ABSTRACT
BACKGROUND: The purpose of this study is to evaluate the effect of an IGK pretreatment on the cardiotoxicity of bupivacaine. METHODS: Twenty-one anesthetized mongrel dogs were randomly divided into the following three groups: the control group (CG, n = 7), the treatment group (TG, n = 7) and the pretreatment group (PTG, n = 7). For the 30 min of pretreatment period, CG and TG received normal saline, while PTG received an IV bolus of insulin 2 U/kg, followed by an IGK infusion (2 U/kg/hr of insulin, 0.5-1.5 g/kg/hr of glucose, 1-2 mEq/kg/hr of KCl). The bupivacaine infusion was started at the rate of 0.5 mg/kg/min in all groups after the pretreatment period. CG received normal saline only. In TG, insulin (2 U/kg) was injected simultaneously with bupivacaine infusion, followed by the IGK infusion as with PTG. The hemodynamic variables and the time duration to reach the mean arterial pressure (MAP) of 60 mmHg were compared. RESULTS: The bupivacaine infusion decreased the cardiac index, MAP, and heart rate in all three groups. Although insulin concentration was higher in TG than in PTG during bupivacaine infusion, the hemodynamic variables in PTG decreased at the slowest rate. The time taken to reach MAP of 60 mmHg in PTG, TG, and CG was 51.4 +/- 8.5, 36.4 +/- 9.6, and 27.1 +/- 8.7 min, respectively (P < 0.05). CONCLUSIONS: IGK delays the bupivacaine-induced cardiac depression. However, a pretreatment with IGK is more effective in delaying the bupivacaine-induced hypotension than simultaneous administration, regardless of insulin concentration.
Subject(s)
Animals , Dogs , Arterial Pressure , Bupivacaine , Depression , Glucose , Heart Rate , Hemodynamics , Hypotension , Immunoglobulins , InsulinABSTRACT
Aberrant right subclavian artery (ARSA) is a congenital anomaly that usually does not produce symptoms. However, patients with symptoms may require surgical intervention. Surgical procedures consist of division of ARSA from the descending aorta and reimplantation to the right common carotid artery or ascending aorta. Specific anesthetic management includes invasive monitoring of blood pressure in both radial arteries, monitoring of adequate cerebral perfusion, and ventilatory strategy to facilitate surgical exposure. Although many reports are available regarding its surgical treatment, there are few reports, to the author's best knowledge, that describe anesthetic management for its surgical correction. This case report will focus on important aspects of the anesthetic management of patients with ARSA.
Subject(s)
Humans , Anesthesia , Aneurysm , Aorta , Aorta, Thoracic , Blood Pressure , Cardiovascular Abnormalities , Carotid Artery, Common , Deglutition Disorders , Perfusion , Radial Artery , Replantation , Subclavian ArteryABSTRACT
Phenylketonuria (PKU), an autosomal recessive disorder, occurs in one of 53,000 births in Korea. The disorder is associated with deficient activity of phenylalanine hydroxylase. In PKU, phenylalanine cannot be used in a normal fashion because of the deficient enzyme. Untreated, affected individuals develop marked mental disabilities, behavioral difficulties, seizures, rashes, pigment dilution, and unusual body odor. PKU treatment consists of a phenylalanine-restricted diet supplemented with a phenylalanine-free mixture of amino acids. During the restricted diet, PKU patients have an increased risk of developing vitamin B12 deficiency because of a limited intake of animal products. We report a successful anesthetic management in a patient with phenylketonuria for dental procedures.