No abstract available.
Blood Gas Analysis*

Transcranial cerebral oximetry has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. It has been also used in intraoperative monitoring of aortic dissection and surgical procedures performed under deep hypothermia and circulatory arrest. During disending aortic arch exposure, sudden cerebral oxygen saturation change from 63% to 48% was detected. After therapeutic bypass, cerebral oxygen saturation was increased to 65%. During aortic arch repair, deep hypothermic circulatory arrest with retrograde cerebral perfusion was applied for 130 min and cerebral oxygen saturation slowly decreased from 65% to 52%. Patient was discharged from hospital without neurologic complication and cognitive funtion disturbance.
Aorta, Thoracic ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Hypothermia ; Monitoring, Intraoperative ; Oximetry ; Oxygen* ; Perfusion

BACKGROUND: Esmolol has been applied to lower myocardial oxygen consumption and creates a quieter operative field by reducing systemic blood pressure and heart rate but can cause a certain amount of hemodynamic instability during minimally invasive direct vision coronary artery bypass graft (MIDCAB). The aim of this study was to compare the hemodynamic differences between two methods; inducing hypotension and bradycardia between esmolol infusion alone, and concomitant use of neostigmine during MIDCAB anesthesia. METHODS: Twenty MIDCAB patients were randomly allocated into two groups, group E (n = 10) receiving esmolol 0.3 mg/kg/min, group EN (n = 10) receiving esmolol 0.2 mg/kg/min and neostigmine 1.0 mg for induced hypotension and bradycardia during coronary anastomosis. The hemodynamic parameters were evaluated 10 minutes after induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes before the end of anastomosis (T3) and 10 minutes after the end of anastomosis (T4). Data were analyzed by ANOVA test for intragroup comparisons, and by T-test for intergroup comparisons with significance set at a P value of < 0.05. RESULTS: Heart rate significantly decreased at T3 in both groups and more in group EN. Systolic blood pressure decreased at T3 in both groups and there were no group differences but more episodes of extreme hypotension in group E. The cardiac index significantly decreased at T3 in both groups and more in group E. There was a small but significant increase in pulmonary capillary wedge pressure at T3 and T4 in group E and no change of central venous pressure in both groups. CONCLUSION: Concomitant use of neostigmine during esmolol infusion produces more reliable induced hypotension and bradycardia than esmolol infusion alone for MIDCAB anesthesia in terms of prevention of myocardial ischemia and easiness of anastomosis technique.
Anesthesia* ; Blood Pressure ; Bradycardia* ; Central Venous Pressure ; Coronary Artery Bypass ; Heart Rate ; Hemodynamics ; Humans ; Hypotension* ; Myocardial Ischemia ; Neostigmine* ; Oxygen Consumption ; Pulmonary Wedge Pressure ; Transplants

A number of recent reports have described the usefulness of the epidural injection of narcotics for the relief of postoperative pain. But the epidural use of narcotic agonist-antagonist, nalbuphine hydrochloride, has not been reported. To study the effect of epidural nalbuphine hydrochloride for postoperative pain relief, we divided 73 patients into 5 groups randomly: 3 mg nalbuphine hydrochloride in 10 ml saline (group 1, n=9); 4 mg nalbuphine hydrochloride in 10 ml saline (group 2, n=14); 5 mg nalbuphine hydrochloride in 10 ml saline (group 3, n=21); 3 mg morphine in 10 ml saline (group 4, n=16); 4 mg morphine in 10 ml saline (group 5, n=13). The results were as follows 1) The onset time of analgesic effect were average 15~20 minitues in all groups 2) The durations of analgesia of epidural nalbuphine groups were (average; 5~7 hours) significantly shorter than morphine groups (average; 31~32 hours). 3) The degree of analgesia were same between 5 groups 4) The complications were nausea, vomiting and pruritus in all groups, but the frequency of pruritus in morphine groups was more than nalbuphine groups (p<0.05). 5) Urinary retention was observed only in morphine groups. In conclusion, the result of our study suggests that nalbuphine hydrochloride be better agent than morphine in terms of complication for postoperative pain relief but the duration of action is shorter than morphine, when injected epidurally.
Analgesia ; Humans ; Injections, Epidural ; Morphine ; Nalbuphine* ; Narcotics ; Nausea ; Pain, Postoperative* ; Pruritus ; Urinary Retention ; Vomiting

The postanesthetic nausea and vomiting during the recovery period was regarded as one of the almost inevitable and undesirable sequelae of surgery and anesthesia. With the progress of anesthetic technics and agents the incidence of this complication has been reduced. The analysis of the incidence of postanesthetic nausea and vomiting that occurred in the postanesthetic recovery room was performed on 4239 patients who received general inhalation anesthesia from Nov. 1988 to Apr. 1989 in Seoul National University Hospital. The overall incidences of postanesthetic nausea and vomiting were 0.4% and 0.5% of 4239 patients, respectively. Although the use of isoflurane among anesthetics was followed by slightly lower incidence significant. The incidence was not significantly related to sex, operation site, and the department of surgery. The incidence decreased much more than before, but because nausea and vomiting can produce undesirable complications they should be carefully prevented and treated.
Anesthesia ; Anesthesia, Inhalation ; Anesthetics ; Humans ; Incidence ; Isoflurane ; Nausea* ; Recovery Room ; Seoul ; Vomiting*

Fluid resuscitation is a basic treatment in hemorrhagic shock. We compared the circulatory responses to fluid resuscitation of 10% pentastarch with those of fresh whole blood and plasmanate in hemorrhagic shock. Eighteen mongrel dogs were bled 24 ml/kg and replaced by equivalent amounts of fresh whole blood(n=6, group B), pentastarch(n=6, group P) and plasmanate(n=6, group PL). Hemodynamic measurements and calculations were performed before and after bleeding and after volume therapy. The decrease of hematocrit and platelet count after volume replacement indicate that hemodilutional effect was maximum 30 min after volume therapy and significantly greater in group P than PL(p<0.05). Central venous pressure(CVP), pulmonary capillary wedge pressure(PCWP) and cardiac index(CI) were increased to 146-189%, 146-172% and 146-175% in group P, respectively during 60 min. These changes were significantly greater than group B and PL(p<0.05). There was delayed recovery of mean arterial pressure in group PL(92% 30 min after volume therapy) compared with group B and P(92% and 93% 5 min). Also group P and PL showed significant prolongation in prothrombin time and partial thromboplastin time during experiment(120 min) and these were significantly more prolonged in group P than PL(P<0.05). And group P showed similar O transport and O extraction ratio to those of group B. The increases in plasma catecholamine were observed after hemorrhage, but no significant changes 5 and 30 min after volume therapy. This suggests that the neurohumoral response to hemodilution was not marked. Mixed venous O2 saturation(SvO2) was directly proportional to CI during experiment(r=0.69, p<0.01), indicating that SvO2 can represent CI during shock and volume therapy. In conclusion, l0% pentastarch is useful as a substitute for fresh whole blood or plasmanate.
Animals ; Arterial Pressure ; Blood Transfusion, Autologous* ; Capillaries ; Dogs* ; Hematocrit ; Hemodilution ; Hemodynamics ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; Partial Thromboplastin Time ; Plasma ; Platelet Count ; Prothrombin Time ; Resuscitation* ; Shock ; Shock, Hemorrhagic*

In case of cardiopulmonary bypass, organ transplantation and massive transfusion, the electrolyte(Na+, K+, Ca++) and pH are very changeable, and it is very important to correct the pH and electrolyte immediately. We studied the bedside electrolyte monitoring with VIA(Vascular Intermittent Access) 1-01 and its accuracy validation. We selected 13 patients who went an open heart surgery in the Seoul National University HospitaL The patient was catheterized with 16 G triple lumen catheter into the SVC-right atrium junction via right internal jugular vein. Then we connected VIA 1-01 to one lumen. The electrolyte samplings were done during perianesthetic period. The electrolyte values(Na+, K+, ionized Ca++) of each sample was measured by laboratory, NOVA of PAR(postanesthetic recovery room) and VIA 1-01. We compared the values with correlation. The Pearson product-moment coefficient(r) of laboratory vs VIA 1-01 are 0.9073(Na+), 0.9471(K+) 0.6485(Ca++). The r of NOVA vs VIA 1-01 are 0.6348(Na+), 0.9330 (K+), 0.5206(Ca++ ). The r of laboratory vs NOVA are 0.6719(Na+), 0.9532(K+ ), 0.8221(Ca+). All pvalues of r were lower than 0.01. We conclude that bedside electrolyte monitoring with VIA l- 01 is very useful to critically ill-patient and major operations during anesthesia and it improves the prognosis of such patients.
Anesthesia ; Cardiopulmonary Bypass ; Catheters ; Humans ; Hydrogen-Ion Concentration ; Jugular Veins ; Organ Transplantation ; Prognosis ; Seoul ; Thoracic Surgery ; Transplants

BACKGROUND: Activated clotting time (ACT) and thromboelastography (TEG) are generally accepted as adequate measures of the coagulation system for monitoring of the cardiac system. Aprotinin is alleged to affect ACT and TEG. We performed this study to see if the determination of ACT and TEG can provide a basis for the assessment of coagulation and the prediction of postoperative hemorrhage in cardiac surgical patients treated with aprotinin. METHODS: Twenty patients undergoing cardiac operation were studied. The values (control) of ACT and TEG were obtained just after induction of anesthesia. Each patient was fully heparinized and received aprotinin, 2,000,000 KIU added to the prime solution. At the end of the procedure, protamine, 3 mg/kg was given for the neutralization of heparin. Measurement of ACT and TEG were made 20 minutes after the administration of protamine, at the end of surgery, and 1 hour after transfer to ICU. The values were compared with the amount of hemorrage collected by chest tubes 1 hour, 2 hours and 8 hours after transferred to ICU. RESULTS: The values of ACT at 20 minutes after protamine administration and at the end of surgery significantly (P < 0.05) increased compared with the values of control, but the values in ICU did not show significant change. All values of TEG significantly (P < 0.05) changed compared with the values of control. No single variable of ACT and TEG showed correlation with the amount of hemorrhage through chest tubing postoperatively. CONCLUSIONS: The results indicate that neither ACT nor TEG predict the amount of postperative hemorrhage in aprotinin-treated patients having cardiac surgery. Therefore the TEG results should be interpreted cautiously because of the high rate of unreliable results.
Anesthesia ; Aprotinin* ; Chest Tubes ; Hemorrhage* ; Heparin ; Humans ; Postoperative Hemorrhage ; Thoracic Surgery ; Thorax ; Thrombelastography*

Animals ; Anoxia* ; Muscles* ; Rats*

We studied the cardiovascular and neuromuscular effects of Norcuron (a new nondepo larizing muscle relaxant) in ASA Claas I patients under halothane and nitrous oxide ane-sthegia. The onset time of Norcuron was 1.06+/-0.27 win, and Clinical duration of action time was 41.49+/-5.53 min and recovery index was 16.38+/-2.30 min and total duration of action time was 67.04 +/-14.42 min.. after volus injection Norcuron 0.1 mg/kg. Norcuron did not change mean arterial presaure, heart rate and histamine secretions and had not arrythmogemic effect on heart rhythm. We conclude that vecuronium bromide (Norcuron) produces a excellent neuromuscular blockade of short duration with little cardiovascular changes and histamine releaae.
Halothane ; Heart ; Heart Rate ; Histamine ; Humans ; Neuromuscular Agents* ; Neuromuscular Blockade ; Nitrous Oxide ; Vecuronium Bromide*