Ephedrine sulfate was administrated 30 healthy parturients undergoing elective repeat cesarean section under spinal anesthesia. Fifteen patients received ephedrine infusion (0.01% solution, beginning with approximately 5 mg/min) immediately after induction of spinal anesthesia to maintain maternal systolic blood pressure between 90% and 100% of the baseline systolic blood pressure (mean dose of ephedrine 31.6 mg). Fifteen patients (control group) received 20mg of ephedrine as an intravenous bolus, and additional 10mg increments, if necessary, when systolic blood pressure decreased to 80% of the baseline systolic blood pressure (mean dose of ephedrine 26.8 mg). Nausea and/or vomiting occurred in seven women in the control group and on patient in the infusion group (p<0.001). Apgar scores, fetal blood gas tension, and time for onset of respiration was comparable in the two groups. The results suggest that prophylactic ephedrine infusion is safe and desirable in healthy parturients undergoing cesarean section under spinal anesthesia.
Anesthesia, Spinal* ; Blood Pressure ; Cesarean Section* ; Cesarean Section, Repeat ; Ephedrine* ; Female ; Fetal Blood ; Humans ; Nausea ; Pregnancy ; Respiration ; Vomiting

Although halothane is one of the most widely used inhalation anesthetics, it may cause postanesthetic complications such as halothane hepatitis. Halothane hepatitis has been reported intermittently with variable incidence. However it is not easy to prove halothane as a causative agent, because there are many factors causing postoperative hepatic dysfunction. The author had a case of acute hepatitis developing after open heart surgery used halothane. 37-year-old female underwent an open heart surgery for ASD repair under halothane anesthesia. On the 14th postoperative day, she developed high fever of 38℃. Liver function tests showed marked elevation of SGOT, SGPT, and bilirubin, followed by gross jaundice. HBs Ag(−) and HBs Ab(+) were reported. She died of acute respiratory, hepatic, and renal failure on the 19th postoperative day. Possible causes of the hepatitis were considered halothane, blood transfusion, and drugs.
Adult ; Alanine Transaminase ; Anesthesia* ; Anesthetics, Inhalation ; Aspartate Aminotransferases ; Bilirubin ; Blood Transfusion ; Female ; Fever ; Halothane* ; Heart* ; Hepatitis* ; Humans ; Incidence ; Jaundice ; Liver Function Tests ; Renal Insufficiency ; Thoracic Surgery*

Plain 0.5% bupivacaine and hyperbaric 0.5% tetracaine were compared for spinal anesthesia in 40 patients undergoing operation of lower extremities. Lumbar puncture was performed with a 22 gauge spinal needle with the patient in the lateral recumbent position. The third lumbar interspace was chosen for the puncture, when a free flow of clear CSF was obtained, the local anesthetic solution (2.5 ml of 0.5% bupivacaine or 2.0 ml of hyperbaric 0.5% tetracaine) was injected at a rate of 0.1ml/sec without barbotage. After injection of anesthetics, clinical features were observed and compared between the two groups. The results were as follows: 1. The two groups were well matched for age, sex, height and weight. 2. In both groups, sensory block to T₁₂ dermatome was obtained within 4 minutes, mean maximal level of analgesia was T₆₋₇, and the mean time for maximal level was around 20 minutes. 3. The onset times of motor block were similar in both groups and complete motor block was obtained in all cases within 20 minutes. 4. The duration of analgesia above the T₁₂ dermatome was 3 hours, postoperative analgesia was 7 hours. These value were significantly prolonged than those of the tetracaine group (p<0.05). 5. The changes in systolic pressure in the bupivacaine group were significantly less than those of the tetracaine group (p<0.05). 6. The complications after spinal anesthesia were headache, numbness, urinary retention and backpain, and were no significant difference in both groups. From the obtained results, we concluded that plain 0.5% bupivacaine was a relatively satisfactory agent for spinal anesthesia for operation of lower extremities. The time of onset, height of block and the complications of postoperative period were similar in both groups. The advantages of plain 0.5% bupivacaine were less hypotension and long duration of analgesia.
Analgesia ; Anesthesia, Spinal* ; Anesthetics ; Blood Pressure ; Bupivacaine* ; Headache ; Humans ; Hypesthesia ; Hypotension ; Lower Extremity* ; Needles ; Postoperative Period ; Punctures ; Spinal Puncture ; Tetracaine* ; Urinary Retention

Fifteen patients was analyzed on effect of the management of postherpetic neuralgia by local anesthesia on the special region at pain clinic in Youngnam University Hospital. The results were on follows: 1) The frequency of occurrence of sex and the lesion side were similar in all patients. 2) The age of incidence was between 50 and 70 years old. 3) The most frequent site of lestons was the neck. 4) There was no relationship between age and treatment time. 5) Whole patients was done average 7-10 time local injection.
Anesthesia, Local ; Humans ; Incidence ; Neck ; Neuralgia, Postherpetic* ; Pain Clinics

To assess the effect of postoperative pain control of upper abdominal surgery through lumbar epidural narcotic injection, the 3rd or 4th lumbar epidural puncture was done, and were injected 1 mg of morphine (Group I) or 10 mg of demerol (Group II) mixed with 10 ml of normal saline into the epidural space, after operation of the cholecystectomy in 10 patients and antrectomy and vagotomy, subtotal or total gastrectomy in 10 patients. Time interval of the postoperative analgesic effect between morphine and demerol groups were compared. The results of this study were as follows: 1. In the group I, average analgesic duration was 29.4 hours. 2. In the group II, average analgesic duration was 4.0 hours. It is concluded that postoperative pain control of upper abdominal surgery through the lumbar epidural narcotic injection was effective, and morphine injection was more effective than demerol.
Cholecystectomy ; Epidural Space ; Gastrectomy ; Humans ; Meperidine ; Morphine ; Narcotics* ; Pain, Postoperative ; Punctures ; Vagotomy

The aim of this study was to compare the hemodynamic responses with various administration routes of lidocatine, which was used to blunt the sympathetic stimulation associated with intubation. The study population was from 24 patients scheduled for elective open heart surgery at Yeungnam University Hospital. Patients were randomly assigned to receive lidocaine by intravenous administration, laryngotracheal spray, and oropharyngeal gargling, and endotracheal intubation was performed. Heart rate, mean arterial pressure, central venous pressure, and arterial oxygen saturation were measured at 30 seconds, 1 minute, 3 minutes and 5 minutes after intubation and compared with the control group. The results were as follows: 1) In the control group which was not administered lidocaine, heart rate and mean arterial 1pressure were significantly increased (p<0.05, p<0.01). 2) In the group of intravenous lidocaine administration, heart rate was significantly increased (p < 0.05), but mean arterial pressure was not significantly changed after endotracheal intubation. Compared with control group, the changes of heart rate and mean artrerial pressure were statistically significant (p<0.05). 3) In the group of laryngotracheal lidocaine spray, heart rate and mean arterial pressure were increased after endotracheal intubation. 4) In the group of oropharyngeal lidocaine gargling, heart rate and mean arterial pressure showed significantly increased (p<0.05, p<0.01), and heart rare mintained an increased state but mean arterial pressure was reduced to the baseline value 5 minutes following intubation. 5) Laryngotracheal spray and oropharyngeal gargling group showed more significant increase in heart rate and mean arterial pressure than intravenous administration group. 6) No significant changes were observed in central venous pressure and arterial ocygen saturation in all three groups. It is concluded that intravenous administration of lidocaine before endotracheal intubation is more effective than laryngotracheal spray or oropharyngeal gargling.
Administration, Intravenous ; Arterial Pressure ; Central Venous Pressure ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Intubation, Intratracheal ; Lidocaine* ; Oxygen ; Thoracic Surgery

Vecuronium bromide is a nondepolarizing neuromuscular blocking agent with minimal effect on the autonomic nervous system and little or no histamine release. Some investigators have found that as the dose of vecuronium increased from its ED the onset time is decreased. This study was designed to investigate the influences of a divided dose and single large dose on onset time of vecuronium in 40 ASA physical status l and 2 adult patients. The patients were divided into two groups: Gp. l; Priming dose(0.01 mg/kg) of vecuronium 4 minutes prior to intubating dose(0.14 mg/kg) Gp. 2; Single bolus intubating dose(0.15 mg/kg) of vecuronium followed immediately the induction agent. The results were as follows. l) After the priming dose administration, in the Gp. 2, 13 patients complained of side effcts. 2) The onset time (from the end of injection to l00% depression of the twitch tension) were 172.0+/-23.8 seconds in the Gp. I and 164.0+/-27.5 seconds in the Gp. 2. 3) Clinical duration of blockade (from the end of injection to first return of the second twitch of TOF) was 39,2+/-6.4 minutes in the Gp. l. In conclusion, we recommend the single large dose of vecuronium(0.15 mg/kg) for the endotracheal intubation in whom SCC is contraindicated.
Adult ; Autonomic Nervous System ; Depression ; Histamine Release ; Humans ; Intubation, Intratracheal* ; Neuromuscular Blockade ; Research Personnel ; Vecuronium Bromide*

BACKGROUND: The studies related to induced hypotention using propofol were rare. So we studied the effectiveness of propofol as induced hypotensive agent in brain aneurysmal surgery. METHODS: The hemodynamic changes during induced hypotension with propofol (propofol-group) and isoflurane(isoflurane group) were observed in patients undergoing aneurysmal surgery. Twenty patients were allocated randomly to receive propofol induction and maintenance, or thiopental sodium induction and isoflurane maintenance for anesthesia. Both groups also received fentanyl, vecuronium, nitrous oxide and oxygen. These hypotensive effects were evaluated before, during and after induced hypotension. 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. We also compared the ventilatory effect of hypotensive anesthesia by blood gas analysis. RESULTS: There were no significant changes of heart rate, cardiac output, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure and pulmonary vascular resistance before, during and after induced hypotension in both group. Mean arterial pressure and systemic vascular resistance were significantly decresed during induced hypotension (p<0.05). There were no significant changes of PO2, PCO2, HCO3 , base excess before, during and after induced hypotension in both group. CONCLUSION: Propofol is also an effective hypotensive agent comparable to isoflurane.
Anesthesia ; Anesthetics ; Aneurysm ; Arterial Pressure ; Blood Gas Analysis ; Cardiac Output ; Central Venous Pressure ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension* ; Intracranial Aneurysm ; Isoflurane ; Nitrous Oxide ; Oxygen ; Propofol* ; Pulmonary Wedge Pressure ; Thiopental ; Vascular Resistance ; Vecuronium Bromide

BACKGROUND: In order to understand the pathogenetic mechanism of sepsis-induced acute lung injury, inhibition of phospholipase A2 (PLA A2) was carried out in an endotoxin-induced septic lung model. METHODS: Sprague-Dawley rats were divided three groups; sham group, endotoxin group (instillation of E coli endotoxin, 100microgram/rat, type 017) and mepacrine group (the non-specific PLA2 inhibitor, 50 ml/kg intraperitoneal injection after endotoxin treatment). Five hours after endotoxin treatment, protein contents, neurophils counts, gamma-glutamyl transpeptidase (GGT) activity and surfactant concentrations in the bronchoalveolar fluid (BAL), meyloperoxidase (MPO) and PLA2 activity in the lung were measured. A morphological study for the effect of the endotoxin and mepacirne, and a cytochemical electron microscopy for detection of hydrogen peroxide in the lung were also performed. RESULTS: Endotoxin increased the concentrations of protein, the number of neutrophils, and GGT activity in the BAL fluid, MPO and PLA2 activity in the lung but mepacrine decreased these parameters (P < 0.001). The light density of surfactant was increased by the endotoxin (P < 0.001), but mepacrine diminished this pathological change. In the light microscopic findings, the endotoxin caused pulmonary accumulation of neutrophils, atelectasis and transudation of intravascular protein was observed. In contrast, mepacrine lessened these pathological findings. In ultrastructural findings, adhesion of neutrophils to endothelial cells, necroses of type II cells and endothelial cells, and the damage of lamellar bodies were observed after the endotoxin treatment, which recovered with mepacrine. In the cytochemical electron microscopy for detection of hydrogen peroxide in the lung, the deposits of cerrous perhydroxide were increased by the endotoxin but mepacrine decreased deposits of cerrous perhydroxide. CONCLUSIONS: Inhibition of PLA2 in an endotoxin induced acute lung leak showed protection against oxidative stress by a diminution of neutrophilic respiratory bursts and a decreased production of free radicals. It is suggested that PLA2 has a pivotal role in causing acute oxidative stress in endotoxin induced acute lung injury.
Acute Lung Injury* ; Endothelial Cells ; Escherichia coli* ; Free Radicals* ; gamma-Glutamyltransferase ; Hydrogen Peroxide ; Injections, Intraperitoneal ; Lung* ; Microscopy, Electron ; Necrosis ; Neutrophils ; Oxidative Stress ; Oxygen* ; Phospholipases A2* ; Phospholipases* ; Pulmonary Atelectasis ; Quinacrine ; Rats, Sprague-Dawley ; Respiratory Burst

The induction agents produce various effects to cardiovascular system. Among these, thio- pental, propofol, and etomidate produce reduction in cardiac output and peripheral vascular resistance. As a result severe systemic arterial hypotension is evoked. This phenomenon results from combined effects of CNS, cardiovascular and peripheral vascular systems. The purpose of this study was to obeserve direct effects of thiopental, propofol, etomidate in isolated rat aorta and pulmonary artery. Isometric tension was recorded in rat aortic and pulmonary artery ring preparation contracted by norepinephrine(1.8x10-6) . Thereafter thiopental, etomidate, propofol was added to organ bath. And the contractile or relaxing response was observed. Thiopental relaxed aortic ring by 3.6+/-1.3%(low dose), 3.9+/-1.4%(high dose), etomidate relaxed aortic ring by 2.0+/-0.7%(low dose), 5.4+/-2.8% (high dose), respectively. It was statistically insignificant. However, propofol relaxed aortic ring by 12.7+/-3.8%(low dose), 14.7+/-2.7%(high dose), respectively(p <0.05). Thiopental relaxed pulmonary artery ring by 4.8+/-1.1%(low dose), 5.1+/-2.3%(high dose), etomidate relaxed pulmonary artery ring by 4.8+/-1.1%(low dose), 5.1+/-2.3%(high dose), respectively. It was statistically insignificant. However, propofol relaxed pulmonary artery ring by 8.4+/-2.4%(low dose), 10.4+/-3.6(high dose), respectively( p<0.05). The results suggest that hypotension after propofol administration was due to direct vascular smooth muscle relaxation.
Animals ; Aorta* ; Baths ; Cardiac Output ; Cardiovascular System ; Etomidate* ; Hypotension ; Muscle, Smooth, Vascular ; Propofol* ; Pulmonary Artery* ; Rats* ; Relaxation ; Thiopental* ; Vascular Resistance