Induced hypotensive anesthesia is well known anesthetic method. It reduces bleeding into surgical field and provides better visibility for the surgery of cerebral aneurysm. The most current method for induced hypotensive anesthesia is composed of general anesthesia and ganglionic blockade. This study was performed to compare the clinical experience from hypotensive anesthesia with halothane only to hypotensive anesthesia with trimetaphan and halothane. The results of our study were as follows; 1) There are no different technical difficulties during hypotensive anesthesia between halothane induced cases and trimetaphan used cases. 2) No clinical evidence of direct organic damage because of hypotensive anesthesia was found. 3) The prognosis of postoperative recovery may deeply related to preoperative physical state than anesthesia. To conclude through this experience, induced hypotensive anesthesia is a useful method for the cerebral aneurysmal surgery. The technique of deliberate hypotension is not too difficult to use in ordinary equiped hospital.
Anesthesia ; Anesthesia, General ; Ganglion Cysts ; Halothane* ; Hemorrhage ; Hypotension ; Hypotension, Controlled* ; Intracranial Aneurysm* ; Methods ; Prognosis ; Trimethaphan*

BACKGROUND: Controlled hypotension improves surgical field and decreases transfusion requirement in surgical patients and can be induced with various kinds of drugs including esmolol and hydralazine. METHODS: This study examined the effect of a combination of esmolol and hydralazine as hypotensive agents in spine surgery. In the esmolol group (n = 15), after boluses of esmolol (0.5 mg/kg) injection, esmolol was infused to maintain the mean arterial pressure of 55-65 mmHg. In the hydralazine-esmolol group (n = 15), hydralazine (0.3 mg/kg) was administered 15 minutes before esmolol injection which was done in the same way as that of the esmolol group. RESULTS: The mean arterial pressure decreased to the target range more rapidly in the hydralazine-esmolol group. The heart rate was increased by hydralazine, but reduced by esmolol. The cardiac output remained elevated after hydralazine injection in the hydralazine-esmolol group, and decreased significantly by esmolol in the esmolol group. The administered dose of esmolol was much less in the hydralazine-esmolol group than in the esmolol group. CONCLUSIONS: Our data suggest that hydralazine can enhance the efficacy of esmolol-induced controlled hypotension. It can reduce the requirement of esmolol and maintain a higher cardiac output during hypotension.
Arterial Pressure ; Cardiac Output ; Heart Rate ; Humans ; Hydralazine* ; Hypotension ; Hypotension, Controlled* ; Spine*

Controlled hypotension has been used to facilitate the surgical procedure and to reduce blood loss. This study was performed to compare the change of the cardiovascular systerm and intracranial pressure following the controlled hypotension induced by isoflurane, sodium nitroprusside, and labetalol in 28 cats. The results were as follows. 1) Heart rate was decreased with the isoflurane-induced hypotension, increased with the sodium nitroprusside-mduced hypotension. Both were not significant, but labetalol-induced hypotension increased heart rate significantly(P< 0.05). 2) Intracranial pressure was increased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.05), but there was significantly small per cent ehange in labetalol-induced hypotension than sodium nitroprusside-induced hypotension(P< 0.05). 3) Cerebral perfusion pressure was decreased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.01), but there was significantly small per cent change in labetalol-induced hypotension than isoflurane or sodium nitroprusside-induced hypotension(P < 0.01, P< 0.001).
Animals ; Cats* ; Heart Rate ; Hypotension* ; Hypotension, Controlled ; Intracranial Pressure ; Isoflurane* ; Labetalol ; Nitroprusside* ; Perfusion ; Sodium*

Controlled hypotension has been used to facilitate the surgical procedure and to reduce blood loss. This study was performed to compare the change of the cardiovascular systerm and intracranial pressure following the controlled hypotension induced by isoflurane, sodium nitroprusside, and labetalol in 28 cats. The results were as follows. 1) Heart rate was decreased with the isoflurane-induced hypotension, increased with the sodium nitroprusside-mduced hypotension. Both were not significant, but labetalol-induced hypotension increased heart rate significantly(P< 0.05). 2) Intracranial pressure was increased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.05), but there was significantly small per cent ehange in labetalol-induced hypotension than sodium nitroprusside-induced hypotension(P< 0.05). 3) Cerebral perfusion pressure was decreased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.01), but there was significantly small per cent change in labetalol-induced hypotension than isoflurane or sodium nitroprusside-induced hypotension(P < 0.01, P< 0.001).
Animals ; Cats* ; Heart Rate ; Hypotension* ; Hypotension, Controlled ; Intracranial Pressure ; Isoflurane* ; Labetalol ; Nitroprusside* ; Perfusion ; Sodium*

BACKGROUND: Controlled hypotension is used to reduce bleeding and improve surgical conditions during surgery. Remifentanil is an ultrashort-acting opioid with potent analgesic effect and is useful for rapid emergence. This study was performed to investigate the clinical usefulness of remifentanil for induced hypotension during orthognathic surgery. METHODS: Fifty adult patients scheduled for orthognathic two jaw surgery were randomly allocated to nitroglycerin (group N) and remifentanil group (group R). After induction of anesthesia, group N (n = 25) was infused with nitroglycerin to induce hypotension, and group R (n = 25) was infused with remifentanil. Mean arterial pressure (MAP) and heart rate (HR) were measured before, 5, 10, 20, and 30 min after drug administration. Surgical field rating and blood loss were measured after surgery. RESULTS: Heart rates at 10, 20, 30 minutes after continuous infusion of drug were lower in group R than in group N (P < 0.05). The time for the MAP to return to the baseline after discontinuation of drug infusion was shorter in group R than in group N (P < 0.05). There were no significant differences in the surgical field rating and blood loss between the groups. CONCLUSIONS: Remifentanil enabled controlled hypotension and provided good surgical conditions for orthognathic surgery with no need for additional use of a hypotensive agent.
Adult ; Anesthesia ; Arterial Pressure ; Heart Rate ; Hemorrhage ; Humans ; Hypotension ; Hypotension, Controlled* ; Jaw* ; Nitroglycerin ; Orthognathic Surgery*

Background: Esmolol as a drug for induced hypotension can, not only avoid many drawbacks of nitroprusside, but reduce the amount of intraoperative bleeding and make better operative field. This study was performed to evalute cardiovascular changes during esmolol-induced controlled hypotension. Methods: Induced hypotension using esmolol was applied to 18 adult patients receiving spinal surgery under the diagnosis of spinal stenosis or scoliosis. After prehydraion of 2,000 ml of crystalloid solution, 0.5 mg/kg esmolol was used as loading dose once, twice or three times until mean blood pressure (MBP) fell below 70 mmHg, followed by continuous infusion (50~300 microg/kg/min) of esmolol. MBP and heart rate (HR) were measured before, 5, 10, 15, 30, 60 and 90 min after esmolol administration, and 5, 10 and 15 minutes after discontinuation of esmolol. In 8 patients, cardiac output (CO) and mixed venous oxygen tension and saturation were measured before, during and after esmolol use. Results: MBP was decreased from 91+/-12 mmHg to 67+/-7 mmHg after 15 min (P<0.05). HR(BPM) was decreased from 76+/-17 to about 60 after 15 min (P<0.05). CO was decreased about 30% during induced hypotension but recoverd to initial level 15 min after esmolol discontinuation. While oxygen transport was reduced significantly during induced hypotension (P<0.05), oxygen consumption was maintained all the time. Conclusion: With the use of esmolol, stable hypotension could be achieved. Although oxygen transport decreased possibly due to reduction of CO, but oxygen consumption was maintained.
Adult ; Blood Pressure ; Cardiac Output ; Diagnosis ; Heart Rate ; Hemorrhage ; Humans ; Hypotension* ; Hypotension, Controlled ; Nitroprusside ; Oxygen ; Oxygen Consumption ; Scoliosis ; Spinal Stenosis

Damage control resuscitation is a relatively new resuscitative strategy for patients with severe traumatic hemorrhage. This strategy consists of permissive hypotension and early balanced transfusion, and transfers the patients to subsequent surgery. There is growing evidence on harms of excessive fluids. Since 2013, survival benefit of massive transfusion protocol has been proven in adults. Despite insufficient evidence, pediatric massive transfusion protocols are widely used in North American trauma centers. This review focuses on the concept of damage control resuscitation, and summarizes the relevant pediatric evidence.
Adult ; Blood Coagulation Disorders ; Blood Transfusion ; Child ; Emergency Medicine ; Hemorrhage ; Hemostasis ; Humans ; Hypotension ; Hypotension, Controlled ; Resuscitation ; Trauma Centers ; Wounds and Injuries

Patient-controlled analgesia (PCA) provides excellent pain control and high stability, thereby minimizing the incidence of adverse effects. However, one of our patients experienced respiratory depression and hypotension within 30 minutes of initiation of PCA therapy. We discovered that machine malfunction caused continuous activation of the PCA button, resulting in a drug overdose. The PCA machine was sent to the manufacturer, who found an electrical short in the PCA button. All PCA units of the same make and model were immediately removed from hospitals and replaced with redesigned units without defects in the PCA button. We have used the improved machines without any problems. The purpose of this report is to raise awareness of this type of malfunction in PCA units in order to help prevent adverse events in the future.
Analgesia, Patient-Controlled ; Drug Overdose ; Humans ; Hypotension ; Incidence ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency

The hemodynamic and metabolic changes during induced hypotension with isoflurane (isoflurane group) or sodium nitroprusside (SNP group) were observed in twelve mongrel dogs. These hypotensive effects were evaluated at 30 and 60 minutes after the mean arterial blood pressure was lowered to 50% from the control. Hemodynamic changes were evaluated by measuring systemic arterial blood pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure, cardiac output, systemic vascular resistance and pulmonary vascular resistance. Metabolic changes were evaluated by measuring serum lactate and pyruvate, arterio-venous oxygen content difference and oxygen extraction rate. We also compared the ventilatory effect of hypotensive anesthesia by blood gas analysis. The results were as follows: 1. Isoflurane inhalation 2-4% or SNP infusion 10-20 micrograms/kg/min was required to reduce the mean arterial pressure to 50% of the control. 2. Heart rate was decreased slightly in the isoflurane group but significantly decreased in the SNP group. 3. There were no significant changes in central venous pressure and pulmonary capillary wedge pressure in either group. 4. Cardiac output was reduced in both groups but was more severe in the isoflurane group. 5. Systemic vascular resistance was decreased by 36% in the isoflurane group and 47% in the SNP group. 6. Acidosis was apparent and did not recover to the control until 30 minutes after recovery in the SNP group. 7. Arterio-venous oxygen difference was increased during hypotension in the isoflurane group probably due to decreased cardiac output. 8. The lactate/pyruvate ratio increased slightly in the SNP group.
Anesthesia ; Animal ; Dogs ; *Hemodynamics ; *Hypotension, Controlled ; *Isoflurane ; Lactates/metabolism ; *Nitroprusside ; Pyruvates/metabolism ; Pyruvic Acid

Sodium nidroprusside has recently come. into widespread usage, not only for the treatment of severe hypertension but also for induced hypotension during surgery. Induced hypotension was produced during general anesthesia by the infusion of sodium nidruopsside in 0. 0l% solution, in two patients undergoing ligation and division of patent ductus arteriosua with pulmonary hypertension. In these cases, no acidotic tendency or CN toxicity were seen and conditions were satisfactory for correction of the PDA.
Anesthesia, General ; Ductus Arteriosus, Patent* ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hypotension, Controlled ; Ligation ; Nitroprusside* ; Sodium*