A Comparison of the Effect of Propofol and Thiopental on the Hemodynamic parameters in Valvular Replacement Surgery / 대한마취과학회지

Propofol is a short acting, rapidly metabolized intravenous anesthetic agent. It cause a decrease in arterial pressure after induction of anesthesia and a decrease in heart rate. Hypertension, tachycardia during induction of anesthesia or in response to tracheal intubation is undesirable in high-risk patients, Propofol might attenuate the pressor to tracheal intubation than thiopental. In this study we compared propofol with thiopental for induction of anesthesia. Forty patients of ASA class III scheduled to undergoing valvular replacements divided two groups. Twenty patients were induced with thiopental, twenty patients were induced with propofol and maintained using 50% nitrous oxide in oxygen. Cardiovascular parameters were checked before induction, after propofol or thiopental injection, after succinylcholine injection, after tracheal intubation, after isoflurane mixed inhalations. The aim of this study is to examine a camparison of hemodynamic effects between propofol and thiopental for valvular replacement. The results were as follows. 1) There is little change in heart rate with thiopental group, but heart rate was decreased in propofol group. 2) There is slightly deaeased in arterial pressure with thiopental group, but markedly decreased in propofol group. 3) There is no difference of central venous pressure between two groups.

The change of lymphocyte subpopulation of the thermal injured rats by exchange transfusion

No abstract available.

Changes of Blood Sugar Levels by Infusion of Elitol, D5 / W and D5 / LR / 대한마취과학회지

Rapid administration of solution containing dextrose results in marked hyperglycemia and osmotic diuresis. Jeon reported blood sugar of 200 to 465mg per 100ml. in patients receiving 10ml per hour of 5% dextrose in 1/3 saline and the urine output went up to 340ml per hour. This study was undertatken to evaluate Elitol asto changes of blood sugar concentrations when it was administered rapidly. Elitol is a maltose contained in a balanced salt solution shich has a different effect in the blood sugar level from a gulcose contained solution. 40 patients were chosen at random and divided into 3 groups i.e. one group 5% dextrose in water(D5/W), the second group 5% dextrose in lactated ringer's solution(D5/LR) and the third group the Elitol solution. Patient's blood was drawn on the operating table prior to starting I.V. infusion for the measurement of blood sugar in various conditions of N.P.O. Intravenous fluid was administered at 10ml/kg/hour while anesthesia was induced and maintained with an endotracheal tube in place. The blood samples were taken after one hour, 2 hours and 3 hours from the time the LV. infusion started. In the group of 5% dextrose in water, the value of blood sugar was 82+/-mg% at NPO2 205+/-36mg% at 1 hour, 273+/-49mg% at 2 hours, and 316+/-63mg% at 3 hours. The blood sugar values increased markedly. In the group of 5% dextrose in lactate Ringer's solution the values of blood sugar were 99+/-16mg% at NPO, 255+/-49mg% at 1 hour, 285+/-54mg% at 2 hours and 292+/-78mg% at 3hours. The values of blood sugar increased significantly and were very similar to the 1st group. In the group of Elitol, the values of blood sugar were 92+/-12mg% at NPO, 126+/-21mg% at 1 hour, 131+/-24mg% at 2 hours and 128+/-23mg% at 3hours. The increase of blood sugar levels were insignificant which is entirely different from the change of blood sugar in the above groups. Accordingly we came to the conclusion that rapid infusion of Elitol solution affects the blood sugar levels insignificantly compared to the dextrose containing solutions which increase the blood sugar levels greatly.

Evaluation of CVP Values according to the Location of Catheter / 대한마취과학회지

Central vanous pressure is an extremely useful parameter in the effective monitoring of a patient who is seriously ill. Central venous pressure may be defined as a dynamic measurement of the ability of the right heart and the placement of the catheter in either the right atrium or the superior cava is considered satisfactory. The purpose for this study is to evaluate CVP values according to the placement of the catheter in clinical practice because we have used a short anglocath instead of a long intracath for the measurement of CVP. Ten patients were catheterized with a 20cm in tracathin the right subclavian vein by a supraclavicular approach. AS a control group CVP was measured at 13cm from the puncture site to the tip of catheter which was estimated to be in the right atrium. In the second group, CVP was measured at 8cm which goes the innominate vein and in the fourth group, measured at 5cm which locates in the subclavian vein. Mean values of venous pressures in each location are as follows: The right atrium(13cm from the puncture site): 8.68cm H2O. THe superior vena cava (10cm from the puncture site): 8.69cm H2o/ The innominate vein(8cm from the puncture site): 8.64cm H2O. The subclavian vein (5cm from the puncture site):8.68cm H2O. As a result of this study, we came to the conclusion that the CVP values in all four groups(right atrium, superior vena cava, innominate vein, subclavian vein) are almost the same, so that we can use a short angiocath with no problems for the measurements of CVP which is anchored in the innominate vein or the subclavian vein.

Intraspinal Morphine Anesthesia for Open Heart Surgery / 대한마취과학회지

Morphine anesthesia for cardiac surgery became very popular since Lowenstein at al. reported that 1.5~3.0mg/kg of morphine administered intravenously during ventilating with 100% oxygen did not alter cardiovascular dynamics in patients without heart disease and improved them in patients with aortic valve disease. However, morphine anesthesia soon appeared to cause significant disadvantages and many problems such as intraoperative awareness, histamine reactions marked increases in intraoperative blood pressure and prolonges postoperative respiratory depression. This study was primarily undertaken to evaluate the effects of intraspinal morphine anesthesia and compare them with the problems resulting from intravenous morphine anesthesia. We had 25 patients scheduled for open heart surgery. They were anesthetized mainly by intraspinal morphine and intravenous tranquilizers. Spinal tapping using Whitacre pencil point needle was performed in a sitting position at a level between L2-L4 and spinal fluid was drawn and mixed with morphine by a 10cc syringe and was administered rapidly with barbotage 3 times. Then the patient was given pentothal and anectin, and was intubated, followed by intravenous administration of Ativan or valium. The patient's respiration was controlled with 100% oxygen throughout the entire surgery. 1) The dosages of intraspinal morphine ranged between 6~10mg which was bridfly calculated by 0.1mg/kg with some variation according to heights and patients conditions. 2) Activan or valium was administered intravenously to eliminate intraoperative awareness. Ativan was preferred to valium for valve surgery. 3) Cardiovascular dynamics appeared stable throughout the intraoperative, recovery and ICUcare periods. 4) Respiratory depression seemed to be most serious between 12~16hour after intraspinal injection of morphine. Therfore this technique is recommended only in patients who need a controlled respiration for more than 12 hours because respiratory arrest occurs more commonly at that hour. 5) Respiratory care in the ICU was very effective satisfactory without any further medication for synchronisation between patient and respiratior becauses of the length of respiratory depression. 6) Somnolence lasts 24~36hours with no inadvertent reactions. 7) Well documented complications such as respiratory depression, pruritis and urinary retention were not problems in patients for open heart surgery. 8) The anesthesia induced by intraspinal morphine injection was satisfactory in anesthesia practice for open heart surgery. Therefore, we have called this procedure which has not been reported yet intraspinal morphine anesthesia.