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.

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.

Effects of Magnesium Sulfate on Supraceliac Aortic Unclamping in Experimental Dogs

Intravascular administration of magnesium (Mg) causes vasodilation and increases renal blood flow. The aim of this study was to investigate the renal effect of Mg following unclamping of the supraceliac aorta. Mongrels were divided into two groups, control (group C, n=7) and Mg group (group Mg, n=7). In group Mg, 30 mg/kg MgSO4 was injected as a bolus immediately prior to unclamping the supraceliac aorta and thereafter as an infusion (10 mg/kg/hr). The group C received an equivalent volume of saline solution. Systemic hemodynamics, renal artery blood flow, renal cortical blood flow (RCBF), renal vascular resistance, and renal function were compared. Following the aortic unclamping, cardiac output and RCBF were less attenuated, and the systemic and renal vascular resistance was elevated to a lesser degree in the group Mg compared to the group C. There was no significant difference in the plasma renin activity, serum creatinine and Cystatin-C between the two groups. The present study shows that Mg infusion improves systemic hemodynamics and RCBF after aortic unclamping. However, we did not observe any improvement in renal function when Mg was administered after supraceliac aortic unclamping.

Tissue Pressure Changes following Tibia Fracture / 대한정형외과학회잡지

Delayed diagnosis of the compartmental syndrome and subsequent delay in performing the fasciotomy can result in needless loss of function and possible amputation of the involved extremity. Unfortunately early evidence of this syndrome is difficult to assess. A direct measurement of the tissue pressure within a closed compartment has been developed which provides physicians with reliable information for determining the need for fasciotomy. In the 27 cases of the tibia fracture, tissue pressure was measured directly by method of the needle manometer in the Department of Orthopedic Surgery, Han Kang Sung Sim Hospital from March, 1979 to August, 1979. The results were as follows: 1. The highest mean tissue pressure per hour was 28 mmHg in anterior compartment at 24 hours after trauma, and 28.4 mmHg in deep post compartment at the same hours. 2. The highest pressure measured in all cases was 38 mmHg in anterior compartment at 24 hours and 39 mmHg in deep posterior compartment at 48 hours after trauma. 3. The return of increased tissue pressure to less than 10 mmHg took 122.6 hours in anterior and 124.4 hours in deep posterior compartment. 4. Tissue pressre was higher when there was associated fibula fracture. 5. Tissue pressure was higher in displaced fractures than in undisplaced fractures. 6. Tissue pressure was higher when fracture was in its upper one-third. 7. Tissue pressure was higher in comminuted fracture than simple fracture.