A Suspected Case of Central Anticholinergic Syndrome after N2O-O2-Propofol Anesthesia / 대한마취과학회지

Central anticholinergic syndrome (CAS) is the clinical picture of the central cholinergic blockade. Many drugs used in anesthesia may cause blockade of central cholinergic neurotransmission. Early diagnosis of CAS is very important clinically, CAS's effects are broad and life-threatening. However, it is difficult to find physostigmine in Korea, which is essential to confirm a diagnosis for CAS. An 18-year-old female who was diagnosed with hyperhydrosis underwent a thoracoscopic sympathicotomy. She received N2O-O2-Propofol anesthesia. The anesthesia was unevenful, but postoperatively, she suffered from drowsiness, fever, mydriasis, stiffness of the left upper and lower extremities, and seizures. All tests to seek the cause of CAS such as blood chemistry, brain CT, brain MRI, and CSF test, were normal. She completely recovered without any sequelae after 3 days in ICU. Though it was not confirmed with physostigmine, we report the case to be suspected CAS by all other indications.

Effects of Pretreated-Fentanyl on the Myocardial Function in Isolated Stunned Rat Heart / 대한마취과학회지

BACKGROUND: Fentanyl is commonly used as a anesthetics for patients who have poor cardiac reserve, because it provides cardiovascular stability. But little data exist on the effects of fentanyl on myocardial ischemia and reperfusion injury. The purpose of this study was to examine the effects of the fentanyl on the recovery of myocardial contracility, coronary flow, and myocardial oxygen balance in isolated rat hearts subjected to ischemia and reperfusion. METHODS: Isolated Sprague-Dawley rat hearts were perfused at constant pressure with oxygenated modified-Krebs solution (pH 7.4, 37oC). After stabilization period, all hearts were given fentanyl 0, 1, 10 ng/ml, respectively. Then, myocardial ischemia was induced by global ischemia for 15 minutes. Isovolumetric left ventricular pressure (LVP) and dP/dt were measured via a latex balloon and transducer. Also, coronary flow and oxygen tensions at the coronary inflow and outflow were measured. RESULTS: The application of fentanyl did not significantly affect myocardial contractility, coronary flow, and myocardial oxygen balance. After global ischemia, myocardial contractility, coronary flow, and myocardial O2 consumption were decreased, but percentage of O2 extraction was increased. However, these changes were not significantly different between fentanyl pretreated and control groups. CONCLUSIONS: These in vitro findings demonstrate that the pretreatment of fentanyl is devoid of major effects on recovery of the myocardial contracility, coronary flow, and myocardial oxygen balance in isolated stunned rat hearts.