groups. The groups were a SHAM group(injection of normal saline 5 min before the formalin injection), infiltration groups(MSLO; 0.1 mL of 0.1% morphine 5 min before the formalin injection, DMLO for 1% meperidine, FTLO for 0.001% fentanyl), intraperitoneal groups(MSIP, DMIP, FTIP), reversal groups(MSLONAIP, MSLONALO) and a naloxone group(NALO). Under inhalation anesthesia, all animals were injected with an opioid according to their allocated group followed by the injection of 0.1 mL of 5% formalin in the plantar area of the hind paw. After recovery from anesthesia, all animals were observed for the number of flinches during phase 1(2~3 min, 5~6 min) and phase 2(every 1 min from 10 to 61 min) after the formalin injection. RESULTS: The flinches were significantly less in the infiltration groups(MSLO, DMLO, FTLO) than in the SHAM group(p<0.05). In addition, there were significantly different peripheral analgesia according to the type of opioid(p<0.05): morphine had a weak, prolonged but delayed onset of peripheral analgesia; meperidine had a potent, prolonged, rapid onset of analgesia but the number of flinches increased in the latter stages of the test; and fentanyl had a rapid, potent but very short duration of analgesia. Differences between peripheral and systemic analgesia were observed; the numbers of flinches in the DMLO, MSLO and FTLO groups were less than in the DMIP, MSIP and FTIP groups respectively(p<0.05). The reversals by naloxone applied locally or intraperitoneally did not increase the number of flinches in the groups of local infiltration of morphine. Furthermore, local infiltration of naloxone alone had less flinches than in the SHAM group(p<0.05). CONCLUSIONS: In this study, peripheral analgesia of opioids are readily present. Local infiltration of opioids such as morphine, meperidine and fentanyl has more potent analgesia than in systemic injection and the characteristics of these peripheral analgesia are different by the type of opioid. Moreover, these effects are not reversed by naloxone.

There is Some Differences in the Changes of Liver Enzyme Levels among the Type of Surgery under Enflurane Inhalation Anesthesia / 대한마취과학회지

BACKGROUND: There are many factors which cause postoperative hepatic dysfunction. Anesthetic agents are not the most common factor and there aremany other factors such as preoperative condition of the patients, site and duration of the operation, operation per se and so on. The purposeof this study is to evaluate postoperative liver function with respect to different types of surgery. METHOD: Fourty three patients were classified into three groups; 11 patients for tympanoplasty with mastoidectomy (Group 1), 16 patients for total abdominal hysterectomy (Group 2), 15 patients for subtotal gastrectomy (Group 3). All patients were anesthesized with about 2 vol% of enflurane combined with 50% nitrous oxide. Serum glutamic oxalacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase (ALP) were measured before anesthesia, 1, 3 and 7 days after surgery in all group, respectively. RESULT: In Group 1 and 2, postoperative SGOT and SGPT levels were maintained with preoperative level during the 7days, but in Group 3, those levels were increased in the 1st day but below upper limit (p<0.05) and decreased thereafter. Alkaline phosphatase level was maintained within the normal range for all the group during the 7 days. CONCLUSION: We consider that postoperative liver functioin may be influenced by different types of surgery, and also may be influenced by anesthetic time.

Thiopental Prevents A Beta-Endorphin Response to Cardiopulmonary Bypass / 영남의대학술지

No abstract available.

Propofol Does not Prevent to Increase Intraocular Pressure During Tracheal Intubation / 대한마취과학회지

BACKGROUND: Anesthesiologists should understand the physiology of intraocular pressure and the implications of anesthetic drugs and maneuvers on intraocular pressure(IOP). Although most anesthetics reduce IOP, succinylcholine causes a transient but significant increase in IOP. And thiopental by itself does not prevent to increase blood pressure, IOP. This study was designed to evaluate the preventive effect of propofol on IOP changes during tracheal intubation. METHODS: IOP was measured with a hand-held applanation tonometer in the eye. Baseline(control) IOP was measured before the induction of anesthesia(stage 1) and serial measurements of IOP were made after administration of the induction agent before intubation(stage 2), immediately after intubation(stage 3) and 10 minutes after intubation(stage 4). Heart rate and systolic blood pressure were recorded simultaneously. According to induction agent and neuromuscular blocker, the 60 patients were divided into control group(C; thiopental, succinylcholine), pretreatment group(T) using defasciculation dose of vecuronium bromide, propofol group(P; propofol, succinylcholine) and vecuronium group(V; propofol, vecuronium bromide). RESULTS: Administration of either propofol or thiopenal resulted in a significant reduction in IOP(P<0.01). At stage 2, IOP of gpoup P and V were significantly lower than that of group C(P<0.05). At stage 3, IOP increased significantly compared to the values of stage 1 in all group(P<0.01). At stage 4, IOP decreased significantly compared to the values of stage 1 in all group(P<0.01), but there was no significant difference between groups in IOP at stage 4. CONCLUSIONS: Propofol may be a useful induction agent of general anesthesia for opthalmic surgery, but cannot prevent to increase IOP during endotracheal intubation.

The Appropriate Inflow Rates of Oxygen and Nitrous Oxide in Adult General Anesthesia / 대한마취과학회지

BACKGROUND: During adult general anesthesia, we used 3~5 L/min of fresh gas flow(FGF) but low FGF are employed, the amount of anesthetic consumption and air contamination can be reduced. The aim of this study was to determine the minimal appropriate inflow rate of oxygen and nitrous oxide during semiclosed circle technique. METHODS: We selected 40 patients, ASA group 1 or 2, scheduled for elective, nonabdominal surgery under general anesthesia with semiclosed circle system. Anesthesia was maintained with 50% oxygen, nitrous oxide and enflurane, controlled ventilation was used; rate of 10/min, tidal volume of 10 ml/kg. After induction and vital signs stabilized, FGF was changed to 4 L, 3 L, 2 L and 1L/min at interval of 30 minutes. We observed mean airway pressure and arterial blood gas tensions. RESULTS: The changes of mean airway pressure did not correlated with fresh gas inflow rate. In arterial blood gas analysis, PaO2 showed a decreasing tendency significantly according to decreasing fresh gas inflow rate(p<0.01) but there were no clinical hypoxemia in all patients. There were no significant changes in pH, PaCO2 and base excess. CONCLUSIONS: We consider that FGF of 1~2 L/min is appropriate during adult general anesthesia because of economic and ecological advantages. Also, we consider low flow technique with below 1L/min can be used safely and effectively under proper gas monitoring such as oxygen analyzer, capnometer.

Pre-emptive Infiltration of Lidocaine Reduces Formalin Pain Behavior in Rat / 대한마취과학회지

Surgical tissue damage induces dual phenomenon of peripheral and central sensitization. Postoperative pain could be partially explained by neuronal hyperexcitability. As a postoperative pain model, formalin test, subcutaneous injection of formalin in the rat hind paw, results in initial vigorous flinching(phase 1), depends on acute chemical stimulation, followed by cessation of activity, and then resumption of flinching(phase 2), which depends on central sensitization. Pre-emptive analgesia, given before the onset of a painful stimuli, reduces or ptevents postoperative pain by preventing this central sensitization. This study was performed to evaluate the effect of local infiltration of lidocaine as a pre-emptive analgesia in the formalin test. Forty experimental rats were divided four groups; CONTROL group(without any treatment), POST group(0.04 mL of 1% lidocaine injection 5 min after formalin injection), PRE group(0.04mL of 1% lidocaine 5 min before formalin injection), and SHAM group(injection of normal saline 5 min before formalin injection). All animals received inhalation anesthesia for 15 min before and 5 min after formalin injection. Under halothane inhalation anesthesia, all were injected subcutaneously 0.04 mL of 5% formalin in the distal plantar area of right hind paw. After recovery of anesthesia, the formalin-induced flinching behavior was observed during only the phase 2 period(10-60 min) after formalin injection. The time to first flinching, the mean number of flinches per min, and the mean number of total flinches during phase 2 expressed as a percent of the values of the CONTROL group were compared between the groups with an t-test or an ANOVA. The first flinching was appeared before recovery of anesthesia in CONTROL and SHAM groups. The time to first flinching after formalin injection was 21.2+/-3.4, 16.6+/-3.1 min respectively in PRE and POST groups. It was significantly longer in PRE group than in POST group(P<0.05), despite of 10 min earlier injeetion of lidocaine in PRE group. The mean number of flinches per min was significantly lower in PRE and POST groups(P<0.05) until 25 min after formalin injection, and after that time the difference between PRE group and POST group was significant(P<0.05). The means of the total number of flinches during phase 2, expressed as a percent of the values of the CONTROL poup, were 100+/-17.2%, 31.8+/-13.1%, 76.9+/-14.5% respectively in SHAM, PRE and POST groups. Those in PRE and POST groups were significantly lower than that of CONTROL group(P<0.001), and the difference between PRE group and POST group was significant(P<0.05). In summary, pre-emptive infiltration of lidocaine on formalin test prolongs the duration of analgesia and reduces the severity of formalin pain in rat. Therefore, the infiltration of lidocaine before formalin test is really provided pre-emptive analgesia.

Intravenous Infusion of Lidocaine in the Management of Chronic Pain States / 대한마취과학회지

Recently, intravenous lidocaine has been reported to relieve chronic pain and to suppress the spontaneous abnormal ectopic discharge in injured nerve. Interest in the use of these modalities has been stimulated by animal researches of neuropathic pain syndromes. We performed this study to evaluate the analgesic responses and the side effects of intravenous(IV) irifusion of lidocaine used in chronic pain patients. Patients received 5 mg/kg of lidocaine, mixed in 150 mL over 40 minutes. The analgesic efficacy was evaluated in 20, 40, 60 minutes after the start of the initial IV lidocaine infusion, by a numeric rating scales (NRS) scores. The responders were received the repeated infusions at one week interval. The results were as follows; 1. Mean NRS scores was 6.7+/-1.9 before the infusion, and changed to 4.2, 2.7, 2.6, in 20,40,60 minutes after the start of the initial IV lidocaine infusion. 2. Eight of ten patients were responders during initial IV lidocaine infusion, and two patients were nonresponders. During the series of repeated lidocaine infusions to eight responders, six were partial relief, and two were complete relief of their pain without any medication. The diagnoses in responders were diabetic neuropathy, ischemic neuropathy, traumatic neuropathy, causalgia, reflex sympathetic dystrophy, erythromelalgia, and spinal stenosis. 3. The side effects, including sedation, dizziness, slurred speech, circumoral numbness, and lightheadedness, were not serious during the period of infusion. The conclusion is that repeated intravenous lidocaine infusions would be effective in the management of chronic pain states. But it needs more studies on the method of infusion and the safety of these modalities.

Effects of Laryngeal Mask Insertion on Cardiovascular Responses during Cesarean Section / 대한마취과학회지

In 1983, Brain introduced laryngeal mask as a new airway. Laryngeal mask bave many advantages of easy insertion without laryngoscope and muscle relaxants, minimal cardiovascular responses, decreasing damages of larynx and pharynx and also useful in difficult intubation or emergency airway care. We studied cardiovascular responses of parturients and Apgar score of neonates during tracheal intubation(Group I) and laryngeal mask insertion(Group II), After tracheal intubation or insertion of laryngeal mask, blood pressure(systolic, diastolic and mean) and heart rate were measured for 5 minutes at 1 minute interval. The results were as follows: 1) There were significant increase in systolic, diastolic, mean arterial pressure and heart rate in both groups, but degree of increase was less in laryngeal mask group. 2) The Apgar scores of the neonates did not differ significantly, 1 minute Apgar score was up 8 in both group. It is concluded that insertion of laryngeal mask is beneficial to parturients than use of laryngoscope and tracheal intubation to avoid harmful cardiovascular responses in the management of airway during cesarean section.

Cardiovascular effects of esmolol, lidocaine and fentanyl on endotracheal intubation in hypertensive patient / 대한마취과학회지

This study is designed to compare the effectiveness of single-bolus lidocaine, fentanyl and esmolol at the time of postintubation to blunt the hemodynamic intubation response in hypertensive patients. Sixty mildly hypertensive patients, scheduled for elective surgery, were randomly assigned in a double blind to receive a preintubation dose : in the firat group(Group A),20 patients received 1.5mg/kg lidocaine ; in the second group(Group B), another 20 patients received 3 ug/kg fentanyl; and in the third group(Group C), another 20 patients received 100mg esmolol. Within the above mentioned framework, this study obtained the following results : Systolic arterial pressure (SAP), heart rste (HR) and rate-pressure product (RPP) all significantly increased 1 minute after intubation. Fentanyl was more effective in protecting sgainst increase in SAP than lidocaine, which proves to be significant as shown in P<0.05. The statistical result, however, did not show the effectiveness of fentanyl signifieantly differed from that of esmolol in this respect. Esmolol preloading was significantly more effective in blunting hesrt rate than any other drugs. On the other hand, preloading of esmolol or fentanyl was significantly more effective in blunting rate-pressure product thsn lidocaine,which turned out to be P <0.05. Given these results, the present study concludes that esmolol preloading provides a reliable protection against increases in both heart rate and systolic srterial pressure accompanying laryngoscopy and intubation in hypertensive patients.

Hemodynamic Changes by Speed of Injection of d-Tubocurarine under General Anesthesia / 대한마취과학회지

d-Tubocurarine(d-TC) causes hypotension, probably as a result of the liberation of histamine; in larger doses, it produces ganglionic blockade. An increase of histamine levels in plasma to 200 to 300 percent of baseline causes a brief decrease in arterial blood pressure(1 to 5 minutes) and the increase in heart rate. The amount of histamine released by d- TC is dose related and is also related to speed of injection. Therefore histamine release can be minimized by the slow administration, light level of surgical anesthesia, and the use of smaller doses. Thus, the purpose of this study was to prevent the cardiovascular effect of d-TC by the slow administration undergoing general anesthesia. The study population was from 40 patients scheduled for elective surgery at Yeungnam University Hospital, who belonged to physical status I or II of ASA classification. Patients were divided into 4 groups by speed of injection of 10, 30, 60 and 120 seconds(group 1, 2, 3 and 4, respectively). All patients were premedicated with hydroxyzine 1mg/kg, glycopyrrolate 0.2mg, and fentanyl 1 ug/kg IM 30 minutes before anesthesia. Patients were induced with thiopental sodium 4-5 mg/kg until the disappearance of lid-reflex. Succinylcholine 1.0 mg/kg IV was used to facilitate endotracheal intubation. As soon as relaxafion was complete, laryngoscopy was initiated. After the completion of intubation, nitrous oxide and 50% oxygen with 0.6% halothane was administrated. The blood pressure and heart rate were measured using noninvasive automatic blood pressure manometer for 60 minutes per 1 minute. Data were analyzed with one-way ANOVA test within the groups. p<0.05 was considered significant. The results were as follows, The changes of blood pressure was decreased in rapid injection groups(Group 1 & 2) compared with slowly injection groups(Group 3 & 4) at 2 min, 5 min after d-TC administration. The changes of heart rate was significantly increased(p<0.05) at 1min, 2 min after d-TC administration in rapid injection groups compared with slow injection groups. These results show that the cardiovascular effect of d-TC might be prevented by slowly administration undergoing general anesthesia.

The effect of lidocaine dose and pretreated diazepam on cardiovascular system and plasma concentration of lidocaine in dogs ansthetized with halothane-nitrous oxide / 영남의대학술지

Lidocaline if frequently administered as a component of an anesthetic : for local or regional nerve blocks, to mitigate the autonomic response to laryngoscopy and tracheal intubation, to suppress the cough reflex, and for antiarrythmic therapy. Diazepam dectease the potential central nervous system (CNS) toxicity of local anesthetic agents but -may modify the sitmulant action of lidocaine in addition to their own cardiovascular depressant. The potential cardiovascular toxicity of local anesthetics may be enhanced by the concomitant administration of diazepam. This study was designed to investigate the effects of lidocaine dose and pretreated diazepam to cardiovascular system and plasma concentration of lidocaine. Lidocaine in 100 mcg/kg/min, 200 mcg/kg/min, and 300 mcg/kg/min was given by sequential infusion to dogs anesthetized with halothane-nitrous oxide (Group I). And in group II, after diazepam pretreatment, lidocaine was infused by same way when lidocaine was administered in 100 mcg/kg/min, the low plasma levels (3.97+/-0.22-4.48+/-0.36 mcg/ml) caused a little reduction in cardiovascular hemodynamics. As administered in 200 mcg/kg/min, 300 mcg/kg/min, the higher plasma levels (7.50+/-0.66-11.83+/-0.59 mcg/ml) reduced mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), left ventricular stroke work index (LVSWI), and right ventricular stroke work index (PVSWI) and incresed pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), but was assciated with little changes of heart rate (HR), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance index (PVM). When lidocaine with pretreated diazepam was administered in 100 mcg/kg/min, the low plasma level, the lower level than when only lidocaine administered. reduced MAP, but was not changed other cardiovascular hemodynamics. While lidocaine was infused in 200 mcg/kg/min, 300 mcg/kg/min in dogs pretreated diazepam, the higher plasma level (7.64+/-0.79-13.79+/-0.82 mcg/ml) was maintained and was associated with reduced CI, SI, LVSWI and incresed PAWP, CVP, SVRI but was a little changes of HR, MPAP, PVRI. After CaCl2 administeration, CI, SI, SVRI, LVSWI was recovered but PAWP, UP was rather incresed than recovered. The foregoing results demonstrate that pretreated diazepam imposes no additional burden on cardiovascular system when a infusion of large dose of lidocaine is given to dogs anesthetized with halothanenitrous oxide. But caution may be advised if the addition of lidocaine is indicated in subjects who have impared autonomic nervous system and who are in hypercarbic, hypoxic, or acidotic states.

Effects of Furosemide on Perioperative Serum Electrolytes and Osmolality during Transurethral Resection of the Prostate / 대한마취과학회지

The purpose of this study was to prevent the dilutional effect of excessive absorption of irrigating solution by using furosemide intraoperatively during transurethral resection of the prostate. Thirty patients, classified as ASA ps 2 or 3, were selected randomly and divided them into two groups as follows: Group l(N=15); Not-administrated furosemide(control group) Group 2(N=15); Administrated furosemide(Experimental group) All patients were premedicated with hydroxyzine(1 mg/kg, IM) and were performed continuous epidural anesthesia with 2/ lidocaine(1-1.5 mg/segment). 5% D-sorbitols were used for irrigating solution, and Hartmans solutions were given for maintenance fluid. And fixed the irrigating container to 60 cm in height from symphysis pubis. With the starting of operation, 20 mg furosemide was administrated to experimental group. The blood samples for serum Na+, K+, glucose and BUN were obtained at preoperation, 10 min, 20 min, 30 min after the stating of operation and immediate postoperative period, and serum osmolality and effective osmolality were calculated. The results were as follows: l) The values of sodium concentration of control group were decreased significantly at 10 min, 20 min, 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p<0.05). But those of experimental group were not changed significantly. 2) The values of serum osmolality and effective osmolality were decreased significantly at 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p<0.05). But those of experimenta1 group were not changed significantly. These results show that the dilutional effect of excessive absorption of irrigating solution might be prevented by using furosemide intraopertively. So we would like to recommend the use of furosemide during TURP, especially in patients with congestive heart failure or renal failure.