Pharmacokinetic of florfenicol in pulmonary epithelial lining fluid of swine and effects of anesthetic agent on drug plasma disposition kinetics / Farmacoqu'imica de florfenicol em fluido de epitélio pulmonar de suínos e efeitos de agente anestésico em cinética de droga em plasma

The primary objective of the current study was to compare the pharmacokinetic (PK) of florfenicol (FFL) in pulmonary epithelial lining fluid and the plasma in swine. The second objectives were to evaluate the effect of anesthesia with ketamine and propofol on the PK of FFL in plasma. Bronchoaveolar lavage was utilized for quantification of PELF volume and the urea dilution method was used to determine the concentration of FFL in PELF. FFL was administered intramuscularly (IM) to swine in a single dose of 20mg/kg body weight. The main PK parameters of FFL in plasma and PELF were as follows: the area under the concentration-time curve, maximal drug concentration, elimination half-life and mean residence time were 69.45±4.36 vs 85.03±9.26µg·hr/ml, 4.65±0.34 vs 5.94±0.86µg/ml, 9.87±1.70 vs 10.69±1.60hr and 12.75±0.35 vs 14.46±1.26hr, respectively. There was no statistically significant difference between the PK profiles of FFL for the anesthetized and unanesthetized pigs. This study suggest that (i) FFL penetrated rapidly into the pulmonary and the drug concentration decay faster in plasma than in the pulmonary, (ii) the PK profile of FFL in swine was not interfered after administration of anesthetic agent.(AU)

O objetivo primário desse estudo foi comparar a farmacocinética de florfenicol (FFL) em fluido epitelial pulmonar à farmacocinética (PK) de FFL em plasma suíno. O segundo objetivo foi avaliar o efeito de anestesia com ketamina e propofol no PK de FFL em plasma. Lavagem broncoalveolar foi utilizada para quantificar volume de fluido epitelial pulmonar (PELF) e método de diluição de uréia para determinar FFL em PELF. Injeção de FFL foi administrada intramuscular a suínos em dose única de 20mg/kg de peso corporal. Os principais parâmetros de PK em FFL em plasma e PELF foram os seguintes: a área sob a curva de concentração-tempo, concentração máxima da droga, eliminação de meia-vida e média de tempo de permanência foram 69,45±4,36 vs 85,03±9,26µg·hr/ml, 4,65±0,34 vs 5,94±0,86µg/ml, 9,87±1,70 vs 10,69±1,60hr e 12,75±0,35 vs 14,46±1,26hr, respectivamente. Não houve diferença estatisticamente significante entre os perfis de PK de FFL para os porcos anestesiados e não anestesiados. Esse estudo sugere que (i) FFL penetrou rapidamente no pulmão e concentração da droga sofre queda mais veloz em plasma que líquido pulmonar, (ii) o perfil de PK de FFL em suínos não modificou após administração de agente anestésico.(AU)

Comparative study to evaluate anesthetic effect of Thiopentone Sodium and Propofol in electroconvulsive therapy.

Introduction: In therapeutic management of psychiatric illness the response to electroconvulsive therapy may be attenuated if anesthesia that is used abolishes or inhibits seizures. Anesthetic agents used for electroconvulsive therapy should provided smooth and rapid induction, a rapid recovery, minimal alteration of the physiological effects of electroconvulsive therapy as well as minimal antagonistic effects on seizure activity. Material and methods: In study of 120 patients with ASA grade I or II, having indication for Electroconvulsive therapy, half were randomly anaesthetized by 2.5% Thiopental Sodium with dose 3 mg/kg (Group I) and 1% Propofol in 1.5 mg/kg dose (Group II). A current of 110 volts was psychiatrist. Pulse and Blood pressure monitoring and Seizure response were evaluated along with side effects if any. Observation: After Induction, systolic BP in the 2 Groups did not show any significant (p>0.05) difference while the diastolic BP was significantly (p<0.05) lower in the propofol group. After suxamethonium systolic and diastolic BP were significantly (p<0.05) decreased in the propofol group. After completion of seizure systolic BP came down to basal level at 10 mins and diastolic BP came down to basal level at 15 mins. While in the thiopentone sodium group, the BP did not come down even the end of 15 mins. The duration of seizure activity in the propofol group was markedly reduced (p<0.05) as compared to the thiopentone sodium group. The time from induction to eye opening and induction to walking unaided were significantly (p<0.001) lower in the propofol groups suggesting faster recovery. During induction, higher percentage of patients showed discomfort on injection in the propofol group while during recovery headache, nausea and vomiting were noted in more patients within thiopentone group. Conclusion: Propofol group compared to thiopentone sodium had reduced increase in BP and pulse rate, reduced duration of seizure activity. Recovery was faster and side effects were reduced during recovery.

Local anesthetic agents along with hyaluronidase for inguinal hernia block provides excellent analgesia: a double blind study.

Background: Inguinal hernia block is cost effective, but fear of intra-operative pain may hinder its widespread use. It is unknown whether hyaluronidase along with local anesthetic agent provides good analgesia for hernia block. The aim was to evaluate the effectiveness of hyaluronidase along with local anesthetic agents for inguinal hernia block in patients undergoing inguinal hernioplasty. Methods: 50 patients ASA grade I and II, age above 18 years, undergoing inguinal hernioplasty were randomized into two groups. Group A received inguinal hernia block with local anesthetic agents without hyaluronidase and Group B received inguinal hernia block with hyaluronidase and local anesthetic agents. Both groups received premedication 10 minutes before induction in the form of inj. Fentanyl, Midazolam, Ranitidine and Ondansetron Results: In Group B, out of 25 patients only 4 patients required intraoperative analgesia while in group A 16 patients required intraoperative analgesia. Post operative pain was assessed for 24 hours using the pain rating scale. The mean duration of analgesia was significantly longer in group B (16.16±6.8780 hrs) compared to group A (7.32±2.5285 hrs); pain score was compared between the two groups. Group B had lower pain scores than group A which was statistically significant (P<0.05). Conclusion: It concludes that hyaluronidase with local anesthetic agent for inguinal hernia block provides excellent intraoperative analgesia and also prolongs the post operative analgesia.

Free Toe Tissue Transfer using Infiltration Method of Local Anesthetic Agent

This study was designed to introduce free toe tissue transfer using infiltration method of local anesthetic agent. Four toe pulp tissues were transferred to reconstruct finger tip defect in four patients who were not suitable for general anesthesia. Two flaps taken from the lateral side of the great toe was used for reconstruction of thumb defect and two flaps from the medial side of the second toe for resurfacing of the index and fifth finger. Flap sizes were various from 2.0x2.0 cm2 to 1.6x4.0 cm2. Anesthesia was induced by infiltration of 2% lidocaine hydrochloride (with 1:100,000 epinephrine) with dilution of normal saline in same volume unit, as like as in ordinary digital block. All vessels were anastomosed within 2 cm of distance from the proximal margin of the defect. Whole operative procedures were carried out by one team. All flaps were successfully taken without complication. The average operation time was 4 hours 10 minutes. The amount of anesthetic agent used in whole operative procedures was roughly 4 mL in the toe, 8 mL in the finger, and 12 mL totally. In conclusion, free toe tissue transfer using infiltration method of local anesthetic agent would be good strategy for finger tip reconstruction in the patient not suitable for general anesthesia.

Research Output Accuracies of Private Hospital Vaporizers / 대한마취과학회지

BACKGROUND: Vaporizers convert liquid anesthetics into measured amount of vapor that are added to the fresh gas mixture to produce known concentrations of anesthetics. As with anesthesia machines, mordern precision vaporizers require regular checks with respect to technical safety by experts. Some private hospitals in Korea do not have had a anesthesiologist belong exclusively to hospital. Therefore it is difficult to perform a regular checks of anesthesia machine especially vaporizers. We had a question about the accuracy of vaporizer output which used in the private hospitals. METHODS: We investigated outputs of 47 vaporizers which used in 23 private hospitals and 5 general hospitals around Kangdong Gu and Kangnam Gu in Seoul, Korea. Anesthetic agent monitor(Biochem anesthetic agent monitor 8100, Waukesha, Wisc, USA) was used and its analysis value was 0.1 vo1%. 50 vo1% O2 and 50 vol% N2O were used as a carrier gas. The flow rates of the carrier gas were 4 1/min. Dial settings were 0.5, 1, 1.5, 2, 3 vo1%. RESULTS: The result was that vaporizers which had the inaccuracy ranges of concentration less than +/-0.5 vo1% was 76.6% of 47 vaporizers, +/-1 vo1% was 93.6%. And above +/-1 vol% was 6.4% of all. CONCLUSIONS: This research concludes that great care needed when the anesthesiologist strange to the vaporizers in the private hospitals operates the vaporizers.

Anesthetic Management for Coronary Artery Bypass Surgery with Coronary Artery Stenosis / 대한마취과학회지

This report is concerned with our clincal experiences of sixty one cases of anesthesia for coronary artery bypass grafting at the Dong San Medical Center during the period from Februry 1986 to September 1993. The results were as follows; 1) There were 41 men and 20 women with a mean age of 54 (25 to 79 years). 2) Among 61 cases, 17 cases (28%) were history of myocardial infarction. 3) Among 61 cases, single aortocoronary grafts were placed in 37 patients (60%), double or more grafts in 24 patients (40%). 4) The mean bypass time was 135+/-63.9 minutes and cross-clamp time was 45+/-23.5 minutes. 5) Glycopyrrolate, morphine or demerol, vistaril or lorazepam or veprin were used as premedicants. 6) 2% thiopental or 2% thiopental and fentanyl or midazolam and fentanyl were used as induction agents. 7) We have also used isoflurane and fentanyl as anesthetic agents in conjuction with nitrous oxide. 8) Succinylcholin and pancuronium or vecuronium were used for intubation. 9) Early mortality was 16.4% (10 patients) and poor ejection fraction was significantly associated with mortality rate. 10) perioperative myocardial infarction was most common complication.

The Effect of Anesthetic Agents on the Blood Glucose Levels in Surgical Patients / 대한마취과학회지

This study was undertaken to investigate the effects of Thalamonal and enflurane on the blood glucose level. Anesthesia was maintained with Thalamonal (0.5~1ml/10kg), N2O(41/min), and pancuronium(0.1mg/kg) in group l patients and with enflurane(1.5~2.5vol%), N2O(41/min), pancuronium(0.1mg/kg) in group ll patients. Blood glucose levels were measured at ward, just before induction, 15 min after induction, 5 min and 40 min after skin incision and at recovery room respectively. The following results were obtained. 1) Blood plucose levels in both groups were not significantly changed during a period of fasting(p<0.05). 2) Blood glucose levels in both groups were more significantly increased during anesthesia and surgery than those measured at ward(p<0.01). 3) In group l patients, blood glucose levels measured at recovery room were more significantly increased than those measured at 40 min after skin incision(p<0.01), while in group ll patients blood glucose levels at recovery room were more significantly decreased than those measured at 40 min after skin incision(p<0.05). 4) Changes in blood glucose levels during anesthesia and operation were not significantly different in both groups. 5) Both groups did not show hypoglycemia or hyperglycemia beyond the clinically acceptable range. From above results, it is suggested that both Thalamonal and enflurane are safe anesthetic agents in the patients with diabetes mellitus as well as in the normal patients.