Effectiveness of propofol pretreatment on the extent of deranged cerebral mitochondrial oxidative enzyme system after incomplete forebrain ischemia/reperfusion in rats

It has been suggested that propofol has the protective effect on cerebral ischemia-reperfusion injury. The aim of this study is to evaluate the effect of propofol pretreatment on incomplete forebrain ischemia-reperfusion injury in rats. Thirty Sprague-Dawley rats were anesthetized with isoflurane in oxygen and randomly allocated into propofol group (n=13) and saline group (n=17). In propofol group, propofol was pretreated in a step-down scheme before inducing forebrain ischemia by occlusion of both common carotid arteries and arterial hypotension. After ischemia (20 min) and reperfusion (30 min), rats were decapitated. Brain was sliced to obtain coronal slices of 4-12 mm from frontal pole, which were reacted with 2% 2,3,5-triphenyl-2H-tetrazolium chloride (TTC) for 10 min to differentiate the damaged tissues from normal tissues. Median (interquartile range) values of the average percent infarct area were 0.0 (8.6)% and 20.1 (41.2)% in propofol and saline groups, respectively. There was significant difference between the groups. In conclusion, propofol may have a protective effect on incomplete forebrain ischemia-reperfusion injury.

Effects of Diltiazem on Mean Arterial Pressure and Heart Rate during Tracheal Extubation in Hypertensive Patients / 대한마취과학회지

BACKGROUND: Tracheal extubation provokes hypertension and tachycardia, as does tracheal intubation. Especially hypertensive patients are more likely to exhibit substantial fluctuations in hemodynamics and myocardial ischemia than normotensive patients during these stressful periods. The aim of present study was to evaluate the effects of intravenous diltiazem in attenuating mean arterial pressure(MAP) and heart rate(HR) responses to tracheal extubation in hypertensive patients. METHODS: Thirty-seven hypertensive patients who were to undergo elective surgery were randomly assigned to one of three groups : saline (control), lidocaine 1 mg/kg, and diltiazem 0.2 mg/kg. These drugs were given 2 minutes prior to tracheal extubation. Anesthesia was induced by the injection of fentanyl 1.5 microgram/kg, thiopental 5 mg/kg, and vecuronium 0.1 mg/kg and maintained with 50% N2O in O2 and 1~2 vol.% enflurane. Changes in HR and MAP were measured during and after tracheal extubation. RESULTS: In the diltiazem group, the MAP decreased significantly at drug administration, extubation, and post-extubation 1 min. However there were no significant differences in HR among 3 groups. CONCLUSIONS: These data suggest that intravenous injection of diltiazem 0.2 mg/kg given 2 minutes before tracheal extubation was effective in attenuating MAP changes associated with tracheal extubation. But HR changes were not different significantly among 3 groups. Further studies are required for the effective prophylaxis against tachycardia associated with tracheal extubation.

Patient-Controlled Epidural Analgesia during Labor and Delivery / 대한마취과학회지

BACKGROUND: Epidural administration of dilute solution of local anesthetic and lipid-soluble opioid provides the best pain relief during labor and delivery. The purpose of this study was to evaluate the safety, efficacy and patient satisfaction of patient-controlled epidural analgesia compared with continuous infusion epidural analgesia. METHODS: Forty healthy full-term parturients who requested epidural analgesia were assigned randomly to either patient-controlled epidural analgesia (PCEA) group or continuous infusion epidural analgesia (CIEA) group. All parturients received proper dose of 0.25% bupivacaine with 0.0008% fentanyl to block T10 sensory level. PCEA was programmed as followings; no background infusion, a 4 ml bolus dose and 15min lock-out interval using 0.0625% bupivacaine with 0.0002% fentanyl. CIEA was started with the same solution at 12ml/hr constantly. RESULTS: Hourly requirement of 0.0625% bupivacaine (mean+/-SD 7.1+/-5.8 ml/hr, median 7.6 ml/hr in PCEA group and mean+/-SD 13.2+/-2.9 ml/hr, median 12 ml/hr in CIEA group) during labor was significantly reduced in PCEA group (p<0.05). Maternal satisfaction, obstetric and neonatal parameters were shown no statistically significant difference. Incidences of postpartum complications such as gait disturbance, urinary difficulty, pruritus, nausea and vomiting were rare in both groups. CONCLUSIONS: Patient-controlled epidural analgesia is safe and effective and has 37% sparing effect of bupivacaine dosage used per hour compared with continuous infusion epidural analgesia.

The Effect of Lidocaine on the Onset of Vecuronium-Induced Neuromuscular Block / 대한마취과학회지

BACKGROUND: Rapid-sequence induction is common technique to reduce anesthetic complications. Due to side effects of succinylcholine, nondepolarizing muscle relaxants have been tried. The authors tried to observe the effect of lidocaine on the onset of vecuronium. METHODS: Sixty patients were divided into lidocaine group(L) and control group(C). Anesthetic induction with 4-5 mg/kg of thiopental and 0.1 mg/kg of vecuronium was made. The L-group received 1.5 mg/kg of lidocaine 90 seconds prior to the injection of vecuronium and the C-group received normal saline with the same volume and at the same time like L-group. The ulnar nerve stimulations were applied to detect the contraction of the adductor pollicis on thumb by using Accelograph . The condition of intubation, the appearanee of arrhythmias, side effects of drugs, and the changes of mean arterial pressure and heart rate were checked and compared in peri-induction periods. RESULTS: The results are followings; (1) There were no differences in changes of MAP and HR, and the appearance of arrhythmias in 2 groups, (2) the conditions of intubation were satisfactory with same degree in 2 groups, (3) ths lidocaine pretreatment decreased significantly the onset of vecuronium (137.5+/-33.4 seconds vs. 176.4+/-62.7 seconds) comparing to the C-group and augumented the potency of vecuronium by 28% CONCLUSIONS : From the above results, the authors concluded that 1.5mg/kg of intravenous lidocaine at 90 seconds before induction can be safely used to reduce the onset time of vecuronium especially in the case of rapid endotracheal intubation. Furthermore, it is expected that lidocaine in combination with other techniques will be more effective in shortening the onset of vecuronium.