Involvement of Protein Kinase C Isoforms and Rho GTPase in Contractile Response of Swine Pulmonary Artery / 대한마취과학회지

BACKGROUND: It is well established that vascular contraction is caused by not only an increase in cytosolic Ca2+ level but also activations of Ca2+-sensitizing mechanisms including protein kinase C (PKC) and low molecular GTP binding protein. However, the roles of PKC and RhoA, a low molecular GTP-binding protein, on the receptor agonist-mediated contraction in swine pulmonary artery has not been clarified. In the present study, we examined the contribution of PKC isoform and RhoA to the arterial stimulants-induced contraction in swine pulmonary artery. METHOD: The large (> 5 mm), medium (1-3 mm) and small (< 1 mm in outer diameter) sized pulmonary arteries were excised and the contractions were recorded isometrically. The contents and subcellular distribution of PKC isoforms and RhoA were detected using immunoblotting. RESULTS: In medium pulmonary artery, norepinephrine (NE, 10 nM-30micrometer) led contraction in a dose-dependent manner. In large and small pulmonary arteries, however, NE failed to induce a contraction. Adding of 12-deoxyphorbol 13-isobutyrate (DPB, 1micrometer), a PKC activator, developed muscle force in 1 mM EGTA-contained Ca2+-free physiological salt solution. The expressions of PKC alpha, elsilon were significantly increased in medium pulmonary artery. NE (10micrometer) evoked the translocation of RhoA from cytosol to the membrane but not those of PKC isoforms. In Ca2+-free physiological salt solution, DPB (1micrometer) caused a translocation of PKC isoforms. CONCLUSIONS: These results support that NE induces contraction via RhoA pathway but not PKC pathway in swine pulmonary artery.

The Effects of Succinylcholine on the Neuromuscular Block of Mivacurium / 대한마취과학회지

BACKGROUND: We studied the interaction between Succinylcholine (SCh) and mivacurium when mivacurium was administered during early and late recovery from SCh block was investigated. METHODS: Eighty patients undergoing elective surgery under general anesthesia were studied. General anesthesia was induced and maintained with propofol under TCI control. Neuromuscular function was measured in response to TOF stimulation of the ulnar nerve using an electromyographic method. The patients were allocated randomly to the following four groups; group 1 (n = 20): a bolus intravenous injection of 0.08 mg/kg mivacurium; group 2 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 2 minutes of 1 mg/kg SCh injection; group 3 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 25% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh; group 4 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 75% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh. The onset and duration of neuromuscular blockade, recovery rate and TOF ratio at T75% were measured. RESULTS: The onset of block in groups 3 and 4 were slower than in group 1 (5.2 +/- 0.7 and 2.3 +/- 0.6 vs 2.5 +/- 0.4 min P < 0.05). The clinical duration in groups 2 and 3 were longer than in groups 1 and 4 (12.5 +/- 2.1 min and 11.3 +/- 1.7 min vs 17.0 +/- 3.0 min and 18.5 +/- 2.6 min, p < 0.05). There was no difference in recovery index all groups. The TOF ratio of groups 2, 3 and 4 were smaller than for group 1 (38.2 +/- 5.3, 32.3 +/- 5.6 and 31.5 +/- 4.2 vs 56.0 +/- 7.3, P < 0.05). CONCLUSIONS: The Previous 1 mg/kg SCh injection was affected the time course of action of mivacurium 0.08 mg/kg-induced neuromuscular block.

The Changes of Serum Triiodothyronine(T3) and Thyroxine(T4) Levels during General Anesthesia with Enflurane and Propofol / 대한마취과학회지

Serum Ta and T were measured in 34 patients scheduled elective surgery with general anesthesia, who were divided into two groups (enflurane group' 12, propofol group' 22). No clinical signs of thyroid disturbances could be observed preoperatively in the patients. Anesthesia was induced with thiopental 5 mg/kg in enflurane group; propofol 2 mg/kg in propofol group, and maintained with Oz 2 L/min, NH 2 L/min, enflurane (1.0-2.596) in enflurane group,' 2 L/ min, N 4 L/min and continuous controlled infusion of pmpofol (50-150 mcg/kg/min) in propofol group. Blood samples were collected 5 minutes after arrival in operating room, 1 minute after induction, 5 minutes after intubation, 1 minute after skin incision, during operation and 10 minutes after extubation. Blood samples were centrifused and serum was taken from each sample. Determinations of Ta and T4 were performed using enhanced chemiluminescence immunoassay (ELIA). Comparisons of our results were made using repeated measuves analysis of variance, paired students t-test and statistically significant when p value was less than 0.05. The results are summarized as follows' 1) In enflurane group, serum Ta levels showed a decreasing tendency after extubation compared to baseline. Decreasing serum T4 after administration of thiopental could be considered statistically significant and serum T levels showed a decreasing tendency after extubation compared to baseline. 2) In propofol gnup, serum Tz levels showed a decreasing tendency after extubation compared to baseline. Rises in serum Te after incision and extubation could be considered statistically significant. Based on these results, no direct negative influence of propofol need be expected on Tg metabolism in euthyroid patients. However, the changes in these hormones, although with in the physiological range here, indicate that propofol may adversely influence their levels in the presence of manifested thyroid disease.

Clinical Evaluation of Atracurium for Endotracheal Intubation / 대한마취과학회지

The usefulness of nondepolarizing muscle relaxants for intubation is limited by a relatively slow onset of neuromuscular block compared to that achived with succinylcholine. But, authors have reported that larger doses of nondepolarizing muscle relaxants produce a more rapid onset of maximal neuromuscular block and conditions conductive to endotracheal intubation and recent reports support the use of the "priming principle in the clinical practice of anesthesiology. This phenomenon may apply to all nondepolarizing relaxants: it is reported to facilitated neuromuscular blockade and tracheal intubation when used with atracurium, vecurouium, alcuronium or pancuronium. In this study, administering a small subclinical dose of atracurium (75ug/kg) Smin. prior to the remainder of an intubating doae of atracurium (250ug/kg) had no different on grade of block for intubation compared to single IV bolus of atracurium (500ug/kg).

Clinical Evaluation of Atracurium for Endotracheal Intubation / 대한마취과학회지

The usefulness of nondepolarizing muscle relaxants for intubation is limited by a relatively slow onset of neuromuscular block compared to that achived with succinylcholine. But, authors have reported that larger doses of nondepolarizing muscle relaxants produce a more rapid onset of maximal neuromuscular block and conditions conductive to endotracheal intubation and recent reports support the use of the "priming principle in the clinical practice of anesthesiology. This phenomenon may apply to all nondepolarizing relaxants: it is reported to facilitated neuromuscular blockade and tracheal intubation when used with atracurium, vecurouium, alcuronium or pancuronium. In this study, administering a small subclinical dose of atracurium (75ug/kg) Smin. prior to the remainder of an intubating doae of atracurium (250ug/kg) had no different on grade of block for intubation compared to single IV bolus of atracurium (500ug/kg).

Paraplegia following Epidural Analgesia / 대한마취과학회지

This article reports the case of a woman who developed a pure motor paraplegia following epidural analgesia. 80mg of Depomedrol and 2ml of 1% lidocaine were injected epidurally for relief of back pain. Within one day the patient complained of severe pain in both lower extremities and the left lower extremity rapidly became paraplegic. Myelography showed no obstruction and compression. The paraplegia was permanent in the left lower extermity. We note a number of potential etiologies and analyze their possible mechanism of action.

Malignant Hyperthermia Syndrome - A case report / 대한마취과학회지

The popular term malignant hyperthermia syndrome (MHS) refers to a clinical syndrome classically observed during general anesthesia. It is characterized by a rapidly increasing .temperature and a high mortality rate. A case of MHS was experienced which developed 60 minutes after induction of general anesthesia with thiopental sodium, succinylcholine, halothane, N2O and 02. High fever, muscle rigidity and cyanosis developed and were followed by arrythmia and unstable blood pressure. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient died about 6 hours after induction of anesthesia.

Epidural Narcotics and Multiple Fractured Ribs / 대한마취과학회지

Pain relief becomes a major concern when treating patients with rib fractures so adequate ventilation must be maintained. Many techniques have been described for the management of frectured ribs, including systemic analgesics, intercostal nerve blockade, intrathecal morphine, epidural bupivacaine and epidural morphine. This case report illustrates the successful use of epidural narcotics in a patient with multiple fractured ribs.

Thoracic Epidural Anesthesia for Upper Abdominal Surgery / 대한마취과학회지

Patients with advanced pulmonary tuberculosis suffer from chronic obstrutive pulmonary disease, making them poor risks for anesthesia. Also, general anesthesia for patients with active hepatitis or arteriosclerotic cardiovascular disease complicates the intraoperative and postoperative course. Inhalation anesthetics, along with the assissted ventilation used in general anesthesia, further complicate the intraoperative and postoperative course. Although regional anesthetic techiques have been used extensively for pelvic and limbic surgery to avoid the complications of general anesthesia, thoracic epidural anesthesia has not been common for upper abdominal surgery because of the fear of damage to the spinal cord. But compared with the lumbar.approach, the danger of accidental damage to the spinal cord has been exaggerated. Thoracic epidural anesthesia has been employed in a number of cases of upper abdominal surgery at Y.U.W.M.C wish remarkable success. We have in describe the use of thoracic epidural anesthesia for upper abdominal surgery.

Thoracic Epidural Anesthesia for Upper Abdominal Surgery / 대한마취과학회지

Patients with advanced pulmonary tuberculosis suffer from chronic obstrutive pulmonary disease, making them poor risks for anesthesia. Also, general anesthesia for patients with active hepatitis or arteriosclerotic cardiovascular disease complicates the intraoperative and postoperative course. Inhalation anesthetics, along with the assissted ventilation used in general anesthesia, further complicate the intraoperative and postoperative course. Although regional anesthetic techiques have been used extensively for pelvic and limbic surgery to avoid the complications of general anesthesia, thoracic epidural anesthesia has not been common for upper abdominal surgery because of the fear of damage to the spinal cord. But compared with the lumbar.approach, the danger of accidental damage to the spinal cord has been exaggerated. Thoracic epidural anesthesia has been employed in a number of cases of upper abdominal surgery at Y.U.W.M.C wish remarkable success. We have in describe the use of thoracic epidural anesthesia for upper abdominal surgery.

Nerve Block for Treatment of Cancer Pain / 대한마취과학회지

Intractable pain associated with advanced cancer is an important and complicated clinical problem. One hundred and forty cases with cancer pain were treated by several nerve blocking techniques at the pain clinic of Yonsei Medical Center during 4 year period from January 1978 to December 1981. These cases had intractable pain from non-resectable or recurrent cancer of the stomach (35 cases), pancreas(24 cases), lung (17 cases), uterine cervix(14 cases), rectum (13 cases), colon, lymphoma, liver, gall bladder and the others. After careful evaluation, they were given celiac plexus block with pure and/or 50% alcohol in 73 cses, intrathecal block with 10% phenol glycerine in 19 cases, continuous epidural block with 1% lidocaine in 35 cases and micellaneous nerve blocks including sympathetic ganglion block and local infiltration in 13 cases. Good to excellent pain relief was achieved in the aobve groups as follows: celiac pleuxs, 93.2%: intrathecal, 89.5%: continuous epidural, 60,5%: miscellaneous, 61.5%. Over all after block, life duraion ranged from 2 weeks to 12 months with an average of 2.4 months. When patients are selected carefully, and the block is performed with great caution, risk is minimal, and long lasting relief of intractable pain is possible in the majority of these patients led normal lives until they died.

Caudal Morphine for Postoperative Pain Control after Abdominal Surgery / 대한마취과학회지

Caudal narcotic analgesia was assessed after the injection of 3mg morphine diluted in 30ml(physiologic) saline into the sacral canal in 15 patients after upper abdominal surgery, in 20 patients after lower abdominal surgery under general anesthesia, and in 20 patients after perianal surgery under caudal block. Pain relief was evaluated by the subsequent need for systemic analgesics. All cases had considerable relief from pain and the morphine was effective for 12 or more hours. There were no significant differences between pain relief of the upper abdominal and lower abdominal surgery group, upper abdomianl and perianal surgery group, and lower abdominal and perianal surgery group (p>0.05, p>0.05, p>0.05). It is suggested that the morphine, which was administered into the sacral, cannal, reached the subarachnoid space and produced it's effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior horn cell of the spinal cord. Consequently, whether analgesia from epidural narcotics appears to be segmental in distribution or not is still in controveray.