Delayed peripartum cardiomyopathy after emergency cesarean section / 대한마취과학회지

No abstract available.

Perimortem cesarean section in a pregnant woman with flecainide-induced ventricular tachycardia: A case report

Flecainide is a drug used to manage supraventricular and ventricular arrhythmias. It is also effective in the treatment of fetal tachyarrhythmia through administration to the mother. However, flecainide toxicity may cause serious complications, including cardiac conduction disturbance, ventricular arrhythmia, resulting in syncope and sudden death. We describe here a 27-year-old woman at 31 weeks of gestation who experienced ventricular tachycardia, leading a perimortem cesarean section. On her past medication history, she has taken overdose of oral flecainide for the treatment of fetal atrial flutter. Just after neonatal delivery, her ventricular tachycardia was successfully reverted to a sinus rhythm through administration of intravenous lidocaine and hemodynamics were stabilized. According to her clinical signs and symptoms, we presume the ventricular tachycardia was likely induced by flecainide toxicity, although serum flecainide concentration could not be measured in our institution.

Left Atrial Thrombus Diagnosed by Transesophageal Echocardiography Immediately after Induction in a Patient with Middle Cerebral Artery Infarction: A case report / 대한마취과학회지

Stroke is one of the most common causes of death; in particular, cardiac source of embolism may be responsible for 15-20% of ischemic strokes. Here we report a case of left atrial thrombus diagnosed by transesophageal echocardiography (TEE) immediately after induction of general anesthesia in a patient with infarction of the middle cerebral artery. In this case, an emergent craniectomy was cancelled and medical treatment was performed. This case report shows that TEE taken in the operating room may play an important role in the change of treatment plan in a patient displaying acute mental change.

Fatal Cardiac and Pulmonary Embolisms during Radical Nephrectomy and Inferior Vena Cava Thrombectomy: A case report / 대한마취과학회지

Intraoperative pulmonary embolism can result in severe hemodynamic instability, including cardiac arrest. Therefore, immediate diagnosis and proper treatment are required. We report a case of the acute cardiac and pulmonary embolisms during radical nephrectomy and inferior vena cava (IVC) thrombectomy in a patient with renal cell carcinoma with thrombus in the IVC. We diagnosed the cardiac embolism intraoperatively using the transesophageal echocardiogram, and performed emergent cardiac and pulmonary embolectomies immediately. After the surgery, the patient was discharged without any complication.

Anesthetic Experience of Percutaneous Nephrolithotomy for Renal Calculi in a Patient with Lesch-Nyhan Syndrome: A case report / 대한마취과학회지

Lesch-Nyhan syndrome (LNS) is a rare, X-linked recessive inherited disorder caused by a deficiency of the enzyme hypoxanthine-guanine-phophoribosyltransferase, leading to excessive purine production and elevation of uric acid. Clinical manifestations include mental retardation, spasticity, choreathetosis, compulsive self-mutilation, renal calculi followed by obstructive nephropathy, and arthritis. Patient with LNS may have increased risk of aspiration pneumonia, acute renal failure and unexpected sudden death. We accomplished successful general anesthesia in a case of LNS requiring percutaneous nephrolithotomy due to renal calculi.

Validity of Heart Rate Variability Using Poincare Plot for Assessing Vagal Tone during General Anesthesia / 대한마취과학회지

BACKGROUND: A poincare plot of the heart rate variability (HRV) allows for the quantitative display of the vagal tone in conscious humans. However, relatively little is known about standard deviation 1 (SD1) from the poincare plot reflecting the vagal tone and correlating with the high frequency (HF) spectral power of the HRV during general anesthesia. Thus, the association of SD1 from the poincare plot was examined, along with the HF spectral power of the HRV during general anesthesia. METHODS: Beat-to-beat electrocardiograms were recorded for 5 min in 23 patients (isoflurane group, n = 13; sevoflurane group, n = 10) before, during and after general anesthesia. The low frequency (LF) and HF spectral powers, the LF/HF ratio of the HRV and the SD1 and standard deviation 2 (SD2) from the poincare plot were calculated. RESULTS: Both the HF spectral power of the HRV and SD1 from the poincare plot were reduced following general anesthesia, but recovered thereafter. The recovery of both the HF spectral power and SD1 from the poincare plot in the sevoflurane group was faster than those in the isoflurane group. There were strong correlations between the HF spectral power and SD1 before, during and after anesthesia. CONCLUSIONS: These data suggest that the SD1 from the poincare plot is a useful and valid parameter for analysis of the vagal tone during general anesthesia.

Assessment of Autonomic Response before and after Total Spinal Anesthesia in Rats: Power Spectral Analysis / 대한마취과학회지

BACKGROUND: Total spinal anesthesia (TSA) after injections of local anesthetics into the intrathecal space during epidural anesthesia is not rare. TSA anesthetizes cranial nerves and peripheral nerves, causes specific circulatory disturbances related to autonomic imbalance. Spectral analysis of heart rate variability (HRV) and blood pressure variability (BPV) provide a dynamic assessment of sympathetic and parasympathetic tone. Cross-spectral analysis has been used to emphasize this dynamic baroreflex control of HR as a frequency-dependent phenomenon and allows an assessment of baroreflex function. To examine the effects of TSA on the autonomic nervous system, we used spectral and cross-spectral analytic METHODS. METHODS: We investigated 14 rats before and after TSA. Power spectral densities of blood pressure (BP) and heart rate (HR) were estimated by fast Fourier transform. To evaluate the effect of TSA on baroreflex function, the cross spectral gain, phase, and coherence between beat-to-beat BP and HR signals were calculated by using transfer function analysis. RESULTS: With the onset of TSA, BP and HR significantly decreased. TSA significantly decreased the low frequency (LF) and high frequency (HF) components of HRV and BPV. Baroreflex sensitivity (BRS) obtained from transfer function gain between these variables was significantly decreased. CONCLUSIONS: TSA reduces the LF and HF components of HRV and BPV. These suggest that TSA in rats decreases both parasympathetic and sympathetic drive. Moreover, the decrease in BRS suggests impairment of cardiac baroreflex buffering function during TSA.

The Effect of Rilmenidine Pretreatment on the Cardiovascular Toxicity Caused by Intravenous Bupivacaine by Autonomic Nervous System Analysis in Anesthetized Cats / 대한마취과학회지

BACKGROUND: This study was designed to assess the effects of rilmenidine on the autonomic nervous system, and to evaluate whether it prevents bupivacaine-induced cardiovascular toxicity during intravenous bupivacaine infusion in anesthetized cats. METHODS: Thirty male cats were randomly divided into a control group (n = 15) and a rilmenidine group (n = 15). Following the injection of rilmenidine (10microgram/kg), systolic blood pressures (SBP) and R-R intervals (RRI) were recorded for 5 minutes. Then power spectral analyses of the SBP and RRI, and transfer function analysis were conducted to evaluate the autonomic nervous system. During the infusion of bupivacaine (0.5 mg/kg/min), blood pressures, heart rates, times to reach each events, and bupivacaine doses were measured at the first QRS modification, the first dysrhythmia, at 25% (HR25) and 50% reductions in baseline heart rate, and at 25% and 50% reductions in baseline mean arterial pressure and at final systole. RESULTS: The high frequency (HF) power of heart rate variability (HRV) was significantly elevated in the rilmenidine group versus the control group. Magnitude HF was significantly higher in the rilmenidine group than in the control group. The onset of dysrhythmia correlated significantly with the HFs of HRV and baroreflex sensitivity (BRS). Except for HR25, the rilmenidine group showed significantly higher bupivacaine doses and delayed event onsets versus the control group. CONCLUSIONS: We suggest that pretreatment with rilmenidine delays the onset of dysrhythmia by increasing vagal tone and BRS and by reducing cardiovascular toxicity when bupivacaine is infused continuously to isoflurane anesthetized cats.

Effects of Respiratory Rate on Cardiovascular Variability under General Anesthesia with Mechanical Ventilation / 대한마취과학회지

BACKGROUND: Although heart rate variability (HRV) and blood pressure variability (BPV) arise from many different influences, probably the most consistent external modulator is respiration. At rest, the heart rate increases on inspiration and decreases on expiration, a phenomenon called respiratory sinus arrhythmia (RSA). Spectral analysis of heart rate offers good and reproducible estimate of RSA and BPV. Many studies have been conducted on the effects of respiration on HRV and BPV during awake subject breathing spontaneously. However, little is known as to whether respiratory rate modulates HRV and BPV during general anesthesia with mechanical ventilation. Here, we studied effects of respiratory rate on HRV and BPV during general anesthesia. METHODS: We studied 40 patients undergoing general anesthesia with mechanical ventilation. Maintaining anesthesia with isoflurane, we recorded R-R interval and systolic blood pressure at respiratory rate of 15, 10 and 6 breaths/minute. Data was analyzed by the power spectral analyses of HRV and BPV, which were divided into low frequency (LF) and high frequency (HF) band. RESULTS: Respiratory rate did not affect RR interval, systolic blood pressure, and total spectral power HRV and BPV. Compared with its value at 15 breaths/minute, HF-HRV was significantly increased at 6 breaths/minute. HF-and LF-BPV at 6 breaths/minute were significantly increased versus 15 breaths/minute. CONCLUSIONS: Respiratory rate modulates HRV and BPV during general anesthesia with mechanical ventilation. We suggest that respiratory rate should be considered and controlled in studies of cardiovascular variability during general anesthesia.

Comparison of Sevoflurane with Enflurane Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: Sevoflurane has a low blood-gas partition coefficient, resulting in rapid induction and recovery. We compared the effects of sevoflurane with those of enflurane anesthesia on parturients and neonates during and after elective cesarean section. METHODS: Ninety-six parturients were divided into two groups: E (enflurane, n = 47) and S (sevoflurane, n = 49). After endotracheal intubation with intravenous administration of thiopental 4 mg/kg and succinylcholine 1.5 mg/kg, anesthesia was maintained with 50% nitrous oxide in oxygen and enflurane 1 vol% or sevoflurane 1 vol%. Maternal hemodynamic parameters, blood loss, and recovery were monitored. Neonatal outcome was evaluated by Apgar scores, umblical artery blood gas analysis and acid-base status. RESULTS: Recovery times were faster with sevoflurane anesthesia (P < 0.05). All patients in two groups developed transient hypertension and tachycardia after intubation, which returned to baseline in approximately 5 minutes. Maternal blood loss did not differ significantly between the two groups, and one patient in S group developed postoperative recall. Neonatal outcome was equally good in the two groups. CONCLUSIONS: Parturients anesthetized with sevoflurane for cesarean section recovered more rapidly compared with enflurane without any differences in hemodynamic parameters and neonatal outcome.

Clinical Evaluation of Total Intravenous Anesthesia Using a 3-in-1 Mixture of Propofol, Alfentanil and Atracurium / 대한마취과학회지

BACKGROUND: The use of 3 syringe pumps for one patient has disadvantages. To avoid errors and confusion associated with 3 separate infusions, we conducted a feasibility study of total intravenous anesthesia (TIVA) using a 1 syringe pump to deliver a 3-in-1 mixture containing fixed proportions of propofol, alfentanil and atracurium. METHODS: The 3-in-1 mixture was obtained by mixing 400 mg propofol, 2.5 mg alfentanil, 40 mg atracurium, and totally 80 ml with a 5% dextrose solution. Light microscopy was used to compare emulsion instability of the 3-in-1 with a control mixture. In 40 ASA physical status 1 patients, bolus infusions of 0.5 ml/kg of the 3-in-1 mixture were given for induction of anesthesia. All patients were subsequently intubated and ventilated with an oxygen. Immediately after induction, the maintenance infusion rate was initially set at 2 ml/kg/hr for the first 5 to 10 minutes followed by 1 ml/kg/hr. If inadequate anesthetic depth or muscle relaxation was suspected clinically, a 5 ml bolus of the 3-in-1 mixture (rescue solution) was administered followed by a 10% stepwise increase in the infusion rate. Ten to fifteen minutes before the expected time of completion of surgery, the infusion rate of the 3-in-1 mixture was reduced to 0.5 ml/kg/hr and was stopped at the end of surgery. RESULTS: The 3-in-1 mixtures remained stable for up to 5 hours after preparation. Induction and maintenance of anesthesia were smooth, intubation conditions satisfactory, and intraoperative hemodynamic changes acceptable. Recovery from anesthesia and neuromuscular blockade was rapid. There were no major intra- or immediate postoperative complications. CONCLUSIONS: It may be feasible to provide TIVA using the 3-in-1 mixture for induction and maintenance of anesthesia.

Expression of Chromogranin A, Cathepsin D, Cyclin D1 and p53 proteins in Colorectal Adenocarcinoma

BACKGROUND: The purpose of this study is to assess the roles of chromogranin A, cathepsin D, cyclin D1 and p53 protein expression in colorectal tumorigenesis. METHODS: 83 colorectal cancer and 12 villotubular adenoma tissue specimens were investigated by immunohistochemical staining for chromogranin A, cathepsin D, cyclin D1 and p53 protein. Clinicopathologic values (tumor size, histologic grade, Astler-Coller stage and lymph node metastasis) were compared with the incidence of chromogranin A, cathepsin D, cyclin D1 and p53 protein expression in colorectal adenocarcinomas. RESULTS: Statistically significant correlation was noted between the expression of chromogranin A and histologic grade (p<0.05). The incidence of positive cathepsin D expression was increased with tumor size (p<0.05), and there was a statistically significant correlation between histologic grade and cathepsin D expression (p<0.005). There were no statistically significant correlations among cyclin D1 expression and tumor size, histologic grade, stage and lymph node metastasis. Patients with lymph node metastasis had a high incidence of positive p53 protein expression compared to those without this finding (p<0.001). CONCLUSION: It is suggested that chromogranin A, cathepsin D, and p53 protein are useful variables for the prognostic assessment of colorectal adenocarcinoma. The p53 protein seems to involve the metastatic ability of colorectal adenocarcinomas. Also, the expression of cathepsin D, cyclin D1, and p53 protein may play an important role in the tumorigenesis and progression of the colorectal adenoma-carcinoma sequence.

Patterns of Nerve Conduction Blockade by Different Combinations of Lidocaine-bupivacaine Mixture / 대한마취과학회지

BACKGROUND: A mixture of local anesthetics such as lidocaine and bupivacaine has frequently been used in clinical practice. The rationale behind this is to take advantage of lidocaine's rapid onset and bupivacaine's perpetuation in anesthesia. The purpose of this study was to examine the changes in the onset and recovery of nerve blocking action exerted by the different combinations of these two in the mixture. METHODS: Isolated sciatic nerve preparations obtained from adult male Sprague-Dawley rats were used in this study. Recordings of A-fiber compound action potentials (A-CAPs) were made at the end of the isolated nerve while single pulse stimuli (0.5 msec, supramaximal intensity, 2 Hz) were applied to the opposite end of the nerve. Seven different composition of lidocaine-bupivacaine mixtures were prepared (0 : 6, 1 : 5, 2 : 4, 3 : 3, 4 : 2, 5 : 1, 6 : 0 vol./vol.), where basal concentrations of lidocaine and bupivacaine were 0.2% and 0.05%, respectively. Amplitudes of A-CAPs were measured before, during and after perfusion of mixture solution. The time needed for A-CAPs amplitude to decrease to 10% of the basal value after starting perfusion (onset time) and that needed to reach to 50% of the basal value after ceasing the perfusion (recovery time) were measured. RESULTS: With increasing concentration ratios of lidocaine to bupivacaine in the mixture as mentioned above, the following onset and recovery times were obtained (6.0 +/- 0.3, 5.6 +/- 0.3, 6.0 +/- 0.5, 8.3 +/- 0.5, 7.3 +/- 0.6, 7.8 +/- 0.3, and 10.8 +/- 0.8, minutes; 38 +/- 4, 63 +/- 12, 87 +/- 19, 100 +/- 13, 104 +/- 18, 137 +/- 27, and 157 +/- 18 minutes, respectively). CONCLUSION: Onset times were, in general, exponentially decreased with the increase in the lidocaine concentration. However, recovery times were lineary increased with the increase in the bupivacaine concentration. So, it should be kept in mind that rapid onset can only be obtained with the expense of substantial reduction in the duration of local anesthetic effect of the mixture, and vice versa.

Epidural Anesthesia for Cesarean Section in a Parturient with Eisenmenger's Syndrome / 대한마취과학회지

Eisenmenger's syndrome is defined as pulmonary hypertension with right-to-left or bidirectional shunting of blood through an intracardiac or aorto-pulmonary commumication. It can occur with complex congenital cardiac malformations, such as septal defect and patent ductus arteriosus. Parturients with Eisenmenger's syndrome are at high risk for peripartum morbidity and mortality. We experienced a case of parturient for cesarean section with Eisenmenger's syndrome and performed epidural anesthesia with fractionated doses of 2% lidocaine and fentanyl. The sensory block reached to T10 level and blood pressure was maintained with intravenous phenylephrine. After baby out, sudden hypotension with severe bradycardia developed and arterial oxygen saturation dropped. Immediate intubation and resuscitation was done, but cardiac rhythm disturbance, hypoxemia, and acidosis did not corrected. Cardiac standstill developed and stopped resuscitation. The neonate's Apgar score was 7 and he was transferred to pediatric ICU.

The Effect of Clonidine Administered with Bupivacaine in Brachial Plexus Block / 대한마취과학회지

BACKGROUND: Clonidine, a alpha2-receptor agonist, has sedative and decrease the MAC of anesthetics. Clonidine also has analgesic properties following intrathecal administration. This study evaluates the effects of clonidine on the onset time and duration of analgesia when added to bupivacaine for brachial plexus block. METHODS: Forty patients of ASA physical ststus 1 and 2I who scheduled for elective upper limb surgery were divided into two groups in randomized, double-bline fashion. The brachial plexus block was performed with 30 ml of 0.33% bupivacaine plus saline(1ml; n=20)or clonidine(150ug, 1ml; n=20). The following variables were recorded; onset time, duration of analgesia, sedation, heart rate and blood pressure. RESULTS: The onset time produced with the addition of clonidine was faster(15.6+/-5 vs 19+/-4 min). The duration of block, heart rate and blood pressure were not different between the groups. There were more sedation in the clonidine group. CONCLUSIONS: From the above results, adding clonidine to bupivacaine is an attractive adjuvants for brachial plexus block.

The Effects of Fentanyl and Isoflurane on the Cerebrovascular CO2 Reactivity / 대한마취과학회지

The changes of arterial carbon dioxide partial pressure considerably influence cerebral blood flow and different anesthetic agents have different effects on cerebrovascular physiology. However the importance of these differences in neuroanesthetic practice are unclear. Transcranial Doppler ultrasonography allows the noninvasive direct measurements of cerebral blood flow velocity and direction in the basal brain arteries. The authors performed transcranial Doppler ultrasonography to measure the blood flow velocity of middle cerebral artery in 12 patients who were anesthetized with 10 mcg/kg of fentanyl and 66 % nitrous oxide in oxygen(fentanyl group) and 12 patients with 1.0 vo1% isoflurane and 66 % nitrous oxide in oxygen(isoflurane group) during normocapnia(P(ET)CO(2)=38 mmHg) and hypocapnia(P(ET)CO(2)=28 mmHg)state. The carbon dioxide reactivity was expressed as the changes in mean blood flow velocity per unit changes in endtidal carbon dioxide partial pressure(P(ET)CO(2)). Mean blood flow velocity of middle cerebral artery decreased from 46.6+/-8.9 cm/s to 30.0+/-5.3 cm/s in the fentanyl group and 42.7+/-5.6 cm/s to 32.5+/-4.6 cm/s in the isoflurane group as the P(ET)CO(2) decreased from 38 mmHg to 28 mmHg. There was a significant difference between the CO2 reactivity of fentanyl group(1.7+/-0.7 cm/s/mmHg) and isoflurane group(1,0+/-0,2 cm/s/mmHg) (p<0.05). It is concluded that hyperventilation is more likely to affect cerebral blood flow during fentanyl-nitrous oxide anesthesia than during isoflurane-nitrous oxide anesthesia.

Comparison of the Analgesic Duration of Clonidine and Epinephrine Mixture with Tetracaine on Saddle Block / 대한마취과학회지

Clonidine, a2 adrenergic agonist, has a vasoconstrictive property like epinephrine when injected into the subarachoid space. Thus duration of anesthesia would be prolonged in regional block. Besides this effects clonidine also produces direct analgesic effect at spinal cord level and potentiates the effect of local anesthetics injected into intrathecal space. In this study saddle blocks were induced in sitting position by the intrathecal injection of tetracaine for the perianal procedures. 45 patients were classified randomly into three groups. In group I (control) 0.5% tetracaine 4 mg (0.8 ml) and normal saline 0.2 ml was injected intrathecally at L4-5 interspace. In group II (epinephrine) epinephrine 0.2 mg (0.2 ml) was added to 0.5% tetracaine 4 mg and in group III (clonidine) clonidine 30 ug (0.2 ml) was added to tetracaine 4 mg. After intrathecal injections, sensory block level and motor impairment was checked at 5 min and 50 min, The duration of analgesia was defined by the patients who complain the postoperative pain at the incision site. The results in each group were as follows. Sensory block level was Sl (control), L51 (epinephrine) and L5+/-1 (clonidine) at 50 min after injections. The duration of analgesia was significantly prolonged in epinephrine group (369.6+/-64.1 min) and clonidine group (297.9+/-33.8 min) compared with control group (194.3+/-18.2 min). The number of patients with motor block was 12 in epinephrine group, 4 in clonidine group and 1 in control group. In conclusion, tetracaine plus clonidine 30 ug to prolong the duration of analgesia is considered as adequate and safe dosage without significant adverse effects in saddle block.

Supraclavicular Brachial Plexus Block Guided by Chest PA Film / 대한마취과학회지

The brachial plexus block is a valuable method of providing anesthesia for the surgery of forearm and hand. Common technique for brachial plexus block include axillary, supraclaviculer, and interscalene approaches. The supraclavicular brachial plexus block offers adventages, ie, high success rate, rapid onset of action and relatively complete block over axillary and interscalene approach, but may be associated with pneumothorax. We marked the P point which was placed on the upper margin of clavicle that crossed the first rib on the chest PA film and marked on the skin of the patient and inserted 23G scalp needle at that point to the first rib. We performed this modified technique of supraclavicular brachial plexus block using chest PA film in 20 patients and there was no incidence of pneumothorax after this block but general anesthesia was sdministered in one case because of incomplete block. We recommend that this modified technique guided by chest PA film for supraclavicular block is simple, reliable and may reduce the incidence of pneumothorax and to increase the success rate in difficult case such as patient with extremely obesity.

Comparison of Right Atrium to Pulmonary Artery Oxygen Saturation During Hemorrhagic Shock , Resuscitation , and Hypoxia in Anesthetized Cats / 대한마취과학회지

Because central venous O2 saturation (superior vena cava, ScvO2) can be monitored with less risk of the patients than mixed venous O2 saturation (pulmonary artery, SvO2), there have been studies to see if ScvO2 could replace SvO2. But previous studies showed that these two measurements were correlated but "not interchangeable. Therefore the authors compared right atrial C#b saturation (SraO2) with S vO2 over a wide range of cardiorespiratory status including control, hemorrhage, resuscitation, and hypoxia in anesthetized cats. We performed thoracotomy and inserted cannulae directly into the right atrium and the pulmonary artery. Blood sampling were obtained synchronously through the cannulae and tested immediately. The correlation coefficients in control, hemorrhage, resuscitation, and hypoxia groups were 0.876, 0.794, 0.946, 0.948 respectively and the two measurements in each group showed statistically significant correlations (p<0.05). But the biases of the two measurements in each group were 0.11+/-2.9, 0.35+/-4.2, -0.55+/-3.2, 0.23+/-4.2 respectively and the limits of agreement ( 2 standard deviation) in all groups exceeded permissible (5%) to conclude that the two measurements were in agreement. Thus, we reached the conclusion that the absolute values of SraO2, though not being sufficiently identical to S vO2 to calculate O2 uptake or pulmonary shunt precisely, can reflect the S vO2 trend following the O2 supply / demand change. Further clinical studies are needed.

Effects of 10 % Pentastarch on Hypervolemia and Hemodilution following clipping of cerebral aneurysm / 대한마취과학회지

Cerebral vasospasm following aneurysmal subarachnoid hemorrhage is one of the most important causes of cerebral ischemia. Hypervolemic hypertension and hemodilution have been reported to be an effective method for prevention and treatment for cerebral ischemia secondary to cerebral vasospasm.We compared the volume expanding effects between normal saline(20 cases), 10% pentastarch(20 cases) and dextran(20 cases) after clipping of cerebral aneurysm in the patients with subarachnoid hemorrhage and the incidence of vasospasm by transcranial doppler(TCD) postoperatively. The results were as follows ;1) The total amount of infused volume in pentastarch and dextran group were 310+/-46ml, 438 +/-262ml respectively,and were significantly smaller than normal saline group, 1078+/-187ml.(p<0.05) 2) Plasma osmolality was increased by 10 mOsm/kg in pentastarch group, but statistically insignificant. 3) Hematocrit value was decreased significantly in pentastarch and dextran group from 34.9+/-1.03%, 34.8+/-1,4% to 31.6+/-1.38%, 31.9+/-0.9% respectively.(p<0.05) 4) Cases over 80cm/sec by TCD were 3 in normal saline, 2 in pentastarch, and 2 in dextran group. We conclude that 10% pentastareh could be used as an effective blood volume expander after cerebral aneurysm clipping.