The Impact of Depression on Fracture in Elderly: A Nationwide Population-Based Retrospective-Cohort Study

BACKGROUND: Fractures should be actively prevented in the elderly because recovery from the damage of fractures is slow and fractures can cause both physical and psychological pain in the elderly. Previous studies have reported that depression is related to falls or low bone mineral density (BMD). This study aimed to evaluate the risk of fracture according to the depression status among the elderly.METHODS: This study used the National Health Insurance Corporation cohort data to examine 96,188 elderly people aged >65 years who were examined in 2007 and 2008. The chi-square test was used to determine the general characteristics and fracture incidence in patients with depression and healthy controls, and the hazard ratio was calculated using the Cox proportional hazards model corrected for general characteristics. The Kaplan-Meier method predicted the risk of fracture in two groups during the observation period.RESULTS: In the depressed group, 23.2% (441 of 1,904) of the patients had a fracture during the 5-year follow-up period; however, in the control group, only 17.5% (16,470 of 94,284) had a fracture (P < 0.001). In addition, multivariate analysis of the adjusted variables showed that the risk of fracture in the depressed group was 1.34 times higher than that in the control group. The risk of fracture in women was 1.71 times higher than that in men, and the risk of fracture increased with age.CONCLUSION: The risk of fracture in the elderly who were depressed was significantly higher than that in the elderly who were not depressed.

Effects of Nicardipine on Changes of Blood Pressure and Heart Rate during Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Laryngoscopy, tracheal intubation and the suspension laryngoscopy often provoke an undesirable increase in blood pressure and/or heart rate during laryngeal microscopic surgery. Thus, the anesthesiologist's objectives are to maintain sufficient anesthetic depth and to promote rapid awakening. Nicardipine, a direct arterial dilator, can be used to attenuate increasing blood pressure. We investigated the effects of nicardipine on changes of blood pressure and heart rate during laryngeal microscopic surgery. METHODS: Eighty patients of ASA class 1 or 2 scheduled for laryngeal microscopic surgery were randomly allocated into 4 groups. For anesthetic induction, IV propofol 1.5 mg/kg, rocuronium 0.4 mg/kg, and glycopyrrolate 0.2 mg were administered followed by mask ventilation for 5 minutes with isoflurane. One minute before tracheal intubation and suspension laryngoscopy saline, nicardipine 10, 20, or 30microgram/kg was injected in each group. Thereafter we measured blood pressure and heart rate one minute after each procedure. RESULTS: Increases in blood pressure were blunted in the nicardipine 20 and 30microgram/kg group. In the nicardipine 30microgram/kg group, heart rates were significantly increased and facial flushing was observed in two patients. CONCLUSIONS: We suggest that nicardipine 20microgram/kg can alleviate blood pressure increases with little effect on heart rate during laryngeal microscopic surgery. However, although nicardipine 30microgram/kg could blunt blood pressure increases, it produces tachycardia and perhaps overdose.

Interaction between Bupivacaine, Ropivacaine and Diltiazem in the Isolated Rat Heart / 대한마취과학회지

BACKGROUND: Local anesthetics are often used for a regional block in patients who are being treated with calcium channel blockers (CCB). Bupivacaine is a local anesthetic with potential for serious cardiovascular toxicity. Ropivacaine is a relatively new local anesthetic. It is clinically equipotent and chemically similar to bupivacaine. Diltiazem (CCB) is a potent coronary and systemic vasodilator with antiarrhythmic properties. Local anesthetics such as bupivacaine and ropivacaine have been suggested to show drug interactions with diltiazem. Therefore, we tried to observe the drug interactions between bupivacaine, ropivacaine and diltiazem using an animal model. METHODS: This study was performed using an isolated rat heart (N = 40) by the Langendorff method. After a stabilization period, all hearts were subjected to the application of local anesthetics of a 1 microgram/ml or 3/ml concentration, respectively. Thereafter, they were subdivided into four groups; the bupivacaine (B) group, bupivacaine with diltiazem (BD) group, ropivacaine (R) group, and ropivacaine with diltiazem (RD) group. Parameters such as, LVP, dp/dt, heart rate (HR), coronary flow (CF), DO2, and MVO2 were measured. RESULTS: All parameters decreased in all groups, respectively (P < 0.05). The BD group and R group showed a lower LVP and dp/dt than those of the B group (P < 0.05). The BD group and B group showed lower HR than that of the R group (P < 0.05). The RD group showed a higher CF than other groups (P < 0.05). CONCLUSIONS: The negative inotropic potency of bupivacaine was enhanced in the presence of diltiazem. We suggest that diltiazem has a protective effect against reduction of CF by ropivacaine. Therefore, we should consider this when selecting local anesthetics for cardiovascular patients under the treatment of diltiazem.

Electrocardiographic and Hemodynamic Changes during Recovery from Bupivacaine Toxicity in Anesthetized Dogs / 대한마취과학회지

BACKGROUND: Severe cardiac arrhythmia after accidental intravascular injection of bupivacaine in the practice of regional anesthesia has been reported and is known to be difficult to treat. We evaluated the electrocardiographic and hemodynamic changes during recovery from bupivacaine-induced cardiac toxicity. METHODS: In eight male dogs receiving pentobarbital, after baseline recordings were obtained, 0.5% bupivacaine was infused at a rate of 0.5 mg/kg/min intravenously until cardiac output decreased to 50% or less(1/2 CO), which was defined as the point of cardiac depression in this study. The hemodynamic and electrocardiographic parameters were recorded at 1/2 CO, and 5, 10, 15, 20, 30 and 40 min after 1/2 CO. The following electrocardiographic parameters were measured: duration of QRS complex and T wave, PR interval and the corrected QT interval, all determined on the lead II. RESULTS: Mean arterial pressure was significantly decreased throughout the experimental period after 1/2 CO, and cardiac output and SO2 were significantly decreased until 20 min after 1/2 CO in comparison with those at baseline. All dogs had serious changes on the ECG. Heart rate and ECG changes returned to baseline within 20 min after 1/2 CO, but QRS duration remained increased until 30 min after 1/2 CO. Systemic vascular resistance, pulmonary vascular resistance and serum electrolytes were not changed with time. CONCLUSIONS: In the absence of hypoxia, acidosis, and hyperkalemia, QRS duration returned to control values more slowly than other variables on the EKG after bupivacaine cardiac toxicity. MAP and PCWP recovered the slowest of all hemodynamic variables.

The Effect of Intrathecal Midazolam on Bupivacaine Induced Spinal Anesthesia after Hemorrhoidectomy / 대한마취과학회지

BACKGROUND: Benzodiazepines acting on the GABA receptor complex in the spinal cord are known to induce antinociception. In the present study we aimed to evaluate the effect of intrathecal midazolam with bupivacaine following hemorroidectomy. METHODS: Forty five patients were involved in this study. Patients were randomly allocated to one of 3 groups: the control group received 0.5% heavy bupivacaine 5 mg and 0.9% NaCl 0.2 ml intrathecally, group BM1 0.5% bupivacaine and midazolam 1 mg (0.2 ml), group BM2 0.5% bupivacaine 5 mg and midazolam 2 mg (0.4 ml), respectively. The analgesic effects and side effects were compared among the 3 groups. RESULTS: There was a significant difference among the 3 groups in time-to-first-pain medication and total consumption of analgesics during the 24 h after surgery. Furthermore, the analgesic effect of midazolam was dose-dependent: 2 mg of midazolam showed better results than 1 mg. All the patients showed no considerable side effects. CONCLUSIONS: We conclude that intrathecal midazolam caused a significant delay in time-to-first-pain medication and reduced utilization of analgesics within 24 h. Therefore, intrathecal midazolam can be used as an effective adjunct for spinal anesthesia for postoperative pain control.

Changes in Epidural Pressure during Genernal Anesthesia / 대한마취과학회지

BACKGROUND: Epidural pressure is reported to change in accordance with intracranial pressure (ICP). As ICP changes during general anesthesia, it is also possible that epidural pressure may change during general anesthesia. The aim of this study was to obtain trends of epidural pressure change during general anesthesia. METHODS: Eighteen patients scheduled for gastrectomy were allocated for this study after obtaining informed consent. Epidural catheter was inserted at T7-8, T8-9 interspace before induction. Catheter was connected to a pressure transducer after calibration. General anesthesia was induced with thiopental sodium (5 mg/kg), succinylcholine (1 mg/kg), followed by 3% enflurane. Anesthesia was maintained with 50% N2O in oxygen and 1-2% enflurane with vecuronium (0.1 mg/kg). Each patients was mechanically ventilated with tidal volume of 10 ml/kg at a rate of 10 bpm. Epidural pressure was measured before induction, at the time of injection of thiopental sodium, succinylcholine, laryngoscopy, intubation, surgical incision, and 30 minutes after surgical incision. Stastical analysis was done using repeated measures of ANOVA with Helmert option (p<0.05). RESULTS: Epidural pressure significantly changed dynamically during general anesthesia. Epidural pressures increased at intubation and at 30 minutes after surgical incision when compared with those at the time of laryngoscopy and incision, respectively (p<0.05). CONCLUSION: Our study indicates that epidural pressures changes dynamically during induction period of general anesthesia and also showed possibility that epidural pressure monitoring could be used instead of more invasive direct ICP monitoring.

Malignant Hyperthermia during General Anesthesia and Anesthetic Management for That Same Patient in Day Surgery Center: A case report / 대한마취과학회지

Malignant hyperthermia is a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia and skeletal muscle rigidity. We experienced a case of malignant hyperthermia after general anesthesia with halothane and succinylcholine in day surgery center. 2 years old male patient arrived to get congenital ptosis operation. He was relatively healthy and had no considerable past or family history of hereditary disease. Anesthesia induced with halothane inhalation and succinylcholine. After induction, he abruptly showed masseter muscle rigidity, total body rigidity, elevation of end-tidal CO2 tension, tachycardia and hyperthermia. Under the suspicion of malignant hyperthermia, all anesthetics were discontinued and vigorous emergency treatment was attemped with dantrolene sodium. The patient survived without any sequele and discharged after 11 days. About 10 months later, that same patient comes to our hospital to take the operation. We experienced successful anesthetic management for malignant hyperthermia.

Anesthetic Management for Pediatric Living Related Liver Transplantation: Experience of 30 Cases / 대한마취과학회지

BACKGROUND: Living related liver transplantation (LRLT) was developed to alleviate the mortality resulting from the scarcity of suitable cadevaric grafts. The purpose of this study is to review 30 cases of pediatric living-related liver transplantation, and to find the proper anesthetic management for this operation. METHODS: We retrospectively analyzed the medical records of 23 cases (body weight < 15 kg) of liver transplantation from living related donors between August 1995 and May 1998. RESULTS: Mean age and body weight were 14 (range; 6-29) months, 8.7 (range: 5.4-12.2) kg, respectively. The most common cause of end stage liver disease was biliary atresia. After reperfusion there were significant decreases of mean arterial pressure and body temperature, and increases of central venous pressure (P< 0.05), whereas the change of heart rate was not significant. The incidence of postreperfusion syndrome was 26%. Serum Na levels increased significantly (P< 0.05) from 133 3 to 144+/-3 mEq/L, and K level decreased from 4.1+/-0.7 to 3.2+/-0.5 mEq/L during surgery. Hematocrit was 26+/-3.5%, platelet 10.3+/-7.2 x 104/mm3 at the time of peritoneal closure. Wide inter-individual RBC and FFP requirements were observed, 43+/-40 (range: 5-133) mL/kg, 108+/-82 (range: 22-300) mL/kg, respectively. CONCLUSIONS: We conclude that anesthetic management for pediatric LRLT and LRLT in recipients less than 15 kg in body weight can be carrid out, through with some precautions.

Acid-Base Status without Sodium Bicarbonate Administration during Orthotopic Liver Transplantation / 대한마취과학회지

BACKGROUND: Marked derangements in acid-base status are frequently seen during orthotopic liver transplantaton. To prevent the progression of metabolic acidosis, treatment with sodium bicarbonate has been recommended. However, sodium bicarbonate may exacerbate intracellular acidosis, increase plasma lactate, contribute to hypernatremia. The value of giving bicarbonate has been questioned. Accordingly, we reviewed the intraoperative the acid-base status of patients who underwent orthotopic liver transplatation. METHODS: We reviewed ten patients showed severe metabolic acidosis (7.2 or = 10). Despite of BD > or = 10, sodium bicarbonate was not given to all. Intraoperative pH and BD were analyzed retrospectively. RESULTS: At the anhepatic and immediate post-reperfusion periods, the pH was decreased (P < 0.05) and BD was increased (P < 0.05), but both were normalized at the end of surgery. The mean blood pressure transiently decreased at the immediate post-reperfusion periods (P < 0.05), but that was acceptable. CONCLUSIONS: This study showed that a severe metabolic acidosis is tolerated by the patients undergoing orthotopic liver transplantation without administration of sodium bicarbonate.

Acid-Base Status without Sodium Bicarbonate Administration during Orthotopic Liver Transplantation / 대한마취과학회지

BACKGROUND: Marked derangements in acid-base status are frequently seen during orthotopic liver transplantaton. To prevent the progression of metabolic acidosis, treatment with sodium bicarbonate has been recommended. However, sodium bicarbonate may exacerbate intracellular acidosis, increase plasma lactate, contribute to hypernatremia. The value of giving bicarbonate has been questioned. Accordingly, we reviewed the intraoperative the acid-base status of patients who underwent orthotopic liver transplatation. METHODS: We reviewed ten patients showed severe metabolic acidosis (7.2 or = 10). Despite of BD > or = 10, sodium bicarbonate was not given to all. Intraoperative pH and BD were analyzed retrospectively. RESULTS: At the anhepatic and immediate post-reperfusion periods, the pH was decreased (P < 0.05) and BD was increased (P < 0.05), but both were normalized at the end of surgery. The mean blood pressure transiently decreased at the immediate post-reperfusion periods (P < 0.05), but that was acceptable. CONCLUSIONS: This study showed that a severe metabolic acidosis is tolerated by the patients undergoing orthotopic liver transplantation without administration of sodium bicarbonate.

Clinical Status and Anesthetic Management of Very Low Birth Weight Premature Infants who underwent Surgical Closure of Patent Ductus Arteriosus / 대한마취과학회지

BACKGROUND: A delay in spontaneous closure of the patent ductus arteriosus (PDA) is frequent in premature infant and may lead to cardiopulmonary congestion and death. Surgical closure of the PDA in the premature infant can be a safe and effective procedure. Now, several centers prefer to eliminate the problem of transportation to operating room and adopt the policy of operating in the newborn intensive care unit (NBICU). So we investgated the anesthetic management and clinical status of premature infants who underwent surgical closure of PDA. METHODS: We analyzed retrospectively the anesthetic management and clinical status of eleven premature infants below 1,500 g birth weight. RESULTS: Range of gestational age of infants was 24-30 weeks. Most common cause of operation was failure of medical treatment. All infants had features of respiratory distresses and prematurity complications. Fentanyl, vecuronium, oxygen, and air constituted a anesthetic regimen. The body temperature remained stable. Systemic blood pressure with ligation of PDA increased to 66.3 17.4 mmHg (mean+/-SD). After operation, three infants died from complication of prematurity. There were no deaths directly related to operation. Four infants underwent operation in NBICU and also had no wound infections. CONCLUSIONS: Premature infants with PDA had associated complications of prematurity and were severely ill. If the infants did not respond to medical therapy, the PDA was closed by operation with adequate anesthesia. Furthermore, the operation can be performed safely and efficiently in the operating room or NBICU.

An Analysis of the Clinical Status of the Brain Death Donors / 대한마취과학회지

BACKGROUND: Since the first successful kidney transplantation from a brain death donor (BDD) was done in 1979, organ transplantations from BDD have steadily increased. The number of BDDs have been increasing year by year. The purpose of this study is to analyze clinical status of organ donor from BDDs. METHODS: We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. RESULTS: The male to female ratio was 3 : 1, and the age distribution was the highest in twenties. The distribution of cause of brain death was the highest in motor vehicle accidents. The distribution of acquired organ was the highest in kidney, heart, liver in order. The distribution of days stayed in ICU before organ donation was the highest in 2 days. The choice of agent for inotropic support of the myocardium is dobutamine. The donors have been transfused with packed red blood cell (PRBC) to maintain the hematocrit between 25~35%. Two units of PRBC should be readily available at all times for transfusion. The failure of organ donation was mainly very poor organ condition. CONCLUSIONS: We wish that these results were made use of bases of status of organ donation from BDDs.

Hemodynamic Changes during Continuous Hyperthermic Intraperitoneal Perfusion for Gastric Cancer Patients with Peritoneal Seeding / 대한마취과학회지

BACKGREOUND: Hyperthermia is currently effective treatment against numerous cancer gastric cells' seeding on the peritoneal surface and floating in the cancerous ascites. We evaluated changes in hemodynamics during continuous hyperthermic intraperitoneal perfusion (CHPP) to determine strategies for safer general management during this procedure. METHODS: Ten patients with far-advanced gastric cancer were given surgical treatment followed by CHPP with anticancer drug. The body temperature, blood pressure, heart rate, central venous pressure, pulmonary artery pressure, cardiac output, electrolyte and blood gas were measured during pre-CHPP, CHPP and post-CHPP period. RESULTS: The blood temperature reached 39.3 +/- 0.4 degrees C(mean SD) during CHPP. Heart rate increased to 104.4 +/- 14.2 bpm and the cardiac index to 5.3 +/- 1.5 l.min 1.m 2 during CHPP. The mean arterial pressure remained stable during the study period. The systemic vascular resistance index decreased to 996.7 +/- 324.0 dynes.s.cm 5.m2. The mixed venous oxygen saturation fell during the first part of the CHPP period. CONCLUSIONS: This study suggest that the CHPP with anticancer drug may be safe in humans, provided that appropriate monitoring, cooling and technical support are applied.

Inhibitory Effect of Ldegrees Cal Anesthetics on Voltage-Dependent Calcium Current; Relationship Between Potency and Hydrophobicity / 대한마취과학회지

BACKGROUND: The primary mode of conduction bldegrees Ckade by ldegrees Cal anesthetics degrees Ccurs through the inhibition of voltage-dependent sodium current and, inhibitory potency of ldegrees Cal anesthetics are correlated with their hydrophobicity, expressed as degrees Ctanol/buffer partition coefficients(PC). The homologous structural bidegrees Chemistry and analogous physiology of voltage-dependent sodium and calcium channels prompted us to examine the relationship between potency of various ldegrees Cal anesthetics for the inhibition of voltage-dependent calcium channels(VDCC) and their PC values. METHODS: Whole cell patch clamp recordings were made from acutely dissdegrees Ciated rat dorsal root ganglion neurons, and voltage dependent calcium current(ICa) was evoked by depolarizing pulse. The concentrations of various ldegrees Cal anesthetics(bupivacaine, liddegrees Caine, prildegrees Caine, prdegrees Caine, tetracaine) that bldegrees Ck 50% of the control ICa(IC50) were calculated from dose-response curves. The relationship between IC50 and PC values of various ldegrees Cal anesthetics were investigated. RESULTS: Ldegrees Cal anesthetics inhibited ICa with neglegible effect on the current- voltage relatonship. IC50 values of tetracaine, bupivacaine, liddegrees Caine, prildegrees Caine and prdegrees Caine were 98, 142, 2710, 10400, 16900 uM respectively, and linear regression of the plot of log(IC50) against log(PC) was statistically significant (p<0.001). CONCLUSIONS: It is speculated that inhibitory effects of ldegrees Cal anesthetics on the VDCC when used in epidural and spinal anesthesia may contribute to their analgesic and anesthetic actions. Inhibitory potency of ldegrees Cal anesthetics on the VDCC, as for voltage-dependent sodium channels, was correlated with their hydrophobicity.

Effects of Ketamine and Clonidine for Caudal Analgesia Produced by Bupivacaine in Pediatric Ambulatory Surgery / 대한마취과학회지

BACKGROUND: Caudal block has proved to be a satisfactory method of providing perioperative analgesia for pediatric surgery in inguinal and perineal areas. This study was designed to evaluate the effects of ketamine or clonidine as an adjunctive of caudal block produced by bupivacaine. METHODS: One hundred ninety five children aged 1~10 years, undergoing surgery in inguinal and perineal areas as ambulatory cases, were randomly allocated to one of four groups after the induction of general anesthesia; 0.25 % bupivacaine 1 ml/kg(group B), 0.25 % bupivacaine 1 ml/kg with ketamine 0.5 mg/kg(group K), 0.25 % bupivacaine 1 ml/kg with clonidine 1 microgram/kg(group C), and local infiltration group(group L). Postoperative pain was assessed using an objective pain scale and the incidence of side effects, such as urinary retention and nausea/vomiting was observed after surgery. RESULTS: In the group B and L, OPS score was higher and analgesics were more frequently administered than group K and C at the recovery room and at home after discharge(p<0.05). There was no difference between the groups in the incidence of nausea and vomiting but urinary retention at the recovery room was more frequent in group C than other groups(p<0.05). CONCLUSIONS: Caudal block provided more effective postoperative analgesia than local infiltration. In caudal block, the addition of ketamine or clonidine prolongs the duration of postoperative analgesia without significant increase in side effects.

Clinical Investigation of Laryngeal Mask Airway Use in Geriatric Patients / 대한마취과학회지

BACKGROUND: The laryngeal mask airway (LMA) has many advantages including easy insertion, less trauma, minimal cardiovascular changes. And the elderly have many problems such as poor dentition, limited cervical extension and age related cardiovascular changes, so endotracheal intubation in geriatric patient is sometimes difficult and harzardous. This clinical study was designed to investigate availability and problems of LMA insertion in geriatric patients. METHODS: 60 geriatric patients undergoing elective surgery were induced with intravenous injection of pentothal sodium or propofol, vecuronium or atracurium and inhalation of O2, N2O, enflurane or isoflurane. After deep anethesia and full muscle relaxation LMA was inserted and cuff was inflated. When blind insertion was failed, laryngoscope was used. Anesthesia was maintained with inhalation of O2, N2O, enflurane or isoflurane under positive pressure ventilation. Thereafter, we observed peak inspiratory pressure and any incident including gas leakage, stomach distension, regurgitation of stomach content intraoperatively and then any complication postoperatively. RESULTS: LMA placement was successful in 98.8%, but LMA insertion in geriatric patient had some difficulty because patient's tongue slided down with LMA due to oropharyngeal dryness, teeth loss. Intraoperatively LMA was well maintained under positive pressure ventilation. There was no critical incident associated with LMA use. CONCLUSIONS: LMA is safe and may have a useful role in the anesthetic management of geriatric patients who have many problems such as poor dentition, limited cervical extension and age related cardiovascular changes.

An Analysis of the Social and Clinical Status of Organ Donation from Brain Death Donors / 대한이식학회지

BACKGROUND: Since the first successful kidney transplatation from a brain death donor(BDD) in 1979, organ transplantations from BDD have steadily increased. The legal definition of brain death has not yet been. However the number of BDDs have been increasing year by year. The purpose of this study is to analyze the social and clinical status of organ donation from BDDs. METHODS: We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. RESULTS: The male to female ratio was 3:1, and the age distribution was the highest in twenties. Occupation distribution was the highest in students and distribution of religion was the highest in these who were non-believers. The distribution of cause of brain death was the highest in motor vehicle accidents. The blood type distribution was the highest in type A+, type B+, O+, and AB+ in order. The distribution of days stayed in ICU before organ donation was the highest in 3D, 2D, and 4D in order. The failure of organ donation was mainly very poor organ condition. CONCLUSIONS: We wish that these results were made use of bases of status of organ donation from BDDs.

The Effect of Intraluminal Oxygen Insufflation on the Oxygenation of Gut Mucosa in Hemorrhaged Cats / 대한마취과학회지

BACKGROUND: This study was purposed to study the therapeutic value of intraluminal oxygen insufflation on the oxygenation of gut mucosa in a feline model subjected to a hemorrhagic shock followed by reperfusion. METHODS: Eighteen cats were divided into three groups : For group 1, 6 cats were subjected to sham operation as a control group ; for group 2, 6 cats were subjected to a hemorrhagic shock for 2 hours prior to reperfusion as a hemorrhagic shock(HS) group ; for group 3, 6 cats were subjected to a simultaneous insufflation of intraluminal oxygen, continued during the shock and reperfusion periods as a oxygenated hemorrhagic shock(OHS) group. Mesenteric PvO2, mesenteric venous arterial(v-a) lactate difference, mesenteric P(v-a)CO2 and mesenteric pH(a-v) were measured for every 30 minutes during the shock and reperfusion. RESULTS: The lactate(v-a) was increased during the shock. For group OHS, the lactate(v-a) returned to the baseline value after reperfusion, but for group HS, it did not return. The values of pH(v-a) and P(v-a)CO2 were increased during the shock and returned to the baseline value for group OHS, but for group HS, the increase was greater than group OHS(p<0.05), but not returned to the baseline value after reperfusion. For both pH(v-a) and P(v-a)CO2, there were statistically significant differences(p<0.05) between group HS and group OHS during the shock and reperfusion. CONCLUSIONS: We conclude that the insufflation of intraluminal oxygen improves the oxygenation of gut mucosa in the feline model undergone a hemorrhagic shock followed by reperfusion.

Vasodilating Effect of Sodium Nitroprusside, Nitroglycerin, and Isosorbide Dinitrate during Cardiopulmonary Bypass / 대한마취과학회지

We have studied the vasodilating effect of bolus doses of sodium nitroprusside (SNP), nitro- glycerin (NTG), and isosorbide dinitrate (ISDN) in 40 patients during cardiopulmonary bypass with a constant pump flow. Blood volume of the venous reservoir and mean arterial pressure were recorded for 10 minutes after drug administration to detect changes in venous capacitance and arteriolar resistance. SNP 500 ug decreased mean blood pressure significantly more than NTG and ISDN compared with placebo. NTG 500 ug decreased mean blood pressure transiently at 1-4 min but significantly reduced reservoir blood volume. ISDN 500 ug increased mean blood pressure after drug administration, decreased reservoir blood volume less than NTG. We could conclude that SNP was more effective arteriolar vasodilator than NTG and ISDN, but NTG and ISDN were effective as a venodilator during cardiopulmonary bypass.

Effect of Nimodipine on Incomplete Global Cerebral Ischemia-Reperfusion with prior Hyperglycemia: in vivo 31P Magnetic Resonance Spectroscopic Study in Cats / 대한마취과학회지

In vivo 31P magnetic resonance spectroscopy (MRS) was used to evaluate the effect of nimodipine on changes of [H] (pH) and the ratio of [PCr]/[Pi] in cats subjected to an incomplete global cerebral ischemia-reperfusion under the pretreated condition of hyperglycemia. Animals were subjected to a transient (18 minutes) incomplete global cerebral ischemia; the systemic arterial hypotension was induced, and immediately followed by the bilateral carotid artery ligation. Twenty cats were divided into 3 groups; for group 1 (control), 7 cats were employed for a control group; for group 2 (hyperglycemia), 7 cats were a hyperglycemia group with infusion of 50% glucose prior to ischemia; for group 3 (Nimodipine), 6 cats were infused with 50% glucose prior to ischemia, and nimodipine after ischemia. The time course of changes in pH and [PCr]/ [Pi] was monitored before, during and after ischemia. The pH decreased immediately after ischemia in all three groups. After the reperfusion was made, the values of the pH did not retum to the baseline value for the group 2 (hyperglycemia) and 3 (nimodipine), in contrary to the group 1 (control). The ratio of [PCr]/[Pi] was dropped to 20% of the baseline value after ischemia in all three groups. The value was recovered progres- sively during reperfusion period for group 1 (control), whereas for group 2 (hyperglycemia) and group 3 (Nimodipine) the values were remained depressed. The results suggest that the condition of hyperglycemia induced by the infusion of 50% glucose prior to the incomplete global cerebral ischemia-reperfusion, may deteriorate the cerebral ischemia and the infusion of nimodipine during ischemia-reperfusion has no beneficial effects to improve the cerebral acidosis and the metabolic recovery.