Comparison of Pseudocholinesterase Activity between Nonpregnant and Term-pregnant Women with the Genotypically Normal Enzyme / 대한마취과학회지

BACKGROUND: Many reports on the change of pseudocholinesterase activity in pregnant women showed that it declines during pregnancy and in the immediate postpartum period. In Korea, there are two papers that show dissident results. However, they didn't prove that the subjects in their studies had genotypically normal enzyme. So, we compared the pseudocholinesterase activities between nonpregnant and term-pregnant women who have the genotypically normal enzyme. METHODS: We measured the dibucaine, fluoride, chloride number as well as the pseudocholinesterase astivity using butyrylthiocholine as substrate by automatic analyser, urea and scoline numbers using benzoylcholine as substrate by manual technique in nonpregnant(n=15) and term-pregnant(n=15) women aging 20 to 40 years old before induction of anesthesia. RESULTS: The dibucaine, fluoride, chloride, urea and scoline numbers(mean+/-SD,%) in female subjects were 86+/-1.2, 50+/-5.2, 5+/-2.4, 47+/-2.8 and 92+/-2.0, respectively. There were two subjects showing low pseudocholinesterase activity(<4.8 U/ml) and the one(3.9 U/ml) was in nonpregnant group, the other(4.5 U/ml) in term-pregnant group. We found that they had genotypically normal enzymes because their inhibition numbers were within normal ranges. Pseudocholinesterase activity(mean+/-SD) in term-pregnant group(7.04+/-1.30) was significantly decreased compared with that in nonpregnant group(9.15+/-2.01)(P<0.01). CONCLUSIONS: We conclude that in subjects with the genotypically normal enzyme, term-pregnant women had significantly lower pseudocholinesterase activity than nonpregnant ones did.

Effects of High-Dose Atracurium on the Cardiovascular Response and Histamine Release during Induction of Anesthesia / 대한마취과학회지

To compare the effects of atracurium, 0.75 mg/kg, on the mean arterial pressures, heart rates and plasma histamine levels under 2%-enflurane inhalation with mask, 24 patients were allocated randomly into two groups; one(Group I, n=12) which atracurium was administered with rapid bolus injection for 5 seconds and the other(Group II, n=12) with the slow injection for 75 seconds. In both groups, there are the most significant decreases and the recovery in mean arterial pressure 1~2 min and 5 min after atracurium, respectively, Group I showed a significant decrease of mean arterial pressure about 10% more than Group II. In heart rate, there are the significant decreases gradually to 87~88% of control 5 min after atracurium in both graups except the only significant increase(104%) 1 min after atracurium in Group I. And Group I showed a significant increase(200%) in plasma histamine concentration (p< 0.05) 2 min after injection than before, but Group II did no significant change. In conclusion, the slow injection of atracurium over 75s during induction of anesthesia can attenuate the histamine-induced cardiovascular response.

Anaphylactoid Reaction to Atracurium / 대한마취과학회지

A case is reported of anaphylactoid reaction to atracurium, used for the induetion of an- esthesia for skin graft in a 36 year old man. The patient had no previous history of any allergic tendency. It is not possible to distinguish between direct pharmacological effects and immune mediated hypersensitivity reactions by clinical observation alone. The mechanism of reaction in this patient was investigated by the leukocyte histamine release test, intradermal test, direct intravenous challenge with other induction agents used during the induction of anesthesia and radioallergosorbent test. The histamine releasing property of atracurium, the distinguishing methods between ana phylactic and anaphylatoid reaction, and the anesthetic management for this kind of reaction are discussed.

Prolonged Neuromuscular Blockade Following Succinycholine Administration in a Patient with Plasma Cholinestrase Variant / 대한마취과학회지

The authors experienced a case of plasma cholinesterase variant who received succinylcholine, atracurium and reversal with pyridostigmine, and showed prolonged neuromuscular blockade postoperatively, and was ventilated artificia1ly until complete recovery. The patient and her two children later gave samples of blood. The patients blood revealed very low plasma cholinesterase activity of 0.11 IU/L(normal range; 5-12 IU/L) and dibucaine number of 33. In consideration of her childrens plasma cholinesterase activities and dibucaine numbers, we suggest that she has genetically abnormal plasma cholinesterase and probably her genotype is E E or E E.

Evaluation of Esmolol and Fentanyl in Controlling Increase in Heart Rate and Blood Pressure during Endotracheal Intubation / 대한마취과학회지

Laryngoscopy and intubation cause an adrenergic response manifested by tachycardia and hypertension. Various phamacological agents have been administered prior to induction in an attempt to attenuate the adrenergic response but they all have limitations. The objective of our study was to determine if esmolol would be equally effective when adrninistered in a bolus with and without fentanyl. A double-blind, randomized trial was conducted in sixty ASA physical status 1 patients undergoing elective surgery. All patients were premedicated with 0.2 mg/kg diazepam orally and glycopyrrolate 0.04 mg/kg intramuseularyly 1 hour beforehand. Induction of anesthesia was accomplished with 4 mg/kg thiopental intravenously foUowed immediately by 0.15-0.2 mg/kg vecuronium and study drug (placebo, esmolol 150 mg, esmolol 150 mg and fentanyl 100 mcg). Endotracheal intubation was performed at 2 minutes after study drug adrninistration. Anesthesia was maintained with 1 MAC (+/-10%) isoflurane in 60% nitrous oxide in oxygen at a 5 L/min flow for 6 minutes. Heart rate and blood pressure were measured every minute by an automatic recording device. After laryngoscopy and intubation, maximum increase in stolic blood pressure above awake levels was 33 mmHg (p<0.05) and 14 mmHg (p<0.05) in esmolol 150 mg, esmolol 150 mg with fentanyl 100 mcg respectively, whereas systolic blood pressure increased 62 mmHg after tracheal intubation in patients with placebo. In six patients with esmolol 150 mg, rate-pressure product reached a level considered potentially dangerous to patients with coronary artery disease. However, when used with fentanyl, esmolol provides effectvie protection against the adrenergic response and increase of the rate-pressure product to laryngoscopy and intubation.

Dramatic Control of Tachycardia during Enflurane Anesthesia in a Patient with Hyperthyroidism by Verapamil - A case report / 대한마취과학회지

Though clinical use of verapamil, a calcium channel blocker, is increasingly presenting and hemodynamic change due to verapamil alone and in combination with beta b1ockerg or inhalation aneathetics are in active investgation now, there is scare Korean literature about the use of verapamil for the treatment of tachycardia during aneatheeia. Here, we report our clinical enflurance of dramatic, even dangerous, control of tachy-cardia during enflurane anesthesia in a patient with hyperthyroidism after trial of verapamil. There are two episodes of tachycardia in a 52-year old female with hyperthyroidism of 3-rearg duration and atrial fibrillation, each developed during enflurane anesthesia for 2 operations performed one moath apart. After slow intravenous injection of verapamil(0.1mg/kg for the first and 0.05 mg/kg for the second episode), the heart rates were reduced from 130 and 132 to 80 and 75. The effect was much sustained and the reduction of BP were slight in both instances. We feel that the dramatic reduction of heart rate is probably related to drug interaction between verapamil, propranolol given preoperatively, and enflurane. Literatures concerning the use of, and the heinodynamic changes induced by verapamil in various situations are reviewed briefly.

Pulse Rate Changes after Increased Doses of Glycopyrrolate in Combination with Neostigmine / 대한마취과학회지

Glycopyrrolate is frequently administered in combination with neostigmine to reverse a neuromus- cular blockade. The dosage was well established at 1/5 of neostigmine. But the authers have often observed a delayed manifestation of relative bradycardia after such a recommended dosage. This is not mentioned in the literature, but this may be due to an insufficient observation period. The authors monitored the change of pulse rate for 1 hour after the administration of the recom. mended dose. Further, the data wIns compared with that obtained after studies of lower and higher doses. The doses were 0.004, 0.008 and 0.012mg/kg of glycopyrrolate with 0.04mg/kg of neostigmine. 1) At all doses, bradycardia relative to the pre-reversal pulse rate was progressive until 30 minutes after injection. 2) As the glycopyrrate dose was increased the degree of bradycardia decreased (-24.7, -20.5, - 15.0 at 30 min.). 3) There was no difference in the immediate change in the pulse rate between the dcsages of 0.008 and 0.012 mg/kg. Change occured at 9 mins. 4) At dosages of 0.004 and 0.008 mg/kg, the pulse rates at 60 min were comparable to their ward pulses, but at a dosage of 0.012 mg/kg, the pulse rate was 8.5 beats/min higher.