Validity and reliability of the Korean version of the Quality of Recovery-15 questionnaire / 대한마취과학회지

Background@# The qulity of recovery-40 questionnaire (QoR-40) has been widely used to assess quality of recovery after surgery, but it is too lengthy for clinical use. The short form of QoR-40, QoR-15, has been validated in many languages; however, an official Korean version of the QoR-15 (QoR-15K) has not yet been established. This study aimed to develop and validate QoR-15K. @*Methods@# Based on the previously-validated Korean QoR-40, we selected 15 items; the QoR-15K was patterned on the original QoR-15. We analyzed 210 subjects who had been scheduled for elective surgery under general anesthesia. The patients completed the questionnaire before surgery and on postoperative days one and two. The validity, reliability, and responsiveness of the QoR-15K were evaluated. @*Results@# We obtained excellent convergent validity on visual analog scale for recovery (VAS) (ρ = 0.88, P < 0.001). The duration of anesthesia, post-anesthesia care unit, and overall hospital stay with the QoR-15K showed a significant negative correlation (ρ = -0.183, -0.151, and -0.185, respectively). Cronbach’s α was 0.909. Cohen’s effect size and standardized response mean were 0.819 and 0.721. The recruitment and completion rate were 92.9% and 100%, respectively. We based the above calculations on the results obtained on the first day following surgery. @*Conclusions@# The validity and reliability of the QoR-15K are comparable to those of the English version. The QoR-15K would be a good instrument to assess the quality of recovery in Korean patients after surgery.

Validity and reliability of the Korean version of the Quality of Recovery-15 questionnaire / 대한마취과학회지

Background@# The qulity of recovery-40 questionnaire (QoR-40) has been widely used to assess quality of recovery after surgery, but it is too lengthy for clinical use. The short form of QoR-40, QoR-15, has been validated in many languages; however, an official Korean version of the QoR-15 (QoR-15K) has not yet been established. This study aimed to develop and validate QoR-15K. @*Methods@# Based on the previously-validated Korean QoR-40, we selected 15 items; the QoR-15K was patterned on the original QoR-15. We analyzed 210 subjects who had been scheduled for elective surgery under general anesthesia. The patients completed the questionnaire before surgery and on postoperative days one and two. The validity, reliability, and responsiveness of the QoR-15K were evaluated. @*Results@# We obtained excellent convergent validity on visual analog scale for recovery (VAS) (ρ = 0.88, P < 0.001). The duration of anesthesia, post-anesthesia care unit, and overall hospital stay with the QoR-15K showed a significant negative correlation (ρ = -0.183, -0.151, and -0.185, respectively). Cronbach’s α was 0.909. Cohen’s effect size and standardized response mean were 0.819 and 0.721. The recruitment and completion rate were 92.9% and 100%, respectively. We based the above calculations on the results obtained on the first day following surgery. @*Conclusions@# The validity and reliability of the QoR-15K are comparable to those of the English version. The QoR-15K would be a good instrument to assess the quality of recovery in Korean patients after surgery.

The change of stroke volume variation during thoracotomy or one lung ventilation

BACKGROUND: Stroke volume variation (SVV) is based on cyclic changes of intrathoracic pressure during respiratory cycle. Thoracotomy and one-lung ventilation (OLV) can lead to changes in airway and intrathoracic pressure. The aim of this study was to determine whether thoracotomy and converting from two lung ventilation to OLV could affect SVV values. METHODS: Thirty patients who were scheduled for pulmonary lobectomy or pneumonectomy requiring OLV were enrolled. Induction and maintenance of anesthesia were performed with propofol and remifentanil via total intravenous anesthesia. Hemodynamic variables including mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), and SVV were measured at intervals of 1 min for 10 min after thoracotomy and OLV, respectively. RESULTS: MAP and HR increased from baseline at intervals between 3 and 10 min and between 4 and 10 min after thoracotomy, respectively (P < 0.001). CI increased between 4 and 10 min (P < 0.001). SVV did not change for 10 min after thoracotomy. After OLV, MAP decreased between 4 and 10 min (P = 0.112). SVV was the highest at 1 min after OLV. It returned to the baseline value at 7 min (P < 0.001). CI decreased between 8 and 10 min after OLV (P < 0.001). CONCLUSIONS: SVV can increase after OLV temporarily. Transient increase of SVV may be considered when fluid responsiveness is predicted by SVV during early period after OLV.

Hemodynamic effects of different types of pneumatic compression of the lower extremities during anesthesia induction: a prospective randomized controlled trial / 대한마취과학회지

BACKGROUND: The current study evaluated the hemodynamic effects of different types of pneumatic compressions of the lower extremities during anesthesia induction. In addition, the hemodynamic effects were compared between patients older than 65 age years and those aged 65 years or younger. METHODS: One hundred and eighty patients (90: > 65 years and 90: ≤ 65 years) were enrolled. Each age group of patients was randomly assigned to one of three groups; Group 1 (no compression), Group 2 (sequential pneumatic compression), and Group 3 (sustained pneumatic compression without decompression). Invasive blood pressure, cardiac index (CI), and stroke volume variation (SVV) were measured. RESULTS: In patients aged ≤ 65 years, mean arterial pressure (MAP) and CI were significantly higher and SVV was lower in Group 3 compared to Group 1 before tracheal intubation, but there were no differences between Groups 1 and 2. However, there were no differences in MAP, CI, and SVV among the three groups in patients aged > 65 years. The number of patients who showed a MAP 65 years. CONCLUSIONS: Sustained pneumatic compression of the lower extremities has more hemodynamic stabilizing effects compared to sequential compression during anesthesia induction in patients aged 65 years or younger. However, no difference between methods of compression was observed in patients older than 65 years.

Comparing the Rates of Dopamine Hemodynamic Effect Onset after Infusion through Peripheral Veins in Three Regions / 대한중환자의학회지

BACKGROUND: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 µg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). METHODS: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 µg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. RESULTS: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. CONCLUSIONS: For patients under general anesthesia receiving dopamine at 10 µg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.

Comparing the Rates of Dopamine Hemodynamic Effect Onset after Infusion through Peripheral Veins in Three Regions / 대한구급학회지

BACKGROUND: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 µg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). METHODS: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 µg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. RESULTS: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. CONCLUSIONS: For patients under general anesthesia receiving dopamine at 10 µg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.

A comparison of the temperature difference according to the placement of a nasopharyngeal temperature probe / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare temperatures measured at three different sites where a nasopharyngeal temperature probe is commonly placed. METHODS: Eighty elective abdominal surgical patients were enrolled. After anesthesia induction, four temperature probes were placed at the nasal cavity, upper portion of the nasopharynx, oropharynx, and the esophagus. The placement of the nasopharyngeal temperature probes was evaluated using a flexible nasendoscope, and the depth from the nares was measured. The four temperatures were simultaneously recorded at 10-minute intervals for 60 minutes. RESULTS: The average depths of the probes that were placed in the nasal cavity, upper nasopharynx, and the oropharynx were respectively 5.7 ± 0.9 cm, 9.9 ± 0.7 cm, and 13.6 ± 1.7 cm from the nares. In the baseline temperatures, the temperature differences were significantly greater in the nasal cavity 0.32 (95% CI; 0.27-0.37)℃ than in the nasopharynx 0.02 (0.01-0.04)℃, and oropharynx 0.02 (−0.01 to 0.05)℃ compared with the esophagus (P < 0.001). These differences were maintained for 60 minutes. Twenty patients showed a 0.5℃ or greater temperature difference between the nasal cavity and the esophagus, but no patient showed such a difference at the nasopharynx and oropharynx. CONCLUSIONS: During general anesthesia, the temperatures measured at the upper nasopharynx and the oropharynx, but not the nasal cavity, reflected the core temperature. Therefore, the authors recommend that a probe should be placed at the nasopharynx (≈ 10 cm) or oropharynx (≈ 14 cm) with mucosal attachment for accurate core temperature measurement.

Effects of intraoperative single bolus fentanyl administration and remifentanil infusion on postoperative nausea and vomiting / 대한마취과학회지

BACKGROUND: Although the use of postoperative opioids is a well-known risk factor for postoperative nausea and vomiting (PONV), few studies have been performed on the effects of intraoperative opioids on PONV. We examined the effects of a single bolus administration of fentanyl during anesthesia induction and the intraoperative infusion of remifentanil on PONV. METHODS: Two hundred and fifty women, aged 20 to 65 years and scheduled for thyroidectomy, were allocated to a control group (Group C), a single bolus administration of fentanyl 2 microg/kg during anesthesia induction (Group F), or 2 ng/ ml of effect-site concentration-controlled intraoperative infusion of remifentanil (Group R) groups. Anesthesia was maintained with sevoflurane and 50% N2O. The incidence and severity of PONV and use of rescue antiemetics were recorded at 2, 6, and 24 h postoperatively. RESULTS: Group F showed higher incidences of nausea (60/82, 73% vs. 38/77, 49%; P = 0.008), vomiting (40/82, 49% vs. 23/77 30%; P = 0.041) and the use of rescue antiemetics (47/82, 57% vs. 29/77, 38%; P = 0.044) compared with Group C at postoperative 24 h. However, there were no significant differences in the incidence of PONV between Groups C and R. The overall incidences of PONV for postoperative 24 h were 49%, 73%, and 59% in Groups C, F, and R, respectively (P = 0.008). CONCLUSIONS: A single bolus administration of fentanyl 2 microg/kg during anesthesia induction increases the incidence of PONV, but intraoperative remifentanil infusion with 2 ng/ml effect-site concentration did not affect the incidence of PONV.

The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head / 대한마취과학회지

BACKGROUND: The proper cuff pressure is important to prevent complications related to the endotracheal tube (ETT). We evaluated the change in ETT cuff pressure by changing the position from supine to prone without head movement. METHODS: Fifty-five patients were enrolled and scheduled for lumbar spine surgery. Neutral angle, which was the angle on the mandibular angle between the neck midline and mandibular inferior border, was measured. The initial neutral pressure of the ETT cuff was measured, and the cuff pressure was subsequently adjusted to 26 cmH2O. Flexed or extended angles and cuff pressure were measured in both supine and prone positions, when the patient's head was flexed or extended. Initial neutral pressure in prone was compared with adjusted neutral pressure (26 cmH2O) in supine. Flexed and extended pressure were compared with adjusted neutral pressure in supine or prone, respectively. RESULTS: There were no differences between supine and prone position for neutral, flexed, and extended angles. The initial neutral pressure increased after changing position from supine to prone (26.0 vs. 31.5 +/- 5.9 cmH2O, P < 0.001). Flexed and extended pressure in supine were increased to 38.7 +/- 6.7 (P < 0.001) and 26.7 +/- 4.7 cmH2O (not statistically significant) than the adjusted neutral pressure. Flexed and extended pressure in prone were increased to 40.5 +/- 8.8 (P < 0.001) and 29.9 +/- 8.7 cmH2O (P = 0.002) than the adjusted neutral pressure. CONCLUSIONS: The position change from supine to prone without head movement can cause a change in ETT cuff pressure.

The tip fracture of the Coopdech bronchial blocker during insertion in the patient with lung surgery / 대한마취과학회지

No abstract available.

A method for optimal depth of the nasopharyngeal temperature probe: the philtrum to tragus distance / 대한마취과학회지

BACKGROUND: The nasopharyngeal temperature probe should be placed in the upper nasopharynx to reflect accurate core temperature. However, there have been no studies conducted to predict parameters for the optimal depth of the nasopharyngeal temperature probe. The purpose of this study was to examine the correlation between the optimal depth to the upper nasopharynx and the distance from the philtrum to the tragus and height. METHODS: Two hundred patients (100 females and 100 males) were enrolled in the study. The distance from the philtrum to the tragus along the facial curvature was measured, and the optimal depth from the nostril to the upper nasopharynx was evaluated using nasendoscopy. The relationships between the optimal depth to the upper nasopharynx and the distance from the philtrum to the tragus and height were examined. RESULTS: The distances from the philtrum to the tragus were 14.4 +/- 0.5 cm in females and 15.1 +/- 0.6 cm in males (P < 0.01). The depths from the nostril to the upper nasopharynx were 9.4 +/- 0.6 cm in females and 10.0 +/- 0.5 cm in males (P < 0.01). The correlation coefficients between the depth from the nostril to the upper nasopharynx and the distance to the tragus from the philtrum were 0.43 in females and 0.41 in males (P < 0.01). However, there were very weak correlations and no correlations between height and the depth from the nostril to the upper nasopharynx in females and males, respectively. CONCLUSIONS: The depth from the nostril to the upper nasopharynx is correlated weakly with the distance from the philtrum to the tragus. Although the distance from the philtrum to the tragus is not a good predicting parameter for the optimal depth of nasopharyngeal temperature probe placement, subtraction of 5 cm from the distance is helpful to estimate the optimal depth of the nasopharyngeal temperature probe.

Effect of ketorolac on the prevention of emergence agitation in children after sevoflurane anesthesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the effects of ketorolac on the incidence and severity of emergence agitation in children recovering from sevoflurane anesthesia. METHODS: Eighty-five children aged 3 to 7 years were randomly assigned to the control group or the ketorolac group (1 mg/kg ketorolac). The children were evaluated by the Pediatric Anesthesia Emergence Delirium Scale and a four-point agitation scale. RESULTS: The median agitation scores did not differ significantly between the two groups. The overall incidence of emergence agitation was similar in the two groups (41% in the control group vs. 32% in the ketorolac group, P = 0.526). The number of children who received rescue drugs for treatment of emergence agitation was not significantly different between the two groups. CONCLUSIONS: The administration of 1 mg/kg of ketorolac is not effective in decreasing the incidence and severity of emergence agitation in children aged 3 to 7 years after sevoflurane anesthesia.

Measurement of the length from vocal cord to carina and diameter of the trachea with a three-dimensional chest CT scan in adults; comparison with demographic data

BACKGROUND: Most morphometric studies of the airway have relied on plain radiographs or CT scan with their attendant limitations. We evaluated the length from vocal cord to carina and diameter of the trachea in adults who had no abnormality of the airway using three-dimensional chest CT scan and compared with demographic data. METHODS: We performed a multiplane reconstruction of the airway using axial, sagittal, and coronal slices (aged 18-87, 100 men, 100 women). We measured that the lengths from vocal cord to carina and the diameters (AP, anteroposterior; TR, transverse) of 50 mm above carina of the trachea. RESULTS: The lengths from vocal cord to carina was 130.2 +/- 11.4 mm in men and 119.5 +/- 10.5 mm in women. The AP and TR diameters of the trachea at 50 mm above carina were men; 18.0 +/- 2.4 mm, 17.2 +/- 2.6 mm, women; 14.4 +/- 2.0 mm, 14.4 +/- 1.9 mm, respectively. The correlation between airway length and age and height was statically significant in men and women but less clinically significant. The correlation between diameter of trachea and height was only statically significant in men but less clinically significant. CONCLUSIONS: This study suggests that these measured data are helpful for the endotracheal intubation and endotracheal tube placement in airway management.

Tracheal rupture after endotracheal intubation: A report of three cases / 대한마취과학회지

Tracheal rupture is a rare but serious complication that occurs after endotracheal intubation. It usually presents as a linear lesion in the membranous wall of the trachea, and is more prevalent in women and patients older than 50 years. The clinical manifestations of tracheal injury include subcutaneous emphysema and respiratory distress. We report the cases of three female patients of old age presenting tracheal rupture after endotracheal intubation. Two cases received surgical repair without complication and one recovered uneventfully after conservative management. We presume that the tracheal injuries were caused by over-inflation of cuff and sudden movement of the tube by positional change. Therefore, we recommend cuff pressure monitoring during general anesthesia and minimized movement of the head and neck at positional change.

The effects of incremental continuous positive airway pressure on arterial oxygenation and pulmonary shunt during one-lung ventilation / 대한마취과학회지

BACKGROUND: Although one lung ventilation (OLV) is frequently used for facilitating thoracic surgical procedures, arterial hypoxemia can occur while using one lung anesthesia. Continuous positive airway pressure (CPAP) in 5 or 10 cmH2O to the non-ventilating lung is commonly recommended to prevent hypoxemia. We evaluated the effects of incremental CPAP to the non-ventilating lung on arterial oxygenation and pulmonary shunt without obstruction of the surgical field during OLV. METHODS: Twenty patients that were scheduled for one lung anesthesia were included in this study. Systemic and pulmonary hemodynamic data and blood gas analysis was recorded every fifteen minutes according to the patient's positions and CPAP levels. CPAP was applied from 0 cmH2O by 3 cmH2O increments until a surgeon notifies that the surgical field was obstructed by the expanded lung. Following that, pulmonary shunt fraction (QS/QT) was calculated. RESULTS: There were no significant differences of QS/QT between supine and lateral positions with two lung ventilation (TLV). OLV significantly decreased arterial oxygen partial pressure (PaO2) and increased QS/QT compared to TLV. PaO2 and QS/QT significantly improved at 6 and 9 cmH2O of CPAP compared to 0 cmH2O. However, there were no significant differences of PaO2 and QS/QT between 6 and 9 cmH2O CPAP. In 18 patients (90%), surgical fields were obstructed at 9 cmH2O CPAP. CONCLUSIONS: This study suggests that 6 cmH2O CPAP effectively improved arterial oxygenation without interference of the surgical field during OLV when CPAP was applied from 0 cmH2O in 3 cmH2O increments.

The willingness of patients to pay for intravenous patient-controlled analgesia in Korea / 대한마취과학회지

BACKGROUND: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. METHODS: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. RESULTS: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. CONCLUSIONS: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea.

The willingness of patients to pay for intravenous patient-controlled analgesia in Korea / 대한마취과학회지

BACKGROUND: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. METHODS: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. RESULTS: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. CONCLUSIONS: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea.

Knotting and Kinking of the Guidewire during Central Venous Catheterization: A Case Report / 대한구급학회지

Central venous catheterization is often necessary to manage critically ill patients in the intensive care unit and some surgical patients in the operating room. However, this procedure can lead to various complications. We experienced a case of subclavian venous catheterization that was complicated by looping, kinking, knotting, and entrapment of the guidewire. We were able to identify the extravascular looping and knotting of the guidewire under fluoroscopy and consequently removed it successfully. We suggest that a guidewire should be confirmed by fluoroscopic imaging if it has become entrapped.

Effective Management for Incidental Detachment of the Pilot Balloon on the Endotracheal Tube: A Case Report / 대한구급학회지

A 57-year-old female with lumbar spinal stenosis at L4-S1 was scheduled to undergo posterolateral interbody fusion. Intubation with a 7.0 size ID cuffed reinforced tracheal tube (Mallinckrodt(TM), Mallinckrodt Medical Atholen, Ireland) was uncomplicated, and any air leakage was not detected at that time. Two hours after the start of operation, an air leak was apparent at the trachea during ventilation in the prone position. Closer inspection of the inflation tube and pilot balloon showed that the pilot balloon had become detached. Because she was being operated on in the prone position, and ventilation was only possible at a less than optimal state, we attempted to fix this without having to reintubate the patient's trachea. Our solution involved inserting a 21-gauge needle into the inflation tube and a handheld aneroid manometer was then connected to it. The tube cuff was thereafter inflated up to a pressure of 20 cmH2O. In conclusion, careful manipulation is recommended when performing intubation and a needle connector may help secure the airway if the pilot balloon becomes detached during the procedure.

Desflurane-induced hemodynamic changes in patients with diabetic cardiovascular autonomic neuropathy / 대한마취과학회지

BACKGROUND: Diabetic cardiovascular autonomic neuropathy (CAN) causes perioperative cardiovascular instability. A rapid increase in the desflurane concentration induces tachycardia and hypertension (HTN). This study examined the effects of the cardiovascular response to desflurane on patients with diabetic CAN. METHODS: Forty diabetes mellitus (DM) patients with CAN were divided two groups: one with HTN (DM+HTN group, n = 17) and one without HTN (DM group, n = 23). The control group (n = 20) was composed of healthy patients without DM or HTN. In each group, the concentration of desflurane inspired was increased abruptly to 12.0 vol% 2 minutes after a thiopental injection. The target was to produce an end-tidal concentration of desflurane of 10.0 vol%, which was maintained until the end of the study by adjusting the vaporizer dial setting. The heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) were measured. RESULTS: The HR, MAP and CI increased significantly in all three groups when compared with the baseline (P<0.05). Additionally, the HR and MAP showed did not differ among the three groups at any of sampling times. However, the CI of the DM group and the DM+HTN group differed when compared with the control group at 90 and 120 seconds after intubation (P<0.05). CONCLUSIONS: In diabetic patients with CAN, the hemodynamic responses to a rapid increase in desflurane concentration are similar to those in non-diabetic patients before endotracheal intubation. However, after endotracheal intubation, increments in CI are blunted in diabetic patients with CAN.