BACKGROUND: A thoracic epidural combined with general anesthesia may reduce the oxygen demand of the heart by cardiac sympathetic blockade, but it may also reduce the systemic and cardiac oxygen delivery due to hypoperfusion which is critical to patients with significant coronary lesions. This study was done to investigate the effects of thoracic epidural anesthesia on the systemic and cardiac oxygen supply/demand balance during coronary occlusion in dogs. METHODS: In 10 dogs, the left circumflex coronary artery was occluded, and then thoracic epidural anesthesia was given at the T5-6 or T6-7 level with 5 ml of 0.5% bupivacaine to block T1-T12 through the surgically introduced epidural catheter. Hemodynamic parameters and arterial, mixed venous and coronary sinus blood samples were obtained at baseline and 30 minutes after coronary occlusion. The same parameters were also measured at 30, 60, 90, 120 and 150 minutes after the epidural blockade. An epicardial 2D-echocardiogram was done by a cardiologist at baseline, 30 minutes after occlusion and 1 hour after the epidural blockade. RESULTS: Systemic oxygen delivery (O2 flux) was decreased after epidural anesthesia (p < 0.05), but oxygen consumption (VO2) was maintained throughout the experimental periods. Although the systemic oxygen extraction ratio (O2ER) was not changed, cardiac O2ER was increased at 90, 120 and 150 minutes after epidural anesthesia (p < 0.05). The end-diastolic noncontractile area of the left ventricle was increased, pulmonary capillary wedge pressure was increased 90 minutes after epidural anesthesia and cardiac output was decreased 120 minutes after epidural anesthesia (p < 0.05). CONCLSIONS: In the experimental canine model of coronary occlusion, thoracic epidural anesthesia induces diminished systemic oxygen delivery without deteriorating oxygen supply/demand balance. However, as PsO2 and SsO2 diminished and the noncontractile left ventricular area increased after epidural anesthesia in the setting of acute coronary occlusion, perioperative use of thoracic epidural anesthesia in patients of coronary disease should be done carefully in order not to aggravate myocardial ischemia.
Anesthesia, Epidural* ; Anesthesia, General ; Animals ; Bupivacaine ; Cardiac Output ; Catheters ; Coronary Disease ; Coronary Occlusion* ; Coronary Sinus ; Coronary Vessels ; Dogs* ; Heart ; Heart Ventricles ; Hemodynamics ; Humans ; Myocardial Ischemia ; Oxygen Consumption ; Oxygen* ; Pulmonary Wedge Pressure

Anesthetic care is usually provided for patients undergoing surgical procedures to make them unconscious and painless during surgery. Nowadays there are increasing therapeutic or diagnostic procedures performed outside operating room. Sedation is more frequently provided as healthcare during procedures for patient's comfort and safety by non-anesthesiologist or anesthesiologist. Early in 1999, ASA (the American Society of Anesthesiologists defined sedation and analgesia and established 4 states: minimal sedation, moderate sedation, deep sedation, and general anesthesia. Monitored anesthetic care implies the potential for a deep sedation and is always administered by an anesthesiologist. It is not always possible to predict how an individual patient will respond by nature of being a continuum of sedation. Hence, practitioners intending to induce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. The standards for preoperative evaluation, intraoperative monitoring, anesthetic care, etc. are not different from those for general anesthesia.
Analgesia ; Anesthesia* ; Anesthesia, General ; Conscious Sedation ; Deep Sedation ; Delivery of Health Care ; Humans ; Methods ; Monitoring, Intraoperative ; Operating Rooms

BACKGROUND: A retrospective study was performed to evaluate postoperative mortality within 30 days following surgery. METHODS: The records of 31,806 patients who received operation under general anesthesia were reviewed. RESULTS: 1) Postoperative deaths were 184 cases, the ratio of which was comprising 0.57% of all surgical operative cases. 2) The highest ratio of the mortality in age group was 51~60 years group which was 24.5%, and in physical status it was ASA class III which was 36.4%. The highest ratio to the mortality rate in postoperative days was 8~30 days which was 45.1%. 3) The most common causes of death was low cardiac output due to heart failure on operating theater, and hypovolemic shock within postoperative 2 days, and intracranial problem within postoperative 7 days, and pulmonary complication within postoperative 30 days. CONCLUSION: We conclude that fatality rate could be decreased by intensive and multidisciplinary care for postoperaive complications as respiratory and renal failure.
Anesthesia, General ; Cardiac Output, Low ; Cause of Death ; Heart Failure ; Humans ; Mortality ; Renal Insufficiency ; Retrospective Studies ; Shock

BACKGROUND: The aim of this study was to examine the cardiac function and transcriptional response of the heart to propofol after ischemia-reperfusion. METHODS: Rat hearts were Langendorff-perfused using the modified Krebs-Henseleit buffer, and took 20 min stabilizing periods, 40 min ischemia periods, and then 120 min reperfusion period. The hearts were divided into 5 groups; Control: 180 min perfusion after stabilization, Ischemic: 40 min global ischemia after stabilization, followed by 120 min reperfusion, Pre: 2 micrometer propofol treatment was preformed only before ischemia, Post: 2 micrometer propofol treatment was performed only during reperfusion after ischemia, Pre/Post: 2 micrometer propofol treatment was performed both before and after ischemia. The measurement for cardiac performances, such as left ventricular developed pressure (LVDP), rate of left ventricular pressure generation (dP/dt), heart rate, and coronary flow were obtained. The expression profiles of isolated mRNA were determined by using Agilent microarray and real time-polymerase chain reaction (RT-PCR) was used to confirm the microarray results for a subset of genes. RESULTS: The Post group showed better LVDP and dP/dt than the Ischemic group. But there were no significant differences in heart rate and coronary flow among the groups. On the results of RT-PCR, the expressions of Abcc9, Bard1, and Casp4 were increased, but the expressions of Lyz, Casp8, and Timp1 were decreased in the Post group compared with the Ischemic group. CONCLUSIONS: This study suggests that 2 micrometer propofol may provide cardioprotective effect, and modulate gene expression such as apoptosis, and K(ATP) ion channel related-genes during reperfusion in the isolated rat hearts.
Animals ; Apoptosis ; Gene Expression ; Glucose ; Heart ; Heart Rate ; Ion Channels ; Ischemia ; Perfusion ; Propofol ; Rats ; Reperfusion ; RNA, Messenger ; Tromethamine ; Ventricular Pressure

BACKGROUND: The aim of this study was to examine the cardiac function and transcriptional response of the heart to propofol after ischemia-reperfusion. METHODS: Rat hearts were Langendorff-perfused using the modified Krebs-Henseleit buffer, and took 20 min stabilizing periods, 40 min ischemia periods, and then 120 min reperfusion period. The hearts were divided into 5 groups; Control: 180 min perfusion after stabilization, Ischemic: 40 min global ischemia after stabilization, followed by 120 min reperfusion, Pre: 2 micrometer propofol treatment was preformed only before ischemia, Post: 2 micrometer propofol treatment was performed only during reperfusion after ischemia, Pre/Post: 2 micrometer propofol treatment was performed both before and after ischemia. The measurement for cardiac performances, such as left ventricular developed pressure (LVDP), rate of left ventricular pressure generation (dP/dt), heart rate, and coronary flow were obtained. The expression profiles of isolated mRNA were determined by using Agilent microarray and real time-polymerase chain reaction (RT-PCR) was used to confirm the microarray results for a subset of genes. RESULTS: The Post group showed better LVDP and dP/dt than the Ischemic group. But there were no significant differences in heart rate and coronary flow among the groups. On the results of RT-PCR, the expressions of Abcc9, Bard1, and Casp4 were increased, but the expressions of Lyz, Casp8, and Timp1 were decreased in the Post group compared with the Ischemic group. CONCLUSIONS: This study suggests that 2 micrometer propofol may provide cardioprotective effect, and modulate gene expression such as apoptosis, and K(ATP) ion channel related-genes during reperfusion in the isolated rat hearts.
Animals ; Apoptosis ; Gene Expression ; Glucose ; Heart ; Heart Rate ; Ion Channels ; Ischemia ; Perfusion ; Propofol ; Rats ; Reperfusion ; RNA, Messenger ; Tromethamine ; Ventricular Pressure

No abstract available.
Child ; Humans ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory*

No abstract available.
Child ; Humans ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory*

In the last decade, advances in laparoscopic equipments have allowed the development of laparoscopic surgical treatment for gynecologic affeetion. The purpose of this study is to investigate the cardiovascular effects and blood gas changes during laparoscope assisted vaginal hysterectomy (LAVH) in Trendelenburg position and intraabdominal CO2 insufflation to obtain optimal surgical field. Mean arterial pressure (MAP), heart rate. SaO2, PaO2, end-tidal CO2 (ETCO2) PaCO2, pH, and peak airway pressure (PAP) were measured in twenty patients who underwent laparoscope assisted vaginal hysterectomy in Trendelenburg position and intraabdominal CO2 insufflation. Each measurement was taken immedistely after intubation (control), 15 minutes after Trendelenburg position, 30 minutes after CO2 insufflation, 15 minutes, 1 hour and 6 hrs. after CO2 deflation. ETCO2 and PAP were not measured 1 hour and 6 hrs. after deflation The results were as follows; 1) Mean arterial pressure and heart rate were decreased after Trendelenburg position, but increased after CO2 insufflation. 2) Arterial O2 saturation was decreased after CO2 insufflation, 1 hour after deflation 3) Arterial PO2 was decreased after CO2 insufflation. 4) End-tidal CO2 was increased after CO2 insufflation. 5) Arterial PCO2 was increased after CO2 insufflation compared to control value, but it was decreased at 15 minutes after CO2 deflation. Arterial PCO2 at 1 hour after CO2 deflation was higher than at 15 minutes after CO2 deflation and 6 hrs. after CO2 deflation. 6) Arterial pH was decreased after CO2 insufflation. 7) Peak airway pressure was increased after Trendelenburg position and after CO2 insufflation.
Arterial Pressure ; Female ; Head-Down Tilt ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hysterectomy, Vaginal* ; Insufflation ; Intubation ; Laparoscopes*

In the last decade, advances in laparoscopic equipments have allowed the development of laparoscopic surgical treatment for gynecologic affeetion. The purpose of this study is to investigate the cardiovascular effects and blood gas changes during laparoscope assisted vaginal hysterectomy (LAVH) in Trendelenburg position and intraabdominal CO2 insufflation to obtain optimal surgical field. Mean arterial pressure (MAP), heart rate. SaO2, PaO2, end-tidal CO2 (ETCO2) PaCO2, pH, and peak airway pressure (PAP) were measured in twenty patients who underwent laparoscope assisted vaginal hysterectomy in Trendelenburg position and intraabdominal CO2 insufflation. Each measurement was taken immedistely after intubation (control), 15 minutes after Trendelenburg position, 30 minutes after CO2 insufflation, 15 minutes, 1 hour and 6 hrs. after CO2 deflation. ETCO2 and PAP were not measured 1 hour and 6 hrs. after deflation The results were as follows; 1) Mean arterial pressure and heart rate were decreased after Trendelenburg position, but increased after CO2 insufflation. 2) Arterial O2 saturation was decreased after CO2 insufflation, 1 hour after deflation 3) Arterial PO2 was decreased after CO2 insufflation. 4) End-tidal CO2 was increased after CO2 insufflation. 5) Arterial PCO2 was increased after CO2 insufflation compared to control value, but it was decreased at 15 minutes after CO2 deflation. Arterial PCO2 at 1 hour after CO2 deflation was higher than at 15 minutes after CO2 deflation and 6 hrs. after CO2 deflation. 6) Arterial pH was decreased after CO2 insufflation. 7) Peak airway pressure was increased after Trendelenburg position and after CO2 insufflation.
Arterial Pressure ; Female ; Head-Down Tilt ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hysterectomy, Vaginal* ; Insufflation ; Intubation ; Laparoscopes*

No abstract available.
Child* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis*