Anti-Allodynic Effects of Levodopa in Neuropathic Rats

PURPOSE: Levodopa is the most effective anti-Parkinsonian agent. It has also been known to exhibit analgesic properties in laboratory and clinical settings. However, studies evaluating its effects on neuropathic pain are limited. The aim of the present study was to examine the anti-allodynic effects of levodopa in neuropathic rats. MATERIALS AND METHODS: Sprague-Dawley male rats underwent the surgical procedure for L5 and L6 spinal nerves ligation. Sixty neuropathic rats were randomly divided into 6 groups for the oral administration of distilled water and levodopa at 10, 30, 50, 70, and 100 mg/kg, respectively. We co-administered carbidopa with levodopa to prevent peripheral synthesis of dopamine from levodopa, and observed tactile, cold, and heat allodynia pre-administration, and at 15, 30, 60, 90, 120, 150, 180, and 240 min after drug administration. We also measured locomotor function of neuropathic rats using rotarod test to examine whether levodopa caused side effects or not. RESULTS: Distilled water group didn't show any difference in all allodynia. For the levodopa groups (10-100 mg/kg), tactile and heat withdrawal thresholds were increased, and cold withdrawal frequency was decreased dose-dependently (p0.05). CONCLUSION: Levodopa reversed tactile, cold and heat allodynia in neuropathic rat without any side effects.

Anesthetic management for the insertion of a self-expandable metallic tracheal stent under venovenous extracorporeal membrane oxygenation / 대한마취과학회지

No abstract available.

The Risk Factors of Postoperative Respiratory Insufficiency after Prolonged Robotic Radical Prostatectomy / 대한구급학회지

BACKGROUND: Robotic radical prostatectomy is performed in elderly patients and requires extreme changes in the patient's position and is often associated with a long surgery time. This study reviewed the pulmonary complications occurring after a robotic radical prostatectomy and analyzed the potential risk factors. METHODS: The medical records of all patients who had undergone robotic radical prostatectomy at our institution were reviewed. Among the 80 total patients, 58 were capable of spontaneous respiration at the end of surgery (Group I), whereas 22 patients required assisted ventilation (Group II). A comparison between the two groups was made in terms of the demographic characteristics, coexisting diseases, anesthesia and operation time, amount of intraoperative blood loss and transfused blood products. RESULTS: The mean age of the patients was 67.2 +/- 7.3 years. The mean operation time was 384.1 +/- 203.4 min (range, 195-1,180 min). The anesthesia and operation time, amount of intraoperative blood loss and number of transfused patients were all significantly higher in Group II. Univariate analysis revealed age, body mass index, intraoperative blood loss and transfusion, anesthesia and operation time to be related to postoperative respiratory insufficiency. Multivariate analysis revealed intraoperative transfusion and operation time to be predictive risk factors. CONCLUSIONS: Prolonged laparoscopic surgery in a steep Trendelenburg position has a high likelihood of postoperative respiratory insufficiency, with the intraoperative transfusion and a longer operation time being possible contributing factors.

Intra-operative refractory hypotension in patient chronically treated with renin-angiotensin system antagonists: A case report / 대한마취과학회지

Chronic treatment with renin-angiotensin system antagonists frequently causes deleterious hypotension during anesthesia. We present a case of marked intra-operative refractory hypotension in a 61-year-old male patient undergoing elective total thyroidectomy. He has been chronically treated for hypertension with angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and atenolol, which were taken until the morning of surgery. After induction of anesthesia, marked hypotension which was refractory to fluid therapy occurred and did not respond to ephedrine administration. After continuous norepinephrine infusion, blood pressure increased and remained stable during the anesthesia period. Before extubation, norepinephrine was discontinued and recovery took place without complications. We discuss the anesthetic implication of chronic renin-angiotensin system antagonists treatment and intra-operative hemodynamic instability.

C-arm guided placement of Fogarty embolectomy catheter for one lung ventilation in an infant: A case report / 대한마취과학회지

We experienced one lung anesthesia using Fogarty embolectomy catheter as a bronchial blocker in an infant undergoing thoracotomy for foreign body removal. For the guidance of catheter placement in left mainstem bronchus, C-arm fluoroscopy was used. Size of catheter and its balloon was decided beforehand by measuring the diameter and length of bronchus based on the view obtained from computerized tomography. There was no accidental episode during anesthesia. C-arm fluoroscopy is safe and useful method to decide the position of Fogarty occlusion catheter in an infant.

The Effects of Lidocaine, Bupivacaine or Combined with Enflurane on the Contraction of Tracheal Smooth Muscle in Guinea Pig / 대한마취과학회지

BACKGROUND: The effects of local and inhalation anesthesia on the contraction of the tracheal smooth muscle have been reported. However, when inhalation and local anesthesia are administered simultaneously, their effects on the contraction of the airway smooth muscle are not well known. Therefore, this study evaluated the effects of lidocaine, bupivacaine, with or without enflurane, on the histamine induced tracheal smooth muscle contraction in guinea pigs. METHODS: Isolated tracheal rings of guinea pigs were suspended in Krebs solution. The contractions were recorded isometrically using a transducer. A contraction was induced by histamine (10(-5) M). Enflurane (1 MAC) was administered for 15 min after administering the histamine. The cumulative dose responses of the lidocaine and bupivacaine (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M, 10(-4) M, and 10(-3) M), enflurane-lidocaine and enflurane-bupivacaine groups were checked. RESULTS: The contraction by histamine were inhibited by lidocaine (10(-4) M and 10(-3) M) and bupivacaine (10(-5) M, 10(-4) M and 10(-3) M). In addition, the contractions were inhibited more significantly in the bupivacaine group (10(-7) M, 10(-6) M, 10(-5) M, 10(-4) M and 10(-3) M) after administering enflurane. CONCLUSIONS: Lidocaine and bupivacaine inhibited the contractions induced by histamine. The contractions by bupivacaine were further inhibited after administering enflurane.

The Effects of Heparin and Protamine on Contraction of Tracheal Smooth Muscle Induced by Carbachol in the Guinea Pig / 대한마취과학회지

BACKGROUND: Several reports have indicated that heparin has a bronchodilative effect in asthma patients, and that it enhances airway smooth muscle contraction in vitro, protamine is known to inhibit or enhance contraction of tracheal smooth muscle. Thus the effects of protamine and heparin on airway smooth muscle contraction are not consistent. However, no report is available on the effects of enflurane on heparin and protamine tracheal smooth muscle contraction. We performed this study to evaluate the effects of heparin or protamine on the carbachol induced contraction of tracheal smooth muscle in the guinea pig. And we also evaluated the effects of enflurane on heparin or protamine induced tracheal smooth muscle contraction. METHODS: Isolated tracheal rings of the guinea pig were suspended in Krebs solution. Contractions were recorded isometrically using a transducer. Contraction was induced by carbachol (10-6 M) and then cumulative dose responses of heparin or protamine (0.006 mg/ml, 0.02 mg/ml, 0.06 mg/ml, 0.2 mg/ml, 0.4 mg/ml) and in heparin (E) group and protmine (E) group, enflurane (4.34%) was administered for 15 minute after carbachol adminstration. RESULTS: Contraction by carbachol was inhibited by level of heparin or protamine at concentrations of 0.2 mg/ml and 0.4 mg/ml. At an enflurane (4.34%) contraction was inhibited, and no further inhibition of contraction by heparin or protamine was observed. CONCLUSIONS: Heparin or protamine inhibited the tracheal smooth muscle contraction induced by carbachol at 0.2 mg/ml and 0.4 mg/ml, and no further significant inhibition of contraction by heparin or protamine was observed after enflurane administration (4.34%).

The Effect of Enflurane on the Tracheal Smooth Muscle Contracted with Electrical Field Stimulation in the Guinea Pig / 대한마취과학회지

BACKGORUND: inhalation anesthetics have been known as bronchodilators, and there are reports that enflurane has some relaxing effects on tracheal smooth muscles. However, there are not so many reports on the ACh release in the postganglion nerve endings. We tried to evaluate the effect of enflurane on the contraction of the tracheal smooth muscle in the postganglion nerve ending in guinea pigs. METHODS:isolated tracheal preparations of guinea pigs were used and contractions were induced by electrical field stimulation (3 Hz & 30 Hz). in the pilocarpine- enflurane group, pilocarpine (10(-5) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the gallamine-enflurane group, gallamine (10(-6) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the enflurane 1 MAC group and 2 MAC group, contractions were induced by electrical field stimulation before and after administration of enflurane. The percentile contraction to the contraction induced by acetylcholine (10(-4) M) were evaluated. RESULTS: The potentiation of the contraction which was induced by electrical field stimulation was observed by enflurane administration and with prior administration of pilocarpine (10(-6) M), with prior administration of gallamine (10(-5) M). There was no potentiation of contractions, but potentiation of the contraction was observed with enflurazne (2 MAC, 30 Hz). CONCLUSiONS:Enflurane potentiates the contraction induced by electrical field stimulation in guinea pig tracheal smooth muscle. These findings seem to be related with prejunctional M2 receptor in the postganglionic nerve endings.

Severe Hypercarbia by Subcutaneous Emphysema Occurring during Hand Assisted Laparoscopic Donor Nephrectomy: A case report / 대한마취과학회지

Hand assisted laparoscopic donor nephrectomy (HALDN) has recently emerged as a very attractive modality in standard donor nephrectomy because of its many advantages. However, it also has disadvantages, which include gas emboli, subcutaneous emphysema, hypercarbia, pneumothorax and pneumomediastinum. This case involves a male patient who had suffered from temporary hypercarbia due to increased carbon dioxide absorption due to massive subcutaneous emphysema about 1 hour after pneumoperitoneum during HALDN. Following multiple skin punctures with an 18 G disposable needle, chest compliance and blood gas findings improved. Three hours later the operation ended successfully and he was transferred to the recovery room, and show no further problems. We report upon this clinical experience and include a brief review of the literature.

Effects of Oxcarbazepine on Mechanical and Cold Allodynia in a Neuropathic Rat Model / 대한마취과학회지

BACKGROUND: It is well known that anticonvusant drugs such as carbamazepine are effective in the management of various neuropathic pain conditions. Oxcarbazepine, a keto analogue of carbamazepine, might also be expected to have an analgesic effect because it is a derivative of carbamazepine. The aim of this study is to evaluate the analgesic effect of oxcarbazepine in a rat neuropathic pain model. METHODS: Male Sprague-Dawley rats were prepared by tightly ligating the L5 and L6 spinal nerves to reproduce neuropathic pain. Sixty neuropathic rats were randomly assigned into 6 groups for the intraperitoneal administration of drugs. Normal saline, vehicle (polyethylene glycol 400), oxcarbazepine (10 mg/kg, 20 mg/kg, 30 mg/kg and 50 mg/kg) were administered respectively to the individual groups. We examined mechanical and cold allodynia preadministration, and 15, 30, 60, 90, 120, 150 and 180 min after intraperitoneal drug administration. Mechanical allodynia was quantified by measuring the withdrawal frequency to stimuli with two von Frey filaments of 35.6 mN and 115.2 mN. Cold allodynia was quantified by measuring the frequency of foot lift to 100% acetone. Pain behavior may be influenced by the adverse effects of anticonvulsants, which include sedation, motor incoordination. We therefore measured the locomotor function of the neuropathic rats by using the rotarod test. RESULTS: The vehicle group showed no significant differences in the mechanical and cold allodynia versus the saline group. In the oxcarbazepine-treated groups, withdrawal frequencies to mechanical and cold stimuli were significantly reduced versus the pre-administration values and versus the vehicle group. The duration of antiallodynic effects increased dose-dependently, and these were maintained for 150 min at the highest dose. Only at the highest dose (50 mg/kg) did oxcarbazepine reduce the rotarod performance time. CONCLUSIONS: We conclude that oxcarbazepine reduces mechanical and cold allodynia in a rat neuropathic pain model and may be a candidate for the management of neuropathic pain.

Effects of Neostigmine on Tracheal Smooth Muscle Contraction in Rabbits / 대한마취과학회지

BACKGROUND: Neostigmine, a cholinesterase inhibitor, is known to reverse the neuromuscular blocking action induced by nondepolarizing muscle relaxants at the end of general anesthesia. Some authors, however, reported that neostigmine has the properties of a neuromuscular block in skeletal muscles while others reported that neostigmine caused the smooth muscles such as the diaphragm to relax rather than to contract. The purpose of this study was to evaluate the effect of neostigmine at different doses on the tracheal smooth muscle in rabbits. METHODS: Isolated tracheal ring preparation in rabbits was used. Groups were divided into 7 groups; acetylcholine group (acetylcholine cumulative administered at doses of 10 8, 10 7, 10 6, 10 5, 10 4 and 10 3 M), neostigmine group (neostigmine cumulative administered at doses of 10 8, 10 7, 10 6, 10 5, 10 4 and 10 3 M), acetylcholine 10 6 M + neostigmine group (acetylcholine 10 6 M prior to neostigmine administered at doses of 10 8, 10 7, 10 6, 10 5, 10 4 and 10 3 M), acetylcholine 10 4 M + neostigmine group (acetylcholine 10 4 M prior to neostigmine administered at doses of 10 8, 10 7, 10 6, 10 5, 10 4 and 10 3 M), neostigmine 10 5, 10 4 and 10 3 M groups (neostigmine administered at doses of 10 5, 10 4 and 10 3 M). Smooth muscle contraction was evaluated in isometric tension per gram of tissue. RESULTS: In the acetylcholine group, the contractions increased as the dosage increased (10 8 10 3 M). In the neostigmine group, the contractions increased as the dosage increased (10 8 10 4 M), but at 10 3 M of neostigmine, contractions suddenly decreased. In addition when acetylcholine 10 6 M was given as a pretreatment, there was a sudden decrease in muscle contractions induced by neostigmine at 10 3 M. Also the contractions induced by 10 3 M neostigmine were less than that of 10 4 and 10 5 M. CONCLUSIONS: We concluded that neostigmine caused smooth muscle contraction at low concentrations by blocking acetylcholine metabolism, but at high concentrations, smooth muscle contractions were decreased and this might be due to direct action at the acetylcholine receptor.

The Effect of Halothane and Enflurane on the Aorta Contracted with Phenylephrine in Rabbits / 대한마취과학회지

BACKGROUND: Inhalation anesthetics have been known as vasodilators, but there are several reports that halothane and enflurane have different effects on vascular smooth muscles. Vasodilatation and vasoconstriction were observed in different vessels in the same animal. We tried to observe the effect of halothane and enflurane on the contraction of the aorta in rabbits. METHODS: Isolated tracheal preparations of rabbits were used. Halothane (1.4%) and enflurane (1.4%, 2.8% and 5%) were administered after contractions induced by phenylephrine (10(-7) M), and verapamil (10(-7), 10(-6), 10(-5), 10(-4), and 10(-3) M) was administered. In the verapamil pretreated group, after a phenylephrine (10(-7) M) induced contraction, verapamil (10(-7) M) and enflurane (2.8% and 5%) were administered. The percentile contraction to the contraction induced by phenylephrine was evaluated. RESULTS: The potentiation of the contration by phenypephrine was observed by halothane and enflurane administration and these potentiations disappeared with the adminstration of verapamil. With prior administration of verapamil, there was no potentiation of the contraction by enflurane. CONCLUSIONS: Halothane and enflurane potentiates the contraction induced by phenylephrine in rabbit aortas. In addition, the influx of extracellular calcium seems to play a role in this potentiation of the contraction.

The Effect of Halothane and Enflurane on the Contraction of Bronchial Smooth Muscle Induced by Histamine in Rabbits / 대한마취과학회지

BACKGROUND: Inhalation anesthetics are known to be bronchodilators. However there are several reports that these effects are not consistant, and depend on the way of experiments. Some reports showed that inhalation anesthetics don't affect broncheal smooth mucle contraction. So, we tried to evaluate the effects of inhalation anesthetics on the histamine induced contraction of broncheal smooth muscles in rabbits. METHODS: Isolated broncheal rings of rabbit were suspended in a Tyrode's solution. Contractions were recorded isometrically using a transducer. Cumulative dose responses of histamine (10(-6), 10(-5) & 10(-4) Mol, histamine group) were observed and also cumulative dose responses of histamine with halothane and enflurane administration (0.5 MAC & 1 MAC) were evaluated. RESULTS: A contraction by histamine was weakened with enflurane administration, but with halothane, the contraction was slightly weakened at 0.5 MAC and no changes were observed at 1.0 MAC compared to a contraction induced by histamine. CONCLUSIONS: At 0.5 MAC of halothane, a contraction induced by histamine was slightly weakened, but at 1 MAC, no changes of contraction occurred. However enflurane weakened the contraction at 0.5 MAC and 1 MAC. It showed that in vitro studies of the direct effect of inhalation anesthetics on smooth muscle contraction are different from the results of in vivo study reports.

Comparative Effects of Propofol vs Enflurane on Cardiopulmonary Change during Transthoracic Endoscopic Sympathectomy / 대한마취과학회지

BACKGROUND: Respiratory function and pulmonary gas exchange are affected in thoracoscopic procedures where a pneumothorax is introduced using CO2. Carbon dioxide absorption into the blood during thoracoscopic surgery using intrathoracic carbon dioxide insufflation may lead to respiratory acidosis, increased ventilation requirements, and possible serious cardiovascular compromise. In the present study, the effects of propofol on pulmonary gas exchange were compared with those of enflurane in patients undergoing transthoracic endoscopic sympathectomy (TES) during standard tube ventilation with CO2 insufflation to the surgical side in a prospective randomised manner. METHODS: Sixteen patients with ASA physical status I were divided randomly into enflurane or propofol groups. After induction of anesthesia, patients were ventilated in the same mode in each group. Heart rate and mean arterial pressure were checked and blood gas analyses were performed at 3 time points: 10 min after induction of anesthesia (stage 1), 10 min after CO2 insufflation to the surgical side (stage 2), 10 min after CO2 desufflation from the surgical side (stage 3) under two lung ventilation during TES. RESULTS: Arterial oxygen tension (PaO2) did not differ significantly between enflurane and propofol groups and showed no difference among each stage. PaCO2 and end-tidal CO2 (PetCO2) increased significantly at stage 2 compared to stage 1 and then decreased significantly at stage 3 compared to stage 2 (P < 0.05). There were no significant changes in the mean arterial pressure throughout the procedure with CO2 insufflation in both groups, whereas heart rate was significantly lower in the propofol group than in the enflurane group (P < 0.05) at each stage. CONCLUSIONS: This study demonstrates that pulmonary gas exchange in patients with TES using standard tube ventilation with CO2 insufflation to the surgical side is not affected by choice of anesthesia.

Clinical Evaluation of Serum Magnesium Concentration and Its Related Effects after Prophylactic MgSO4 Administration during Orthotopic Liver Transplantation / 대한마취과학회지

BACKGROUND: Mg++ is an important control factor for transport of K+, Na+, Ca++ and also has been known for having an antiarrhythmic and inotropic action on the heart. Orthotopic liver transplantation is a complex surgical procedure with significant physiologic alterations resulting in electrolyte imbalances. Therefore, the goal of this study was to evaluate the effects of prophylactic MgSO4 administration on intraoperative serum magnesium concentration and its related clinical outcomes. METHODS: 19 patients receiving liver transplants were divided into two groups. Both groups received normal saline (300 ml/3 hr) right after anesthetic induction. MgSO4 (35 mg/kg) was mixed with saline in the experimental group but not in the control group. Serum magnesium concentration was measured four times during surgery. We also checked the total transfused units of packed cells and CaCl2 requirement, the severity of postreperfusion syndrome and base deficit. RESULTS: Serum magnesium concentration significantly decreased in the control group at the postanhepatic stage. The experimental group showed less prominent symptoms of postreperfusion syndrome and less need for potassium supply, but both groups did not reveal any differences in the amount of transfusion and CaCl2 requirement. CONCLUSIONS: We confirmed that our prophylactic administration of MgSO4 (35 mg/kg) may be considered a safe dose showing not only prevention of hypomagnesemia but also a decrease in the potassium requirement and in the severity of postreperfusion syndrome. However, routine administration of MgSO4 might cause disadvantageous effects, so more appropriate indications can be prepared after further clinical research.

Effect of Bilateral Superior Cervical Sympathectomy on Focal Cerebral Infarction Induced by Autologous Blood Clot in Rabbits / 대한마취과학회지

BACKGROUND: Many reports suggest that cervical sympathectomy improves cerebral blood flow. But the basal & medial areas of brain are innervated bilaterally, so unilateral sympathectomy may not improve the outcome of infarction of those areas effectively. Actually it was reported that only bilateral, not unilateral cervical sympathectomy increased the blood flow of thalamus which known to be innervated bilaterally, and also reported that unilateral sympathectomy did not reduce the infarct size of caudate nucleus. So we studied the effect of bilateral superior cervical sympathectomy on focal cerebral infarction. METHODS: Twenty rabbits were divided into two groups. In the sham-operated control group (n=10), focal infarction was achieved by administering an autologous blood clot into the internal carotid artery after exposure of bilateral superior cervical sympathetic ganglia. In the sympathectomy group (n=10), bilateral superior cervical sympathetic ganglia were excised following embolization. Seven hours after embolization, brains were sliced into 2 mm coronal sections, stained with 2,3,5-triphenyltetrazolium chloride, and infarct sizes were determined via image analysis. RESULTS: There were no differences in the physiologic variables between two groups. The percentage of infarct size was significantly greater in the control group as compared to the sympathectomy group in both cortex (23+/-8% vs 12+/-5%, respectively; P<0.05) and subcortical area (35+/-8% vs 17+/-8%, respectively; P<0.05). CONCLUSIONS: These results suggest that bilateral superior cervical sympathectomy may reduce the infarct size of subcortical area as well as of cerebral cortex measured at 7 hours following induction of focal cerebral infarction.

Acute Respiratory Failure after Embolectomy in Patient with Chronic Pulmonary Embolism: A case report / 대한마취과학회지

Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism. In desperated cases, however, pulmonary embolectomy is recommended despite its high mortality rate. We experienced acute respiraory failure after embolectomy performed under cardiopulmonary bypass in patient with chronic massive pulmonary embolism. The patient recovered sucessfully with postoperative management in the intensive care unit.

The Effects of Atropine and Glycopyrrolate on the Recovery from Mivacurium: Induced Neuromuscular Blockade in the Rabbit / 대한마취과학회지

BACKGROUND: Antimuscarinic agents are used to block undesirable muscarinic effects of `anticholinesterase given to reverse the residual neuromuscular blockade produced by muscle relaxants. However, besides antimuscarinic effects, atropine was known to have some positive effects on the recovery from neuromuscular blockade by acting at the presynaptic muscarinic receptor of the neuromuscular junction. But there have been few reports about the neuromuscular effects of glycopyrrolate. So we observed the neuromuscular effects of atropine and glycopyrrolate, and compared two. METHODS: Mivacurium(0.064 mg/kg) was administered intravenously and the experimental groups were divided into 5 groups: the control group (no antimuscarinic agent administered), Al group (0.02 mg/kg atropine administered), A2 group (0.04 m atropine administered), Gl group (0.01 mg/kg glycopyrrolate administered) and G2 group (0.02 mg/kg glycopyrrolate administered). The left cammon peroneal nerve was stimulated by the 0.1 Hz single twitch and 100 Hz tetanic stimuli. We manitored the mechanical activity of the anterior tibialis muscle and observed recovery index, tetanic fade, and post-tetanic potentiation. RESULTS: There were no significant differences in recovery indices and post-tetanic potentiations among the 5 groups. Significant differences were found in tetanic fades between the experimental groups(A1, A2, Gl, G2) and the control group(P<0.05). However no significant differences in tetanic fades were found among the experimental groups. CONCLUSIONS: Atropine and glycopyrrolate hastened the recovery from mivacurium induced neuromuscular blockade. The neuromuscular recovery effects of glycopyrmlate were found to be similar to atropine at equipotent dose.

Removal of Renal Cell Carcinoma Extending Into the Inferior Vena Cava and Right Atrium using Hypothermia and Circulatory Arrest / 대한비뇨기과학회지

Intracaval neoplastic extension of renal cell carcinoma to the right atrium has been reported in 14-39% of the patients with carcinoma involving the vena cava. We report a case of 44-year-old woman hospitalized with intermittent vomiting and presented with evidence of renal cell carcinoma extending into the inferior vena cava and right atrium on CF and MRI. We successfully managed renal cell carcinoma surgically extending into the right atrium using hypothermia and circulatory arrest.

The Comparison of the Effects of Pentastarch or Normal Saline Infusion on the Shock Resuscitation / 대한마취과학회지

Volume replacement is a vital therapy in patient with circulatory shock, but the type of fluid that should be infused remains in controversy. This study is designed to compare the cardiopulmonary effects of a colloid solution and a crystalloid solution in dogs subjected to severe hemorrhagic shock. Twelve dogs were bled into shock and mean arterial pressure(MAP) were maintained at 60 mmHg for 1 hour followed by further hemorrhage to 40 mmHg for additional one hour, Animals were randomized to fluid challenge with 10% pentastarch(group P) or 0.9% normal saline(group S) to restore MAP. Complete hemodynamic and blood gas parameters and plasma lactate concentration were measured at pre-shock, during shock and after resuscitation for 2 hours. Cardiac function and hemodynamic stability were restored to higher level than the control level on the completion of fluid challenge with each type of solution, but hemodynamic parameters decreased as time goes after resuscitation. Especially in group S, hemodynamic parameters decreased more significantly and rapidly than group P. Considering the relation of left ventricular stroke work index(LVSWI) and pulmonary capillary wedge pressure(PCWP), the cardiac performance was well maintained to normal level in group P during post-resuscitation period, but rapidly deteriorated in group S. There was a significant increase in intrapulmonary shunt fraction with pentastarch that was maximal on the completion of fluid challenge but which normalized over the next 1 hour. Assessment of tissue perfusion was measured by mixed venous oxygen tension(PVO2) and plasma lactate concentration. In group P, PVO. was restored to higher than the control level and maintained to the cantrol level during post-resuscitation period, but in group S, it was not restored to control level at the completion of fluid challenge, moreover after then, it decreased progressively. Plssma lactate concentration was recovered to control level in group P at the completion of fluid challenge, but in group S, it was recovered lately. It means that tissue perfusion was more rapidly and effectively restored in group P than group S. In conclusion, infusion of pentastarch at severe hemorrhagic shock restored the hemodynamic parameter more rapidly and maintained cardiac performance more effectively during post-resuscitation period than normal saline. Infusion of pentastarch also maintained tissue perfusion more effectively but it increased intrapulmonary shunt fraction transiently.