Effects of Mivacurium in the Strips of Rat Thoracic Aortic Rings / 대한마취과학회지

BACKGROUND: The hypotensive effects of muscle relaxants has traditionally been associated with a ganglion block and histamine release. However, it was exhibited that the ability of certain analogues of the steroidal muscle relaxant directly caused relaxation of isolated vascular smooth muscles. The ability of mivacurium to elicit a direct relaxant effect on vascular smooth muscle has been studied using isolated rat thoracic aortic rings contracted with phenylephrine (PE). METHODS: Each ring of the thoracic aorta was suspended on wire supports in a 20 ml tissue bath under 2 gm of resting tension. All tissues were bathed in a Tris Tyrode solution at 37oC and 100% oxygen was supplied. RESULTS: Mivacurium 3 X 10 5 M and 10 3 M inhibited PE induced contractions of the aortic rings significantly (P < 0.05) and shifted the cumulative concentration-effect curves of PE to the right. The maximum contractile response from 81.9% to 55.0% (with PE 10 6 M) was the same as that seen with mivacurium 10 3 M pretreatment. Relaxation of aortic ring with mivacurium 10 3 M was not reversed with L-NAME pretreatment. Methylene blue reversed the relaxation of the aortic rings with mivacurium 10 3 M and shifted the cumulative concentration-effect curve of PE to the left. Indomethacine enhanced the relaxation of the aortic rings with mivacurium 10 3 M and shifted this curve to the right. Mivacurium 10 3 M inhibited the influx of extracellular Ca2+. CONCLUSIONS: The results suggest that the relaxation effects of mivacurium is related with the endothelium and at least, in part, cyclooxygenase inhibition and guanylate cyclase activation are related with this relaxation effect. Also, mivacurium inhibited extracelluar calcium influx.

The Parascalene Technique of Brachial Plexus Block for the Operation of the Upper Extremity and Shoulder / 대한마취과학회지

BACKGROUND: Brachial plexus is invested by a fascial envelope, which forms a perineural and perivascular space that extends all the way from the cervical intervertebral foramen to the distal axilla. Therefore a single injection of a local anesthetic into any sites of this space can provide anesthesia of the entire brachial plexus. Nowadays many methods of brachial plexus block have been developed but there are some severe complications and they can't prevent tourniquet pain completely. METHODS: We have performed parascalene technique for brachial plexus block in 206 cases from Jan., 1992 to Dec.,1994. We studied the cases retrospectively by reviewing patients' anesthesia records. The technique for parascalene block is the injection of local anesthetic solution into the lower part of the posterior triangle of the neck at the point 1.5~2.0 cm above the clavicle at the lateral border of the anterior scalene muscle. RESULTS: We could provide the proper anesthesia for the upper extremity and shoulder operation without any remarkable complications except Honor's syndrome of 3 cases. And there were no tourniquet pain in all 96 cases who had used tourniquet. CONCLUSIONS: The parascalene approach is the useful, safe and reliable method for brachial plexus block.

The Effects of epidural Anesthesia to the Serum Glucose, Lidocaine Concentration and Cardiovascular System / 대한마취과학회지

In the lower abdominal surgery, it is well known that epidural anethesia inhibit endocrine response to surgical stress. We used lidocaine and morphine for epidural anesthesia and investigated the changes of serum lidocane and glucose concentration compared to general anesthesia. Also we estimated the duration of postoperative pain relief. Patients in group I received general anesthesia and patients in group II received 2% lidocaine 20 cc, patients in group III received 2% lidocaine 20 cc with morphine 4 mg. The results were as follows. 1) Blood pressure and pulse rate were increased significantly in group I but were less changed in group II and group III. 2) Blood glucose concentration increased significantly in group I but there was no significant changes in group II, group IIL 3) The duration that plasma lidocaine concentration was reached peak level was prolonged in group III but no significancy was found. 4) In group III that we adminstrated 4 mg morphine epidurally. postoperaive pain relief was sustained for about 15 hours. We conclucled that Epidural anesthesia with Morphine is more convenient during perioperative and postoperative period.

A case of holoprosencephaly / 대한산부인과학회잡지

No abstract available.

A Case of Dry Gangrenous Extremity in Septic Shock Patient / 대한마취과학회지

Progressive ischemia can result in gangrenous changes of the tissues. Most commonly the digits are affected initially, but progression to the hand is not unusual. Small amounts of infection superimposed on a severe chronic ischemic state can progress very rapidly to gangrene. Clinically, dry and wet gangrene should be differentiated. Dry gangrene represents mummification of tissue, and active purulent tissue and cellulitis are absent. Wet gangrene is characterized by active infection with cellulitis and purulent tissue planes and is an indication for urgent amputation to prevent ascending infection. We experienced a case of dry gangrenous extremity due to septic shock after anethesia.