Preoperative Heart Rate Affects the Degree of Heart Rate Variability during T2 Sympathicotomy / 대한마취과학회지

BACKGROUND: Thoracoscopic sympathicotomy was thought to be a simple and safe method for hyperhidrosis. There is a significant decrease in heart rate during the procedure. Also it has been suggested that the effect of the degree of sympathetic block on cardiac function was affected by the preoperative level of sympathetic activity. Our hypothesis was that the higher heart rate before sympathicotomy the more heart rate change during the procedure because heart rate is one of the indicators of sympathetic activity. METHODS: Sixty two patients with essential hyperhidrosis undergoing thoracoscopic sympathicotomy were studied. During the procedure, we recorded blood pressure at left arm and heart rate after anesthetic induction as baseline values, immediately after left side sympathicotomy, and after right side sympathicotomy. Patients were divided by median value of preoperative heart rate (83 beats/min) into group I (n = 32), preoperative heart rate below 83 beats/min, and group II (n = 30), above 83 beats/min. RESULTS: The preoperative mean heart rates of group I and II were 72 +/- 7.9 beats/min and 100 +/- 12.5 beats/min respectively. After sympathicotomy, the decrease of heart rate compared to the preoperative value in Group I was 6.6%, which was significantly lower than that of Group II, 17.6%. After left sympathicotomy, the number of cases of heart rate decreasing more than 10% was higher in Group II (20/30 cases) than Group I (13/32 cases). CONCLUSIONS: The main result of this study showed that the higher heart rate before sympathicotomy the more heart rate change during procedure.

The Effect of Lidocaine, Verapamil and Lidocaine-Verapamil Combination on Blood Pressure and Heart Rate following Tracheal Extubation / 대한마취과학회지

BACKGROUND: Tracheal extubation, as well as intubation, causes hypertension and tachycardia. The aim of this study was to compare the effect of verapamil, lidocaine to lidocaine-verapamil combination in attenuating the cardiovascular changes following tracheal extubation and emergence from anesthesia. METHODS: Eighty patients (ASA physical status 1) were randomly assigned to one of four groups (n=20 each) ; saline (control), 1 mg/kg lidocaine, 0.05 mg/kg verapamil and lidocaine-verapamil combination. These medication were given intravenously 2 min before tracheal extubation. Changes in blood pressure and heart rate were measured following tracheal extubation. RESULTS: Lidocaine, verapamil and their combination all attenuated the changes of heart rate and blood pressure. The inhibitory effect on changes of heart rate and blood pressure were miximum in group of the combination of lidocaine and verapamil. CONCLUSION: We conclude that the verapamil 0.05 mg/kg and lidocaine 1 mg/kg given iv concomitantly 2 min before tracheal extubation is a more effective prophylaxis than verapamil or lidocaine for attenuating the cardiovascular changes associated with tracheal extubation.

Cardiovascular Changes during General Anesthesia in Patients of Diabetic Autonomic Neuropathy / 대한마취과학회지

BACKGROUND: Autonomic reflex dysfunction in patients with diabetes is associated with unstable cardiovascular response in perioperative period. In this study we wanted to investigate the extent to which the intraoperative cardiovascular responses depend on the degree of autonomic dysfunction. METHODS: The influence of diabetic autonomic neuropathy upon the behavior of the circulatory system was investigated in 35 patients who had undergone ophthalmological surgery. A standardized test combination was used to study the patient's cardiovascular refractory reactions. The patients were then divided into a control group, non-diabetics without autonomic neuropathy (n = 18), and an experimental group, diabetics with autonomic neuropathy (n = 17). The anesthetic and surgical procedures (vitrectomy) were standardized and always identical. RESULTS: During the induction of anesthesia, patients in the experimental group didn't experience changes in mean arterial blood pressure and heart rate as compared to patients in control group. During the maintenance of anesthesia, there were significant decreases in mean arterial blood pressure and heart rate in the experimental group, but in the state of emergence of anesthesia, there were no significant differences in either group. CONCLUSION: Autonomic neuropathy represents a perioperative risk factor, especially during induction and maintenance of anesthesia. I therefore recommend an autonomic nervous function test for evaluation of diabetic autonomic neuropathy in preoperative anesthesiological examination.

Effects of Esmolol on the Responses to Awake Fiberoptic Nasotracheal Intubation / 대한마취과학회지

BACKGROUND: It has recently been shown that esmolol provided consistent and reliable protection against increase in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation. This study was therefore designed to establish whether esmolol was as effective in controlling the responses to awake fiberoptic tracheal intubation as it was in controlling the responses to traditional intubation and to assess the effect of esmolol for conditions of intubation, sedation, respiratory system during fiberoptic laryngoscopy and intubation. METHODS: Thirty patients, ASA physical status I-II, scheduled for oral and maxillofacial surgery, were randomly assigned to receive preintubation dose of either fentanyl 100 microgram(Group F) or fentanyl 50 microgram and esmolol 100 mg(Group E). And during awake fiberoptic nasotracheal intubation, heart rate, systolic and diastolic arterial pressures, minimal peripheral oxygen saturation, sedation score, intubation condition and time were recorded. RESULTS: There were no significant differences in arterial blood pressures, sedation score, intubation condition and time. But the change of heart rate in Group E was significantly less at 1 minite and 2 minites after the start of tracheal intubation and in Group F, minimal peripheral oxygen saturation was significantly reduced and two patients in Group F were hypoxemic and apneic. CONCLUSIONS: The present results show that esmolol provides attenuation of the change of heart rate by awake fiberoptic nasotracheal intubation and minimize the risk of apnea and hypoxia due to combination of fentanyl with midazolam.

The Relationship between Periadmission Blood Pressure and Periinduction Blood Pressure / 대한마취과학회지

BACKGROUND: There has been a study reporting those cases with elevated blood pressure (BP) above 140/90 mmHg on admission and normotension on ward showed more increase in mean arterial pressure(MAP) and pressure-pulse product than the normotensive or hypertensive patients in both situations. But the mean ages of the groups were different each other. This study was done to see if the same results would come without age differences. METHODS: One hundred and sixty-two patients between the age of 45 and 64 were divided into three groups. The patients with BP below 140/90 mmHg on admission and on ward were included in group 1(N=66) and those with BP above 140/90 mmHg on admission and below 140/90 mmHg on ward, in group 2(N=42) and those with BP above 140/90 mmHg in both situations were included in group 3(N=54). Preiinduction BP, PR, the changes of BP, PR during operation, incidence of hypertension at post-anesthesia room(PAR), and the number of cases who needed the use of inotropics or antihypertensives perioperatively were checked. RESULTS: As for the increase of BP just before induction the group 2 showed the greatest, group 1 was the next, and group 3 showed the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next, and group 3 the least amount increase. As for the increase of preinduction pressure-pulse product(PPP) group 2 showed the greatest, group 3 the next, and group 1 the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next,and group 3 the least amount increase. CONCLUSIONS: Intensive anesthetic care is needed also at periinduction period for the patients who showed hypertensive BP on admission and normotension on ward thereafter.