The Effect of Lidocaine on Tracheal Smooth Muscle Tension in Guinea-pigs / 대한마취과학회지

No abstract available.

Upper Airway Obstruction & Brachial Plexus Injury Occurred after Microvascular Decompression under Fukushima Lateral Position: A case report / 대한마취과학회지

A 25 years old woman was adrnitted to the department of neurosurgery for a right hemifacial spasm. She was undertaken microvascular decompression in the Fukushima lateral position. Following completion of operation, she began to complain of dyspnea, but the phonation was not changed. Mild weakness and paresthesia on left upper extremity was complained, too. Severe swelling on the left side of face and neck expending to left shoulder was noted simultaneously. Immediate computerized tomography was taken to reveal the cause of respiratory distress, which suggested that venous and/or lymphatic congestion on the left side of neck. As respiratory distress was getting more severe, emergent tracheostomy was taken. The cause of above symptoms was suspected to an extreme rotation and flexion of the head resulting in direct contact of mandibular body to clavicle. A month after operation, there was still remained mild paresthesia on left thumb and index finger.

Oral Ketamine Premedication for Pediatric Outpatient Anesthesia / 대한마취과학회지

BACKGROUND: In children, fear of venipuncture and seperation from parents may produce stormy induction of anesthesia. Premedication administered by nontraumatic methods helps to decrease anxiety and minimize psychological trauma. METHODS: To define a dose of oral ketamine that would facilitate smooth induction of anesthesia for pediatric outpatient surgery without causing significant side effects, sixty children(ASA Physical Status 1; aged 1-7 years) undergoing inguinal herniorrhaphy were assigned randomly to four separate groups that received 5 mg/kg, 7 mg/kg, 10 mg/kg, or no ketamine(control group) mixed in 0.2 ml/kg cola. They were evaluated preoperatively and postoperatively for acceptance of oral ketamine, reaction to separation from their parents, acceptance of facial mask for inhalation induction, emergence delirium and postanesthetic complications. RESULTS: The 7 mg/kg and 10 mg/kg doses were well accepted; provided predictable sedation within 22-25 minutes; allowed calm seperation from parents and good induction conditions. However, the 10 mg/kg dose prolonged discharge time from recovery room, probably due to delayed recovery. Emergence deliriums were observed in two of all ketamine administered children(4.4%). And the incidences of postanesthetic complications such as vomiting, decreased appetite, lethargy, nausea, nightmare, behavioral change were slightly higher in ketamine administered groups, compared to the control group. CONCLUSION: The authors conclude that an oral dose of 7 mg/kg ketamine is well accepted in young children undergoing outpatient surgery for inguinal hernia and provides relatively predictable and satisfactory sedation without prolongation of discharge time and significant side effects.

Diagnostic and Therapeutic Impacts of Hemodynamic Data from Pulmonary Artery Catheterization in Critically Ill Patients / 대한마취과학회지

BACKGROUND: The hemodynamic status of critically ill patients is poorly predicted from clinical examination and chest x-ray findings, so equipments such as pulmonary artery catheter are needed for monitoring of hemodynamics. The authors undertook this study to evaluate physician's accuracy in predicting hemodynamic profiles, rates of therapeutic change resulting from catheterization and to compare the outcomes with or without therapeutic changes. METHODS: Pulmonary artery catheters were inserted in 19 critically ill patients. The physicians accuracy of predicting the hemodynamic profile, the rate of therapeutic changes by monitoring actual hemodynamic profiles were calculated and compared to the outcome between the patients with and without therapeutic change, RESULTS: Hemodynamic profiles were correctly predicted in 63% of all cases. Hemodynamic data from pulmonary artery catheter made the therapeutic plan changed in 53% of all cases. The cardiac index and left ventricular stroke work index were improved and the mortality rate was lower in patients with therapeutic changes, but there were no significant statistical differences between the patients with and without therapeutic changes. Complications occurred in 6 cases but had no effect on patient' s outcome. CONCLUSIONS: Hemodynamic data from a pulmonary artery catheter could lead to a more accurate diagnosis and therapeutic changes.

Effect of Preemptive Analgesia on the Post-operative Pain / 대한마취과학회지

BACKGROUND: Preemptive analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurons and, therefore, may reduce post-operative pain. But, preemptive analgesia has been shown to decrease postinjury pain in animals, studies in human have provided controversial results. We studied whether intravenous morphine infusion before induction could affect post-operative pain and analgesic demands, when compared with intravenous morphine infusion after the closure of the peritoneum. METHODS: Female patients scheduled for total abdominal hysterectomy were randomly assigned to one of two groups of prospectively studied in a double-blind manner. Group I (n=23) and II (n=20) received intravenous morphine (0.1 mg/kg) before induction of anesthesia and after the closure of the peritoneum, respectively. Either group had continuous infusion of morphine (1.5 mg/hr) immediately after i.v. bolus morphine. Postoperative pain relief was provided with i.v. morphine from a PCA system (Medex Walkmed). Postoperative visual analogue pain scores (VAS), analgesics requirements and side effects were examined and compared between groups for 2 postoperative days. RESULTS: VAS were significantly less in group I (3.3+/-0.4) than in group II (5.3+/-0.5) 2hrs after surgery (p<0.01). Patient-cantrolled morphine cumulative consumption in group I was significantly less than in group II for 24hours (21.9 mg vs 35.3 mg) and 48hours (37.4 mg vs 55.0 mg) after operation (p<0.01). CONCLUSIONS: Preemptive analgesia with intravenous morphine reduces postoperative pain and analgesic requirements. Lower postoperative analgesic requirements in preemptive analgesic group indicate that intravenous morphine prevents development of injury-induced peripheral or central sensitization.

Endothelium dependent Effects of Halothane and Sevoflurane on Isolated Rabbit Aortic Vascular Rings / 대한마취과학회지

This study was aimed to elucidate the endothelium-dependent vascular effects of halothane and sevoflurane on rabbit aortic rings at two conventional concentrations(high induction and low maintenance concentration in human). Isometric tenslon was recorded in isolated aortic rings. Preparations of rabbit thoracic aorta were suspended in Krebs' buffer and aerated with 95% O2 and 5% CO2. One set of the rings had intact endothelium and the other set of the rings had endothelium mechanically denuded. In the first experiments, the rings were precontracted with norepinephrine(NE) of 10-7 M. After tension was stabilized in 10~15 minutes following NE, halothane(1, 2%) or sevoflurane(2, 4%) was bubbled with O2/CO2 gas mixture at increasing concentrations. In the second experiment, O2/CO2 gas mixture only(control rings), halothane 2% or sevoflurane 4 % with O2/CO2, gas mixture was bubbled for 10(-7) minutes prior to and during contraction with NE of 10M. After tension was stabilized following NE, acetylcholine(10(-8)-10(-6) M) was added cumulatively. In the third experiment, the procedure was as same as the second experiment except for that acetylcholine(10(-8)-10(-6) M) was substitued for nitroglycerin (10(-9)-10(-6) M) . The present study demonstated that both of halothane and sevoflurane at high concentration caused a vasoconstriction to 110.7+/-4.2% and 122.4+/-8.4% in vascular rings with intact endothelium, and 106.1+/-1.9% and 118.3+/-3.5% in vascular rings with denuded endothelium, respectively, compared to each control value of 100%. Furthermore, halothane and sevoflurane attenuated the acetylcholine induced relaxing response in NE-precontracted vascular rings with intact endothelium, but did not affect any change of tension in vascular rings with denuded endothelium. Halothane and sevoflurane did not attenuate the nitroglycerin induced relaxing response in NE-precontracted vascular rings with both intact and denuded endothelium. In conclusion, halothane and sevoflurane at high concentration has vasoconstrictory effects on vascular smooth muscles in rabbit aortic rings regardless of presence of endothelium and also attenuated the endothelium-dependent relaxation.

Cardiovascular Effects of Propofol as an Induction Agent in Kidney Recipients / 대한마취과학회지

A need has been recognized for a safe and effective induction for patients undergoing elective renal transplantations. We have evaluated the effect of propofol (injection rate; 50 mg/min, average dosage; 2.28+/-0.08 mg/kg, n=10) on a cardiovascular stability compared with that of thiopental (injection rate; 100 mg/min, average dosage; 5.22+/-0.18 mg/kg, n=10) as an induction agent. Blood pressure and heart rate as cardiovascular parameters were checked before induction(control), one, two, three minutes after induction, before and after orotracheal spray of lidocaine, and immediately, one and two minutes after endotracheal intubation. The results were as follows: 1) There were no significant cardiovascular changes in the propofol group during the whole induction period. 2) In the thiopental group, diastolic blood pressures checked just after intubation, which were 120.20+/-7.79 mmHg, were significantly higher than those of one or two minutes after induction, which were 86.30+/-4.36, 88.40+/-3.85 mmHg, respectively. The above results suggest that intravenous propofol (2.0~2.5 mg/kg) is a safe and effective induction agent for renal recipients.

Does the Temperature of 0.5% Plain bupivacaine Affect the Sensory Level in Spinal Anesthesia? / 대한마취과학회지

The level of sensory blockade in spinal anesthesia is determined by the distribution of local anesthetics within cerebrospinal fluid (CSF) which is affected by the density of local anesthetics. Temperature is one of the factors which can influence the density of local anesthetics. The level of sensory blockade in spinal anesthesia may be altered by the density change of local anesthetics and by the time needed for thermal equilibration in CSF, depending on the storage temperature of local anesthetics. A study was conducted at Inchon Severance hospital on 20 elective surgery patients under spinal anesthesia, to compare the clinical differences between two groups stored at different temperatures. Group I was used 0.5% plain bupivacaine 3 ml (15 mg) stored in a refrigerator for longer than 24 hours and group II was used that stored in operating room temperature. The results were as follows : The level of sensory blockade in group II was significantly higher than that of group I, 3 minutes after spinal anesthesia by segmental level of sensory loss to pinprick test. The degree of motor blockade was significantly greater by Bromage scale in group II than in group I at 2 minutes after spinal anesthesia, but no significant difference was observed after 5 minutes. When 15 minutes elapsed, the complete motor blockade of lower extremities was observed in both groups. The onset of sensory block was significantly faster in group II(3.1+/-0.2 min) than in group I (5.2+/-0.5 min). The onset of maximum sensory block was also significantly faster in group II(9.5+/-0.5 min) than in group I (14.0+/-1.5 min). The maximum sensory block level was significantly higher in group II(T6.7+/-0.3 dermatome) than in group I (8.2+/-0.3 dermatome). However, the regression time was not significantly different between group I (122.0+/-3.8 min) and group II (117.2+/-6.0 min). The above results showed that when 0.5% plain bupivacaine stored in room temperature was used in spinal anesthesia, gave higher level of sensory blockade and faster onset than that kept in a refrigerator, which may due to the time difference needed for thermal equilibration in CSF.

Tumor Embolism of Right Heart Diagnosed with Echocardiogram in Patients of Hepatoma with Inferior Vena Cava Thrombus / 대한마취과학회지

Pulmonary thromboembolism is a leading cause of morbidity and mortality. Many patients dying of pulmonary thromboembolism have serious underlying illness such as cancer and congestive heart failure. Cancer patients are prone to both thrombotic and tumor embolism. In cancer patients, tumor pulmonary embolism and thrombotic pulmonary embolism can be associated with dyspnea, cor pulmonale and pulmonary hypertension. We presented a female patient of 63 year-old age of a hepatoma with inferior vena cava thrombosis. She had been transferred to the intensive care umt in state of refractory hypoxemia with 100% oxygen inhalation. Perfusion scan showed 60.71% defect in right lung and 39.28% defect in left lower lung field. Heparin infusion was done with the impression of pulmoary embolism without effect. Initial hemodynamic data with insertion of pulmonary ery catheter showed that cardiac index, 1.62 L/minute/M2, right atrial pressure, 28 mmHg, pulmonary capillary wedge pressure 14 mmHg. Cardiac index did not increase in spite of dobutamine and dopamine infusion. Right atrial pressure increased to 29 mmHg but pulmonary capillary wedge pressure was 11 mmHg with fluid administration. Echocardiogram revealed that mass, 7X8 cm of size, was in right heart in connection to inferior vena cava thrombus. Tumor embolism from hepatoma would be suspected in our patient, but we did not confirm that case with the biopsy or autopsy. Echocardiography with pulmoary artery catheter insertion would be helpful to diagnose the disease which was suspected of pulmonary embolism and tumor embolism in cancer patient.

Pressure Controlled Ventilation(PCV) in a Patient with Status Asthmaticus / 대한마취과학회지

High peak inspiratory pressure during control-mode ventilation (CMV) with volume cycled ventilator is associated with increased risk of barotrauma. Pressure controlled ventilation can reduce peak inspiratory pressure and barotrauma, and provide for adequate gas exchange. We present a case of the patient of status asthmaticus in whom we used pressure controll ventilation of lower inspiratory pressure (initially 45 cmH2O) with good outcome during midazolam infusion. At the admission to the ICU, the peak inspiratory pressure was 80 cmH2O with control- mode ventilation of volume cycled ventilator and respiratory acidosis developed (pH: 7.20, PaCO2: 64.1 mmHg). After changing the volume control mode to pressure controlled mode, the peak inspiratory pressure could be reduced from 80 cmH2O to 45 cmH2O with improvement of respiratory acidosis. From our experience, we recommend the application of pressure control ventilation safely to the patients in whom peak inspiratory pressure is high enough to induce barotrauma, if expired tidal volume is monitored.

Intracellular Mechanism of Sevoflurane`s Effect on Isolated Vascular Rings of the Rabbits / 대한마취과학회지

The purpose of this study were to elucidate how sevoflurane affects vascular smooth musde and to understand the intracellular mechanism of sevoflurane. Isolated aortic rings of the rabbit were examined. Rings were mounted on tissue bath containing 40 ml of modified Krebs solution bubbled with 95% O2/5% CO2 and attached to force transducers. The preparations were contracted with either 40 mM KC1, or 0.1 uM norepinephrine followed by 0.1 uM acetylcholine (and 1 nM ryanodine)- or 2.8 mM lidocaine induced relaxation. At steady state contraction or relaxation, the effects of sevoflurane (2, 4, 5%) were studied. The steady state tension before administration of sevoflurane was considered as 100% and the changing tension during sevoflurane was expressed as a percentage. Sevoflurane (2, 4, 5%) produced relaxing effects (99.4+/-0.6, 98.1+/-0.9, 95.9+/-1.0%) on KC1-induced tension, independent of endothelium. Sevoflurane increased tension in the acetylcholine (55.4+/-5.1%)- or lidocaine (75.3+/-8.3%)- relaxed state (acetylcholine: 73.6+/-5.3, 86.8+/-3.2, 94.1+/-5.2%, acetylcholine+ryanodine ; 63.7+/-4.6, 68.6+/-7.2, 70.4+/-2.5%, lidocaine ; 83.7+/-7.0, 84.6+/-12.1, 85.3+/-4.4%). The effects were dose-dependent manner. It is concluded that sevoflurane directly alters vascular contraction or relaxation in relation to Ca2+ mobilization on condition and that mechanism of sevofluranes effects on the sarcoplasmic reticulum may play a primary role.

The effects of gentamicin on metodurine-induced neuromuscular blockade and its reversal with neostigmine or calcium in the cat / 대한마취과학회지

To determine the neuromuscular effect and its reversals of gentamicin, alone or in combination with metocurine, pharmacodynamic studies were done using a common peroneal nerve- anterior tibialis muscle preparation in 24 adult cats weighing 2.5-4.0 kg. The median effective dose of gentamicin obtained by cumulative dose-response study was 21.6+/-4.83 mg/kg. Under the pretreatment of gentamicin, the onset and duration of metocurine was 1.32+/-0.91 min and 28.8+/-10.95 min, respectively. There was no significant difference in the recovery indicies for its reversal between neostigmine and calcium. Each values of recovery indices were 1.85+/-0.65 and 2.05+/-1.00 min with neostigmine and calcium, respectively. These results suggested that gentamicin by itself had neuromuscular blocking effect. With the pretreatrnent of gentamicin, the onset of metocurine was shortened to one third and its duration was prolonged as much as seven times. Additionally, metocurine induced neuromuscular block with pretreatment of gentamicin was reversed completely.

Some Effects of Histamine Type 2 Blockers on the Nosocomial Pneumonia in Patients with Prolonged Intubation / 대한마취과학회지

Nosocomial pneumonia, which can develop in patients with prolonged intubation, may have in fatal consequences. The histamine type 2 blockers used for prevention of stress ulcers, increases gastric pH, and may increase the incidence of nosocomial pneumonia in patients with prolonged intubation by promoting bacterial overgrowth in the stomach and retrograde colonization in the trachea. We assessed the effect of histamine type 2 blockers on the incidence of nosocomial pneumonia in patients with prolonged intubation, who were admitted to the Intensive Care Unit, Young Dong Severance Hospital, Yonsei University College of Medicine from September 1992 to February 1993. The patients were divided into two groups Group 1 was the patients given histamine type 2 blockers and total parenteral nutrition, and Group 2 was the patients not given histamine type 2 blockers and with enteral feeding through the gastric tube. Gastric juice was aspirated for measurement of gastric pH. A culture of isolates was grown from endotracheal secretion and pharyngeal swab for identification of isolate cultured. Chest X-rays were taken for assess of pneumonic infiltrate, The results were as follows ;. 1. There were no difference of age, APACHE II scores at admission to ICU, duration of ICU stay and mortality between the two groups. 2. Gastric pH differed significantly between the two groups. In group 2, there was a significant difference between gastric pH before and after feeding. 3. The incidence of upper gastrointestinal bleeding did not differ between the two groups. 4. Colonization developed more frequently in the patients with enteral feeding. 5. The incidence of retrograde colonization was higher in patients with enteral feeding. 6. The incidence of nosocomial pneumonia were 30 and 40 percent, and there was no significant difference between the two groups. From our study, the incidence of nosocomial pneumonia was not different significantly between the two groups although gastric pH differed significantly.

The effect of endotracheal tube exchange with tube exchanger device on arterial oxygen saturation and heart rate / 대한마취과학회지

There are several situations where the indications for changing an endotracheal tube is absolute and relative in ICU. Intubation times of 7 days or less have a low but significant incidence of serious sequelae in the modern ICU settings. In general, three techniques (Direct laryngoscopy, Tube exchangers, Fiberoptic bronchoscopy) are available for changing endotracheal tube. Each techniques is examined in terms of its advantages and disadvantages, along with its potential complication. The majority of anesthesiologists are familiar with direct laryngoscopy, however, the technique has some serious potential disadvantages. Direct laryngoscopy involves a significant stress on the cardiovascular system. Either this stress or the sedation that may be given to blunt it may be deleterious in a marginal patients. Use of tube exchangers have become popular because of their relative simplicity, widespread availability, and their potential for providing oxygenation, minimal need for sedatives and little hemodynamic insult, atraumatic teehniques. Ineluded in the study were 43 patients scheduled for changing of endotracheal tube admitted at ICU. The purpose of the present study is to compare with time, pulse rate, SaO2 between direct laryngoscopy and tube exchangers so as to endotracheal reintubation. The results were as follows. 1) Use of 19F sized tube exchanger, 21 cases were succeeded among 21 cases, but 3 cases were succeeded among 8 cases using 11F sized tube exchangers. 2) In the tube exchanger group, 28 cases among 29 cases were succeeded without use of sedatives or muscle relaxant. In laryngoscopy group, 10 cases among 14 cases were succeeded use of sedatives, 4 cases among 14 cases were succeeded use of muscle relaxants. 3) SaO2 was significantly lower in direct laryngoscopy group than tube exchanger group after tube exchange.

Complications during ventilatory support in patients with acute respiratory failure

When ventilatory support becomes necessary in patients with acute respiratory failure, there is an associated increase in complications. We reviewed the charts of acute respiratory failure patients with the ventilatory support retrospectively who were admitted to the General Intensive Care Unit, Yonsei University College of Medicine, Seoul, Korea for the 6 months period, from March through August, 1990. The data included incidence of complications, morbidity and mortality, and reasons for and the duration of the ventilatory support. Of 269 patients receiving the ventilatory support, 107 patients (39.8%) developed 159 complications including alveolar hyperventilation (56 times), premature extubation (20 times) and right bronchial intubation (16 times). A single complication was associated with mortality rate of 19.5%, while with two or more complications, mortality rate was 60%, giving an average mortality rate of 29% when the complications were identified. The highest incidence of complications was in patients with multiple organ failure (80%). The highest mortality rate (50%) occurred in patients with heart failure. Patients with the ventilatory support less than one day had 23% incidence of complications and 2.7% mortality, while those with support for more than one month, these figures were 90.0% and 40.0% respectively (p<0.05).

Comparison of plasma inorganic fluoride concentration with sevoflurane-N2O and enflurane-N2O anesthesia

Plasma inorganic fluoride concentrations were measured in adult patients without hepatic or renal disease following sevoflurane-N2O anesthesia (n = 7) or enflurane-N2O anesthesia (n = 6). The anesthetic dosage of sevoflurane and enflurane was 6.48 +/- 2.15 %-hours and 6.57 +/- 2.50 %-hours, respectively. The mean peak plasma inorganic fluoride concentration in the sevoflurane group was 19.5 +/- 13.4 mumol/L 1 hour after anesthesia, which decreased to preanesthetic levels 24 hours after anesthesia. In the enflurane group the values were 13.2 +/- 5.8 mumol/L at the end of anesthesia and decreased, but remained, still twice as high as the preanesthetic level 24 hours after anesthesia. The relationship of plasma inorganic fluoride concentration and anesthetic dosage was more pronounced in the sevoflurane group (r = 0.68, slope = 4.2) than in the enflurane group (r = 0.39, slope = 1.2). In conclusion, sevoflurane-N2O anesthesia results in similar subnephrotoxic levels of plasma inorganic fluoride as enflurane-N2O anesthesia, and although the fluoride concentration had a better correlation to anesthetic dosage in the sevoflurane group than in the enflurane group, its excretion was faster in the sevoflurane group than in the enflurane group.

Continuous Epidural Analgesia in Labor / 대한마취과학회지

Effects of epidural continuous infusion were compared with those of intermittent injection method in 50 primigravid parturients in active labor. After the intial bolus epidural injection of 0.25% bupivacaine 7-10ml, the parturients were divided randomly assigned to either continuous epidural infusion(INF) group or no infusion control(CONT) group. INF group received continuous epidural infusion of 0.125% bupivacaine 10ml h(-1). The parturients in both groups received intermittent top-ups of 0.25% bupivacaine 5ml with pain above 4 on visual analog scale. Epidural administration of bupivacaine was discontinued at the beginning of second stage of labor. No difference was noted between the two groups compared with respect to pain score during first stage of labor and to duration of epidural analgesia and second stage of labor. The mean pain score during second stage was lower and the general patient satisfaction was greater in INF group. The time interval between top-ups was longer in INF group than in CONT group. The total dose of bupivacaine administered during epidural analgesia was more in INF group than in CONT group. However the difference of hourly dose between two groups when the duration of epidural anagesia exeed four hours was not significant. No parturients in either group experienced severe hypotension, high level of sensory blockade or heavy motor blockade. We conclude that continuous epidural infusion seems capable of keeping parturient's hemodynamics stable during labor, and offers greater satisfaction and safety to the parturients.

Survey for the Knowledge regarding anesthesia in inpatients undergoing cardiothorcic surgeries / 대한마취과학회지

Most patients, who will undergo risky surgical operations such as cardiac surgery or lung surgery, may have some knowledge on the surgical or anesthetic procedure involved in the operations. In order to understand the actual degree of patients' knowledge regarding anesthesia and to make anesthetic information available to the public more effectively based on this understanding, a questionnaire survey was conducted to 154 patients who had operations at the Yonsei cardiac center between June 1992 and January 1993. The questionnaire was composed of 21 questions; 19 multiple-choices and 2 askings for simple descriptive answers. The survey results analyzed by sex, age, education and occupation. The Chi-Square analysis is conducted to test the statistical significance among different groups in each category. The survey shows that first, most patients wanted to get anesthetic information at the practical common sense through mass media. Thus it is necessary to continuously provide detailed anesthetic information to the public through mass media. Obviously, it is more effective to provide anesthetic information to the public or patients adjusted to their educational level. Secondly, patients wanted to consult anesthesiologist about their own anesthesia before operations, and the informative preoperative visit by anesthesiologist have positive psychological effect to patients. Therefore, it is desirable for an anesthesiologist to give preoperative visit to a patient explaining complexities which may occur during and after anesthesia.

Plasma inorganic fluoride concentrations following sevoflurane anesthesia / 대한마취과학회지

Plasma inorganic fluoride concentrations were measured in adult patients without hepatic or renal disease following sevoflurane-N2O anesthesia (n=7) or enflurane-N2O anesthesia (n=6). The anesthetic dosage of sevoflurane and enflurane was 6.48+/-2,15%-hour and 6.57+/-2.05%-hour, respectively. The mean peak plasma inorganic fluoride concentration in the sevoflurane group was 19.5+/-13.4 umol/L 1hour after anesthesia, which decreased to preanesthetic levels 24 hours after anesthesia. In the enflurane group the values were 13.2+/-5.8 umol/L at the end of anesthesia and decreased, but remained, still twice as high as the preanesthetic level 24 hours after anesthesia. The relationship of plasma inorganic fluoride concentration and anesthetic dosage was more pronounced in the sevoflurane group (r=0.68, slope=4.2) than in the enflurane group (r=0.39, slope=1.2). In conclusian, sevoflurane-N2O anesthesia results in similar subnephrotoxic levels of plasma inorganic fluoride as enflurane-N2O. anesthesia, and although the fluoride concentration had a better correlation to anesthetic dosage in the sevoflurane group than in the enflurane group, its excretion was faster in the sevoflurane group than in the enflurane group.

The Neuromuscular Blocking Actions of Metocurine and its Reversal in Cats with Acute Renal Failure / 대한마취과학회지

Acute renal failure was induced to investigate it effects on the neuromuscular blocking actions and reversals of metocurine in 14 adult cats, either sex, weighing 2.5-4.5 kg. Ligation of both renal pedicles in 6 cats (Group II) and its sham operations in 8 cats (Group I) were done under the pentobarbital anesthesia. Neuromuscular monitoring was done using a common peroneal nerve-tibialis anterior muscle preparation. The mean blood pressures, acid-base status and serum electrolytes at the time of injection of metocurine or neostigmine were not significantly different between two groups. The heart rates at the administration of neostigmine were significantly decreased probably due to the decreased body temperatures in group I. The onset time of metocurine with 3 X ED95 in acute renal failure was simiiar to that in normal renal function. However, the duration of metocurine with 3 X ED95 in acute renal failure was significantly longer that that in normal renal function. The effeets of neostigmine administered at 15%-spontaneous twitch recovery for the recovery indices and antagonism effects were not significantly different between two groups. In conclusion, acute renal failure prolongs the duration of metocurine, but not interfere its onset. Additionally, there is no effect on the reversal actions of neostigmine if administered at the spontaneous recovery of twitch height more than 15%.