The dose-ralated dffects of intravenous infusion of thiopental and ketamine on the rat EEG were evaluated quantitatively by spectrum analysis of EEG recorded from the rat scalp. The anesthetics were infused into jugular vein at various rates ranging from 0 to 8ug/min/g body weight, and then bipolar EEG was recorded from the rat scalp and tis spectrum were calculated by powere wpectrum analysis. the density of each bands(delta 1-3.25, theta 3.5-7.75, alpha 8-12.15, beta 1.13-17.75, beta 2.18-20.75, and beta 3.21-31.75Hz) and total density were derived from the spectrums. In visual inspection of conventional EEG, low doses of thiopental increased the amplitudes of spinles. but higher doses decreased the amplitube gradually to electrical silence with increase of infusion rates. During infusion of higher doses of ketamine, two types of EEG were identified by the spectral patterns:The one was the cases in which increases of the power density over all frequency ranges were observed, and the other was those in which marked increases of density in specific frequency were observed. In thiopental infusion, the densities of all bands were increased to peak at 1~2ug/min/g and therafter were decreased with higher rates of infusion. In ketamine infusion, the densities were increased when the infusion rate was increased. These results suggest that, by the changing patterns of the band densities dervied from spectrum analysis of EEG, not only the effect on EEG of thiopental of tetamine can be quantified but also their differences of mechanisms of action on brain be reflected.
Anesthetics ; Animals ; Body Weight ; Brain ; Electroencephalography* ; Infusions, Intravenous ; Jugular Veins ; Ketamine* ; Rats* ; Scalp ; Spectrum Analysis* ; Thiopental*

We replaced anesthesia of operations, which has done under local or general anesthesia, by MAC(monitored anesthesia care) with various patient's monitoring devices such as BIS(bispectral index). From April 2003 to March 2004, 48 cases of operations were done in MAC with supplemental equipments. Induction, maintenance of anesthesia was performed by propofol and midazolam. Pain control was done by fentanyl and ketamine. For monitoring the depth of anesthesia in real time, and BIS scale was checked and was maintained in 40-60. All anesthesias were done by the anesthesiologist that was communicated with operator for information between patient's status and operation procedures. All operations and anesthesias progressed with stability and safety, and there was no major postoperative complication. Because BIS was relatively accurate device, there was no over dose of anesthetic agents, which was induced by patient's uncertain pain complain under sedation and no anxiety of operator, that was raised by no responsive patient. BIS made possible that operation under MAC was effective and safe, operator perform it with non-stress condition and followed by good surgical result.
Anesthesia* ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Anxiety ; Conscious Sedation* ; Fentanyl ; Humans ; Ketamine ; Midazolam ; Postoperative Complications ; Propofol ; Spectrum Analysis ; Surgery, Plastic*

BACKGROUND: If epileptogenic foci are close to eloquent areas of the brain, awakening is needed for functional mapping during seizure surgery. In these cases adequate analgesia and sedation are needed. However sufficient dosage of intravenous anesthetics leads to many side effects. The authors used propofol and fentanyl infusion combined with scalp nerve block to reduce the severity of side effects from overdose of anesthetics. METHODS: The subjects were adult patients who would undergo awake craniotomy. After administering fentanyl 50~100 mcg intravenously, scalp nerve block was done to supraorbital, supratrochlear, auriculotemporal and lesser and greater occipital nerves of the surgical side with 0.25% bupivacaine containing 1 : 200,000 epinephrine. The anterior temporal region was infiltrated with the same local anesthetics. Oxygen was given by nasal cannula. During operation fentanyl was infused. Propofol was infused except during the awake period. Invasive arterial blood pressure, end-tidal CO2 and respiratory rate were monitored throughout the operation and arterial blood gas analysis was done intermittently. RESULTS: During total anesthesia time (410.3 39.9 min) propofol 16.2 6.3 mg/kg and fentanyl 11.9 3.7 mcg/kg were administered. The results of scalp nerve block were satisfactory. Brain swelling and transient decrease in respiratory rate were noticed in six patients and oxygen desaturation to 94% in one patient. All the patients were cooperative and the above problems were solved by reducing drug infusion rates. CONCLUSIONS: Propofol and fentanyl infusion with scalp nerve block may be an adequate method of anesthetic management for awake craniotomy.
Adult ; Analgesia ; Anesthesia ; Anesthetics ; Anesthetics, Intravenous ; Anesthetics, Local ; Arterial Pressure ; Blood Gas Analysis ; Brain ; Brain Edema ; Bupivacaine ; Catheters ; Craniotomy* ; Epinephrine ; Fentanyl ; Humans ; Nerve Block* ; Oxygen ; Propofol ; Respiratory Rate ; Scalp* ; Seizures

OBJECTIVE: To establish an analytical method for the determination of GHB in beverages using GC/MS and LC/MS/MS. METHODS After beverage samples with GHB-d6 as the internal standard were extracted with ethyl acetate, then the extracts were derivatized with N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA), at last the derivateized extracts analyzed by gas chromatography- mass spectrometry. After beverage samples with GHB-d6 as the internal standard were diluted by mobile phase then directly analyzed by LC/MS/MS. Results The limit of detection was 0.2 microg/mL and both relative standard deviations for between-day and within-day assays were < 8.54% in GC/MS. The limit of detection was 2 microg/mL and both relative standard deviations for between-day and within-day assays were <8.62% in LC/MS/MS. Conclusion These methods of qualitative and quantitative analysis were found to be sensitive, accurate, rapid and suitable for the forensic toxicology to test of GHB in real cases.
Anesthetics, Intravenous/analysis* ; Beverages/analysis* ; Forensic Medicine/methods* ; Gas Chromatography-Mass Spectrometry/methods* ; Humans ; Hydrogen-Ion Concentration ; Reproducibility of Results ; Sensitivity and Specificity ; Sodium Oxybate/chemistry* ; Substance Abuse Detection/methods*

BACKGROUND: The dose-related effects of intravenous infusion of propofol on the rat EEG were evaluated quantitatively by spectral analysis of EEG recorded from the rat skull. METHODS: Propofol was infused into femoral vein at various concentrations ranging from 0 to 400 g/g body weight, and bipolar EEG was recorded from the rat skull and its spectrum were calculated by power spectrum analysis. The EEG electrodes were fixed at the right and left frontal, parieatal, and occipital bone on rat stereotaxic table. The density of each spectral bands(delta 1 3.25, theta 3.5 7.75, alpha 8 12.75, beta 13 31.75 Hz), total power density, median power frquency, and spectral edge frequency were derived from the spectra. RESULTS: In visual inspection of conventional EEG, low doses of propofol(100, 200 g/100 g) showed no significant changes except appearance of high frequency waves, but higher doses of propofol(300, 400 g/100 g) showed high amplitude with low frequency wave. In quantitative spectral analysis of EEG, low dose of propofol revealed no significant change except appearance of beta-waves in the frontal lobe especially. Significant EEG changes were identified during infusion of higher dose of propofol. 300 and 400 g/g of propofol revealed high amplitude and low frequency waves. Median power frequency and spectral edge frequency were significantly changed at 300 and 400 g/g of propofol in range 4.2Hz and 3.8Hz, and 12.4 Hz and 10.2 Hz respectively. CONCLUSIONS: Taken together, these findings suggest that analysis of EEG parameters derived from EEG power spectrum could be applied to determine the depth of propofol anesthesia in rats.
Anesthesia ; Anesthetics ; Animals ; Body Weight ; Electrodes ; Electroencephalography* ; Femoral Vein ; Frontal Lobe ; Infusions, Intravenous ; Occipital Bone ; Propofol* ; Radio Waves ; Rats* ; Skull ; Spectrum Analysis

High frequency jet ventilation(HFJV) administered through a thin catheter instead of a standard endotracheal tube provides improved operation field during laryngeal microsurgery. In this study, effect of changes in inspiration time and frequency on gas exchange was observed. Sixty five patients(ASA class 1-2) underwent laryngeal microsurgery were divided into 3 groups according to inspiration time(50%, 40% and 30%) and then subdivided into 3 groups according to frequency(3.3 Hz, 2.5 Hz and 1.7 Hz). Driving pressure was same in all groups(2.4 kg, cm). Anesthesia was induced with thiopental sodium, fentanyl and succinylcholine with 100% oxygen mask ventilation and maintained with intermittent intravenous anesthetics during jet ventilation via 10 Fr. catheter with 100% oxygen. Jet cannular was located 1 cm proximal to carina. Arterial blood gas analysis and hemodynamic data(blood pressure and heart rate) were measured at 0 minute(just after catheter intubated and jet ventilation started), 5 minute, 10 minute and after then, every 10 minutes. There was significant change in PaCO; by varing inspiration time but, no significant change by frequency except in group of 3.3 Hz at inspiration time 40% and 30%. Number of patients who showed in excess of 45 mmHg of PaCO2 at 20 minute were 2 out of 19, 9 out of 23 and 9 out of 23 in inspiration time 50%, 40% and 30%, respectively. In summary, HFJV via thin catheter located 1 cm proximal to carina during laryngeal microsurgery can be done safely with inspiration time 50% under good operation field at driving pressure 2.4 kg/cm and frequency 3.3, 2.5 and 1.7 Hz.
Anesthesia ; Anesthetics, Intravenous ; Blood Gas Analysis ; Catheters ; Fentanyl ; Heart ; Hemodynamics ; High-Frequency Jet Ventilation* ; Humans ; Masks ; Microsurgery* ; Oxygen ; Succinylcholine ; Thiopental ; Ventilation

The purpose of the present study was to evaluate the correlation among the trial number of in vitro fertilization (IVF), preoperative anxiety, and propofol requirement for conscious sedation. One hundred and twenty six Korean women undergoing oocyte retrieval were enrolled. The target-controlled infusion by the anesthesiologist was conducted with initial target propofol concentration of 2.5 microgram/mL, which was manipulated until the sedation score 3 and desired clinical end point were achieved. A weak correlation was observed between visual analogue scale (VAS) anxiety and the dose of propofol required for the induction of conscious sedation (r=0.22, p=0.0192). A weak correlation was also found between VAS anxiety and the sedation time needed to reach the proper conscious sedation level for the procedure (r=0.181, p=0.0484). Multiple regression analysis showed that VAS anxiety, preoperative baseline prolactin level, and cortisol level had statistically significant effects on the propofol induction dose for target controlled conscious sedation. We concluded that the induction dose and time requirements for propofol in anesthesiologist- controlled conscious sedation be modified based on the preoperative anxiety level and the baseline blood concentration of stress hormone, cortisol and prolactin.
Adult ; Anesthetics, Intravenous ; *Anxiety ; *Conscious Sedation ; Female ; *Fertilization in Vitro ; Human ; Hydrocortisone/blood ; Korea ; *Ovum ; Preoperative Care ; Prolactin/blood ; *Propofol ; Regression Analysis ; Statistics ; *Tissue Harvesting

BACKGROUND: The combination of ketamine and propofol, fentanyl and propofol has been used for anesthesia induction and total intravenous anesthesia. Advantages of using the combination have included hemodynamic stability intraoperatively and superior analgesia. METHODS: Forty patients (ASA physical status 1, 2) scheduled for cesarean section were randomized to either propofol-fentanyl (n=20) (P-F) or propofol-ketamine (n=20) (P-K) group. We checked to the cardiovascular effects of anesthetic induction, neonatal outcome, and maternal recovery time during cesarean section. RESULTS: There were no significant differences in systolic and mean arterial pressure in both groups. Diastolic arterial pressure was increased significantly in both groups at intubation, but degree of increase was less in P-F group. The Apgar scores of the newborn and blood gas analysis of umbilical vein were not significantly different in both groups. Maternal recovery from anesthesia was significantly quicker in P-F group. CONCLUSIONS: Propofol infusion coupled with fentanyl or ketamine would provide good anesthesia instead of inhalational anesthesia for cesarean section without significant adverse effects on both mother and fetus. However, recovery from anesthesia was faster and cardiovascular changes were less with P-F than P-K group.
Analgesia ; Anesthesia* ; Anesthesia, Intravenous ; Anesthetics ; Arterial Pressure ; Blood Gas Analysis ; Cesarean Section* ; Female ; Fentanyl ; Fetus ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Ketamine ; Mothers ; Pregnancy ; Propofol ; Umbilical Veins

BACKGROUND: Perioperative respiratory adverse events remain a major cause of postoperative morbidity and mortality during pediatric anesthesia. This multicenter study was designed to evaluate the incidence of perioperative respiratory adverse events during elective pediatric surgery and to identify the risk factors for these events. METHODS: Pediatric patients undergoing elective surgery under general anesthesia in 11 hospitals were randomly selected for this prospective, multicenter study. Preanesthetic assessments, anesthetic and surgical conditions were recorded by anesthesiologists in charge. Adverse respiratory events were registered. RESULTS: Eight hundred and twenty-three patients were included. The overall incidence of any perioperative respiratory adverse respiratory event was 15.1%. The incidences of perioperative bronchospasm, laryngospasm, coughing, desaturatioin (oxygen saturation <95%), and airway obstruction were 0.1, 0.5, 10.2, 4.1, and 1.6% respectively. According to the multivariate analysis, five risk factors were identified: multiple attempts for airway device insertion, odds ratio (OR) 2.88; recent URI (< or =2 weeks), OR 1.96; induction with intravenous anesthetics, OR 1.95; airway related surgery, OR 1.88; ASA class > or =2, OR 1.62. CONCLUSIONS: Multiple attempts for airway device insertion, recent URI, induction with intravenous anesthetics, airway related surgery and ASA class > or =2 were associated with increased risk for perioperative respiratory adverse events.
Airway Obstruction ; Anesthesia ; Anesthesia, General ; Anesthetics, Intravenous ; Bronchial Spasm ; Child ; Cough ; Fees and Charges ; Humans ; Incidence ; Laryngismus ; Multivariate Analysis ; Odds Ratio ; Prospective Studies ; Risk Factors

BACKGROUNDThe optimal ventilated status under total intravenous or inhalation anesthesia in neurosurgical patients with a supratentorial tumor has not been ascertained. The purpose of this study was to intraoperatively compare the effects of moderate hyperventilation on the jugular bulb oxygen saturation (SjO 2 ), cerebral oxygen extraction ratio (O 2 ER), mean arterial blood pressure (MAP), and heart rate (HR) in patients with a supratentorial tumor under different anesthetic regimens.

METHODSTwenty adult patients suffered from supratentorial tumors were randomly assigned to receive a propofol infusion followed by isoflurane anesthesia after a 30-min stabilization period or isoflurane followed by propofol. The patients were randomized to one of the following two treatment sequences: hyperventilation followed by normoventilation or normoventilation followed by hyperventilation during isoflurane or propofol anesthesia, respectively. The ventilation and end-tidal CO 2 tension were maintained at a constant level for 20 min. Radial arterial and jugular bulb catheters were inserted for the blood gas sampling. At the end of each study period, we measured the change in the arterial and jugular bulb blood gases.

RESULTSThe mean value of the jugular bulb oxygen saturation (SjO 2 ) significantly decreased, and the oxygen extraction ratio (O 2 ER) significantly increased under isoflurane or propofol anesthesia during hyperventilation compared with those during normoventilation (SjO 2 : t = -2.728, P = 0.011 or t = -3.504, P = 0.001; O 2 ER: t = 2.484, P = 0.020 or t = 2.892, P = 0.009). The SjO 2 significantly decreased, and the O 2 ER significantly increased under propofol anesthesia compared with those values under isoflurane anesthesia during moderate hyperventilation (SjO 2 : t = -2.769, P = 0.012; O 2 ER: t = 2.719, P = 0.013). In the study, no significant changes in the SjO 2 and the O 2 ER were observed under propofol compared with those values under isoflurane during normoventilation.

CONCLUSIONSOur results suggest that the optimal ventilated status under propofol or isoflurane anesthesia in neurosurgical patients varies. Hyperventilation under propofol anesthesia should be cautiously performed in neurosurgery to maintain an improved balance between the cerebral oxygen supply and demand.

Adolescent ; Adult ; Aged ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Arterial Pressure ; physiology ; Blood Gas Analysis ; Craniotomy ; methods ; Female ; Heart Rate ; physiology ; Humans ; Hyperventilation ; chemically induced ; physiopathology ; Isoflurane ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Propofol ; administration & dosage ; therapeutic use ; Young Adult