Thoracoscopic T2 Sympathicotomy Effects on QT Interval / 대한마취과학회지

BACKGROUND: Thoracoscopic sympathicotomy was, at first, thought to be a simple and safe method for treatment of hyperhydrosis. However, few studies refer to the cardiac effects of this procedure, despite the fact that the T2 ganglia are in the direct pathway of the sympathetic innervation of the heart. An imbalance of right and left sympathetic efferent activity has been proposed as a mechanism for arrhythmia in patients with long QT syndrome. The aim of this study was to compare hemodynamic effect as well as ECG changes after right and left side sympathicotomy. METHODS: 42 patients with essential hyperhydrosis in ASA physical status class 1 undergoing thoracoscopic sympathicotomy were randomly divided into two groups: left side first operation group (group L, n = 22) and right side first operation group (group R, n = 20). Anesthesia was induced with thiopental sodium (5 mg/kg) and pancuronium (0.05 mg/Kg) and maintained with enflurane. During the procedure, we recorded blood pressure at both forearms and heart rate and ECG were recorded after anesthetic induction as baseline values, immediately after one side resectioned of sympathetic trunk, and after complete resectioning of both side. All operations were done with usual methods by experienced surgeons. All the records were coded and analysed singl blind by one author. RESULTS: After sympathicotomy, there was a significant decrease in heart rate but not in blood pressure. However, statistically there were no significant changes in QT interval during sympathicotomy either right side first operation or left side first operation. CONCLUSIONS: The main result of this study was that there were no significant changes in QT interval during sympathicotomy of either right or left side first operations. However, This does not mean that there was no possibility of prolongation of QT interval during thoracoscopic sympathicotomy. Careful observation of QT interval changes is needed during sympathicotomy.

The Infusion Rate of Cisatracurium and Its Spontaneous Recovery for Cesarean Section under Enflurane Anesthesia / 대한마취과학회지

BACKGROUND: Cisatracurium, one of 10 isomers of atracurium, undergoes pH and temperature-dependent Hofmann elimination in plasma and tissues. Physiologic changes may affect the pharmacodynamics of neuromuscular bldegrees Cking agent during pregnancy. So, we compared the difference in the infusion rate and its spontaneous recovery of cisatracurium between full-term pregnant and nonpregnant women. METHODS: Muscle relaxation of full-term pregnant(group I, n=10) and nonpregnant(group II, n=10) women was maintained by continuous infusion of cisatracurium to keep 1st twitch response of train-of-four(TOF) at 5~10% of control. After discontinuation of infusion, recovery index was measured without reversals using the accelerograph. RESULTS: The infusion rate of cisatracurium in group I(1.25+/-0.16 mcg/kg/min) was not significantly different from that in group II(1.31+/-0.22) and recovery indices were not different between two groups(10.7+/-2.0 vs. 11.6+/-1.9 min). CONCLUSION: The infusion rate of cisatracurium in parturients to maintain surgical relaxation is not different from that in non-parturients. For Cesarean section, the usual infusion rate of cisatracurium is recommeneded to achieve the adequate surgical relaxation.

Does Heparin Attenuate the Renal Injury Induced by Ischemia Reperfusion in the Rabbit? / 대한마취과학회지

BACKGROUND: Increasing degrees of medullary hyperemia induced by ischemia reperfusion injury were associated with renal dysfunction. A possible mechanism may be that ischemia causes alterations in the structure and function of vascular membranes which leads to an aggregation of red blood cells in the medullary vessel. It has been shown that heparin prevents postischemic endothelial cell dysfunction. Aim of this study was to evaluate heparin effects on renal hyperemia induced by ischemia reperfusion injury. METHOD: In this study, fifteen rabbits were randomized to either heparin treatment group(500 IU/kg IV bolus 10 minutes before renal artery occlusion, n=8) or control group(n=7). One side kidney underwent 60 minutes ischemia only by clamping renal pedicle and after that kidney tissue sample was obtained for histologic evaluation. The other side of kidney were permitted 60 minutes ischemia following 60 minutes reperfusion and after that kidney tissue sample was obtained for histologic evaluation. RESULTS: There was significant difference in the degree of congestion(2.6+/-0.2 vs 1.1+/-0.3, P<0.05) between outer medulla of control and heparin treatment group. CONCLUSION: Heparin significantly attenuated outer medullary congestion induced ischemic injury.

The Pharmacodynamics and Infusion Rate of Mivacurium in Patients with Liver Cirrhosis or Cholestasis / 대한마취과학회지

BACKGROUND: Action of mivacurium varies in condition with reduced plasma cholinesterase activity. The aim of this study is to evaluate the pharmacodynamics of mivacurium and to obtain the infusion rate of mivacurium in patients with liver cirrhosis or cholestasis. METHOD: We allocated into three groups. Healthy subjects without hepatobiliary disease(Group I, n=10), patients with liver cirrhosis(Group II, n=5), and patients with cholestasis(Group III, n=9) received 5 mg/kg thiopental sodium and 1~2g/kg fentanyl. They were ventilated by mask with 2.5~3% enflurane(in O2/N2O 50%) until I/E ratio of enfurane concentration gt; or = 0.8, and then received 3 ED95 mivacurium(0.18 mg/kg). Accelerographic responses to train-of-four(TOF) stimulation of ulnar nerve at 15 seconds interval were used for neuromuscular monitoring. The onset time, the duration, recovery indices and infusion rate of mivacurium were compared among groups. RESULT: The durations from the injection of mivacurium to 10% single twitch recovered (Dur10) in group II(16.5+/-4.3 min) and III(17.1+/-0.6 min) were longer significantly than that in group I(10.7+/-5.3 min). The infusion rates to maintain a steady twitch height at 5~10% for 20 min in group II(1.9+/-1.5 microgram/kg/min) and III(1.6+/-0.7g/kg/min) were lower than that in group I(3.5+/-1.3 g/kg/min). However, there was no significant difference between group II and III. CONCLUSION: Clinical duration of relaxation with 3 ED95 mivacurium is prolonged significantly and infusion rate to maintain the steady twitch height at 5~10% is lower in patient with liver cirrhosis or cholestasis than in patient without hepatobiliary disease.

Effect of Injection Speed on the Anesthetic Level and Duration of Hypobaric Spinal Anesthesia with 0.1% Tetracaine in Jack-Knife Position at 15o Head-down Tilting / 대한마취과학회지

BACKGROUND: The speed of injection of local anesthetic solutions into the subarachnoid space may influence the spread of these agents in the cerebrospinal fluid by the amount of turbulence generated, especially with large volume. To determine the proper injection speed of anesthetics in hypobaric spinal anesthesia on jack-knife position, the anesthetic level and duration were measured with the fast or slow injection speed. METHODS: Twenty patients for perianal surgery in jack-knife position under hypobaric spinal anesthesia were randomly assigned to one of two groups. Tetracaine (0.1%) in distilled water 5 ml was administered to all the patients. Group I patients received the drug with the speed of injection as 5 ml/20 sec (15 ml/min) and the others (Group II) as 5 ml/4 min (1.25 ml/min). The mean arterial pressures and heart rates at the preanesthetic period, and 5, 10, 15 and 20 min after the end of injection were measured. The anesthetic levels at 5, 10, 15 and 20 min after the injection and anesthesia duration were measured. RESULTS: There was no significant difference in mean arterial pressures, heart rates and anesthetic duration between two groups. The anesthetic level 20 min after the injection was higher in Group I than Group II, and not different at the other time sequences. CONCLUSION: At the injection speed within 1.25-15 ml/min in hypobaric spinal anesthesia on jack-knife position at 15o head-down, we acquired appropriate anesthetic level and duration for perianal surgery without any undesirable effects.

Does low dose dopamine attenuate the decrease of renal function in the treatment of patients under controlled mechanical ventilation with positive end expiratory pressure?

Controlled mechanical ventilation (CMV) with positive and expiratory pressure (PEEP) is often used to improve the pulmonary gas exchange in patients with acute respiratory distress syndrome. However, this ventilatory technique may induce hemodynamic and hormonal changes which may lead to vital organ dysfunction, such as oliguria. Low dose dopamine, acting as a dopaminergic receptor agonist, may improve vital organ perfusions, i.e. renal, mesenteric and coronary perfusions. The purpose of this current study was to evaluate the effects of low dose dopamine on renal function and hemodynamic change during controlled mechanical ventilation with PEEP. The study was performed on 10 patients treated with PEEP in the surgical intensive care unit. Starting with 0 cmH2O of PEEP and adding 4 cmH2O of PEEP at 4-hour intervals until it reached 12 cmH2O of PEEP, dopamine, 2 ug/kg/min, was selectively, administered, intravenously during the last two hours of each four hour intervals. Following each procedure, hemodynamic parameters, urine output, creatinine clearance and fractional excretion of sodium were measured. The cardiac index and mean arterial pressure had both decreased, but the mean pulmonary arterial pressure was increased at 12 cmH2O of PEEP compared with 0 cmH2O of PEEP in both groups with and without low dose dopamine. The main result of this study was that low dose dopamine attenuated the decrease of the cardiac index, urine output and creatinine clearance induced by mechanical ventilation with PEEP at 12 cmH2O.

The Potency of Mivacurium during Halothane or Enflurane Anesthesia in Infants and Preschool Children / 대한마취과학회지

BACKGROUND: The dose-responses of neuromuscular blocking agents may be influenced by many factors including age and inhalation anesthetics. This study was designed to determine the dose-response relationships of a new, short-acting muscle relaxant, mivacurium during nitrous oxide-halothane or nitrous oxide-enflurane anesthesia in two age groups, infants and 1 to 6 years old preschool children. METHODS: Neuromuscular blockade was monitored by recording the accelerographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. To estimate dose-response relationships, 24 infants or children of two anesthetic subgroups for each age group received single bolus doses of 45~100 g/kg of mivacurium. The ED50 and ED95 were estimated from linear regression plots of log-dose vs probit of twitch depression. The lag time, onset time and maximal depression of twitch height for the selective medium dose were mesured. RESULTS: The ED50 and ED95 for the infants group were 38.2 and 53.3 g/kg during halothane anesthesia, and 29.8 and 48.6 g/kg during enflurane anesthesia, respectively. And, those for preschool children group were 49.4 and 90.7 g/kg during halothane anesthesia, and 32.3 and 81.4 g/kg during enflurane anesthesia, respectively. There was a parallelism of the dose-response curve between halothane and enflurane anesthesia in either age group. Also, there was statistically significant difference in the maximal twitch depression for the selective medium dose of mivacurium between halothane and enflurane anesthesia in either group. CONCLUSIONS: The potency of mivacurium during enflurane anesthesia is higher than that during halothane anesthesia in infants and preschool children, and during either inhalation anesthesia the dose of mivacurium is less required in infants than preschool children.

Heparin attenuated neutrophil infiltration but did not affect renal injury induced by ischemia reperfusion

Although heparin is better known as an anticoagulant, it also has several anti-inflammatory effects. Heparin is known to inhibit neutrophil adhesion, chemotaxis and oxygen free radical production. In addition, heparin is also known to act as an oxygen radical scavenger. Our hypothesis was that heparin would attenuate renal ischemia reperfusion injury. In this study, we investigated whether heparin had a protective effect on renal ischemia reperfusion injury. Sheep (n = 12) were prepared for the chronic study with venous, arterial and urinary catheters inserted. In addition, pneumatic occluders and ultrasonic flow probes were placed on renal arteries. After a 5-day recovery period, the sheep were randomized to either a heparin treatment group (400 IU/kg i.v. bolus 10 minutes before renal artery occlusion, followed by a continuous effusion 25,000 IU in 250 ml of 0.9% NaCl at 10 ml/hr, n = 6) or a control group (n = 6), which received an equivalent volume of 0.9% NaCl. All the sheep then underwent 90 minutes of bilateral renal ischemia followed by 24 hours of reperfusion. Blood urea nitrogen (BUN), serum creatinine (Scr), and creatinine clearance (CrCl) were determined at various intervals during both the ischemic and reperfusion periods. Kidney tissue samples were obtained at autopsy for histologic examination. As a result, there were significant differences in the degree of inflammation (1.50 +/- 1.24 Vs 0.50 +/- 0.79, P < 0.05) between the control and heparin treatment groups, but not in the degree of injury (2.83 +/- 0.44 Vs 2.33 +/- 0.28). In this study, heparin significantly attenuated polymorphonuclear leukocytes (PMNs) infiltration within the interstitium, but it did not affect the degree of renal damage as measured by urinary chemistries or renal tubular damage as assessed by histopathologic evaluation.

The Effects of Acute Renal Failure on Mivacurium-induced Neuromuscular Blockade in the Cat / 대한마취과학회지

BACKGROUND: Mivacurium is mainly metabolized by plasma cholinesterase. However, the duration of action may be changed in various conditions such as liver dysfunction. To evaluate the action duration and recovery of mivacurium under the experimental acute renal failure, the pharmacodynamic studies were done. METHODS: The pharmacodynamic studies were done using a common peroneal nerve-anterior tibialis muscle preparation in 12, either sex, adult cats(weight 2.0~4.0 kg). The acute renal failure was made by the ligation of bilateral renal pedicles 1 hour prior to the pharmacodynamic study. All the cat received 5XED95 of mivacurium. The action durations and recovery indices were measured. And plasma cholinesterase activities were measured at each event. RESULTS: The duration of mivacurium was not prolonged with acute renal failure group(17.20 5.48 min.) compared to control group(13.48 4.30 min.). The recovery indices were not increased in the acute renal failure group(3.56 0.58 min.) as compaired with the control group(2.82 0.99 min.). CONCLUSIONS: The mivacurium-induced neuromuscular blockade is not prolonged by the experimental acute renal failure.

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%.

Poisoning patients in intensive care unit / 대한구급학회지

No abstract available.

A Clinical Observation on Urinary Diversion / 대한비뇨기과학회지

A clinical observation was made on the urinary diversion among the 78 cases of in-patients from the Department of urology, National Medical Center, Seoul, during the period from March,1977 to Feruary 1982.

Leiomyoma of the Urinary Bladder: A Case Report / 대한비뇨기과학회지

A case of leiomyoma of the urinary bladder is presented.