No abstract available.
Humans ; Kidney Transplantation* ; Living Donors*

No abstract available.
Humans ; Intensive Care Units* ; Critical Care* ; Korea*

Thoracic epidural anesthesia has been used to manage intraoperative and postoperative pain for thoracic surgical patients with general anesthesia recently, And this combined anesthesia has been associated with less sedation, earlier ambulation, blunting of the stress response and better pain control in the post-operative period. But the effects of thoracic epidural anesthesia on pulmonary shunt, pulmonary vasoactivity and oxygenation are still unknown. The author has investigated the effects of thorarcic epidural anesthesia on pulmonary hypertension induced by acute diffuse alveolar hypoxia and N(W) -nitro-L-arginine(L-NNA) in 12 mongrel dogs. Acute diffuse alveolar hypoxia which is similar to the early stage of acute respiratory failure may induce the pulmonary hypertension. And L-NNA, inhibitor of endothelium derived relaxing factor(EDRF), may also induce pulmonary hypertension under hypoxic state. The measurements were made three times, the first was baseline at room air ventilation. Following baseline recordings, saline 4 ml(group A, n=6) or 2% lidocaine 4 ml(group B, n=6) was injected through the epidural catheter and ventilation was started with hypoxic gas mixture(10% O2, 90% N2). The seeond measurements was made 30 min after the hypoxic ventilation and third was 20 min after infusion of L-NNA(50 mg/kg mixed with distill water 50 ml, infusion rate is 50 ml/20min) under the continuous ventilation with hypoxic gas mixture. The results were as follows: 1) There were significant changes in mean pulmonary arterial pressure, pulmonary vascular resistance in group A(p<0.05) and in arterial and mixed venous oxygen tension, arterial and mixed venous oxygen content, intrapulmonary shunt in both groups(p<0.05) 30 minutes after hypoxia but there were not significant differences between groups. 2) There were significant changes in mean pulmonary arterial pressure, in group B (p<0.05) and pulmonary vascular resistance, systemic vascular resistance and mixed venous oxygen tension and content in both groups (p<0.05) 20 miniutes after infusion of L-NNA under the continuous ventilation with hypoxic gas mixture but there were not significant differences between groups. But there were significant changes in central venous pressure in group B(p<0.05) and significant differences between groups(p<0.05) at 20 miniutes after infusion of L-NNA. These results indicate that thoracic epidura1 anesthesia does not influence the pulmonary hypertension directly and does not praduce any unfavorable hemodynamic events during pulmonary hypertension induced by acute diffuse alveolar hypoxia and N(W)-nitro-L-arginine. Therefore thoracic epidural anesthesia shoud be valuable assistant to the general anesthesia for pulmonary hypertensive patients.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Animals ; Anoxia* ; Arterial Pressure ; Catheters ; Central Venous Pressure ; Dogs* ; Endothelium ; Hemodynamics ; Humans ; Hypertension, Pulmonary* ; Lidocaine ; Oxygen ; Pain, Postoperative ; Respiratory Insufficiency ; Vascular Resistance ; Ventilation ; Walking ; Water

Perioperative surgical stress makes various metabolic and endocrinologic changes that may influence the postoperative outcome. These changes, so-called, "surgical stress responses" ar hyperglycemia, lipolysis, negative nitrogen balance due to proteolysis, and changes in the hormonal secretion, e.g. increased release of ACTH, prolactin, cortisol, catecholamine, and so on. To prevent these stress responses, many studies reported some kinds of effective methods. In these study we used general anesthesia combined with epidural blockade with local anesthetic(bupivacaine) and narcotic(fentanyl) mixture via epidural catheter for the total abdominal hysterectomy and the postoperative pain control(group II). We measured serum prolactin and cortisol concentrations by time-resolved fluoroimmunoassay and glucose concentrations by routine glucose oxidase method and scored the degree of postoperative pain and compared the results with those of group I, given general anesthesia during surgery and nalbuphine intramuscular injection for postoperative pain control. The results were as follows. 1) Serum prolactin concentrations were increased during the operation in both groups. 2) Serum cortisol concentrations were increased during and after the operation in both groups but were normalized sooner in group II. 3) Serum glucose concentrations were increased during and after the operation but were normalized sooner in group IL 4) The three measurements showed significant differences between the two groups during and on the first postoperative day. 5) The pain scores were significantly lower in group II untill the third postoperative day. According to the results, we concluded that serum prolactin concentration could be as much valuable index to surgical stress response as serum cortisol concentration and that the method of epidural blockade combined with general anesthesia for the surgery and postoperative pain control via epidural route could prevent or alleviate the stress response more effectively.
Adrenocorticotropic Hormone ; Anesthesia, Epidural* ; Anesthesia, General* ; Blood Glucose* ; Catheters ; Fentanyl* ; Fluoroimmunoassay ; Glucose ; Glucose Oxidase ; Hydrocortisone* ; Hyperglycemia ; Hysterectomy ; Injections, Intramuscular ; Lipolysis ; Nalbuphine ; Nitrogen ; Pain, Postoperative ; Prolactin* ; Proteolysis

Drug Therapy* ; Humans

Up to the present, the existing residency training in Korea, functions only as a factory to produce the heartless and increative medical technician. So, we performed the elective course in residency t raining especially about the basic medicine by the 18 residents for 5 years since since 1990 in college of medicne, Korea University. The residents who paticipate in the elective course, can have enough time to consider the nature, human and doctor and to act as a pioneer to study the basic science. Thus, we concluded that the elective course residency training about the interesting department can enables not only the increment of autonomy but also time to contact with the human nature and basic science.
Human Characteristics ; Internship and Residency* ; Korea ; Rain

Among the pharmacological methods treating postoperative shivering, there were no studies which compare the doses of doxapram. In this study, we have compared the effectiveness of doxapram in a placebo-controlled, double blind method. Sixty patients who shivered after operation under general anesthesia were examined. They were allocated randomly to receive normal saline(n=15), doxapram l mg/Kg(n=15), 1.5 mg/Kg(n=15) or 2 mg/Kg(n=15) from identical syringes intravenously. The investigator who gave the intravenous injection was unaware of the treatment received by the patient, and assessed the shivering. Both doxapram 1.5 mg/Kg and 2 mg/Kg were effective on shivering within 1~2 minutes after intravenous injection. In the saline group, all patients were still shivering 10 minutes after injection. In the doxapram 1 mg/Kg group, only two patients had stopped shivering by 6, 7 minutes after injection. In the doxapram 1.5 mg/Kg group, only three patients were shivering after injection. In the doxapram 2 mg/Kg group, only one patient was shivering after injection. We conclude that doxapram 1.5 mg/kg and 2 mg/kg were effective on postoperative shivering. And the results suggested that doxapram 2 mg/kg may be marginally superior to doxapram 1.5 mg/kg in this respect.
Anesthesia, General ; Double-Blind Method ; Doxapram* ; Humans ; Injections, Intravenous ; Research Personnel ; Shivering* ; Syringes

Patients undergoing thoracotomy experience severe postoperative pain and marked respiratory impairment. Analgesics(narcotics or loeal anesthetics) administered via epidural catheter in epidural space have been shown to provide postoperative analgesia and improve respiratory mechanics after thoracotomy. Several different methods have been utilized in an attempt to reduce pain and pulmonary mechanics after thoracotomy. These include epidural blocks using local anesthetics, epidural narcotics, ketamine, steroid, and clonidine. These methods have been shown to provide pain relief with relative preservation of lung volumes in the postoperative period, but have disadvantages. Especially epidural local anesthetics may cause hypotension and motor blockade of lower extremities, and epidural narcotics may cause pruritus, nausea and vomiting, urinary retension and respiratory depression. In an attempt to provide excellent analgesia and improve pulmonary mechanics after thoracotomy and to decrease the side effects associated with the intermittent bolus administration of epidural narcotics or local anesthetics, we performed a study of continuously administered epidural infusion of small concentration of fentanyl combined with low concentration of bupivacaine. Twenty eight patients undergoing thoracotomy were randomized into groups based upon a postoperative pain regimen as indicated: Group I: intermittent intramuscualr injection of nalbuphine 0.2 mg/kg(n=13), Group II: continuous epidural injection of mixtures of 0.2/ bupivacaine and fentanyl 3 ug/ml(n= 15). Two, 8, 24 and 48 hours postoperative, the following indices were measured: visual analogue pain scale, vital capacity, tidal volume, arterial blood gas analysis(pH, PaCo2, PaO2), side effects, and 24 hour urine 17-ketosteroids. The results were as follows: 1) Pain score was evaluated by visual analogue pain scale postoperatively and the pain scores significantly decresed in group II as compaired with those in group L 2) Vital capacity and tidal volume in group II were more improved than group I. 3) There was no difference in arterial blood gas analysis except for decreased PaO2 at 2 hour and 24 hour compared with preoperative value in group L 4) Major complications in group II were two cases of nausea and vomiting, one case of urinary retension, whereas only I patient in group I complained of nausea and vomiting. 5) No significant difference occurred in 24 hour urine l7-ketosteroid at 24 hour and 48 hour postoperatively in group I and group II, which were within normal limits.
17-Ketosteroids ; Analgesia* ; Anesthetics, Local ; Blood Gas Analysis ; Bupivacaine* ; Catheters ; Clonidine ; Epidural Space ; Fentanyl* ; Humans ; Hypotension ; Injections, Epidural ; Ketamine ; Lower Extremity ; Lung ; Mechanics ; Nalbuphine ; Narcotics ; Nausea ; Pain Measurement ; Pain, Postoperative ; Postoperative Period ; Pruritus ; Respiratory Insufficiency ; Respiratory Mechanics ; Thoracotomy* ; Tidal Volume ; Vital Capacity ; Vomiting

BACKGROUND: There has been a study reporting those cases with elevated blood pressure (BP) above 140/90 mmHg on admission and normotension on ward showed more increase in mean arterial pressure(MAP) and pressure-pulse product than the normotensive or hypertensive patients in both situations. But the mean ages of the groups were different each other. This study was done to see if the same results would come without age differences. METHODS: One hundred and sixty-two patients between the age of 45 and 64 were divided into three groups. The patients with BP below 140/90 mmHg on admission and on ward were included in group 1(N=66) and those with BP above 140/90 mmHg on admission and below 140/90 mmHg on ward, in group 2(N=42) and those with BP above 140/90 mmHg in both situations were included in group 3(N=54). Preiinduction BP, PR, the changes of BP, PR during operation, incidence of hypertension at post-anesthesia room(PAR), and the number of cases who needed the use of inotropics or antihypertensives perioperatively were checked. RESULTS: As for the increase of BP just before induction the group 2 showed the greatest, group 1 was the next, and group 3 showed the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next, and group 3 the least amount increase. As for the increase of preinduction pressure-pulse product(PPP) group 2 showed the greatest, group 3 the next, and group 1 the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next,and group 3 the least amount increase. CONCLUSIONS: Intensive anesthetic care is needed also at periinduction period for the patients who showed hypertensive BP on admission and normotension on ward thereafter.
Antihypertensive Agents ; Blood Pressure* ; Humans ; Hypertension ; Incidence

The changes in heart rate, systolic, mean and diastolic arterial blood pressure, and the plasma concentration of epinephrine and norepinephrine were measured before and thmughout the induction periods of anesthesia in 60 elective surgical patients in a randomized, double-blind manner to evaluate the effects of continuous intravenous infusion of esmolol for 1 minute at 500 ug/kg/min as a loading dose and for 4 minutes at 100 ug/kg/min as a maintenance dose. The control group (n=30) was given the continuous infusion of normal saline at the same volume-rate. During the study, anesthesia was maintained with N2O-O2-enflurane-vecuronium and controlled ventilation. In the esmolol group, statisticaUy, the heart rate at 1 minute after the intubation was less increased and systolic and diastolic pressure after 11 minutes were more decreased than the control group. And plasma norepinephrine concentration was elevated more than the control group at 3 minutes after the intubation. We concluded that the used infusion rate of esmolol blunted the hemodynamic changes following the laryngoscopy and endotracheal intubation but it is still needed to find the dosage for complete blocking the adrenergic response.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Epinephrine ; Heart Rate ; Hemodynamics* ; Humans ; Infusions, Intravenous* ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Norepinephrine ; Plasma ; Ventilation