The Effect of Fentanyl, Esmolol and Labetalol on Hemodynamic Responses to Endotracheal Intubation / 대한마취과학회지

This study was done to determine the attenuating effect of fentanyl, esmolol and labetalol on the undesirable hemodynamic response to endotracheal intubation. Eighty patients, ASA physical status I-II, scheduled for elective surgery, were randomly divided to 4 groups(n=20, respectively), received a preintubation dose of either normal saline, 3 ug/kg fentanyl, 3 ug/kg fentanyl and 2.5 mg/kg esmolol, or 3 ug/kg fentanyl and 0.5 mg/kg labetalol. Controlled blood pressure and heart rate were recorded in the operating room at arrival of patients. Denitrogenation was done and 3 ug/kg fentanyl was administered at minute 0. Either sympathetic blocker was intravenously infused for 1 minute at minute 1. Induction was accomplished by administering 5 mg/kg thiopental sodium at minute 3, Larynogscopy and endotracheal intubation were performed by one investigator at minute 5. Data from patients in whom intubation required more than 15 seconds were excluded. Heart rate and blood pressure were recorded every minute for 10 minutes after administration of fentanyl. Highest value of heart rate and systolic blood pressure in all groups were recorded 1 minute after endotracheal intubation. Maximum percent increase in systolic blood pressure(meanSD) after intubation were significantly lower in fentanyl(4%+/-17%), esmolol and fentanyl(-5%+/-14%), and labetalol and fentanyl(-3%+/-20%) groups than in the normal saline(27%+/-15%) group(P<0.05). Maximal percent increase in heart rate was significantly lower only in esmolol and fentanyl(4%+/- 18%)group than in normal saline(27%+/-23%) group(P<0.05). The authors observed that combined pretreatment with esmolol and fentanyl provided more reliable protection against increases in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation.

A Case of Right Sleeve Pneumonectomy and Carinal Reconstruction using Femoro - femoral Cardiopulmanary Bypass / 대한마취과학회지

A 26 year-old woman was scheduled for right sleeve pneumonectomy and carinal reconstruction using Femoro-femoral extracorporeal circulation to correct tracheal stenosis due to endotracheal tuberculosis. Only 0.2 mg glycopyrrolate was given intramuscularly for premedication. A radial artery cannulation was inserted for blood has sampling and direct arterial pressure monitoring. Under the monitoring for SaO2, ECG and direct radial artery pressure, we conducted continuous epidural anesthesia for the cannulation of extracorporeal circulation. Immediately after establishment of lines for extracorporeal circulation, we injected 15 mg midazolam, 200 ug fentanyl and 50 mg succinylcholine, and then did orotracheal intubation. Under extracorporeal circulation, right sleeve pneumonectomy was performed, and left bronchial intubation was done using another sterile armored tube number 7.0 by surgeon. From skin incision to left bronchial intubation, maintenance of anesthesia was conducted by intermittent injection of fentanyl-midazolam, and after left bronchial intubation, it was done by using conventional inhalation anesthetics, halothane-98% O2. The prime importance in anesthetic management of these patient should be focused on the maintenance of adequate oxygenation and ventilation, and we think it is a kind of safe method to use extracorporeal circulation during carinal reconstruction.

Effect of the Types of Operation or Agieng on Blood Glucose Changes during Halothane Anesthesia / 대한마취과학회지

The goal of this study was of what change in blood glucose the operation area and ageing made during halothane anesthesia. Sixty patients who were chosen randomly were divided into 4 operation groups according to operation site, that is, nil, surface, abdomen and thorax. Again, each operation group was fractionated into the young(below 40 year old), the middle (from 4l to 60) and the old(above 61). The blood sampling was done at preinduction for control value, 15 min, 30 min, 45 min and 60 min after induction for nil, and 15 min, 30 min, 45 min and 60 min after incision for operation-received groups. The results were as follows; 1) In nil, the young and the middle increased, but the old decreased in blood glucose. 2) In operation-received groups, there was no significance in blood glucose change among 3 age fractions. 3) The blood glucose change was larger in operation-received groups than in nil, more prominent in abdomen and thorax groups than in surface group. 4) The blood glucose of preinduction had no significance among 4 operation groups.