The Effect of Propofol on Outward K+ Currents in Canine Colonic Myocytes / 대한마취과학회지

BACKGROUND: Propofol (2,6-diisopropylphenol) is a widely used intravenous anesthetic, and the effects of propofol on several ion channels have been studied at the whole cell and single-channel levels. However, in general there is no report on the effect of propofol on outward K+ currents in canine colonic myocytes, in which there are two types of outward K+ currents, a large-conductance Ca2+-activated K+ current and a classical delayed rectifier K+ current. We examined the effects of propofol on the two types of outward K+ currents the kinetics involved. METHODS: Experiments were performed on freshly dispersed smooth muscle cells from the circular muscle layer of the proximal canine colon. Outward currents were recorded using the patch clamp technique in the whole cell configuration. RESULTS: The application of propofol (600 nM-600microM) decreased net outward current in a dose-dependent manner. Propofol (6-60microM) also decreased peak delayed rectifier K+ currents. Pretreatment with TEA abolished propofol effects on delayed rectifier K+ currents. However, propofol still decreased delayed rectifier K+ currents in the presence of 4-AP. CONCLUSIONS: These data suggest that propofol decrease net outward K+ currents primarily by inhibiting large-conductance Ca2+-activated K+ currents and 4-AP resistant delayed rectifier K+ currents. These results suggest that propofol action on outward currents may depend on the different blocking mechanisms of the different types of K+ channels. If propofol cannot induce contraction, Ca2+ currents in colonic myocytes warrant further study.

Changes Induced by the Infusion of Normal Saline in Arterial Blood Gas Analysis, Serum Electrolytes and Central Venous Pressure during Renal Transplantation / 대한마취과학회지

BACKGROUND: The changes in acid-base balance and serum electrolytes after infusion of 0.9% normal saline during renal transplantation are poorly characterized. In this study, the relationships between the infusion of fluids and the changes in arterial blood gas analysis, serum electrolytes and central venous pressure during renal transplantation were determined. METHODS: Sixty-seven patients undergoing elective renal transplantation were divided into two groups: group I (n = 33) was made up of patients who received a living related renal transplantation, while group II (n = 34) was made up of those who received a living unrelated renal transplantation. Blood gas analysis, central venous pressure and serum electrolytes were evaluated just after the beginning of the operation, just before reperfusion (unclamping of the renal artery and vein), just after reperfusion and 20 minutes after arriving in the recovery room. RESULTS: pH, base excess, HCO3 and Na+ concentration were decreased, but PaCO2 was not changed during the operation. Central venous pressure and K+ concentrations were elevated during the operation. CONCLUSIONS: The results of this study suggest that 0.9% normal saline and mannitol leads to dilutional acidosis. If a lot of fluids are required during transplantation, we need to consider that 0.9% normal saline can aggravate acidosis in a renal transplantation patient.

Pneumothorax and Pneumomediastinum Occurred after Esophageal Perforation by a Stylet during Difficult Endotracheal Intubation / 대한마취과학회지

Pneumothorax and pneumomediastinum can occur spontaneously, secondary to trauma, or from dissection of air from the neck or retroperitoneal space. The most common cause of traumatic pneumomediastinum is a rupture of the esophagus, which can occur during an episode of severe vomiting or, less frequently, following esophageal instrumention. We experienced a case of pneumothorax and pneumomediastinum, developed after esophageal perforation by stylet during difficult endotracheal intubation even though an esophagogram did not reveal the perforation site.

Interaction between Mivacurium and Nitroglycerin / 대한마취과학회지

BACKGROUND: The neuromuscular blocking effects of a nondepolarizing neuromuscular blocker (NDNM) during a nitroglycerin (NTG) infusion were significantly potentiated and prolonged. NTG reduced the requirement of a NDNM in surgical patients. We investigated the influence of a NTG single bolus injection on a mivacurium nuromuscular blockade. METHODS: We studied 36 adult surgical patients, ASA physical status I or II, between 15 and 53 years old. Neuromuscular monitoring was measured by TOF-GUARD (Biometer Co., Denmark). Anesthesia was induced by thiopental sodium 3-5 mg/kg and fentanyl 3 microgram/kg, and maintained with 3 L/min N2O, 2 L/min O2 and 1 vol.% isoflurane. Patients were randomly assigned to 3 groups: 1) Control group (mivacurium 0.16 mg/kg), 2) N100 group (mivacurium 0.16 mg/kg, NTG 100 microgram), 3) N200 group (mivacurium 0.16 mg/kg, NTG 200 microgram). We measured the train-of-four (TOF) response from the beginning of recovery to the complete regaining of muscle twitch. RESULTS: NTG produced a prolongation of the neuromuscular blocking effect by mivacurium. T1 (contro group: 12.1 +/- 0.5, N100 group: 15.8 +/- 0.4 and N200 group: 11.6 +/- 0.4 min), T25 (16.4 +/- 0.4, 20.5 +/- 0.5 and 14.9 +/- 1.0 min), T75 (22.5 +/- 0.9, 29.4 +/- 0.7 and 20.1 +/- 1.0 min), T95 (27.3 +/- 0.6, 39.6 +/- 0.7 and 24.6 +/- 1.5 min) and the recovery index (6.1 +/- 0.6, 9.0 +/- 0.4 and 5.3 +/- 0.7 min) were significantly prolonged in the N100 and N200 groups (P < 0.05). CONCLUSION: These results suggest that a NTG bolus injection prolonged the neuromuscular blocking effect of mivacurium, dose relatively.

Clinicopathologic Analysis of Four Cases of Primary Ovarian and Parovarian Transitional Cell Carcinoma / 대한부인종양콜포스코피학회잡지

Four cases of primary transitional cell carcinoma (TCC) arising in the ovary (3 cases) and the parovarium (1 case) were collected for clinicopathologic analysis. The mean age was 46.2 years (range, 39-57 years). Two patients complained abdominal discomfort and vaginal discharge, respectively. Other 2 cases were incidentally found from routine check. Grossly, the tumors were solid and cystic (2 cases), solid (1 case) and surface papillary growth on capsule (1 case). Microscopically, the tumor showed almostly same to the histologic features of TCC of urinary bladder. Three cases were pure TCC, and one was mixed TCC and serous carcinoma. FIGO stage were 1 IIa, 2 IIc, and 1 IIIc. Treatment was surgery with adjuvant chemotherapy. Two patients are alive with no evidence of disease, and two have lung or brain metastasis.

Effects of Acid-Base Balance on the Isolated Rabbit Vascular Tone / 대한마취과학회지

The effects of acidosis and alkalosis on vascular smooth muscle contractions were studied. Ring segments(3-4 mm in length) of rabbit abdominal aorta and pulmonary artery were mounted in the tissue bath(for respiratory study) and superfusion device(for metabolic study) for isometric tension recording. Respiratory acidosis and alkalosis were obtained by increasing and lowering the PCO2(80 and 15 mmHg, respectively). Metabolic acidosis and alkalosis were obtained by lowering and increasing the HCO3 concentration(12 and 50 mEq/l, respectively). After precontraction with norepinephrine(10-7 M), Vessels were exposed to acidosis and alkalosis for 30 minutes. The study was done with and without endothelium. The mechanism of vasorelaxation and vasoconstriction were confirmed with Ca2+ activated K+ channel blocker and Ca2+ free Krebs solution. The results were as follows: 1) Respiratory and metabolic acidosis induced significant vasorelaxation in both group of abdominal aorta and pulmonary artery(p<0.05). In endothelium intact group, vasorelaxation was greater than endothelium removed group. especially in respiratory acidosis was statistically significant(p<0.05). 2) Respiratory and metabolic alkalosis induced significant vasoconstriction in both group of abdominal aorta and pulmonary artery(p<0.05). In endothelium intact group, vasoconstriction was lesser than endothelium removed group, but was not statistically significant. 3) Acidosis induced vasorelaxation was blocked by tetraethylammonium(TEA). 4) Alkalosis induced vasoconstriction was blocked by Ca2+ free Krebs solution. These results suggested that: 1) Acidosis induced vasorelaxation. 2) alkalosis induced vasoconstriction 3) Vasorelaxation during acidosis was induced by K+ efflux through the Ca2+ activated K' channel. 4) Vasoconstriction during alkalosis was induced by Ca2+ influx.

Malignant Hyperthermia after Incomplete Relaxation of masseter Muscle / 대한마취과학회지

Masseter muscle rigidity may herald a fulminant malignant hyperthermia reaction or may be an isolated abnormal anesthetic response. It is very hard to differentiate, Significant masseter muscle rigidity is a muscle spasm of at least 30 seconds duration that interferes with mouth opening despite an appropriate succinylcholine dose in a patient who has no temporo-mandibular joint dysfuntion. They thought mild to moderate foims of spasm are tolerable for anesthesia. We suffered incomplete relaxation of masseter muscle after succinylcholine that followed by fulminant malignant hyperthermic reaction. At that time, a little resistance was felt during mouth opening put intubation was done . without difficulty. After this experience, because Caffeine-Halothane contracture test is performed only in limited institutes and dantrolene is not available in our hospital, we decide to hold the anesthetic practice in case of any degree of masseter muscle rigidity.

What Plasma Ionized Calcium Concentration Increased by Intravenous Injection with 3% Calcium Chloride and 10 % Calcium Gluconate Is Affected on Cardiovascular System? / 대한마취과학회지

Total 87 patients were divided into 4 different dosage and try to observe what was affected to cardiovascular system depends on the increasing the plasma ionized cakium concentration (3% calcium chloride; 4 mg/kg, as its double 8 mg/kg and 10% calcium gluconate; 14 mg/kg, as its double 28 mg/kg). The results were as follows;, 1) Though using double dosage of 3% calcium chloride and 10% calcium gluconate, could not get to increase as double of plasma ionized calcium concentration. 2) Plasma ionized calcium concentration was increased to the highest level on 1 minute after intravenous administration with each dosage and after increasing to highest level was show to be decreased gradually during 30 minutes after injection. 3) Heart rate was decreased until 30 minute after injection with each dosage of 10% calcium gluconate with statistically significancy (p<0.05) but when 3% calcium chloride were used, the change of heart rate following increase of calcium concentration have not any statistically signi- ficancy. 4) When 3% calcium chloride and 10% calcium gluconate were used, mean arterial pressure (MAP) and increasing of plasma ionized calcium concentration have not any statistically signi- ficancy. 5) Changing of cardiac index (CI) following plasma ionized calcium concentration, have only statistically significancy after each dosage of 10% calcium gluconate was injected but each dosage of 3% calcium chloride have not any statistically significancy respectively. With the above results, equivalent dosage of 3% calcium chloride and 10% calcium gluconate were increased as similar change of plasma ionized calcium concentration but 10% calcium gluconate 14 mg/kg, 28 mg/kg are only have statistically significany between the change of PR, CI and increasing plasma ionized calcium concentration (p<0.05).

What Plasma Ionized Calcium Concentration Increased by Intravenous Injection with 3% Calcium Chloride and 10 % Calcium Gluconate Is Affected on Cardiovascular System? / 대한마취과학회지

Total 87 patients were divided into 4 different dosage and try to observe what was affected to cardiovascular system depends on the increasing the plasma ionized cakium concentration (3% calcium chloride; 4 mg/kg, as its double 8 mg/kg and 10% calcium gluconate; 14 mg/kg, as its double 28 mg/kg). The results were as follows;, 1) Though using double dosage of 3% calcium chloride and 10% calcium gluconate, could not get to increase as double of plasma ionized calcium concentration. 2) Plasma ionized calcium concentration was increased to the highest level on 1 minute after intravenous administration with each dosage and after increasing to highest level was show to be decreased gradually during 30 minutes after injection. 3) Heart rate was decreased until 30 minute after injection with each dosage of 10% calcium gluconate with statistically significancy (p<0.05) but when 3% calcium chloride were used, the change of heart rate following increase of calcium concentration have not any statistically signi- ficancy. 4) When 3% calcium chloride and 10% calcium gluconate were used, mean arterial pressure (MAP) and increasing of plasma ionized calcium concentration have not any statistically signi- ficancy. 5) Changing of cardiac index (CI) following plasma ionized calcium concentration, have only statistically significancy after each dosage of 10% calcium gluconate was injected but each dosage of 3% calcium chloride have not any statistically significancy respectively. With the above results, equivalent dosage of 3% calcium chloride and 10% calcium gluconate were increased as similar change of plasma ionized calcium concentration but 10% calcium gluconate 14 mg/kg, 28 mg/kg are only have statistically significany between the change of PR, CI and increasing plasma ionized calcium concentration (p<0.05).