No abstract available.
Blood Gas Analysis*

Transcranial cerebral oximetry has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. It has been also used in intraoperative monitoring of aortic dissection and surgical procedures performed under deep hypothermia and circulatory arrest. During disending aortic arch exposure, sudden cerebral oxygen saturation change from 63% to 48% was detected. After therapeutic bypass, cerebral oxygen saturation was increased to 65%. During aortic arch repair, deep hypothermic circulatory arrest with retrograde cerebral perfusion was applied for 130 min and cerebral oxygen saturation slowly decreased from 65% to 52%. Patient was discharged from hospital without neurologic complication and cognitive funtion disturbance.
Aorta, Thoracic ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Hypothermia ; Monitoring, Intraoperative ; Oximetry ; Oxygen* ; Perfusion

BACKGROUND: Esmolol has been applied to lower myocardial oxygen consumption and creates a quieter operative field by reducing systemic blood pressure and heart rate but can cause a certain amount of hemodynamic instability during minimally invasive direct vision coronary artery bypass graft (MIDCAB). The aim of this study was to compare the hemodynamic differences between two methods; inducing hypotension and bradycardia between esmolol infusion alone, and concomitant use of neostigmine during MIDCAB anesthesia. METHODS: Twenty MIDCAB patients were randomly allocated into two groups, group E (n = 10) receiving esmolol 0.3 mg/kg/min, group EN (n = 10) receiving esmolol 0.2 mg/kg/min and neostigmine 1.0 mg for induced hypotension and bradycardia during coronary anastomosis. The hemodynamic parameters were evaluated 10 minutes after induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes before the end of anastomosis (T3) and 10 minutes after the end of anastomosis (T4). Data were analyzed by ANOVA test for intragroup comparisons, and by T-test for intergroup comparisons with significance set at a P value of < 0.05. RESULTS: Heart rate significantly decreased at T3 in both groups and more in group EN. Systolic blood pressure decreased at T3 in both groups and there were no group differences but more episodes of extreme hypotension in group E. The cardiac index significantly decreased at T3 in both groups and more in group E. There was a small but significant increase in pulmonary capillary wedge pressure at T3 and T4 in group E and no change of central venous pressure in both groups. CONCLUSION: Concomitant use of neostigmine during esmolol infusion produces more reliable induced hypotension and bradycardia than esmolol infusion alone for MIDCAB anesthesia in terms of prevention of myocardial ischemia and easiness of anastomosis technique.
Anesthesia* ; Blood Pressure ; Bradycardia* ; Central Venous Pressure ; Coronary Artery Bypass ; Heart Rate ; Hemodynamics ; Humans ; Hypotension* ; Myocardial Ischemia ; Neostigmine* ; Oxygen Consumption ; Pulmonary Wedge Pressure ; Transplants

Fluid resuscitation is a basic treatment in hemorrhagic shock. We compared the circulatory responses to fluid resuscitation of 10% pentastarch with those of fresh whole blood and plasmanate in hemorrhagic shock. Eighteen mongrel dogs were bled 24 ml/kg and replaced by equivalent amounts of fresh whole blood(n=6, group B), pentastarch(n=6, group P) and plasmanate(n=6, group PL). Hemodynamic measurements and calculations were performed before and after bleeding and after volume therapy. The decrease of hematocrit and platelet count after volume replacement indicate that hemodilutional effect was maximum 30 min after volume therapy and significantly greater in group P than PL(p<0.05). Central venous pressure(CVP), pulmonary capillary wedge pressure(PCWP) and cardiac index(CI) were increased to 146-189%, 146-172% and 146-175% in group P, respectively during 60 min. These changes were significantly greater than group B and PL(p<0.05). There was delayed recovery of mean arterial pressure in group PL(92% 30 min after volume therapy) compared with group B and P(92% and 93% 5 min). Also group P and PL showed significant prolongation in prothrombin time and partial thromboplastin time during experiment(120 min) and these were significantly more prolonged in group P than PL(P<0.05). And group P showed similar O transport and O extraction ratio to those of group B. The increases in plasma catecholamine were observed after hemorrhage, but no significant changes 5 and 30 min after volume therapy. This suggests that the neurohumoral response to hemodilution was not marked. Mixed venous O2 saturation(SvO2) was directly proportional to CI during experiment(r=0.69, p<0.01), indicating that SvO2 can represent CI during shock and volume therapy. In conclusion, l0% pentastarch is useful as a substitute for fresh whole blood or plasmanate.
Animals ; Arterial Pressure ; Blood Transfusion, Autologous* ; Capillaries ; Dogs* ; Hematocrit ; Hemodilution ; Hemodynamics ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; Partial Thromboplastin Time ; Plasma ; Platelet Count ; Prothrombin Time ; Resuscitation* ; Shock ; Shock, Hemorrhagic*

No abstract available.
Blood Transfusion*

BACKGROUND: Induction of general anesthesia in patients with cardiac disease must guarantee hemodynamic stability and should result in a satisfactory anesthetic level. The purpose of this study was to analyze the hemodynamic effects of midazolam/sufentanil in comparison with etomidate/sufentanil used for induction of anesthesia in patients with cardiac disease. METHODS: All the patients (n = 30) in the study were about to undergo cardiac surgery and were divided into the midazolam group (n = 15) and etomidate group (n = 15). The induction dose of midazolam was 0.18 mg/kg, etomidate 0.3 mg/kg, vecuronium 0.15 mg/kg, sufentanil 3 microgram/kg, hemodynamics and oxygenation were recorded in the awake state (pre-induction), and 10 minutes after intubation (post-intubation). RESULTS: The etomidate group had a shorter time of anesthetic induction, and some myoclonic movement (13%) was observed. After intubation, reductions of heart rate (13.8%), mean arterial pressure (18.4%), cardiac index (14.8%), left ventricular stroke work index (9.7 - 38.5%), oxygen delivery index (7.43%), oxygen consumption index (10.3%), and Qs/Qt (25.6%), and an increase in central venous pressure (0 - 50%) were observed in both groups. Decreases in right ventricular stroke work index and mean arterial pressure were observed in the midazolam group, but no change in right ventricular stroke work index and a decrease in mean arterial pressure was observed in the etomidate group. In the midazolam group the values of right ventricular stroke work index and mean arterial pressure were significantly lower than in the etomidate group. The heart rate of the midazolam group in patients with CABG were significantly lower than in the etomidate group. CONCLUSIONS: The results of this study shows that etomidate was found to be as reliable and effective an agent for induction as midazolam.
Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Central Venous Pressure ; Etomidate ; Heart Diseases* ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam ; Oxygen ; Oxygen Consumption ; Stroke ; Sufentanil ; Thoracic Surgery ; Vecuronium Bromide

A number of recent reports have described the usefulness of the epidural injection of narcotics for the relief of postoperative pain. But the epidural use of narcotic agonist-antagonist, nalbuphine hydrochloride, has not been reported. To study the effect of epidural nalbuphine hydrochloride for postoperative pain relief, we divided 73 patients into 5 groups randomly: 3 mg nalbuphine hydrochloride in 10 ml saline (group 1, n=9); 4 mg nalbuphine hydrochloride in 10 ml saline (group 2, n=14); 5 mg nalbuphine hydrochloride in 10 ml saline (group 3, n=21); 3 mg morphine in 10 ml saline (group 4, n=16); 4 mg morphine in 10 ml saline (group 5, n=13). The results were as follows 1) The onset time of analgesic effect were average 15~20 minitues in all groups 2) The durations of analgesia of epidural nalbuphine groups were (average; 5~7 hours) significantly shorter than morphine groups (average; 31~32 hours). 3) The degree of analgesia were same between 5 groups 4) The complications were nausea, vomiting and pruritus in all groups, but the frequency of pruritus in morphine groups was more than nalbuphine groups (p<0.05). 5) Urinary retention was observed only in morphine groups. In conclusion, the result of our study suggests that nalbuphine hydrochloride be better agent than morphine in terms of complication for postoperative pain relief but the duration of action is shorter than morphine, when injected epidurally.
Analgesia ; Humans ; Injections, Epidural ; Morphine ; Nalbuphine* ; Narcotics ; Nausea ; Pain, Postoperative* ; Pruritus ; Urinary Retention ; Vomiting

The postanesthetic nausea and vomiting during the recovery period was regarded as one of the almost inevitable and undesirable sequelae of surgery and anesthesia. With the progress of anesthetic technics and agents the incidence of this complication has been reduced. The analysis of the incidence of postanesthetic nausea and vomiting that occurred in the postanesthetic recovery room was performed on 4239 patients who received general inhalation anesthesia from Nov. 1988 to Apr. 1989 in Seoul National University Hospital. The overall incidences of postanesthetic nausea and vomiting were 0.4% and 0.5% of 4239 patients, respectively. Although the use of isoflurane among anesthetics was followed by slightly lower incidence significant. The incidence was not significantly related to sex, operation site, and the department of surgery. The incidence decreased much more than before, but because nausea and vomiting can produce undesirable complications they should be carefully prevented and treated.
Anesthesia ; Anesthesia, Inhalation ; Anesthetics ; Humans ; Incidence ; Isoflurane ; Nausea* ; Recovery Room ; Seoul ; Vomiting*

We studied the cardiovascular and neuromuscular effects of Norcuron (a new nondepo larizing muscle relaxant) in ASA Claas I patients under halothane and nitrous oxide ane-sthegia. The onset time of Norcuron was 1.06+/-0.27 win, and Clinical duration of action time was 41.49+/-5.53 min and recovery index was 16.38+/-2.30 min and total duration of action time was 67.04 +/-14.42 min.. after volus injection Norcuron 0.1 mg/kg. Norcuron did not change mean arterial presaure, heart rate and histamine secretions and had not arrythmogemic effect on heart rhythm. We conclude that vecuronium bromide (Norcuron) produces a excellent neuromuscular blockade of short duration with little cardiovascular changes and histamine releaae.
Halothane ; Heart ; Heart Rate ; Histamine ; Humans ; Neuromuscular Agents* ; Neuromuscular Blockade ; Nitrous Oxide ; Vecuronium Bromide*

The correlation of ventilatory support with sex, age, operation time, aortic cross clamp time was studied in 274 patients undergone open heart surgery after dividing them into total, congenital heart disease, acquired heart disease groups. 1) Ventilatory support time was not significantly different between male and female. 2) In total group, ventilatory support time increased significantly with an increase of pump time, aortic cross clamp time (p<0.05) and age (p<0.01). 3) In congenital heart disease group, ventilatory support time increased significantly with an increase of operation time (p<0.05), pump time, aortic cross clamp time (p<0.001). 4) In acquired heart disease group, ventilatory support time increased significantly with an increase of age (p<0.001).
Anesthesia* ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart* ; Humans ; Male ; Thoracic Surgery*