Propofol and Thiopental-Enflurane: A Comparison of Anesthesia for Laryngomicrosurgery / 대한마취과학회지

BACKGROUND: Laryngomicrosurgery has some special characteristics. It is stressful due to intubation and direct laryngoscopy during a short operation time. Therefore both adequate anesthesia and quick recovery for the slience therapy after the operation are needed. This study compared the cardiovascular responses and recovery pattern between propofol and Thiopental-Enflurane anesthesia. METHODS: Sixty outpatients of ASA class 1 or 2 for microlaryngoscopy were randomly assigned to receive either anesthesia with propofol (Group P, n = 30) and thiopental-enflurane (Group E, n = 30). Group P was induced with propofol 2 mg/kg and succinylcholine 1 mg/kg and maintained with vecuronium 0.04 mg/kg, propofol 10 - 6 mg/kg/h, and N2:O2/3 L/min:2 L/min. Group E was induced with thiopental 5 mg/kg and succinylcholine 1 mg/kg and maintained with vecuronium 0.04 mg/kg, enflurane 1 3 vol%, and N2O:O2/3 L/min:2 L/min. Ketorolac (30 mg) and hydrocortisone (100 mg) were added for postoperative pain in both groups. The changes in blood pressure and heart rate, pre and post induction, were compared in both groups. In addition, we compared energence time and the state of recovery (Steward's score) 5 minutes and 15 minutes after extubation and the frequencies of other complications. RESULTS: No significant differences in age, wt, sex and anesthesia time of the two groups were observed. Mean arterial pressures were significantly different after anesthesia and after intubation between the two groups. However the heart rates were not different among the groups. The extubation time was significantly shorter in Group P. The recovery score at 5 min and 15 min after extubation was significantly higher in Group P. CONCLUSIONS: We conclude that propofol with nitrous oxide may be useful in laryngeal microsurgery, especially, when silence therapy is needed.

The Effect of Clonidine Pretreatment on Cardiovascular Response and Seizure Duration according to Electroconvulsive Therapy / 대한마취과학회지

BACKGROUND: Elecroconvulsive therapy (ECT) is frequently associated with cardiovascular complications such as hypertension and tachycardia. The aim of this study was to evaluate whether clonidine given as an oral preanesthetic medication would influence the hemodynamic stress response, peripheral oxygen saturation and seizure duration which follows ECT. METHODS: Twenty-two ASA physical status I, II patients with major depressive disorders were included in a crossover study design and assigned randomly to either a control group who received placebo, or a clonidine group who received oral clonidine of 3 microgram/kg 90 min before preparation of ECT. All patients received glycopyrrolate 0.2 mg intramuscularly 60 min before anesthetic induction. Electrocardiography, pulse oximetry, and blood pressure monitors were applied to all patients. Patients were pre-oxygenated with 100% O2. Patients received thiopental 2.5 mg/kg and succinylcholine 0.5 mg/kg for anesthetic induction. Noninvasive mean arterial blood pressure (MAP), heart rate, and oxygen saturation were recorded just before test drug administration, immediately before ECT, and each minute for five minutes after ECT. The times from ECT stimulus to the cessation of clonic-tonic motor activity in the "isolated" arm were noted. RESULTS: There was a significant decrease in MAP (P = 0.007) through the peri-ECT period in groups with oral clonidine pretreatment (3 microgram/kg) relative to the control group. There were no significant differences in heart rate and peripheral oxygen saturation values between two groups. The duration of motor seizure activity was similar between the clonidine pretreatment and placebo groups. CONCLUSIONS: We conclude that oral clonidine 3 microgram/kg as a pretreatment medication is effective in attenuating the MAP increase in routine ECT.

Comparison of the Effects of Propofol and Isoflurane Anesthesia on Respiratory Gas Exchange during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Introduction of a pneumoperitoneum using CO2 is accompanied by significant alterations in respiratory function and pulmonary gas exchange during laparoscopic cholecystectomy. Previous studies have shown differing results concerning pulmonary gas exchange: a significant decrease of PaO2 was induced with isoflurane. In contrast, no significant changes were observed with propofol. The purpose of the present study was to compare the effects of propofol vs isoflurane on pulmonary gas exchange during general anesthesia for laparoscopic cholecystectomy. METHODS: Forty patients were divided randomly between isoflurane and propofol groups. After induction of anesthesia, ventilation was controlled and intra-abdominal pressure was maintained automatically at 12 mmHg by a CO2 insufflator. After the measuring of baseline values of blood pressure, heart rate, PaO2, PaCO2 and PetCO2 before CO2 insufflation, measurements were also made immediately, 30min after CO2 insufflation and 5 min after CO2 exsufflation. RESULTS: In the isoflurane group, PaCO2, PetCO2, PaO2, and P(a-et)CO2 changed significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). In the propofol group, PaCO2 and PetCO2 increased significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05), but PaO2 and P(a-et)CO2 remained constant. When the two groups were compared, there were significant differences in PaO2, PaCO2, PetCO2 and P(a-et)CO2 at 30min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). CONCLUSIONS: These results indicate that during laparoscopic cholecystectomy the PaO2 was significantly lower and PaCO2 and P(a-et)CO2 were significantly higher in the isoflurane group compared with the propofol group.

The Study of Priming with Vecuronium and Atracurium on Young and Elderly Patients / 대한마취과학회지

BACKGROUND: Succinylcholine is the muscle relaxant of choice for rapid endotracheal intubation, but may produce many side effects such as hyperkalemia, myalgia, increase intraocular pressure. Nondepolarizing muscle relaxants were used instead of succinylcholine, still late onset time was be dangerous. For this reason, priming principle was reported and applied to rapid intubation using nondepolarizing muscle relaxation. We studied the effect of priming with vecuronium and atracurium on elderly and young patients. METHODS: We were randomly assigned 40 patients and observed the effects of priming doses of vecuronium (0.01 mg/kg) and atracurium (0.05 mg/kg). Ten young (20-35 yrs) and ten elderly (65-75 yrs) patients were each placed in vecuronium and atracurium group. Arterial blood gas analysis and train of four (TOF) were determined before priming. All tests were performed again 4 min after vecuronium and 3 min after atracurium. We asked for symptoms and signs of muscle weakness. RESULTS: In arterial blood gas analysis and TOF ratio were decreased in both groups. There is no significant difference between two groups in all tests. PaO2 and TOF ratio were reduced more in elderly patients, significantly (P<0.05). Symptoms and signs of muscle weakness such as ptosis, dizziness, diplopia, swallowing difficulty and respiratory difficulty in elderly patients were more frequent than in young patients. CONCLUSIONS: Priming doses of vecuronium and atracurium produced greater decrease in muscle strength, PaO2 and TOF ratio in the elderly than in their younger counterparts. So using priming method in elderly patients, we need adequate pre-oxygenation and thorough monitoring before endotracheal intubation.

The Influences of the Bispectral Index and Hemodynamics during Induction of Anesthesia with Propofol and/or Midazolam / 대한마취과학회지

BACKGROUND: The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. In this study, we measured BIS, blood pressure (BP) and heart rate (HR) during induction of anesthesia (IA) with propofol, with and without midazolam pretreatment. METHODS: A study design was used in 20 ASA physical status 1 and 2 patients aged from 18 to 60 years undergoing short (2 h) operation times. In the control group (group 1, n = 10), propofol 12 mg/kg/h was infused continuously after propofol 2 mg/kg as an intravenous bolus for IA preceded by normal saline. In group 2 (n = 10), propofol 12 mg/kg/h was infused continuously after half-strength propofol 1 mg/kg as an intravenous bolus for IA preceded by 0.1 mg/kg midazolam 2 min before. Patients received intravenous propofol for IA over 40 seconds. During the infusion, vecuronium (0.15 mg/kg) was given 3 5 min before intubation. The assistant and controlled ventilation were maintained with 100% oxygen over 5 min, and continued until BIS decreased to 40 and intubation was called for. The BIS, BP and HR were measured 2 min after midazolam or normal saline infusion, 3 5 min after propofol with vecuronium and 1, 3 and 5 min after endotracheal intubation. RESULTS: The midazolam pretreatment produced transient decreases in systolic BP and the BIS. During IA with propofol, BP decreased 20% in both groups. BIS decreased significantly 5 min after endotracheal intubation. CONCLUSIONS: Midazolam pretreatment attenuated the cardiovascular response to intubation, so BIS is considered a good monitor as a predictor of hypnotic state during intravenous anesthesia.

The Effect of Lidocaine, Verapamil and Lidocaine-Verapamil Combination on Blood Pressure and Heart Rate following Tracheal Extubation / 대한마취과학회지

BACKGROUND: Tracheal extubation, as well as intubation, causes hypertension and tachycardia. The aim of this study was to compare the effect of verapamil, lidocaine to lidocaine-verapamil combination in attenuating the cardiovascular changes following tracheal extubation and emergence from anesthesia. METHODS: Eighty patients (ASA physical status 1) were randomly assigned to one of four groups (n=20 each) ; saline (control), 1 mg/kg lidocaine, 0.05 mg/kg verapamil and lidocaine-verapamil combination. These medication were given intravenously 2 min before tracheal extubation. Changes in blood pressure and heart rate were measured following tracheal extubation. RESULTS: Lidocaine, verapamil and their combination all attenuated the changes of heart rate and blood pressure. The inhibitory effect on changes of heart rate and blood pressure were miximum in group of the combination of lidocaine and verapamil. CONCLUSION: We conclude that the verapamil 0.05 mg/kg and lidocaine 1 mg/kg given iv concomitantly 2 min before tracheal extubation is a more effective prophylaxis than verapamil or lidocaine for attenuating the cardiovascular changes associated with tracheal extubation.

Response to Capsaicin and Changes in Sodium Currents in Dorsal Root Ganglion Neurons of Neuropathic Rats / 대한마취과학회지

BACKGROUND: Allodynia, one of the most debilitating symptoms of neuropathic pain syndromes, can be defined as `pain due to a stimulus that does not normally provoke pain'. Subsets of dorsal root ganglion (DRG) neurons involved in nociception are characteristically expressed capsaicin sensitivity and high proportion of tetrodotoxin resistant sodium current (TTX-R INa). We performed an experiment to elucidate whether nerve injury induced mechanical allodynia could be resulted from elctrophysiological modulation of large, nonnociceptive afferent neurons to nociceptors. METHODS: Whole cell patch clamp recordings were made from acutely dissociated dorsal root ganglion (DRG) neurons of normal and experimental neuropathic rats. We compared the proportion of capsaicin sensitive neurons which responded to capsaicin (1micrometer) with an inward current > or = 100 pA in amplitude and the proportion of sodium channel subtypes measured in the absence and presence of tetrodotoxin (1micrometer), in small and large DRG neurons. RESULTS: The proportion of capsaicin sensitive cells to total number of cells tested was not changed by nerve injury in both small and large cell populations. In large cell population of nerve injured rats, the proportion of TTX-R INa was significantly increased as compared with normal group (p <0.05), and in small cell population of nerve injured rats, TTX-S INa was increased, but there was no statistical significance. CONCLUSIONS: These data indicate that expression of the sensitivity to capsaicin in DRG neurons would not be altered by nerve injury and increased TTX-R INa in large cell population of nerve injured DRG may underlie increased excitability.

Effects of Capsaicin on the Primary Sensory Neurons in Rat / 대한마취과학회지

BACKGREOUND: Capsaicin acts specifically on a subset of primary sensory neurons involved in nociception. In addition to its excitatory actions, capsaicin can have subsequent antinociception and anti-inflammatory effects due to pharmacological, functional desensitization and axonal degeneration. Because capsaicin has selective actions on unmyelinated C and thinly myelinated Adelta primary sensory neurons, it can be speculated that intrathecally adminstered capsaicin results prolonged analgesia without adverse effects related to the destruction of the nonnociceptive nerve fibers. METHODS: We performed experiments to investigate the effects of capsaicin on electrophysiological responses of acutely dissociated rat dorsal root ganglion neurons and pain-like behaviors, such as tail flick responses to hot water (53 degrees), formalin-induced hyperalgesic responses and allodynic responses induced by peripheral nerve injury. RESULTS: Capsaicin affects preferentially small- to medium-diameter rat dorsal root ganglion neurons. In capsaicin responsive cells, superfusion with capsaicin evoked membrane potential depolarization and large inward currents. Cellular excitablity was continuously suppressed even after 3 min wash-out. Intrathecally administered capsaicin had no effect on tail withdrawal latencies, but flinching responses induced by subcutaneous formalin and allodynic responses induced by peripheral nerve injury were suppressed by capsaicin. CONCLUSIONS: The results suggest that capsaicin which acts on primary sensory neurons carrying nociceptive information is effective in managing pain induced in a pathological condition, such as inflammatory and neuropathic pain. The data may also be applicable for seeking novel pharmacological strategies for managing intractable pain, i.e. chemical neurolysis.

The Effects of Prostaglandin I2, Prostaglandin E1, and Nitroglycerin on Hemodynamics and Blood Gas Exchanges in Pulmonary Hypertension in Dogs / 대한마취과학회지

BACKGREOUND: The ideal drug for treatment of pulmonary hypertension would be a vasodilator which acts preferentially on the pulmonary vascular bed. The aim of this study was to compare the effects of prostaglandin I2 (PGI2) on central hemodynamics and right ventricular function with the more widely used vasodilators, prostaglandin E1 (PGE1) and nitroglycerin (NTG) and to investigate whether PGI2 is more selective to the pulmonary vascular bed compared with PGE1 and NTG in dogs. METHODS: We have used a method for producing sustained pulmonary hypertension in vivo by continuous infusion of U46619 adjusting the infusion rate until a mean pulmonary artery pressure (PAP) exceeded 25 mmHg. And the pulmonary and systemic effects of the three pulmonary vasodilators were compared at doses producing equivalent, lowered approximately 20% of mean arterial pressures (MAP) or mean PAP returned to baseline. RESULTS: After infusion of the three vasodilators, heart rate, cardiac output, and mean PAP/MAP ratio were significantly increased, but there was no statistical significant differences among the three vasodilators. PGI2 and PGE1 significantly increased (worsened) the PVR/SVR ratio, but NTG decreased. However there was no significant difference among the three vasodilators. After infusion of the three vasodilators, the arterial oxygen tension (PaO2), mixed venous oxygen tension (PO2), O2 deliver, and O2 uptake were increased, and shunt ratio (s/t(%)) were significantly decreased, but there were no significant differences among three vasodilators. CONCLUSIONS: PGI2, PGE1, and NTG all decreased both PVR and SVR. None of these vasodilatorswere more selective to the pulmonary vascular bed, myocardial performance, and improved gas exchange.

Effect of Lidocaine and Ketamine Pretreatment on Vascular Pain Associated with Intravenous Propofol Injection / 대한마취과학회지

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of ketamine pretreatment on propofol injection pain. METHODS: Ninety healthy female patients scheduled for general anesthesia were randomly divided into three groups; saline group (n=30), lidocaine group (n=30) and ketamine group (n=30). Each patient received 2 ml of pretreatment solution (normal saline, 1% lidocaine, 0.5% ketamine) via 18G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, followed by intravenous injection of 2.5 mg/kg of propofol. The assessment of pain was made at the induction of anesthesia and in the recovery room, and the severity of pain was classified as none, mild, moderate, severe by one observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine group and the ketamine group compared with the saline group at the induction of anesthesia (p<0.05) and there was no significant difference between the lidocaine group and the ketamine group. We had similar results in the recovery room and one patient from the saline group and the ketamine group had no recall regarding injection pain. CONCLUSION: Intravenous ketamine pretreatment is as effective as intravenous lidocaine pretreatment in alleviating the propofol injection pain.

Antinociceptive Effects of Intrathecal Morphine and NMDA Receptor Antagonists, MK 801 and CPP, on the Formalin Test in Rats / 대한마취과학회지

BACKGROUND: It is emphasized that repetitive stimulation of small diameter afferent fibers produces a progressive increase in the action potential discharge and a prolonged increase in the excitability of neurons in the spinal cord following the stimulus and that this facilitatory component has a unique pharmacology. To investigate the behavioral parallels of this spinal facilitation, we evalusted the antinociceptive effects of intrathecal morphine, N-methyl-D-aspartate(NMDA), (+)-5-methyl-10,11- dihydro-5H-dibizo(a,d) cycloheptene-5, 10-imine hydrogen maleate(MK801) and (+/-)-3-(2-carboxy- piperazine-4-yl)-propyl-I-phosphonic acid(CPP), on the formalin test in rats. METHODS: Four to six days after chronic lumbar intrathecal catheterization, normal saline, morphine(0.1 to 30 ug), MK801(0.1 to 10 ug), CPP(0.1 to 5 ug) or NMDA(10 or 100 ng) were administered intrathecally before formalin injection. Spontanesous flinches were observed at 1-2 and 5-6 min(phase 1) and at 10 min intervals thereafter for 50 min(phase 2) after subcutaneous formalin injection into the dorsum of the right hind paw for each drug treated rats. RESULTS: Intrathecal morphine produced dose dependent inhibition of the phase 1 and phase 2 response(ED50=0.63 ug and 0.37 ug, respectively). Intrathecal MK801(0.1 to 10 ug) and CPP(0.1 to 5 ug) inhibited the phase 2 response more strongly than phase 1 response and inhibition of the phase 2 response(P0.7). Relative potencies of MK801 and CPP when compared with morphine were 1.34 and 0.41, respectively. CONCLUSIONS: This study suggests that intrathecal morphine and NMDA receptor antagonist(MK801 and CPP) have an antinociceptive effect on pathological pain mediated by central sensitization and that NMDA receptor antagonists can be utilized selectively in the treatment of components of central sensitization.

Malignant Hyperthermia During General Anesthesia: A case report / 대한마취과학회지

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia, skeletal muscle rigidity, tachycardia, respiratory and metabolic acidosis, cyanosis etc. Any inhalation anesthetic agent or any skeletal muscle relaxant can trigger this acute catastrophic reaction. This case is presented of a 37 year old female patient in whom total gastrectomy was planed to perform under oxygen-nitrous oxide-isoflurane anesthesia with induction by thiopental sodium and succinylcholine. When administer of succinylcholine to induction, the jaw was very tight and the mouth was impossible to open. We retried with vecuronium and the jaw was slightly resistant to opening, but intubation was successfully performed. After induction, hyperpyrexia, tachycardia, increased end-tidal carbon dioxide developed. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient was treated successfully with early detection and intensive care. According to decrease of temperature and normalization of arterial blood gas, the procedure continued with nontriggering agent, fentanyl. The etiologic factors, clinical features, treatment and preventive measures of malignant hyperthermia are discussed.

Effects of Balloon on the Development of Epistaxis and Impingement during Nasotracheal Intubation / 대한마취과학회지

BACKGROUND: Nasotracheal intubation may cause epistaxis, displacement of adenoids, polyps and intranasal foreign bodies, and bacteremia. So, the goal of this study is to see whether nasotracheal tube with balloon could reduce the incidences of epistaxis and impingement during nasotracheal intubation or not. METHODS: Eighty patients of ASA 1 or 2 classification, scheduled for oromaxillary surgical procedures, were randomly classified into two groups. 40 patients of each group received either nasotracheal RAE(Ring-Adair-Elwyn) tube only or nasotracheal RAE tube with balloon. Esophageal stethoscope was used to provide balloon. Each group was subdivided into two, one with intranasal spray of epinephrine solution 1:50,000 and the other one without intranasal spray of epinephrine solution. Intranasal spray of epinephrine was performed just before intubation. The incidences of epistaxis and the feeling of smooth passage of nasotracheal tube were compared between two groups. RESULTS: During nasotracheal intubation using nasotracheal RAE tube, 18 out of 40 patients without balloon and 9 out of 40 patients with balloon (P<0.05) were seen with epistaxis. Impingement during intubation was felt in 15 patients of group without balloon and in 7 patients of group with balloon (P<0.05). Those results did not differ significantly between the subgroups with and without intranasal spray of epinephrine solution. CONCLUSIONS: We concluded that nasotracheal RAE tube with balloon reduce the incidences of epistaxis and impingement during nasotracheal intubation, but intranasal spray of epinephrine solution 1:50,000 show no influence to reduce the incidence of epistaxis.

Effect of 10% Pentastarch Preloading on Hemodynamic Changes during Transurethral Resection of Prostate (TURP) under Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Isotonic crystalloid solutions have been intravascularly administered before spinal anesthesia for prevention of spinal anesthesia induced hypotension in TURP, however many investigators have suggested that synthetic colloids administered before spinal anesthesia is more effective than equal volume of crystalloid solutions. In this study, effect of 10% pentastarch comparing with eqaul volume of crystalloid solution before spinal anesthesia on cardiovascular response were examined. METHODS: 30 patients undergoing elective TURP were randomly allocated to receive either 7 ml/kg of isotonic saline (saline group) or 7 ml/kg of 10% pentastarch (pentastarch group) for 15 minutes before spinal anesthesia. Blood pressure, heart rate and central venous pressure (CVP) were measured before and after operation. RESULTS: In pentarstarch group, systolic blood pressure and CVP were significantly higher than saline group untill 55minutes and 15 minutes after spinal anesthesia respectively. CONCLUSIONS: 10% pentarstarch administered before spinal anesthesia is more effective than equal volume of isotonic saline in TURP with respect to preserving blood pressure and CVP.

The Effects of Sodium Nitroprusside on Platelet Aggregation Function during Intracranial Aneurysm Operation under Isoflurane Anesthesia / 대한마취과학회지

BACKGROUND: The intravenous infusion of sodium nitroprusside is widely used as a means of producing deliberate hypotension in a variety of clinical situations. However, sodium nitroprusside reported to inhibit platelet aggregation. So we studied the effects of sodium nitroprusside on platelet function in patients undergoing intracranial aneurysm surgery with isoflurane anesthesia. METHODS: Platelet rich plasma from the patients receiving sodium nitroprusside was studied for aggregation in response to adenosine diphosphate, epinephrine and collagen. Maximum aggregation rate and maximum aggregation time were evaluated from the samples collected at pre-sodium nitroprusside infusion, 30min and 90min after sodium nitroprusside infusion, respectively. At the same time, bleeding time was measured. RESULTS: The mean maximum aggregation rate of adenosine diphosphate, epinephrine and collagen at pre-sodium nitroprusside infusion decreased significantly 30min and 90min after sodium nitroprusside infusion, respectively(P<0.05). But the maximum aggregation time showed no significant change. Prolongation of bleeding time was not observed after sodium nitroprusside infusion. Correlation between the total sodium nitroprusside dose delivered and the maximum aggregation rate of adenosine diphosphate, epinephrine and collagen were significant (r=0.797(P<0.05), r=0.732 (P<0.05) and r=0.737(P<0.05)). CONCLUSIONS: In situation where sodium nitroprusside is administered for deliberate hypotensive anesthesia during intracranial aneurysm operation, the platelet aggregation was inhibited by sodium nitroprusside. However, bleeding time was not prolonged.

Comparison of Wakefulness during Cesarean Section after Anesthetic Induction with Thiopental Sodium or Propofol / 대한마취과학회지

BACKGROUND: Experience of wakefulness and pain perception during general anesthesia can be distressful to patients. For cesarean section, a light plane of general anesthesia is chosen for fetal safety and rapid recovery; there is an increased incidence of maternal wakefulness. Propofol may be the choice if smooth induction and rapid maternal recovery are desired. We compared propofol with thiopental sodium as an induction agent of anesthesia in cesarean section, noting in particular the patients wakefulness during operation. METHODS: Twenty six patients who underwent cesarean section received either thiopental sodium 4 mg/kg (n=13) or propofol 2.5 mg/kg (n=13) as an induction agent. To assess intraoperative wakefulness, a tourniquet was applied before the administration of succinylcholine for maintaining motor function in one arm. Wakefulness during anesthesia could be assessed by asking the patient to move her hand. RESULTS: Although the changes in blood pressure and heart rate were similar in both groups, the propofol group had a less increasing systolic blood pressure from the period immediately and 1 minute after intubation (P<0.05). The patients administered with propofol showed significantly higher incidences of "followed commands" and "made reaching movements" (P<0.05). The incidence of dreams was higher in the propofol group than thiopental sodium group. CONCLUSIONS: Propofol was similar to thiopental sodium in hemodynamic effects on mother, but incidence of intraoperative wakefulness was significantly increased in the propofol groups.

Effect of Electric Acupuncture Stimulation of PC 6 and PC 7 Antiemetic Point on Postoperative Nausea and Vomiting / 대한마취과학회지

Nausea, retching and vomiting are among the most common postoperative complaints after general anesthesia. Some effective drugs and approaches were sought to treat postoperative nausea and vomiting, but none of them abolished those complaints completely and without side-effects. We studied postoperative antiemetic effect of electric acupuncture stimulaton (EAS) on PC6 point (Neiguan, on the pericardium meridian) and PC7 point (Daling, on the pericardium meridian) before induction of anesthesia. One hundred patients (ASA I-II) scheduled for transabdominal hysterectomy were randomly selected, premedicated with glycopyrrolate, and divided into two group, the EAS-treated group (experimental group, 50 patients) and the non EAS-treated group (control group, 50 patients). For the EAS-treated group, electrical stimulation of 3Hz was applied for 15 minutes just 45 minutes prior to the induction and as for the non EAS-treated group, no EAS was applied and the incidence of nausea, retching and vomiting were blindly checked every three hours after operation for 12 hours. The incidence of postoperative nausea, retching and vomiting in EAS-treated group 3 hours after operation was 24% as compared to the non EAS-treated group, 54%(p<0.001). Between 3 hours and 6 hours after operation, it was 12% in EAS-treated group and 52% in non EAS-treated group(p<0.001), between 6 hours and 9 hours after operation, it was 26% in EAS-treated group and 64% in non EAS-treated group(p<0.001), and during 9 to 12 hours after operation, it was 28% in EAS-treated group and 60% in non EAS-treated group(p<0.001). For 12 hours after operation, the incidence of postoperative nausea, retching and vomiting in EAS group was significantly lower compared to the non-EAS group, 30% and 68%(p<0.001), respectively. Although definite mechanism is not known, it can be concluded that EAS of PC 6 and PC 7 antiemetic point is very effective in preventing postoperative nausea, retching and vomiting.

The Effects of Lidocaine and Clonidine Premedication on Cardiovascular Response during Induction of Anesthesia with Ketamine / 대한마취과학회지

Ketamine may increase blood pressure and heart rate and should be avoided in hypertensive patients. However, in hypovolemic and asthmatic patients, ketamine is used as an induction agent because of its cardiovascular stimulating effect and bronchodilating effect. This study aims to assess the effects of clonidine and lidocaine on the cardiovascular response of intravenous ketamine administration during induction of anesthesia. sixty patients were divided into 3 groups as followed: group I: control ( received no lidocaine or no clonidine) group II: received lidocaine (1.5 mg/kg IV) 3 minutes before intubation group IIl: received clonidine (0.3 mg PO) 90 minutes before induction of anesthesia The changes of blood pressure, heart rate and rate pressure product following intubation were measured at different time interval (before induction,before intubation just after intubation, postintubation 1, 3, 5, 10 min) and compared with the value of control (2 hours before induction of anesthesia). The results are as follows 1) Group I and Group II: The systolic and diastolic blood pressure increased significantly compared to the control value from preinduction to 5 minutes after intubation(p<0.05). It recovered to the control value in 10 minutes, but heart rate and rate-pressure product increased significantly for 10 minutes after intubation(p<0.05) 2) Group III: The systolic and diastolic blood pressure, heart rate and rate-pressure product of preinduction and preintubation values decreased significantly compared to control values but 1 minute after intubation,all values increased significantly(p<0.05). The systolic and diastolic blood pressure and rate-pressure product values recovered to control value in 3 minutes after intubation and heart rate recovered in 5 minutes. Comparing group III with group I and II, it showed significant changes(p<0.05). From the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia. the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia.

Effect of Clonidine Pretreatment on the Cardiovascular Toxicity Induced by Inrravenous Bupivacaine in Rabbits / 대한마취과학회지

This study was performed to evaluate the influence of clonidine pretreatment on the car- diovascular toxic effects of bupivacaine overdose induced by constant intravenous infusion. Thirty male rabbits were used for this study and they were divided into saline pretreatment group(15) and clonidine-pretreatment group(15). The changes of mean arterial pressure, heart rate and electrocardiogram by the bupivacaine-induced toxic effect during intravenous infusion of bupivacaine were observed. The results were as follows; 1. Mean arterial pressure was significantly decreased in clonidine-premedicated group compared with control group (P<0.01) before infusion of bupivacaine, but the times occuring 25% and 50% decrease of mean arterial pressure were significantly prolonged in clonidine group compared with control group (P <0.001 ). 2. Heart rate was significantly decreased in clonidine group compared with control group (P<0.01) before infusion of bupivacaine, but the times occuring 25% and 50% decrease of heart rate were significantly prolonged in clonidine group compared with control group (P< 0.001). 3. The times occuring the first QRS modification and first dysrhythmia and the final systole were significantly prolonged in clonidine group compared with control group (P < 0.001). In conclusion, clonidine given prophylactically delays the cardiotoxicity caused by bupivacaine overdose snd does not accentuate the subsequent hypotension.

Axillary Artery Occlusion Following Accidental Injection of Diphenylhydantion via Radial Artery Catheter / 대한마취과학회지

Direct arterial pressure monitoring by means of an intra-arterial catheter has been considered benefit for assessment of the critically ill patients, safe conduct of controlled hypotension and frequent obtaining arterial samples for blood gas analysis. However in stead of these advantages, there would be high incidence of potential complications of arterial catheterization, such as pain, trauma to the artery and surrounding tissues(e. g., nerve), hematoma, infection, thrombosis, and distal embolization of air, clot, pieces of the catheter, and other debris. We have recently experienced an unexpected episode of amputation of the upper extremity resulting from axillary arterial occlusion following accidental injection of diphenylhydantoin through the radial arterial catheter in 57 year old neurosurgical patient. To prevent these serious and unexpected complications following arterial cannulation, we have to keep a continuous interest and vigilance to those who have invasive monitorings and those who are stranger to handle the arterial cannulation.