Inhibition of Phospholipase A2 Ameliorates the Acute Lung Injury Induced by E Coli Endotoxin via Reduced Production of Oxygen Free Radicals in the Lung / 대한마취과학회지

BACKGROUND: In order to understand the pathogenetic mechanism of sepsis-induced acute lung injury, inhibition of phospholipase A2 (PLA A2) was carried out in an endotoxin-induced septic lung model. METHODS: Sprague-Dawley rats were divided three groups; sham group, endotoxin group (instillation of E coli endotoxin, 100microgram/rat, type 017) and mepacrine group (the non-specific PLA2 inhibitor, 50 ml/kg intraperitoneal injection after endotoxin treatment). Five hours after endotoxin treatment, protein contents, neurophils counts, gamma-glutamyl transpeptidase (GGT) activity and surfactant concentrations in the bronchoalveolar fluid (BAL), meyloperoxidase (MPO) and PLA2 activity in the lung were measured. A morphological study for the effect of the endotoxin and mepacirne, and a cytochemical electron microscopy for detection of hydrogen peroxide in the lung were also performed. RESULTS: Endotoxin increased the concentrations of protein, the number of neutrophils, and GGT activity in the BAL fluid, MPO and PLA2 activity in the lung but mepacrine decreased these parameters (P < 0.001). The light density of surfactant was increased by the endotoxin (P < 0.001), but mepacrine diminished this pathological change. In the light microscopic findings, the endotoxin caused pulmonary accumulation of neutrophils, atelectasis and transudation of intravascular protein was observed. In contrast, mepacrine lessened these pathological findings. In ultrastructural findings, adhesion of neutrophils to endothelial cells, necroses of type II cells and endothelial cells, and the damage of lamellar bodies were observed after the endotoxin treatment, which recovered with mepacrine. In the cytochemical electron microscopy for detection of hydrogen peroxide in the lung, the deposits of cerrous perhydroxide were increased by the endotoxin but mepacrine decreased deposits of cerrous perhydroxide. CONCLUSIONS: Inhibition of PLA2 in an endotoxin induced acute lung leak showed protection against oxidative stress by a diminution of neutrophilic respiratory bursts and a decreased production of free radicals. It is suggested that PLA2 has a pivotal role in causing acute oxidative stress in endotoxin induced acute lung injury.

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.

The Hemodynamic Changes during Induced Hypotension with Propofol / 대한마취과학회지

BACKGROUND: The studies related to induced hypotention using propofol were rare. So we studied the effectiveness of propofol as induced hypotensive agent in brain aneurysmal surgery. METHODS: The hemodynamic changes during induced hypotension with propofol (propofol-group) and isoflurane(isoflurane group) were observed in patients undergoing aneurysmal surgery. Twenty patients were allocated randomly to receive propofol induction and maintenance, or thiopental sodium induction and isoflurane maintenance for anesthesia. Both groups also received fentanyl, vecuronium, nitrous oxide and oxygen. These hypotensive effects were evaluated before, during and after induced hypotension. Hemodynamic changes were evaluated by measuring systemic arterial blood pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure, cardiac output, systemic vascular resistance and pulmonary vascular resistance. We also compared the ventilatory effect of hypotensive anesthesia by blood gas analysis. RESULTS: There were no significant changes of heart rate, cardiac output, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure and pulmonary vascular resistance before, during and after induced hypotension in both group. Mean arterial pressure and systemic vascular resistance were significantly decresed during induced hypotension (p<0.05). There were no significant changes of PO2, PCO2, HCO3 , base excess before, during and after induced hypotension in both group. CONCLUSION: Propofol is also an effective hypotensive agent comparable to isoflurane.

The Appropriate Inflow Rates of Fresh Anesthetic Gas in the Pediatric General Anesthesia with Mapleson D - circuit / 대한마취과학회지

BACKGROUND: During pediatric general anesthesia with Mapleson D-circuit, we used large amount of FGF(fresh gas flow) for avoidance of rebreathing of expired gas but low FGF are employed, the amount of anesthetic consumption and air contamination can be reduced. The aim of this study was to evaluate the fact that FGF of 220 ml/kg/min is clinically acceptable. METHODS: We selected sixty children weighing or =8 kg because of economic and ecological advantages. Also, we consider FGF can be reduced in children weighing <8 kg under accurate respiratory gas monitoring.

The Appropriate Inflow Rates of Oxygen and Nitrous Oxide in Adult General Anesthesia / 대한마취과학회지

BACKGROUND: During adult general anesthesia, we used 3~5 L/min of fresh gas flow(FGF) but low FGF are employed, the amount of anesthetic consumption and air contamination can be reduced. The aim of this study was to determine the minimal appropriate inflow rate of oxygen and nitrous oxide during semiclosed circle technique. METHODS: We selected 40 patients, ASA group 1 or 2, scheduled for elective, nonabdominal surgery under general anesthesia with semiclosed circle system. Anesthesia was maintained with 50% oxygen, nitrous oxide and enflurane, controlled ventilation was used; rate of 10/min, tidal volume of 10 ml/kg. After induction and vital signs stabilized, FGF was changed to 4 L, 3 L, 2 L and 1L/min at interval of 30 minutes. We observed mean airway pressure and arterial blood gas tensions. RESULTS: The changes of mean airway pressure did not correlated with fresh gas inflow rate. In arterial blood gas analysis, PaO2 showed a decreasing tendency significantly according to decreasing fresh gas inflow rate(p<0.01) but there were no clinical hypoxemia in all patients. There were no significant changes in pH, PaCO2 and base excess. CONCLUSIONS: We consider that FGF of 1~2 L/min is appropriate during adult general anesthesia because of economic and ecological advantages. Also, we consider low flow technique with below 1L/min can be used safely and effectively under proper gas monitoring such as oxygen analyzer, capnometer.

Pre-emptive Infiltration of Lidocaine Reduces Formalin Pain Behavior in Rat / 대한마취과학회지

Surgical tissue damage induces dual phenomenon of peripheral and central sensitization. Postoperative pain could be partially explained by neuronal hyperexcitability. As a postoperative pain model, formalin test, subcutaneous injection of formalin in the rat hind paw, results in initial vigorous flinching(phase 1), depends on acute chemical stimulation, followed by cessation of activity, and then resumption of flinching(phase 2), which depends on central sensitization. Pre-emptive analgesia, given before the onset of a painful stimuli, reduces or ptevents postoperative pain by preventing this central sensitization. This study was performed to evaluate the effect of local infiltration of lidocaine as a pre-emptive analgesia in the formalin test. Forty experimental rats were divided four groups; CONTROL group(without any treatment), POST group(0.04 mL of 1% lidocaine injection 5 min after formalin injection), PRE group(0.04mL of 1% lidocaine 5 min before formalin injection), and SHAM group(injection of normal saline 5 min before formalin injection). All animals received inhalation anesthesia for 15 min before and 5 min after formalin injection. Under halothane inhalation anesthesia, all were injected subcutaneously 0.04 mL of 5% formalin in the distal plantar area of right hind paw. After recovery of anesthesia, the formalin-induced flinching behavior was observed during only the phase 2 period(10-60 min) after formalin injection. The time to first flinching, the mean number of flinches per min, and the mean number of total flinches during phase 2 expressed as a percent of the values of the CONTROL group were compared between the groups with an t-test or an ANOVA. The first flinching was appeared before recovery of anesthesia in CONTROL and SHAM groups. The time to first flinching after formalin injection was 21.2+/-3.4, 16.6+/-3.1 min respectively in PRE and POST groups. It was significantly longer in PRE group than in POST group(P<0.05), despite of 10 min earlier injeetion of lidocaine in PRE group. The mean number of flinches per min was significantly lower in PRE and POST groups(P<0.05) until 25 min after formalin injection, and after that time the difference between PRE group and POST group was significant(P<0.05). The means of the total number of flinches during phase 2, expressed as a percent of the values of the CONTROL poup, were 100+/-17.2%, 31.8+/-13.1%, 76.9+/-14.5% respectively in SHAM, PRE and POST groups. Those in PRE and POST groups were significantly lower than that of CONTROL group(P<0.001), and the difference between PRE group and POST group was significant(P<0.05). In summary, pre-emptive infiltration of lidocaine on formalin test prolongs the duration of analgesia and reduces the severity of formalin pain in rat. Therefore, the infiltration of lidocaine before formalin test is really provided pre-emptive analgesia.

Direct Effects of Ketamine on Isolated Rat Aorta and Pulmonary Artery / 대한마취과학회지

The vasoactive effecs of ketamine on aortic and pulmonary arteries have not heen clearly characterized. Nevertheless, it has been recommended to avoid ketamine in systemic and pulmonary hypertension because of its tendency to increase systemic and pulmonary vascular resistance. This study was designed to investigate and compare the direct effects of ketamine on isolated rat aortic and pulmonary arteries, with or without intact endothelium. The optimal resting tension (Lmax) of each ring was searched hased on contractile responses to 3.7X10(6)M norepinephrine. Once the Lmax was Obtained, the peak developed tension was recorded as the control. Thereafter, in the second part of the experiments, prior to ketamine exposure, the endothelium was denuded which was confirmed pharmacologically using norepinephrine(3.7X10-6M) and acetylcholine(10(-6)M). In groups with intact endothelium, .3X10(3)M ketamine relaxed aortic and pulmonary artery ring by -10.3+/-5.6%, -17.8+/-4.4%, respectively. In groups without intact endothelium, 3X10(3)M ketamine relaxed aortic and pulmonary artery ring by -9.9+/-3.6%, -14.2+/-3.8%, respectively. It was statistically significant. In groups with or without intact endothelium, 0.1X10(3) M ketamine relaxed aortic and pulmonary artery ring. Hut it was statistically insignificant. We conclude that ketamine is a powerful aortic and pulmonary artery dilator in vitro and that is endothelium independent.

Direct Effects of Thiopental, Propofol, Etomidate on Isolated Rat Aorta and Pulmonary artery / 대한마취과학회지

The induction agents produce various effects to cardiovascular system. Among these, thio- pental, propofol, and etomidate produce reduction in cardiac output and peripheral vascular resistance. As a result severe systemic arterial hypotension is evoked. This phenomenon results from combined effects of CNS, cardiovascular and peripheral vascular systems. The purpose of this study was to obeserve direct effects of thiopental, propofol, etomidate in isolated rat aorta and pulmonary artery. Isometric tension was recorded in rat aortic and pulmonary artery ring preparation contracted by norepinephrine(1.8x10-6) . Thereafter thiopental, etomidate, propofol was added to organ bath. And the contractile or relaxing response was observed. Thiopental relaxed aortic ring by 3.6+/-1.3%(low dose), 3.9+/-1.4%(high dose), etomidate relaxed aortic ring by 2.0+/-0.7%(low dose), 5.4+/-2.8% (high dose), respectively. It was statistically insignificant. However, propofol relaxed aortic ring by 12.7+/-3.8%(low dose), 14.7+/-2.7%(high dose), respectively(p <0.05). Thiopental relaxed pulmonary artery ring by 4.8+/-1.1%(low dose), 5.1+/-2.3%(high dose), etomidate relaxed pulmonary artery ring by 4.8+/-1.1%(low dose), 5.1+/-2.3%(high dose), respectively. It was statistically insignificant. However, propofol relaxed pulmonary artery ring by 8.4+/-2.4%(low dose), 10.4+/-3.6(high dose), respectively( p<0.05). The results suggest that hypotension after propofol administration was due to direct vascular smooth muscle relaxation.

Fiberoptic Bronchoscopic Evaluation of Laryngotracheal Injury following Short-term Endotracheal Intubation / 대한마취과학회지

Laryngotracheal injury following endotracheal intubation has been extensively described in the literature, but most discussion has centered around the sequela of prolonged intubation. Little however, has been reported regarding the lesions from short-term endotracheal intubation to ensure the safe practice of anesthesia. In this regard, 72 healthy, male patients undergoing general anesthesia for surgical procedures were randomly assigned to have an endotracheal tube of 7.0, 8.0, or 9.0 mm in internal diameter and were evaluated for the upper airway symptoms by questionnaire within 4-8 hours following extubation. The larynx and trachea were examined and scored for extent and severity of lary- ngotracheal damage by fiberoptic laryngotracheoscopy, and risk factors causing laryngotracheal injury were studied. The results were as follows; The incidence of upper airway symptoms were 13 of 72 (18.1%), of which 10 (13.9%) were throat discomfort and 3 (4.2%) were sore throat. The incidence of laryngeal and tracheal injury was 52 of 72 (72.2%) and 20 of 72 (27.8%), respectively. 20 patients (27.8%) did not reveal any lesion in the laryngotracheal system. The common sites of intubation injury were vocal cords (65.3%, all erythema) and arytenoids (44.4%, erythema 37.5%, edema 6.9%). No correlation could be drawn between the injured and uninjured groups with respect to smoking and length of intubation. However, bucking was associated with severity and extent of laryngeal damage (p<0.05), and with the extent of tracheal damage only (p<0.05). Also, the increase in internal diameter of the tube used was associated with severity and extent of laryngeal damage (p<0.05), but not with tracheal damage.

The Effects of Verapamil and Nifedipine on Isolated Human Uterine Arteries / 대한마취과학회지

Isometric tension was recorded in uterine arterial ring preparation contracted by potassium (60 mM) and norepinephrine(1.8 X 10(-7) M). With pretreatment of various concentrations of nifedipine(2.9 x 10(-9) ~2.9 X10(-7) M) and verapamil(2.2 X 10(-7) -2.2 X 10(-5) M), the relaxation was dose-dependent and inhibitory effects of both agents were more marked on the potassium than norepinephrine-evoked contraction. After immersion of the arterial preparation in calcium-free solution, the potassium-evoked contraction was decreased to 21+/-4.1%(mean+/-SEM) of the response in normal Krebs solution and norepinephrine-evoked contraction to 26+/-3.8%. The responses to both agents were completely restored when the calcium concentration was increased to 4.0 mM. Pretreated nifedipine(2.9 x 10(-7) M) in calcium-free solution depressed the potassium-evoked contraction to 7.3+/-1.6% and norepinephrine-evoked contraction to 12+/-3.7%. In addition of calcium(0-4.0mM), the potassium-evoked contraction increased to 30+/-4.6% and that by norepinephrine to 45+/-5.4%. Pretreated verapamil(2.2 X 10(-5) M) in calcium-free solution depressed the potassium-evoked contraction to 14+/-3.6% and norepinephrine-evoked contraction to 18+/-3.3%. In addition of calcium(0-4.0mM), the potassium-evoked contraction increased to 41+/-4.2% and that by norepinephrine to 57+/-4.7%. It was concluded that nifedipine and verapamil relaxed KC1 contracted ring in the presence of external calcium and relaxed norepinephrine contracted ring in both the presence and absence of external calcium. These findings suggest that calcium antagonists interfere with the release of calcium from intracellular sites as well as with the slow inward current of calcium.

Prophylactic intravenous ephedrine infusion during spinal anesthesia for cesarean section / 영남의대학술지

Ephedrine sulfate was administrated 30 healthy parturients undergoing elective repeat cesarean section under spinal anesthesia. Fifteen patients received ephedrine infusion (0.01% solution, beginning with approximately 5 mg/min) immediately after induction of spinal anesthesia to maintain maternal systolic blood pressure between 90% and 100% of the baseline systolic blood pressure (mean dose of ephedrine 31.6 mg). Fifteen patients (control group) received 20mg of ephedrine as an intravenous bolus, and additional 10mg increments, if necessary, when systolic blood pressure decreased to 80% of the baseline systolic blood pressure (mean dose of ephedrine 26.8 mg). Nausea and/or vomiting occurred in seven women in the control group and on patient in the infusion group (p<0.001). Apgar scores, fetal blood gas tension, and time for onset of respiration was comparable in the two groups. The results suggest that prophylactic ephedrine infusion is safe and desirable in healthy parturients undergoing cesarean section under spinal anesthesia.

Effect on the management of postherpetic neuralgia / 영남의대학술지

Fifteen patients was analyzed on effect of the management of postherpetic neuralgia by local anesthesia on the special region at pain clinic in Youngnam University Hospital. The results were on follows: 1) The frequency of occurrence of sex and the lesion side were similar in all patients. 2) The age of incidence was between 50 and 70 years old. 3) The most frequent site of lestons was the neck. 4) There was no relationship between age and treatment time. 5) Whole patients was done average 7-10 time local injection.

Vecuronium Administration for Endotracheal Intubation / 대한마취과학회지

Vecuronium bromide is a nondepolarizing neuromuscular blocking agent with minimal effect on the autonomic nervous system and little or no histamine release. Some investigators have found that as the dose of vecuronium increased from its ED the onset time is decreased. This study was designed to investigate the influences of a divided dose and single large dose on onset time of vecuronium in 40 ASA physical status l and 2 adult patients. The patients were divided into two groups: Gp. l; Priming dose(0.01 mg/kg) of vecuronium 4 minutes prior to intubating dose(0.14 mg/kg) Gp. 2; Single bolus intubating dose(0.15 mg/kg) of vecuronium followed immediately the induction agent. The results were as follows. l) After the priming dose administration, in the Gp. 2, 13 patients complained of side effcts. 2) The onset time (from the end of injection to l00% depression of the twitch tension) were 172.0+/-23.8 seconds in the Gp. I and 164.0+/-27.5 seconds in the Gp. 2. 3) Clinical duration of blockade (from the end of injection to first return of the second twitch of TOF) was 39,2+/-6.4 minutes in the Gp. l. In conclusion, we recommend the single large dose of vecuronium(0.15 mg/kg) for the endotracheal intubation in whom SCC is contraindicated.

Spinal Anesthesia for Lower Extremities : Comparison of Plain 0.5% Bupivacaine and Hyperbaric 0.5% Tetracaine / 영남의대학술지

Plain 0.5% bupivacaine and hyperbaric 0.5% tetracaine were compared for spinal anesthesia in 40 patients undergoing operation of lower extremities. Lumbar puncture was performed with a 22 gauge spinal needle with the patient in the lateral recumbent position. The third lumbar interspace was chosen for the puncture, when a free flow of clear CSF was obtained, the local anesthetic solution (2.5 ml of 0.5% bupivacaine or 2.0 ml of hyperbaric 0.5% tetracaine) was injected at a rate of 0.1ml/sec without barbotage. After injection of anesthetics, clinical features were observed and compared between the two groups. The results were as follows: 1. The two groups were well matched for age, sex, height and weight. 2. In both groups, sensory block to T₁₂ dermatome was obtained within 4 minutes, mean maximal level of analgesia was T₆₋₇, and the mean time for maximal level was around 20 minutes. 3. The onset times of motor block were similar in both groups and complete motor block was obtained in all cases within 20 minutes. 4. The duration of analgesia above the T₁₂ dermatome was 3 hours, postoperative analgesia was 7 hours. These value were significantly prolonged than those of the tetracaine group (p<0.05). 5. The changes in systolic pressure in the bupivacaine group were significantly less than those of the tetracaine group (p<0.05). 6. The complications after spinal anesthesia were headache, numbness, urinary retention and backpain, and were no significant difference in both groups. From the obtained results, we concluded that plain 0.5% bupivacaine was a relatively satisfactory agent for spinal anesthesia for operation of lower extremities. The time of onset, height of block and the complications of postoperative period were similar in both groups. The advantages of plain 0.5% bupivacaine were less hypotension and long duration of analgesia.

A Comparison of Lidocaine Administration Routes for the Prevention of Hemodynamic Responses to Intubation / 대한마취과학회지

The aim of this study was to compare the hemodynamic responses with various administration routes of lidocatine, which was used to blunt the sympathetic stimulation associated with intubation. The study population was from 24 patients scheduled for elective open heart surgery at Yeungnam University Hospital. Patients were randomly assigned to receive lidocaine by intravenous administration, laryngotracheal spray, and oropharyngeal gargling, and endotracheal intubation was performed. Heart rate, mean arterial pressure, central venous pressure, and arterial oxygen saturation were measured at 30 seconds, 1 minute, 3 minutes and 5 minutes after intubation and compared with the control group. The results were as follows: 1) In the control group which was not administered lidocaine, heart rate and mean arterial 1pressure were significantly increased (p<0.05, p<0.01). 2) In the group of intravenous lidocaine administration, heart rate was significantly increased (p < 0.05), but mean arterial pressure was not significantly changed after endotracheal intubation. Compared with control group, the changes of heart rate and mean artrerial pressure were statistically significant (p<0.05). 3) In the group of laryngotracheal lidocaine spray, heart rate and mean arterial pressure were increased after endotracheal intubation. 4) In the group of oropharyngeal lidocaine gargling, heart rate and mean arterial pressure showed significantly increased (p<0.05, p<0.01), and heart rare mintained an increased state but mean arterial pressure was reduced to the baseline value 5 minutes following intubation. 5) Laryngotracheal spray and oropharyngeal gargling group showed more significant increase in heart rate and mean arterial pressure than intravenous administration group. 6) No significant changes were observed in central venous pressure and arterial ocygen saturation in all three groups. It is concluded that intravenous administration of lidocaine before endotracheal intubation is more effective than laryngotracheal spray or oropharyngeal gargling.

A Case of Hepatitis Developing after Open Heart Surgery used Halothane Anesthesia / 영남의대학술지

Although halothane is one of the most widely used inhalation anesthetics, it may cause postanesthetic complications such as halothane hepatitis. Halothane hepatitis has been reported intermittently with variable incidence. However it is not easy to prove halothane as a causative agent, because there are many factors causing postoperative hepatic dysfunction. The author had a case of acute hepatitis developing after open heart surgery used halothane. 37-year-old female underwent an open heart surgery for ASD repair under halothane anesthesia. On the 14th postoperative day, she developed high fever of 38℃. Liver function tests showed marked elevation of SGOT, SGPT, and bilirubin, followed by gross jaundice. HBs Ag(−) and HBs Ab(+) were reported. She died of acute respiratory, hepatic, and renal failure on the 19th postoperative day. Possible causes of the hepatitis were considered halothane, blood transfusion, and drugs.

Changes of Plasma ADH and beta-endorphin Levels during General Anesthesia / 대한마취과학회지

The purposes of this study were to investigate the changes of plasma ADH and beta-endo-rphin levels during general anesthesia. Tweleve patients, who had surgery at Krungpook National University Hospital, were selected without specific hepatic, renal and other endocrinologic disorders. The patients were anesthetized with thiopental sodium and succinylcholine chloride followed by O2-N2O-ha1othane(4 cases), anti O2-N2O-enflurane(8 cases) , The plasma ADH and beta endorphin levels were chocked before anesthesia(control group), 20 minutes after endotracheal intubation, 20 minutes after surgical incision and at recovery roam when the patients responded to the pain. The plasma ADH levels were 5.69+/-2.19, 12.72+/-14.90. 11.47+/-9.62 and 24.42+/-23.23 ru/ml, respectively. It were progressively incresed and significantly incresed at recovery room (P<0.05). The Plasma beta endorphin levels were 4.1+/-3.54, 6.44+/-3.75, 6.68+/-3.90 and 17.88 +/-12.08 Pmol/l, resPectiTely. Plasma beta endorphin levels at 20 minutes after endotracheal intubation and 20 minutes after surgical incision were significantly increased(p<0.05) and it was very significantly increased at recovery room(P<0.01) . Albo serum electrrolytes(Na+, K+, Cl-, CO2-) were evaluated, but statistically or clinically not significant. Urine electrolytes(Na+, K+) and osmolality were evaluated before, during and after ane Sthesia, but statistically not significant. From the view of inhalation anesthetics, there were no diffrences between halothane and enflurane in plasma ADH and beta endorphin levels.

Circulatory Changes and Blood Gas Analysis of Protamine Administration after Cardiopulmonary Bypass / 대한마취과학회지

Systemic hypotension is commonly observed in association with the administration of protamine after cardiopulmonary bypass. To elucidate the circulatory changes and arterial blood gas changes of protamine sulfate administration, we studied 27 patients following cardiopulmonary bypass. In the intraaortic protamine administration group (N=5), the mean arterial pressure decreased significantly (p<0.05) in 5 minutes during protamine infusion and after protamine, infusion respectively. Heart rate, central venous pressure and blood gas analysis did not change significantly. In intravenous protamine administration group (N=22), the arterial oxygen tension increased significantly(p<0.05 %amp; p<0.01) in 10 minutes during protamine infusion and after protamine infusion respectively. There were no special changes when the more than 0.3mg/kg/min rate of protamine was injected but the mean arterial pressure decreased significantly(p<0.05) in 5 minutes during the protamine infusion. Mean arterial pressure, heart rate, central venous pressure and blood gas analysis did not change in the less than 0.3mg/kg/min rate of protamine was injected. There were no circulatory changes in the less than one hour CPB time group but the arterial oxygen tension increased significantly in 5 minutes and 10 minutes during the protamine infusion and after the protamine infusion. But in the more than one hour CBP time group, the mean arterial pressure decreased significantly in 10 minutes during the protamine infusion and after protamine infusion.

Analgesic Effects of Lumbar Epidural Narcotics for Relief of Upper Abdominal Post-operative Pain / 영남의대학술지

To assess the effect of postoperative pain control of upper abdominal surgery through lumbar epidural narcotic injection, the 3rd or 4th lumbar epidural puncture was done, and were injected 1 mg of morphine (Group I) or 10 mg of demerol (Group II) mixed with 10 ml of normal saline into the epidural space, after operation of the cholecystectomy in 10 patients and antrectomy and vagotomy, subtotal or total gastrectomy in 10 patients. Time interval of the postoperative analgesic effect between morphine and demerol groups were compared. The results of this study were as follows: 1. In the group I, average analgesic duration was 29.4 hours. 2. In the group II, average analgesic duration was 4.0 hours. It is concluded that postoperative pain control of upper abdominal surgery through the lumbar epidural narcotic injection was effective, and morphine injection was more effective than demerol.

Effects of Open Chest Surgery on Blood Gas Valnes during Volume Controlled Ventilation Anesthesia / 대한마취과학회지

This study was attempted to observe the possible effects of open chest and the decubitus position on blood gas values during controlled ventilation. We used a volume-type ventilator to maintain regular tidal volume throughout the operation. A total of 51 cases which underwent open chest surgery between 1979 and 1981 in Department of Anesthesiology in Kyungpook National University Hospital were selected. PaO2, PaCO2, pH and MAP were measured at ten minutes after induction (control group), decubitus position (ducubitus group) and chest was opened(open chest group). The PaCO2 value in open chest and decubitus group revealed a tendency of elevation compared with the control group. The PaCO2 value in open chest revealed no remarkable change compared with the control group. The pH in open chest and decubitus group showed a tendency to increase compared with the control group. The MAP showed a tendency to decrease in open chest & decubitus groups and decreased gradually. From the above results, MAP showed a gradual decrease but the increase of pH and PaO2 suggested the inclination of respiratory alkalosis due to hyperventilation during volume controlled ventilation anesthesia.