Effect of Elimination of CO2 Absorption Canisters on the Rate of Recovery from General Anesthesia / 대한마취과학회지

BACKGROUND: The most important route for elimination of inhalation anesthetics is exhalation. The lower anesthetic circuit volume and absorption by the anesthetic circuit maKes recovery more fast. The purpose of this study is to evaluate the effect of the elimination of CO2 absorption canisters on the rate of recovery from anesthesia. METHODS: Forty patients were randomly assigned into two groups. Group 1 patients recovered from enflurane anesthesia with CO2 absorption canisters (baralyme), but group 2 patients emerged from anesthesia without CO2 absorption canisters. The changes of expiratory enflurane and inspiratory nitrous oxide concentration at 30, 60, 90, 120, 150, 180 sec after the end of anesthetic administration, and time from the end of anesthetic administration to extubation were measured and compared between the groups. RESULTS: Enflurane and nitrous oxide concentrations after the end of anesthetic administration in group 2 were significantly lower than in group 1 at each time interval (P < 0.05). Time from the end of anesthetic administration to extubation in group 2, 7.7 +/- 1.4 min, was significantly shorter than in group 1, 10.5 +/- 2.6 min (P < 0.05). CONCLUSIONS: The results show that the patients emerging from anesthesia without CO2 absorption canisters can recover from anesthesia more rapidly than those with CO2 absorption canisters.

Influence of History of Alcohol Ingestion on AST and ALT Following Enflurane Anesthesia in Gastrectomy Patients / 대한마취과학회지

BACKGROUND: There are many factors including the operation site, duration of anesthesia, preoperative liver function and hepatitis, which cause postoperative hepatic dysfunction. The purpose of this study is to evaluate postoperative liver function with respect to a history of alcohol intake. METHODS: Seventy-five patients were divided into 2 groups:44 patients without alcohol intake (non-alcohol group), 31 patients with alcohol intake (alcohol group). All patients were anesthetized with about 1.5 vol% of enflurane combined with 50% nitrous oxide and 50% oxygen. AST (aspartate aminotransferase) and ALT (alanine aminotransferase) were measured before anesthesia, 1, 3 and 7 days after surgery in both groups, respectively. Postoperative AST and ALT values were compared to preoperative values within each group, and were also compared between groups. RESULTS: In the alcohol group, postoperative AST and ALT values were significantly higher than preoperative values (P < 0.05). In addition, postoperative ALT values significantly increased in the 1st and 7th day over the upper normal limit of ALT (P < 0.05). In the non-alcohol group, postoperative AST and ALT values increased over preoperative values, but those levels were within the normal limits of AST and ALT. CONCLUSIONS: The data suggest that when surgery can reduce hepatic blood flow, patients with a history of alcohol ingestion may have a risk of raised liver-derived enzyme in the first seven postoperative days.

Uptake of Enflurane and Isoflurane as Supplement during General Anesthesia for Cesarean Section and Maternal Awareness / 대한마취과학회지

BACKGROUND: Using a semiclosed circle system, general anesthesia for cesarean section was maintained with either 2/3 MAC enflurane or isoflurane in combination with O2: N2O (2 L/min: 2 L/min). METHODS: We studied the rate of uptake of inhalation agents of pregnant women by measuring inspired concentration and end-tidal concentration of enflurane and isoflurane and we measured the differences in maternal awareness in two groups. The 40 patients presented for elective cesarean section under general anesthesia were randomly assigned to receive either 1.0% enflurane or 0.8% isoflurane with O2: N2O (2 L/min: 2 L/min) for maintenance before delivery using a semiclosed circle system. All patients received thiopental 4 mg/Kg (maximum 250 mg) and succinylcholine 100 mg for induction and were intubated and ventilated with a tidal volume of 10 ml/kg at a rate of 10 breaths/min. After intubation, FI (fractonal inspired concentration) and FE (fractional end tidal concentration) were analyzed by gas monitor (Sirecust 734G, Siemens, Germany) every minute. Intraoperative hemodynamic variables were recorded. Maternal awareness was monitored by the isolated forearm technique. RESULTS: FI/FINF (fractional inflow concentration) and FE/FINF for the inhalation agents were significantly higher for isoflurane than for enflurane throughout the study after 2 minutes (P < 0.05). The incidence of maternal awareness signaled by both 'spontaneous movement' and 'followed commands' was high and there were no significant differences in the two groups. No patient in our study showed any recollection. CONCLUSION: We concluded that the rate of uptake of isoflurane was more rapid than that of enflurane but the incidence of maternal awareness was high and there were no significant differences in the two groups.

The Comparison of Propofol, Isoflurane and Enflurane Anesthesia on Recovery in Day Surgery / 대한마취과학회지

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is expected to provide fast and comfortable recovery, plus an early return to normal daily activities. This study was carried out to compare the characteristics of recovery after VATS in patients anesthetized with isoflurane, enflurane or propofol. METHODS: Sixty patients undergoing VATS were allocated randomly to receive propofol-N2O, isoflurane-N2O or enflurane-N2O anesthesia. The time between the end of anesthesia and extubation were compared. The orientation, cooperation and degree of sedation in Numeric Rating Scale (NRS) were recorded 5, 10, 30 and 60 min after anesthesia. Recovery was also evaluated by the P-deletion test (PDT) and Digit Symbol Substitution test (DSST) 30, 60 and 120 min after anesthesia for the comparison of the recovery of cognitive and psychomotor function. RESULTS: Early recovery was significantly (P < 0.05) faster in the propofol group (orientation, cooperation and degree of sedation in 10 min) when compared to the isoflurane and enflurane groups, but there was no significant difference in the other parameters of recovery. CONCLUSIONS: The authors concluded that although propofol was associated with faster emergence from anesthesia than enflurane and isoflurane after VATS, recovery of cognitive and psychomotor function were similar in the three anesthetic groups.

Comparison of Cost-Effectiveness of Propofol Using Target-Controlled Infusion (TCI) with Standard Anesthesia Regimens in Major Operations / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the cost-effectiveness of propofol using a target-controlled infusion (TCI) with two currently used anesthetic regimens during major operations. METHODS: Forty-two patients undergoing major gynecological surgery were divided into three groups according to the period during which the surgeries were performed. Group propofol/TCI (n = 16) received 1% propofol using TCI-50% N2O, Group isoflurane (n = 14) received thiopental 5 mg/kg-isoflurane-50% N2O, and Group enflurane (n = 12) received thiopental 5 mg/kg-enflurane-50% N2O. All patients also received 2 microgram/kg of fentanyl before induction. Concentrations of propofol and volatile anesthetics were varied according to the patient's hemodynamic responses. Consumption of volatile anesthetics was measured by weighing the vaporizers by a precision weighing machine. RESULTS: Biometric data, duration of surgery and of anesthesia were similar in the three groups. Recovery from anesthesia was significantly shorter in the propofol/TCI group. Episodes of postoperative nausea and vomiting in the recovery room were less common in propofol/TCI group. Patient satisfaction was similar in all three groups. Total (intra- and postoperative) costs were significantly higher in the propofol/TCI group. CONCLUSIONS: When compared with the standard anesthetic regimens, the use of propofol using TCI anesthesia during major operations was associated with higher costs, but did not offer any clinically significant advantages in cost-effectiveness over the standard anesthesia regimens.

Effects of Halothane, Enflurane or Isoflurane on the m1 or m3 Muscarinic Receptor Expressed in Xenopus Oocytes / 대한마취과학회지

BACKGROUND: Muscarinic receptors are distributed abundantly in the central nervous system and peripheral visceral organs, and have a close relationship with anesthesia. We investigated the effects of halothane, enflurane or isoflurane on m1 or m3 muscarinic signaling. METHODS: Using two electrode voltage clamps, Ca2+ -activated Cl- currents (ICl(Ca)) were measured in Xenopus oocytes injected with an m1 or m3 receptor mRNA. ICl(Ca) was induced with the application of acetyl beta-methylcholine with or without exposure to volatile anesthetics. RESULTS: Halothane depressed the m1 and m3 receptor function significantly (m1; 0.49 +/- 0.17 microampere -> 0.1 +/- 0.05 microampere, m3; 0.74 +/- 0.2 -> 0.23 +/- 0.06 microampere, P 0.15 +/- 0.04 microampere, m3; 0.95 +/- 0.34 -> 0.19 +/- 0.05 microampere, P 0.3 +/- 0.09 microampere, P 0.5). From a concentration-response curve, enflurane decreased m1 and m3 signaling dose-dependently. CONCLUSIONS: Our data suggests that m1 and m3 muscarinic receptors were depressed by halothane, enflurane or isoglurane except for the fact that the m1 receptor was not affected by isoflurane.

Comparison of Propofol with Enflurane Anesthesia in Laparoscopic Cholecystectomy for the Change of Liver Function / 대한마취과학회지

BACKGROUND: Recently, using propofol as intravenous anesthetic agent is increasing. And it is known that propofol has little effects on liver function even after long operation such as plastic surgery. But its effect on liver functon after hepatobilliary operation which may damage liver was not studied. Thus, authors carried out this study to evaluate the effect of propofol on liver function by comparing with enflurane in the patients who had laparoscopic cholecystectomy. METHODS: Patients's anesthesia records and hospital charts from January 1994 to June 1996 were anlaysed retrospectively. Three hundred and thirty three patients who had normal liver function preoperatively and had no complications during and after operation were selected. They were divided into two groups ; propofol group (n=191) and enflurane group (n=142). The preoperative values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were compared with those of 1 and 3 days after operation. RESULTS: One day after operation, both propofol and enflurane group showed significant increase in AST and ALT (p<0.05) and decrease in ALP (p<0.05). But there was no difference between two groups. CONCLUSION: Concerned to liver function, propofol is as useful as enflurane to the patients who scheduled for laparoscopic cholecystectomy.

Nausea and Vomiting after Tympanomastoidectomy: Effect of Small Dose of Fentanyl / 대한마취과학회지

BACKGROUND: Nausea and vomiting are among the most common postoperative complaints. There is high incidence of emesis after middle ear surgery and opioids increase the prevalence of postoperative nausea and vomiting. METHODS: Sixty six adult patients undergoing routine tympanomastoidectomy under general anesthesia were divided into two groups to study the incidence and effect of intraoperative fentanyl as supplements on postoperative nausea and vomiting. Patients in group 1 received medical air instead of N2O about 15 minutes before grafting, while patients in group 2 received not only medical air instead of N2O, but also intravenous fentanyl (1~1.5 microgram/kg). RESULTS: The incidences of nausea and vomiting in the group 1 and 2 were 19.4% and 22.9%, respectively. There was no significant difference of postoperative nausea and vomiting between the group 1 and group 2 (P=0.73). CONCLUSION: The incidence of nausea and vomiting after tympanomastoidectomy in adult was not higher than comprehensive that of recent other reports and a small dose of fentanyl, given intraoperatively for supplementation, did not increase the prevalence of nausea and vomiting.

Nausea and Vomiting after Tympanomastoidectomy: Effect of Small Dose of Fentanyl / 대한마취과학회지

BACKGROUND: Nausea and vomiting are among the most common postoperative complaints. There is high incidence of emesis after middle ear surgery and opioids increase the prevalence of postoperative nausea and vomiting. METHODS: Sixty six adult patients undergoing routine tympanomastoidectomy under general anesthesia were divided into two groups to study the incidence and effect of intraoperative fentanyl as supplements on postoperative nausea and vomiting. Patients in group 1 received medical air instead of N2O about 15 minutes before grafting, while patients in group 2 received not only medical air instead of N2O, but also intravenous fentanyl (1~1.5 microgram/kg). RESULTS: The incidences of nausea and vomiting in the group 1 and 2 were 19.4% and 22.9%, respectively. There was no significant difference of postoperative nausea and vomiting between the group 1 and group 2 (P=0.73). CONCLUSION: The incidence of nausea and vomiting after tympanomastoidectomy in adult was not higher than comprehensive that of recent other reports and a small dose of fentanyl, given intraoperatively for supplementation, did not increase the prevalence of nausea and vomiting.

Efficacy of an Epidural Test Dose with Intravenous Isoproterenol in Enflurane-Anesthetized Adults / 대한마취과학회지

BACKGROUND: The efficacy of an epidural test dose for detecting inadvertent intravascular injection during general anesthesia with volatile anesthetics has not been clearly determined. The object of this study is to evaluate the efficacy of a simulated intravenous isoproterenol test dose in adult patients anesthetized with O2-N2O-enflurane. METHODS: Forty-five healthy adult patients were anesthetized with 1 vol% enflurane and nitrous oxide after endotracheal intubation and were randomized to one of three groups according to the dose of isoproterenol. Isoproterenol 1, 2 and 3 microgram groups (n = 15 each) received 3 ml of 2% lidocaine with 1, 2 and 3 microgram isoproterenol IV respectively, to simulate an intravascularly administered test dose. HR and systolic blood pressure were measured at 20-s intervals for 4 min after injection. RESULTS: Mean maximal heart rate increases were 15 8, 21 8, and 27 10 bpm (mean SD) in the isoproterenol 1, 2 and 3 microgram groups, respectively. Isoproterenol 3 microgram produced 100% sensitivity in the modified (> or = 10 bpm increase) HR criteria and 67% sensitivity in the conventional (> or = 20 bpm increase) HR criteria. CONCLUSIONS: To determine whether an epidural catheter may be in a blood vessel, various vasoactive drugs are often administered. The epidural test dose containing 3 microgram isoproterenol might be a reliable marker for intravascular injection based on the modified HR criterion.

Efficacy of an Epidural Test Dose with Intravenous Isoproterenol in Enflurane-Anesthetized Adults / 대한마취과학회지

BACKGROUND: The efficacy of an epidural test dose for detecting inadvertent intravascular injection during general anesthesia with volatile anesthetics has not been clearly determined. The object of this study is to evaluate the efficacy of a simulated intravenous isoproterenol test dose in adult patients anesthetized with O2-N2O-enflurane. METHODS: Forty-five healthy adult patients were anesthetized with 1 vol% enflurane and nitrous oxide after endotracheal intubation and were randomized to one of three groups according to the dose of isoproterenol. Isoproterenol 1, 2 and 3 microgram groups (n = 15 each) received 3 ml of 2% lidocaine with 1, 2 and 3 microgram isoproterenol IV respectively, to simulate an intravascularly administered test dose. HR and systolic blood pressure were measured at 20-s intervals for 4 min after injection. RESULTS: Mean maximal heart rate increases were 15 8, 21 8, and 27 10 bpm (mean SD) in the isoproterenol 1, 2 and 3 microgram groups, respectively. Isoproterenol 3 microgram produced 100% sensitivity in the modified (> or = 10 bpm increase) HR criteria and 67% sensitivity in the conventional (> or = 20 bpm increase) HR criteria. CONCLUSIONS: To determine whether an epidural catheter may be in a blood vessel, various vasoactive drugs are often administered. The epidural test dose containing 3 microgram isoproterenol might be a reliable marker for intravascular injection based on the modified HR criterion.

Oculocardiac Reflex and Postoperative Recovery in Pediatric Strabismus Surgery: A Randomized Trial Comparing Four Anesthetic Techniques / 대한마취과학회지

BACKGROUND: Oculocardiac reflex (OCR) and postoperative nausea/vomiting are major complications of pediatric strabismus surgery. The aim of the study was to assess, in children undergoing strabismus surgery, the incidence of OCR and postoperative emesis with a inhalational and a intravenous technique. METHODS: 44 healthy children undergoing elective strabismus surgery as inpatients were randomly allocated to four anesthetic techniques: (1) induction with propofol, maintenance with propofol infusion and 50% N2O-O2 (propofol-N2O); (2) induction with propofol and fentanyl 1 microgram/kg bolus, maintenance with propofol infusion and 50% air-O2 (propofol-fentnyl-air); (3) induction with thiopental, maintenance with enflurane and 50% N2O-O2 (enflurane-N2O); (4) induction with thiopental and fentanyl 1 microgram/kg, maintenance with enflurane and 50% air-O2 (enflurane-fentanyl-air). RESULTS: The incidence of an OCR significantly increased in the propofol-fentanyl-air group as compared to the enflurane-N2O or enflurane-fentanyl-air groups. Times to extubation were shorter in the propofol- N2O group than in the propofol-fentanyl-air or enflurane-fentanyl-air groups. Alertness scores were lower in the propofol-N2O group than in the enflurane-N2O or enflurane-fentanyl-air groups. Postanesthetic recovery scores and nausea/vomiting during the 24 hr after the operation did not show any differences among the groups. CONCLUSIONS: We concluded that children undergoing strabismus surgery anesthetized with propofolfentanyl-air had more episodes of OCR, propofol-N2O had shorter times to extubation and higher alertness scores, and the addition of N2O or fentanyl to anesthetic regimen was not associated with nausea and vomiting.

Influence of Propofol and Enflurane on the Postoperative Nausea & Vomiting after Pediatric Strabismus Surgery / 대한마취과학회지

INTRODUCTION: Nausea & vomiting are one of the most distressful events after strabismus surgery in pediatric patients. Propofol is known to reduce the incidence of postoperative emesis. The aim of this study was to compare the influence of propofol to that of enflurane on the postoperative nausea & vomiting after pediatric strabismus surgery. METHODS: Forty children scheduled for strabismus surgery were randomly assigned into two groups according to the induction agent and main anesthetics. Propofol group (n=20) received propofol, Enflurane gruop (n=20) thiopental as an induction agent and anesthesia were maintained either propofol- O2-air or enflurane-O2-air. The incidence of postoperative nausea & vomiting was assessed at awakening period, in the recovery room and at the 1st, 2nd day after operation. Operation time, awakening time and the incidence of oculocardiac reflex were evaluated. RESULTS: The operation time was not different between two groups, and the awakening time was shorter in Propofol group than in Enflurane group. Although oculocardiac reflexes were more frequently seen in Propofol group, no cases of postoperative nausea & vomiting were seen in Propofol group. The incidence of postoperative nausea & vomiting was not significantly different between two groups except at the 1st day after operation. At that time, the incidence of nausea was greater in Enflurane group than in Propofol group. CONCLUSION: These findings indicated that propofol resulted in a more rapid recovery and less postoperative nausea & vomiting than enflurane, but more oculocardiac reflexes were seen in propofol.

ST-Segment Displacement during Isoflurane and Enflurane Anesthesia / 대한마취과학회지

BACKGROUND: Isoflurane and enflurane have different activity on the cytoplasmic calcium movements of a cardiac muscle cell and a vascular smooth muscle cell. Isoflurane is less depressive in cardiac contraction, and more potent in vasodilation than enflurane. This study is to elucidate the effects of these anesthetics on the ST-segment displacement. METHODS: The anesthesia was induced by the intravenous injection of thiopental (6 mg.kg 1) and pipecuronium (0.1 mg.kg 1). The patients (n=80) undergoing tympanoplasty were randomly allocated to two groups for the maintenance METHODS: Group I was inhaled with isoflurane (1~2%), O2 (2 L.min 1), and N2O (2 L.min 1), Group II, enflurane (1.5~2.5%), O2 and N2O. Continuous electrocardiographic recordings with Holter monitor were made during anesthesia. The recordings were scanned on an Avionics Electrocardioscanner with particular emphasis on ST-segment changes. The criteria describe an episode as ST-segment displacement greater than or equal to 0.1 mV measured 80 ms from J-point lasting for more than 1 minutes. Mean heart rate was calculated. Results were categorized as induction, maintenance, and emergence, and inferred from unpaired t-test, x2-test, and Mann-Whitney U test with p<0.05 considered significant. RESULTS: Enflurane had higher incidence of ST-segment depression during induction, more maximally depressed ST-segment during maintenance and slower heart rate during induction and maintenance than isoflurane. CONCLUSION: It could be suggested that enflurane make stronger influence on the ST-segment depression than isoflurane. However, the clinical significance remains to be studied.

Comparision of Consumed Amount of Volatile Anesthetics between the Closed with PhysioFlex Anesthesia Machine and Semiclosed Anesthesia Systems / 대한마취과학회지

BACKGROUND: A circle system can be closed or semiclosed depending on the amount of fresh gas flow. A closed system is one in which the inflow gas exactly matches that being taken up or consumed by the patient. A semiclosed system is associated with partial rebreathing of gases and is the most commonly used system today. The purpose of this study is to examine the actual consumed amount of volatile anesthetic by closed and semiclosed anesthesia systems. METHODS: Forty-seven patients undergoing general inhalation anesthesia with enflurane and thirty-six patients with isoflurane were examined. Each group was divided into two subgroups by the circle system; enflurane-closed (33 patients), enflurane-semiclosed (14 patients), isoflurane-closed (23 patients), and isoflurane-semiclosed groups (13 patients). Closed system was performed by using PhysioFlex anesthesia machine. The difference of initial (just before anesthesia) and remained (just after anesthesia) enflurane or isoflurane volumes measured by 30 ml-syringe was obtained as consumed amount of anesthetics. This amount was calculated on the base of 1% enflurane or isoflurane for 1 hour anesthesia with a given fresh gas flow (4 to 5 L/min). RESULTS: Consumed amount of liquid enflurane and isoflurane when using closed system was 6.99 +/- 0.26 ml/hr and 4.84 +/- 0.27 ml/hr respectively while 15.99 +/- 1.48 ml/hr and 14.01 +/- 0.92 ml/hr respectively when using semiclosed system. Consumption of liquid anesthetics was significantly lower in closed anesthesia and significantly higher in both systems than those of predicted values. CONCLUSIONS: In closed system by using PhsioFlex anesthesia machine consumed amount of liquid anesthetic for 1 hour anesthesia with 1% of endtidal anesthetic concentration at 25 degrees C, 1 atm and 4 to 5 L/min of fresh gas flow was within 35 to 44% of that in semiclosed system.

Effects of Enflurane on the Left Ventricular Function in Isolated Diltiazem-Pretreated Rat Heart / 대한마취과학회지

BACKGROUND: Calcium channel blockers and volatile anesthetics have depressant effects on cardiac function. Both of them appear to exert, qualitatively and quantitatively, different effects on myocardial contractility, coronary flow, and myocardial oxygen balance. The aim of this study was to examine the direct cardiac effects of the enflurane in the presence of diltiazem. METHODS: Isolated Sprague-Dawley rat hearts (N=45) were perfused at constant pressure with oxygenated Modified-Krebs solution (pH 7.4, 37oC). 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. After stabilization period, all hearts were subjected to the application with diltiazem (100 ng/ml). Thereafter, they were subdivided into three groups; group 1, 2, 3. Groups subjected to the combination of diltiazem (100 ng/ml) with enflurane 1.1, 2.2, or 3.3 vol%, respectively. RESULTS: After the application of diltiazem, myocardial contractility and heart rate were significantly decreased, and coronary flow were significantly increased. The combination of diltiazem with enflurane depressed myocardial contractility, heart rate, myocardial O2 consumption, and percentage of O2 extraction more than diltiazem alone, and their effects were dependent on the concentration of enflurane. However, there was no difference in the change of coronary flow and oxygen delivery between diltiazem and the combination of diltiazem with enflurane. CONCLUSIONS: These in vitro findings demonstrate that the combination of diltiazem with enflurane shows greater direct negative inotropic and negative chronotropic effect, and is associated with less attenuation of coronary autoregulation, but with a larger reduction in O2 utilization. The present results suggest that high enflurane anesthesia in the diltiazem-pretreated patients could result in profound cardiac depression.

The Effect of Oral Clonidine on the Duration of Vecuronium / 대한마취과학회지

BACKGROUND: As of alpha2-agonist, clonidine reduces generalized sympathetic outflow in nervous system and also reduces acetylcholine release at cholinergic terminals presynaptically. So clonidine premedication is possibly able to decrease muscle contraction and prolong the duration of neuromuscular blockers. Therefore, the aim of our current study is to investigate the effect of oral clonidine on the duration of vecuronium. METHODS: Forty patients (ASA I or II) sheduled for elective low abdominal or extrimities operation were randomly divided into 2 groups. Clonidine group (n=20) received 5 microgram/kg oral clonidine at 90 min before operation. Control group (n=20) received nothing. Neuromuscular transmission was measured with relaxograph. After injection of vecuronium 0.1 mg/kg, we measured onset time (the time from injection of vecuronium to decrease to the 25% of baseline value, duration 1 (the time interval between injection and recovery of the first twitch to 25% of the baseline value), and duration 2 (the time interval between second injection of 0.02 mg/kg vecuronium and recovery of the first twitch to 25% of the baseline value). RESULTS: There were no statistical differences between control and clonidine group in onset time (2.6 +/- 0.6 min vs 2.7 +/- 0.5 min), duration 1 (37.5 +/- 8.9 min vs 40.3 +/- 8.6 min) and duration 2 (22.0 +/- 6.8 min vs 24.4 +/- 6.1 min). CONCLUSIONS: Five microgram/kg of oral clonidine premedication did not prolong the duration of vecuronium.

There is Some Differences in the Changes of Liver Enzyme Levels among the Type of Surgery under Enflurane Inhalation Anesthesia / 대한마취과학회지

BACKGROUND: There are many factors which cause postoperative hepatic dysfunction. Anesthetic agents are not the most common factor and there aremany other factors such as preoperative condition of the patients, site and duration of the operation, operation per se and so on. The purposeof this study is to evaluate postoperative liver function with respect to different types of surgery. METHOD: Fourty three patients were classified into three groups; 11 patients for tympanoplasty with mastoidectomy (Group 1), 16 patients for total abdominal hysterectomy (Group 2), 15 patients for subtotal gastrectomy (Group 3). All patients were anesthesized with about 2 vol% of enflurane combined with 50% nitrous oxide. Serum glutamic oxalacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase (ALP) were measured before anesthesia, 1, 3 and 7 days after surgery in all group, respectively. RESULT: In Group 1 and 2, postoperative SGOT and SGPT levels were maintained with preoperative level during the 7days, but in Group 3, those levels were increased in the 1st day but below upper limit (p<0.05) and decreased thereafter. Alkaline phosphatase level was maintained within the normal range for all the group during the 7 days. CONCLUSION: We consider that postoperative liver functioin may be influenced by different types of surgery, and also may be influenced by anesthetic time.

Comparison of Effects of Propofol and Enflurane on Blood Glucose Level / 대한마취과학회지

BACKGROUND: Even though surgery and anesthesia give stress to patients, adequate anesthesia could attenuate stress reactions and minimize side effects from these reactions. Abnormal glucose homeostasis is well documented side effect during anesthesia, especially when inhalational anesthetics are used. We planned this study to investigate and compare the effects of two popular anesthetics-between propofol, intravenous anesthetics, and enflurane, inhalational agents on blood glucose level. METHODS: Adult patients free of diabetes mellitus and any other endocrine disease were randomly allocated into two groups. In both groups, anesthesia was induced with 2.5% pentothal sodium 5 mg/kg and succinylcholine 1 mg/kg. After intubation, propofol 6~10 mg/kg with 50 % N2O-O2 mixture 4 liter were used for maintenance in one group (Group P). In other group, enflurane 1.5~2% with 50% N2O-O2 mixture 4 liter were used (Group E). Hartmann's solutions were used for maintenance fluid in both groups. Blood glucose levels were measured at preintubation period, postintubation 5, 10, 15 minutes and just-preincision period. Blood glucose level at admission was regarded as control value and statistical analysis was done by Student's t-test. RESULTS: In group E, there was significant increase of the blood glucose level about 23 minutes after induction but in group P, there was no significant increase of glucose level during entire experimental time. Blood glucose levels were higher from postintubation 5 minutes to just-preincision period with statistical significance in group E than group P. CONCLUSIONS: Propofol maintained stable blood glucose level compared to enflurane during general anesthesia.

The Comparison of the Effect of Enflurane and Propofol on Arterial Oxygenation during One-Lung Ventilation / 대한마취과학회지

BACKGROUND: Controversy exists as to whether or not inhalation anesthetics and intravenous anesthetics impair arterial oxygenation (PaO2) during one lung ventilation (OLV). Accordingly, we examined the effect of enflurane and propofol on PaO2 and pulmonary vascular resistance (PVR) during OLV. METHODS: Forty patients, who had prolonged periods of OLV anesthesia with minimal trauma to the nonventilated lung were studied in a cross over design. Patients were randomized to four groups; Group 1 received 1 MAC of enflurane and oxygen from induction until the first 20 min after complete lung collapse, then were switched to propofol 100 g/kg/min (P100). In group 2, the order of the anesthetics was reversed. Group 3, Group 4 received the same order of the anesthetics as Group 1, Group 2, respectively but received propofol 200 g/kg/min (P200). RESULTS: During OLV, the PaO2 values were lower than those with two lung ventilation (TLV), there were no significant differences among each groups and between propofol and enflurane in PaO2, but in the selected patients (n=10, PaO2<120 mmHg during OLV), PaO2 in propofol group was higher than that of enflurane group (p<0.05). Conversion from TLV to OLV caused a significant increase in PVR, but there were no difference in PVR between propofol and enflurane group. CONCLUSIONS: These results suggest that the usual clinical dose of propofol affords no advantage over 1 MAC of enflurane anesthesia except low PaO2 patients during OLV. Propofol might be of value in risk patients of hypoxemia during thoracic surgery when OLV is planned.