Effect of ferrule on the fracture resistance of mandibular premolars with prefabricated posts and cores

PURPOSE: This study evaluated fracture resistance with regard to ferrule lengths and post reinforcement on endodontically treated mandibular premolars incorporating a prefabricated post and resin core. MATERIALS AND METHODS: One hundred extracted mandibular premolars were randomly divided into 5 groups (n=20): intact teeth (NR); endodontically treated teeth (ETT) without post (NP); ETT restored with a prefabricated post with ferrule lengths of either 0 mm (F0), 1 mm (F1), or 2 mm (F2). Prepared teeth were restored with metal crowns. A thermal cycling test was performed for 1,000 cycles. Loading was applied at an angle of 135 degrees to the axis of the tooth using a universal testing machine with a crosshead speed of 2.54 mm/min. Fracture loads were analyzed by one-way ANOVA and Tukey HSD test using a statistical program (α=.05). RESULTS: There were statistical differences in fracture loads among groups (P<.001). The fracture load of F2 (237.7 ± 83.4) was significantly higher than those of NP (155.6 ± 74.3 N), F0 (98.8 ± 43.3 N), and F1 (152.8 ± 78.5 N) (P=.011, P<.001, and P=.008, respectively). CONCLUSION: Fracture resistance of ETT depends on the length of the ferrule, as shown by the significantly increased fracture resistance in the 2 mm ferrule group (F2) compared to the groups with shorter ferrule lengths (F0, F1) and without post (NP).

Evaluation of titanium surface properties by Nd: YVO4 laser irradiation: pilot study / 대한치과보철학회지

PURPOSE: This study was conducted to evaluate the roughness and surface alternations of three differently blasted titanium discs treated by Nd: YVO4 Laser irradiation in different conditions. MATERIALS AND METHODS: Thirty commercially pure titanium discs were prepared and divided into three groups. Each group was consisted of 10 samples and blasted by ZrO2 (zirconium dioxide), Al2O3 (aluminum oxide), and RBM (resorbable blasted media). All the samples were degreased by ultrasonic cleaner afterward. Nine different conditions were established by changing scanning speed (100, 300, 500 mm/s) and repetition rate (5, 15, 35 kHz) of Nd: YVO4 Laser (Laser Pro D-20, Laserval Korea(R) Seoul, South Korea). After laser irradiation, a scanning electron microscope, X-ray diffraction analysis, energy dispersive X-ray spectroscopic analysis, and surface roughness analysis were used to assess the roughness and surface alternations of the samples. RESULTS: According to a scanning electron microscope (SEM), titanium discs treated with laser irradiation showed characteristic patterns in contrast to the control which showed irregular patterns. According to the X-ray diffraction analysis, only Al2O3 group showed its own peak. The oxidation tendency and surface roughness of titanium were similar to the control in the energy dispersive X-ray spectroscopic analysis. The surface roughness was inversely proportional to the scanning speed, whereas proportional to the repetition rate of Nd: YVO4. CONCLUSION: The surface microstructures and roughness of the test discs were modified by the radiation of Nd: YVO4 laser. Therefore, laser irradiation could be considered one of the methods to modify implant surfaces for the enhancement of osseointegration.

Full mouth rehabilitation for a disabled patient: a case report / 대한치과보철학회지

The spectrum of physically challenged patients who visit to a dental clinic for treatments are diverse: from ones of mild disabilities, who lead their lives in a similar way of ordinary people, to others who suffer from diseases that are difficult to be diagnosed, and need medical expertise due to systemic care or special techniques and instruments because of behavior management and difficulty of treatments. The patient in this case was 25-year-old autistic male patient who visited the clinic on account of overall treatment for multiple carious lesions. He could perform normal daily life to some degree under the care of a guardian. This case report describes predicaments of making a treatment plan resulted from lack of information about disabled patients, and difficulties of proceeding treatment procedures under general anesthesia. It is considered that sufficient consultation and history taking are needed before treatment for disabled patients.

Incidence of intravascular insertion in thoracic epidural catheterization by using real time fluoroscopy / 대한마취과학회지

BACKGROUND: Epidural analgesia is commonly used to provide several types of pain relief. Although this technique has been widely used with many advantages, currently the complications appear to be increasing. Especially, inadvertent intravascular cannulation and intravascular local anesthetic administration can lead to fatal consequences. METHODS: Data was collected on 296 patients undergoing elective thoracic or abdominal surgery. Two detection methods were utilized to confirm the epidural intravascular cannulation; flashback and aspiration of indwelling catheter, and injection of a contrast agent through the catheter under fluoroscopy were used to guide the placement of the catheter and to examine the intravascular cannulation. RESULTS: Epidural intravascular cannulation was reported in 4 out of 296 cases (1.4%), and 1 patient underwent subdural cannulation. Among the 4 cases of epidural intravascular cannulation, two were confirmed by the flashback and aspiration methods, while the remaining cases were only detected by real time fluoroscopy. CONCLUSIONS: In this study, inadvertent epidural intravascular cannulation occurred by as much as 1.4% of thoracic epidural catheterization. Utilizing real time fluoroscopy in addition to flashback and aspiration can enhance the sensitivity of detection.

Is the rapid sequence induction possible with 0.6 mg/kg rocuronium in pediatric patient? / 대한마취과학회지

BACKGROUND: We have investigated the possibility of rocuronium 0.6 mg/kg and timing principle application with the same dose for rapid sequence induction (RSI) in 65 children, aged 4-8 yr. METHODS: Sixty five patients were randomly assigned to one of two groups; Group A (n = 31, timing principle application) received rocuronium (0.6 mg/kg) followed by administration of propofol (2.5 mg/kg), and group B (n = 36) received rocuronium (0.6 mg/kg) after administration of propofol. Intubation was assessed at 60 seconds just after administration of last injectants. Intubating conditions (jaw relaxation, vocal cord movement, and response to tracheal intubation) were evaluated as excellent, good, fair and poor. RESULTS: Excellent intubation conditions were obtained in 87% in group A and 61% in group B. However, clinically acceptable intubation conditions which means excellent and good did not show any significant difference as 100% (group A) and 99% (group B). CONCLUSIONS: In cases of pediatiric patients undergoing elective surgery, RSI was possible irrespective of the use of timing principle.

The Effects of Lumbar Sympathetic Ganglion Block in the Patients with Spinal Stenosis and the Skin Temperature Changes according to the Contrast Spread Patterns

BACKGROUND: We hypothesized that if a fluoroscopic image of the lumbar sympathetic ganglion block (LSGB) showed the spread patterns of contrast at both the L2/3 and L4/5 disc areas, then this would demonstrate a more profound blockade effect because the spread patterns are close to sympathetic ganglia. In addition, we compared the effects of LSGB and transforaminal epidural steroid injection (TFESI) for the patients suffering with spinal stenosis. METHODS: Eighty patients were divided into two groups (Group S: the patients treated with TFESI, Group L: the patients treated with LSGB). The patients of group L were classified into three groups (groups A, B and, C) according to their contrast spread pattern. The preblock and postblock temperature difference between the ipsilateral and contralateral great toe (DT(pre), DT(post), degrees C), and the DTnet were calculated as follows. DT(net) = DT(post) - DT(pre). RESULTS: Both group showed a significant reduction of the visual analogue score (VAS) and the Oswestry disability index (ODI) score. Only the patients of group L showed a significant increase of their walking distance (WD). Group A showed the most significant changes in the DT(post) (6.1 +/- 1.2degrees C, P = 0.021), and the DTnet (6.0 +/- 1.0degrees C, p = 0.023), as compared to group C. CONCLUSIONS: LSGB showed a similar effect on the VAS, and ODI, and a significant effect, on WD, compared with TFESI. Group A showed a significant sympatholytic effect, as compared to group C.

Effect of A Kappa-opioid Receptor Agonist U50488H Given at Early Reperfusion Phase in Isolated Rat Hearts / 대한마취과학회지

BACKGROUND: The experiment was performed to determine the role of kappa-opioid receptor (OR) agonist U50488H given at early reperfusion. METHODS: Isolated hearts were subjected to 30 minutes of regional ischemia and 120 minutes of reperfusion.Hearts were assigned randomly to one of the three groups:1) Control (n = 9), 2) U50-1 (n = 8); 10micrometer of U50488H, and 3) U50-10 (n = 8); 10micrometer of U50488H.U50488 was perfused for a period of 5 min before and 30 min after reperfusion. RESULTS: U50488H significantly reduced infarct size as a percentage of ischemic area (12.2 +/- 1.9% in U50-1 and 7.2 +/- 1.7% in U50-10, P < 0.001) compared to the control hearts (27.2 +/- 1.2%). After 2 hrs of reperfusion, left ventricular developed pressure was significantly recovered by U50488H (62.6 +/- 5.7% in U50-1 and 68.6 +/- 4.7% in U50-10, P = 0.018 and 0.002, respectively) compared to the control (46.3 +/- 4.4%).Rate-pressure product was improved by 100micrometer U50488H (62.3 +/- 5.5%, P = 0.007) but not by 1micrometer U50488H (50.0 +/- 4.1%) compared to the control (44.7 +/- 4.5%).U50488H significantly increased the + dP/dt(max) (77.9 +/- 5.5% in U50-1 and 78.0 +/- 4.3 in U50-10, P = 0.005 and 0.001 vs. control, respectively).The -dP/dt(min) also improved by 10micrometer U50488H (64.7 +/- 4.8%, P = 0.003) compared to control (47.0 +/- 2.7%). CONCLUSIONS: U50488H given at early reperfusion phase reduces both infarct size and myocardial stunning in isolated rat hearts.

Ischemic Postconditioning Inhibits Mitochondrial Permeability Transition Pore via Opioid Receptor Activation in Intact Rat Heart / 대한마취과학회지

BACKGROUND: Ischemic postconditioning (Post-C), brief cycles of myocardial ischemia and reperfusion during the early phase of reperfusion, is considered as a novel adjunct strategy to protect myocardium.However, the exact mechanism remains unclear and should be determined. METHODS: The hearts of male Wistar rats were subjected to 30 min ischemia and 2 hrs reperfusion.Control rats had no intervention either before or after left coronary artery occlusion.Post-C was elicited by 6 cycles of 10s reperfusioninterspersed by 10s ischemia immediately after onset of reperfusion.Subsets of postconditioning rats were treated with drugs as followings; naloxone (non-selective opioid receptor antagonist), naltrindole (a delta-opioid receptor antagonist), SB216763 (a glycogen synthase kinase 3beta inhibitor, GSK-3beta inhibitor), or atractyloside (a mitochondrial permeability transition pore opener, mPTP opener). RESULTS: Post-C significantly reduced infarct size (15.9 +/- 2.4%, P = 0.003) compared to control (29.9 +/- 3.7%).The anti-infarct effect by Post-C was blocked by both naloxone (25.5 +/- 3.9%, P = 0.044) and naltrindole (26.9 +/- 2.3%, P = 0.022).Infarct size limiting effect by Post-C was also abolished by atractyloside (30.6 +/- 3.6%, P = 0.003).In SB216763 with naloxone treated animals, the infarct size was decreased (17.4 +/- 3.2%, P = 0.007) but not in SB216763 with atractyloside treated animals (27.4 +/- 2.6%) compared to control. CONCLUSIONS: These data suggest that Post-C may protect myocardium by inhibiting mPTP opening via delta-opioid receptor activation.GSK-3beta is a downstream mediator of opioid receptors and an upstream mediator of mPTP opening in Post-C.

Factors associated with the outcome of transforaminal epidural steroid injections / 대한마취과학회지

BACKGROUND: This study was undertaken to assaythe effectiveness of transforaminal epidural steroid injections (TFESIs) for sciatica and to identify potential predictors related to treatment outcome. METHODS: TFESIs were performed in 150 patients between August 2006 and March 2007. Seventy-five patients (35 women, 40 men; mean age, 59.1 years), who met the inclusion criteria, were studied. Therapeutic effects were evaluated twoweeks after injection. The following potential outcome predictors analyzed were as follows: one level vs. two level injection, Beck depression inventory score (20), Beck anxiety inventory score (16), cause of radiculopathy (spinal stenosis vs. herniated disk), gender, duration of radiculopathy (6 months), and Oswestry disability index score (60). The relationships between possible outcome predictors and therapeutic effects were evaluated. RESULTS: Forty-nine of the 75 patients (65.3%) had a satisfactory result two weeks after TFESIs. Of these, twenty-four of the 46 patients (52.2%) were treated by a one level injection and 25 (89.3%) of the 29 patients were treated by a two level injection. This outcome was statistically significant (P < 0.01). None of the other potential outcome predictors showed any statistical difference. CONCLUSIONS: TFESI is recommended as an effective method of managing radiculopathy. Two-level injectionsmay result in a better outcome than a one-level injection.

Beck Depression Inventory Score and Associated Factors in Korean Patients with Lumbar Spinal Stenosis / 대한통증학회지

BACKGROUND: Depression is a frequent comorbid disease of chronic pain patients. This study was conducted to evaluate the prevalence of depression and to correlate associated factors and depression in patients with lumbar spinal stenosis. METHODS: The data of this survey was collected from 97 patients that visited our pain clinic for the management of lumbar spinal stenosis. Depression was examined by a self-reported survey using the Korean version of the Beck Depression Inventory (BDI). The Oswestry Disability Index (ODI) and the life satisfaction scale score were also obtained. Demographic and clinical characteristics (including spouse status, employment status, smoking status, the number of patients with multiple painful areas, the number of patients with combined disease, pain duration, visual analogue scale, Roland 5-point scale and walking distance) were obtained from an interview with the patient. The patients were divided into group N (BDI 14, n = 54) according to the BDI scale. Of the 97 patients, 55.7% had a high BDI score. RESULTS: The patients in group N had a higher rate of employment (48.0%, P < 0.05) and had higher life satisfaction scale scores (9.4 +/- 2.5, P < 0.01) as compared to group D patients. The BDI score showed a close correlation with employment status and the life satisfaction scale. CONCLUSIONS: Many lumbar spinal stenosis patients had high BDI scores. Employment status and the life satisfaction scale were closely correlated with the BDI score.

The Effects of Lidocaine, Fentanyl, Nicardipine, and Esmolol on Hemodynamic and Bispectral Index Responses during Induction with Thiopental Sodium / 대한마취과학회지

BACKGROUND: The laryngoscopy and tracheal intubation may accompany with undesirable side effects such as hypertension, tachycardia, arrhythmia, and awareness. The aim of this study was to investigate whether the correlation between the hemodynamics and bispectral index (BIS) changes after tracheal intubation following the administration of various adjuvants to attenuate tracheal response exists or not. METHODS: The patients were randomly assigned to one of five groups (control, lidocaine, fentanyl, nicardipine, or esmolol) and the drugs were administered at preselected time before tracheal intubation. The heart rate (HR), blood pressure, rate-pressure product (RPP), BIS and the episode of BIS more than 65 (BIS > or = 65) were measured. RESULTS: There were significant differences in the mean arterial pressure and RPP between control group and other groups. The HR was the most attenuated in esmolol group. The HR and RPP was the most increased in nicardipine group except control group. There was no significant difference in the maximal BIS among the five groups. The BIS > or = 65 were 50% in control group and 0.3% in nicardipine group. CONCLUSIONS: All the adjuvant drugs in the study attenuated with a various degree of the tracheal responses. However, there was no correlation between the changes of hemodynamics and BIS after the administration of various adjuvants following tracheal intubation.

The Effect of Fenoldopam Administration Followed by Unclamping of Supraceliac Aortic Cross-Clamping on Renal Ischemic Injury / 대한마취과학회지

BACKGROUND: The overall rate of renal complication after surgery on the suprarenal aorta remains high. In this study, the changes in renal blood flow (RBF), urinary oxygen tension (PuO2), renal vascular resistance (RVR), and urinary volume following fenoldopam administration were investigated in supraceliac aortic cross-clamping and unclamping animal model. METHODS: Twelve dogs were divided into two groups; control group (n = 6), fenodopam group (n = 6). After brachial, femoral, and pulmonary arterial catheterization, midline abdominal incision was made. For the aortic cross-clamping the supraceliac aorta was exposed. A doppler flowmeter probe was placed around right renal artery. A ureteral catheter was positioned at the right renal pelvis to measure urine volume and urinary oxygen tension (PuO2). In fenoldopam group, 0.5microgram/kg/min of fenoldopam was administered immediately before suprarenal aortic reperfusion. Systemic hemodynamics, renal blood flow, renal vascular resistance, PuO2, and urine volume were compared between two groups. RESULTS: The systemic hemodynamics were not significantly different between the two groups throughout the experiment. After aortic reperfusion, the RVR significantly increased in control group, but the RVR in fenoldopam group remained to baseline level. The urine output, RBF, and PuO2 significantly increased in fenoldopam group compared to control group. BUN and serum creatinine were not different between the two groups. CONCLUSIONS: High dose of fenoldopam administration reverse ischemic renal insufficiency after supraceliac aortic cross clamping.

Optimal Dose of Remifentanil to Attenuate Cardiovascular Responses to Laryngoscopic Double-lumen Endobronchial Intubation / 대한마취과학회지

BACKGROUND: The purpose of the present study was to determine the optimal dose of bolus remifentanil to attenuate hemodynamic changes to laryngoscopic double-lumen endobronchial intubation. METHODS: A total of 80 ASA I or II patients requiring double-lumen endobronchial intubation were randomly assigned to receive normal saline (NS) or one of the three different doses (0.5microgram/kg (group R0.5), 1.0microgram/kg (group R1.0) or 2.0microgram/kg (group R2.0)) of remifentanil. Study drugs for each group were administered over 30 seconds after induction of anesthesia with thiopental sodium and rocuronium. Laryngoscopic endobronchial intubation was carried out 90 seconds after the administration of study drug. Arterial blood pressure and heart rate were recorded at preanesthetic baseline, preintubation, postintubation, and every one minute during the initial 5 minute period after intubation. RESULTS: Mean arterial pressure at postintubation period increased significantly compared to baseline value in group NS, R0.5, and R1.0, but there were no significant changes in group R2.0. Heart rate showed significant increase in comparison to baseline value at every postintubation period in group NS, R0.5, R1.0, with no significant changes in group R2.0. CONCLUSIONS: We suggest that 2.0microgram/kg of remifentanil attenuate the hemodynamic changes to double-lumen endobronchial intubation without adverse effect.

Supraventricular Tachycardia Developed by the Concealed Bypass Tract in a Parturient: A case report / 대한마취과학회지

Specific mechanisms of supraventricular tachycardia include sinoatrial, intraatrial, atrioventricular nodal as well as manifest and concealed bypass tract. The concealed bypass tract is an anoamalous atriventricular conduction via an accessory pathway and the conduction pathway is always retrograde direction. A 29-year-old woman with a history of palpitation arrived at the operating room for her emergency cesarean section at 39 weeks' gestation. The heart rate was about 200 beats/min, and the blood pressure was 90/40 mmHg. After injection of beta blocker, the heart rate transiently decreased and we tried the epidural anesthesia for her delivery but the tachycardia sustained throughout the operation. The patient's tachycardia was recovered at the postanesthetic care unit spontaneously.

Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension for Elective Cesarean Delivery / 대한마취과학회지

BACKGROUND: Epidural volume extension (EVE) via a combined spinal-epidural (CSE) technique involved the enhancement of a small-dose intrathecal block using epidural saline boluses. We compared the EVE technique and single-shot spinal anesthesia with respect to sensory and motor block profiles and hemodynamic stabilities. METHODS: Seventy parturients undergoing elective cesarean deliveries were administered either spinal anesthesia with hyperbaric 0.5% bupivacine 10 mg plus fentanyl 15microgram or CSE anesthesia (comprising intrathecal hyperbaric 0.5% bupivacine 7 mg with fentanyl 15microgram followed by 0.9% saline (5.0 ml)) through a Tuohy needle. In each group, the lowest systolic blood pressure, sensory block level and peak sensory block height to loss of cold sensation to ice were recorded at 1 min intervals. Modified Bromage motor scores and time for sensory regression to the tenth thoracic dermatome (T10) were compared between groups in the PACU. RESULTS: Patients in the CSEA group demonstrated significantly faster motor recovery to modified Bromage 0 (82.2 +/-18.7 min versus 121.1 +/- 15.2 min respectively, P <0.05). CONCLUSION: Our study shows that CSE with EVE provides adequate anesthesia for elective cesarean delivery at only 70% of the bupivacine dose and allows a more rapid motor recovery of the lower limbs, which may have a beneficial impact on PACU stay.

Spinal Anesthesia Using 0.5% Hyperbaric Bupivacaine/Meperidine Mixture for Cesarean Section / 대한마취과학회지

BACKGROUND: Spinal anesthesia for cesarean section is regaining popularity because it can prevent pulmonary aspiration, failure of endotracheal intubation, depression of neonate by anesthetic agent in general anesthesia. Meperidine is unique in having significant local anesthetic properties that differentiate with morphine and fentanyl. Therefore, we compared the effects of adding meperidine 25 mg to intrathecal bupivacaine with fentanyl mixture. METHODS: Sixty parturients were allocated (n = 30 per group) to group 1; 0.5% hyperbaric bupivacaine 7.5 mg plus meperidine 25 mg and group 2; 0.5% hyperbaric bupivacaine 10 mg plus fentanyl 25 microgram in random order. Time to reach T4 sensory level, starting time of surgery, maximal spread of sensory block, incidence of complications, duration of motor block, perioperative analgesic effects, duration of postoperative analgesia were evaluated. We observed Apgar score and umbilical cord blood gas analysis for evaluation of the status of neonate. RESULTS: There were no significant differences in Time to reach T4 sensory level, starting time of surgery, maximal spread of sensory block, incidence of hypotension, perioperative analgesic effects, duration of motor block and neonatal status between two groups. The incidence of intraoperative nausea was greater in group 1 (60%) compared to the group 2 (20%) but the incidence of postoperative nausea and vomiting were not significantly different between two groups. Duration of postoperative analgesia was longer in group 1 (576.4 +/- 197.8 min) compared to the group 2 (192.6 +/- 75.5 min). CONCLUSIONS: Addition of meperidine 25 mg to intrathecal bupivacaine for Cesarean section improves intraoperative analgesia and also provides postoperative analgesia without significant adverse effects on the mother and neonate.

The Renal Effects of Furosemide Administration Followed by Unclamping of Supraceliac Aortic Cross Clamping in Experimental Dogs / 대한마취과학회지

BACKGROUND: The overall rate of renal complications after surgery on the suprarenal aorta remains high. Possible mechanisms are, a reduction and maldistribution of renal blood flow, activation of the renin-angiotensin system, and the release of various mediators. In this study, changes in renal blood flow, local renal perfusion, the oxygen extraction ratio, and in renal function by furosemide following supraceliac aortic cross clamping and unclamping were observed. METHODS: A total of 13 mongrel dogs were divided into two groups; a control group (n = 7), and a furosemide group (n = 6). For aortic cross clamping the supraceliac aorta was exposed and a doppler flowmeter probe was placed on the left renal artery. A thermal diffusion microprobe was also inserted in the renal parenchyme to measure local renal perfusion. Sixty minutes after aortic cross clamping, systemic hemodynamic data, renal blood flow, and local renal perfusion were measured. These parameters were also repeatedly measured at 1, 2, 3, 4, 5, and 6 hours after unclamping. Biomarkers of renal dysfunction and injury (renin activity, creatinine, and Cystatin-C) were measured. RESULTS: No differences were observed between the two groups in terms of renal blood flow, local renal perfusion, and oxygen extraction ratio. Renal blood flow and perfusion did not recover to the baseline level after unclamping in either group. Plasma renin activity significantly reduced in the furosemide group 3 hours after clamping, but serum creatinine, and Cystatin-C concentrations were similar in the tow groups. CONCLUSIONS: We conclude that the administration of furosemide after supraceliac aortic unclamping to improve renal function is not effective in experimental dogs.

Changes in Renal Function by Low Dose Dopamine in Patients Undergoing Hepatectomy with Low Central Venous Pressure Maintenance / 대한마취과학회지

BACKGROUND: The maintenance of low central venous pressure (LCVP) induced by fluid restriction and nitroglycerin administration reduces the overall blood loss during major hepatic resections. We studied the postoperative renal function in hepatectomized patients under LCVP maintenance with nitroglycerin. In addition, the renal effect of low dose dopamine combined with nitroglycerin was evaluated. Methods: A total of 60 patients were randomly divided into two groups: a nitroglycerin group (n = 30), and a nitroglycerin and dopamine group (n = 30). During the Pringle maneuver the central venous pressure (CVP) was maintained at < 5 mmHg in both groups. The nitroglycerin group received 0.5-1microgram/kg/min nitroglycerin before and during the Pringle maneuver, but in nitroglycerin and dopamine group, 3microgram/kg/min dopamine was administered with nitroglycerin. Mean arterial pressure, CVP, and urine output were measured before, during, and after the Pringle maneuver. BUN and serum creatinine were measured on postoperative days 1 and 3. Results: No significant differences were observed between the mean arterial pressures, CVPs, or urine outputs of the two groups. In both groups, urine output reduced after the Pringle maneuver but increased more in the nitroglycerin and dopamine group than in the nitroglycerin control group after anesthesia. There was no overall statistical change in either BUN or creatinine in either group. Conclusions: We conclude that LCVP induced by nitroglycerin with the Pringle maneuver during hepatectomy does not cause postoperative renal dysfunction, and that the use of low dose dopamine with nitroglycerin has no meaning in terms of preventing renal dysfunction in this situation.

The Systemic Hemodynamic and Renal Effects of Nicardipine Administration Followed by Supraceliac Aortic Cross Clamping and Unclamping in Experimental Dogs / 대한마취과학회지

BACKGROUND: The incidence of renal insufficiency is reported about 18-27% during the thoracoabdominal aneurysm surgery. The possible mechanisms are reduction and maldistribution of renal blood flow, activation of renin angiotensin system, release of various mediators. In this study, we observed the effect of nicardipine, one of the calcium channel blockers that commonly used, on the systemic hemodynamics and the renal fuctions. METHODS: A total of 13 mongrel dogs were divided into two groups: control group (C, n = 7), nicardipine administration group (N, n = 6). After brachial arterial and Swan-Ganz catheterization, midline abdominal incision was made. For the aortic cross clamping the supraceilac aorta was exposed and the doppler flowmeter probe was placed on the left renal artery. The thermal diffusion microprobe was inserted in the renal parenchyme to measure local renal perfusion. At sixty minutes after aortic cross clamping, systemic hemodynamic data, renal blood flow and local renal perfusion were measured and at 1, 2, 3, 4, 5 and 6 hours after unclamping the same parameters were measured. RESULTS: There were no differences on renal blood flow, renal perfusion and oxygen extraction ratio between two groups. The renal blood flow and renal perfusion did not recover to the baseline level after unclamping in both groups. The plasma renin activity, serum creatinine concentration and cystatin-c did not show any difference between groups respectively. CONCLUSIONS: We concluded that the administration of nicardipine after supraceliac aortic unclamping to improve the renal function was not effective in experimental dogs.

The Effect of Low Dose Nitroglycerin on Hepatic Blood Flow, Real-time Local Liver Perfusion and Oxygen Extraction Ratio Following the Occlusion and Reperfusion of Hepatic Blood Flow in Experimental Dogs / 대한마취과학회지

BACKGROUND: The Pringle maneuver is traditionally used during the hepatectomy to reduce the blood loss. However, there have been no studies about local liver perfusion (LLP) and oxygen extraction ratio (ERO2) following hepatic ischemia and reperfusion. In this study, the changes in hepatic blood flow (HBF), LLP, ERO2 following hepatic ischemia and reperfusion were observed. And the effects of low dose nitroglycerin (NTG) were observed too. METHODS: A total of 14 mongrel dogs were divided into two groups; control group (C, n = 7), NTG administration group (N, n = 7), NTG administration was started 5 minutes before HBF occlusion. After femoral arterial and central venous catheterization, midline abdominal incision was made. Hepatic artery (HA) and portal vein (PV) were exposed to clamp and declamp. And then doppler flowmeter probes were applied on HA and PV to measure their blood flow and a thermal diffusion microprobe was inserted in the liver parenchyme to measure LLP. RESULTS: The HA and PV blood flow, LLP, and ERO2 were not different between two groups. However, HBF more increased compared to the baseline level in N group after reperfusion. In C group, LLP did not recover after reperfusion. The LLP in N group recovered to the baseline level after reperfusion. CONCLUSIONS: In conclusion, it was observed that the HBF increased and LLP recovered to the baseline level after reperfusion by administration of low dose NTG. The use of low dose NTG is safe and effective for hepatectomy.