Suppression of hemodynamic change before extubation--lidocaine through modified endotracheal tube.

Twenty females, aged 31 to 49 years, scheduled for abdominal total hysterectomy were randomly divided into two groups in this study. An epidural catheter was placed at T11-12 before general anesthesia. All patients receive the combination of epidural anesthesia and general anesthesia for the operation and relief of pain postoperatively. The modified endotracheal tube we used is shown in Fig. 1. For patients in group I (Lidocaine group), 2 mL 4% lidocaine solution was injected through the catheter to desensitize the tracheal mucosa around the cuff after the surgeon had removed the uterus. In group II (Control group), no special management was made. All patients were not extubated until they were considered to be awake. Systolic blood pressure at three and one minute before extubation and pulse rate recorded at one minute before extubation showed in patients of group I were statistically smoother than those recorded in group II (p less than 0.01). All patients had gag reflex just after awake extubation.

The application of pulse oximeter for supraclavicular brachial block.

The subclavian artery is the most important landmark of the supraclavicular brachial block. However, it is difficult to locate the artery by palpation in the patients with poor landmark. The present study was aimed to compare two localizing methods of the subclavian artery by a pulse oximeter or by palpation. One hundred patients were divided into three groups. Group A (Slim Group): 6 patients, Group B (Normal Weight Group): 75 and Group C (Obese Group): 19. All patients received both methods to locate the subclavian artery. The first method was by palpating the pulsation of the subclavian artery. The second was by observing the wave depression of the pulse oximeter while pressing supraclavicular area. It was found that the detection rate of the first method was 83.3% in Group A, 52.0% in Group B, 26.3% in Group C and 49.0% in overall patients. However, the detection rate of the second method was 100% in each group. It shows a significant difference between the two methods in Group B, Group C and all patients (P less than 0.001), but no difference in Group A (P = 0.68). There were 13 patients among the 100 patients undergoing surgery of the upper extremity. Seven of them whose pulsation was not clearly palpated but could be located exactly by pulse oximeter. Supraclavicular brachial block was still completed successfully in these 13 patients. No pneumothorax was found. Utilizing pulse oximeter in supraclavicular block provides a high detection rate of the pulsation of the subclavian artery and improves the reliability of the block, especially in the patients with poor landmark.

Estimation of the length of nasopharyngeal airway in Chinese adults.

Nasopharyngeal airway should be placed to reach the tongue base without contact with the epiglottis. The correct length of the nasopharyngeal airway in Chinese adults was estimated in seventy-three surgical patients under general anesthesia (30 males and 43 females, aged 18-82 yr). Measurements were performed with a soft, uncuffed, ID 6.0 mm endotracheal tube (Portex) introduced through the nasopharyngeal passage. The proper tip placement of the tube was evaluated under direct laryngoscopy. The Nostril-epiglottis distance (N-E distance) is 15.31 +/- 1.09 cm (mean +/- SD) for all cases, 16.03 +/- 1.04 cm for male cases and 14.97 +/- 0.95 cm for female cases. There are correlation between the N-E distance and the height (p less than 0.001, r = 0.41), and between the N-E distance and the N-A distance (The distance from nose tip to mandibular angle) (p less than 0.004, r = 0.324). Linear regression analysis relating the N-E distance to the height and the N-E distance to the N-A distance were also statistically significant (p less than 0.001 and p less than 0.01, respectively).

[Dose-response of intrathecal morphine for post-cesarean analgesia].

Intrathecal morphine for post-operative analgesia is famous for its quality and safety, but its role in post-Cesarean analgesia is not well established. In this study, we investigate its analgesic effect, complication rate and neonatal outcome under various dosages of morphine. The parturients divided into five groups according to morphine dosage: 0, 0.1, 0.25, 0.5, 1.0 mg respectively. The duration of analgesic effect was 19.1 h in 0.1 mg group, 23.6 h in 0.25 mg group, 28.1 h in 0.5 mg group, 30.5 h in 1.0 mg group. Complication rate increased markedly as more than 0.5 mg morphine was injected. Respiratory inhibition (respiratory rate less than 10/min) that required naloxone treatment had occurred twice in 0.5 and 1.0 mg group respectively. Neonatal outcome did not bear any difference among the five groups. In conclusion, adding 0.1 to 0.25 mg morphine to intrathecal anesthetics can be effectively and safely extended into post-Cesarean analgesia.

Influence of nitrous oxide on rat skin allograft.

Adult male Lewis/f Mai rats underwent skin allografts and the time for complete loss of the graft was compared among different groups treated with different methods. The rats were exposed in isolation chambers to an atmosphere of either room air (control groups I and IV for nitrous oxide-exposed groups, 20% and 40%, respectively); or an atmosphere of oxygen supplemented respectively with 20% and 40% nitrous oxide (the balance being nitrogen) continuously after transplant surgery (Groups II and V respectively); or 48 hours prior to transplantation and with air exposure only after surgery (Groups III or VI respectively). Results indicated that nitrous oxide-exposed rats had significantly prolonged skin allograft survival.

Suppression of chemotaxis to corneal inflammation by nitrous oxide.

Immune competency is depressed in the perioperative period. The role of anesthetic agents in immune reactivity remains unclear. The chemotactic migration of polymorphonuclear leukocytes (PMNs) to the cornea of rabbits injured by clove oil was studied. PMNs were previously radiolabeled with tritiated (3H) thymidine. Immediately following injury, the rabbits entered isolation chambers and breathed either air or air containing 10%, 20% or 40% nitrous oxide (N2O) for 24 hours. After sacrifice, the radioactivity of a 10 mm corneal button, removed by trephination, was determined by scintillation counting technique. Peripheral blood was obtained for hemoglobin, white cell and platelet count. The N2O dosage affected on the migration of PMNs to the cornea. 3H was decreased 15.4% by 20% N2O and 38.8% for 40% N2O-exposed rabbits. Peripheral blood values did not differ. N2O can suppress chemotaxis of PMNs in the rabbit, thereby adversely affecting the inflammatory component of immune defense.