BACKGROUND: It has been a standard practice in many institutions to combine light general anesthesia with epidural block for abdominal and pelvic surgery. We attempted to prove the effectiveness of prehydration and to find an suitable epidural local anesthetic dose in terms of hemodynamic stability for upper abdominal surgery. METHODS: For preliminary studies, 11 patients scheduled for elective upper abdominal surgery had received general anesthesia immediately after epidural anesthesia. After epidural injection of 10~16 mL of 2% plain lidocaine into the T9~10 intervertebral space, the changes in blood pressure were observed. Thirty-two patients scheduled for elective upper abdominal surgery were divided into two groups. In group A (study group), after prehydration with Hartmann solution (10 mL/kg), 5~7 mL of 2% plain lidocaine was injected into T8~9 or T9~10 intervertebral space and general anesthesia was then induced. Group B (control group) received general anesthesia only. RESULTS: There were no significant differences in hemodynamics between the epidural with general anesthesia and the control group except SVR (systemic vascular resistance). SVR in group A increased in contrast to the group B in which it remained unchanged. CONCLUSIONS: The combined epidural and general anesthesia, using prehydration and 0.5~1 mL/segment of 2% plain lidocaine at the T8~9 or T9~10 intervertebral space was safe without significant hemodynamic changes.
Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Hemodynamics* ; Humans ; Injections, Epidural ; Lidocaine

A prospective study of 99 pediatric patients were performed to investigate the incidence of perioperative airway complications presenting for various surgery with mild upper respiratory infections(URI's). Anesthesia administered via either face mask or endotracheal intubation. The severity of respiratory complications were scored. Endotracheal intubation in itself increased complication score compared to inhalation anesthesia with face mask. There were significant differences in the complication scores between control children and children fulfilling predetermined URI criteria. Complications showing significant differences were cough, airway obstruction, secretion. However, mean scores were too low to draw CONCLUSION that children with URI's should be postponed elective surgery.
Airway Obstruction ; Anesthesia ; Anesthesia, Inhalation ; Child* ; Cough ; Humans ; Incidence* ; Intubation, Intratracheal ; Masks ; Prospective Studies

BACKGROUND: The effects of a muscle relaxant may differ in elderly compared with young adult patients for a variety of the pharmacokinetic and pharmacodynamic reasons. Atracurium is eliminated by nonorgan dependent pathway, Hofmann elimination and ester hydrolysis. So there are some arguments for age-related differences. The purpose of this study was to compare the differences of the onset and duration of atracurium in young and elderly. METHODS: Eighteen young adults (21-54 yr) and 18 elderly (>65 yr) patients anesthetized with nitrous oxide and enflurane. Atracurium (0.5 mg/kg) was given and then intubation was performed after T1 response was blocked more than 80%. Neuromuscular relaxation was measured by the first twitch of train-of-four (T1) response at the adductor pollicis after supramaximal stimulation of ulnar nerve at 2Hz every 12 sec. The onset (disappearance of T1) and duration of 5, 25, 50, 75% recovery time of T1 and recovery index (time for 25-75% recovery of T1) were recorded. RESULTS: Onset of block was not significantly different between the young and elderly. Recovery time of 5, 25, 50, 75% and recovery index were not prolonged in elderly compared with young adults. CONCLUSIONS: There were no significant differences between young and elderly adults in onest time, recovery time of 5, 25, 50, 75% and recovery index when atracurium is used in a single bolus dose. The results suggest that atracurium in elderly patients has similar onset and action duration compared with younger patients.
Adult ; Aged* ; Atracurium* ; Enflurane ; Humans ; Hydrolysis ; Intubation ; Nitrous Oxide ; Relaxation ; Ulnar Nerve ; Young Adult

A 36 years old man was scheduled for carinal resction, left pneumonectomy, and tracheobronchial anastomosis under the diagncais of malignant tumor in the carina and left main bronchus. During the procedure of carinal resection, anesthesia had been maintained with a right bronchial tube which was intubated through operating thoracic cavity. The E.K.G. was monitored continuously and a radial artery canula was inserted for disect arterial pressure monitoring and blood gas analysis sampling. Anesthetic course was uneventful with nitrous oxide, ahlothane and pancuronium under controlled respiration. Postoperative course had minor problem with right upper lobe atelectasis which disappeared soon after tracheal suction.
Adult ; Anesthesia ; Arterial Pressure ; Blood Gas Analysis ; Bronchi ; Humans ; Nitrous Oxide ; Pancuronium ; Pneumonectomy ; Pulmonary Atelectasis ; Radial Artery ; Respiration ; Suction ; Thoracic Cavity

We managed three cases of anesthesia for living related liver transplantation from December 1994 to July 1995. Donors were recipient's parents and two of them were 35-year old man, the other was 25-year-old woman. The recipients were suffered from congenital liver diseases (two of them were diagnosed as biliary atresia and the other Byler's disease). They had presented severe jaundice and cholangitis and their mean age & body weight were 15 +/- 4.9 months and 8.6 +/- 1.22 kg, respectively. Average duration of anesthesia was about 15 hours, and anhepatic time was 140 minutes, 80 m inutes and 50 minutes, respectively. Careful attention was paid to body temperature, serum potassium, ionized calcium, blood coagulation function, as well as to general condition and respiratory function. Hemodynamic value was relatively stable through out the operation and postoperative mechanical ventilatory support was required for about 3 days.
Adult ; Anesthesia ; Biliary Atresia ; Blood Coagulation ; Body Temperature ; Body Weight ; Calcium ; Child* ; Cholangitis ; Female ; Hemodynamics ; Humans ; Jaundice ; Liver Diseases ; Liver Transplantation* ; Liver* ; Parents ; Potassium ; Tissue Donors*

BACKGROUND: Although exact mechanism of adult respiratory distress syndorme (ARDS) is not known, many evidences suggest that inflammatory mediators such as protease and oxygen radicals may be the final common pathway to the endothelial injury. It is gradually accepted that activated neutrophils play a major role in the process. Pentoxifylline is a methylated xanthine with a wide range of actions that make it theoretically useful in the treatment of ARDS. Studies show that it decreases neutrophil phagocytosis and superoxied production. The aim of this experiment is to determine whether pentoxifylline has a preventive effect on oleic acid-induced lung injury. METHODS: Oleic acid (0.08 ml/kg) was infused in 10 mongrel dogs in order to induce acute lung injury. Pentoxifylline (20 mg/kg) was administered 40 mins before oleic acid injection. The author made a comparative studies on the effects of pentoxifylline on hemodynamics and gas exchange before oleic acid injection and at 15, 30, 45, 60, 90 mins after oleic acid injection. RESULTS: There were not significant changes in mean arterial pressure, cardiac output, systemic vascular resistence, pulmonary wedge pressure intrapulmonary shunt in both groups. There were statistical significance in arterial oxygen tension, pulmonary artery pressure, pulmonary vascular resistance between both groups (p<0.05). CONCLUSIONS: Pentoxifylline is a noteworthy drug that could be a candidate as a therapy to help prevent effect in lung injuries that share a common mechanism with oleic acid-induced lung injury.
Acute Lung Injury ; Adult ; Animals ; Arterial Pressure ; Cardiac Output ; Dogs ; Hemodynamics ; Humans ; Lung Injury* ; Lung* ; Neutrophils ; Oleic Acid ; Oxygen ; Pentoxifylline* ; Phagocytosis ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Reactive Oxygen Species ; Vascular Resistance ; Xanthine

Effects of nitroglycerin (NTC), adenosine triphosphate (ATP) and sodium nitroprusside (SNP) on the hemodynamic and blood gas analysis changes epinephrine (EPI) infusion is air embolized cats were investigated. Under the general anesthesia with pentobarbital and vecuronium cats were given 2~2.5 ml/kg of air via internal jugular vein and were resuscitated with EPI bolus injection. Thirty two cats were divided into 4 groups of 8 each. Each 4 groups, were administered saline (group1), NTG (group 2), ATP (group 3) and SNP (group 4) with EPI continuous infusion, respectively. The air shadow in the heart of cats was visualized C-arm image intensifier throught the study and all three vasodilators augmented the removal of air from the heart on C-arm image. All three vasodilators therapy groups produced statistically significant decrease in rate pressure product (p<0.05) but only NTG therapy group decreased heart rate (p<0.05). Central venous pressure were decreased in all three vasodilators therapy groups but only NTG therapy group was statistically significant (p<0.05). Only NTG therapy group increased both arterial (p<0.05) and venous oxgenation. These results indicate that NTG therapy group produced more prominant hemodynamic and blood oxygenation improvement than the other three groups. It is concluded that NTG with vasopressor therapy coude be recommended in venous air embolism.
Adenosine Triphosphate* ; Adenosine* ; Anesthesia, General ; Animals ; Blood Gas Analysis* ; Cats* ; Central Venous Pressure ; Embolism, Air ; Epinephrine* ; Heart ; Heart Rate ; Hemodynamics* ; Jugular Veins ; Nitroglycerin ; Nitroprusside* ; Oxygen ; Pentobarbital ; Sodium* ; Vasodilator Agents ; Vecuronium Bromide

Effects of nitroglycerin (NTC), adenosine triphosphate (ATP) and sodium nitroprusside (SNP) on the hemodynamic and blood gas analysis changes epinephrine (EPI) infusion is air embolized cats were investigated. Under the general anesthesia with pentobarbital and vecuronium cats were given 2~2.5 ml/kg of air via internal jugular vein and were resuscitated with EPI bolus injection. Thirty two cats were divided into 4 groups of 8 each. Each 4 groups, were administered saline (group1), NTG (group 2), ATP (group 3) and SNP (group 4) with EPI continuous infusion, respectively. The air shadow in the heart of cats was visualized C-arm image intensifier throught the study and all three vasodilators augmented the removal of air from the heart on C-arm image. All three vasodilators therapy groups produced statistically significant decrease in rate pressure product (p<0.05) but only NTG therapy group decreased heart rate (p<0.05). Central venous pressure were decreased in all three vasodilators therapy groups but only NTG therapy group was statistically significant (p<0.05). Only NTG therapy group increased both arterial (p<0.05) and venous oxgenation. These results indicate that NTG therapy group produced more prominant hemodynamic and blood oxygenation improvement than the other three groups. It is concluded that NTG with vasopressor therapy coude be recommended in venous air embolism.
Adenosine Triphosphate* ; Adenosine* ; Anesthesia, General ; Animals ; Blood Gas Analysis* ; Cats* ; Central Venous Pressure ; Embolism, Air ; Epinephrine* ; Heart ; Heart Rate ; Hemodynamics* ; Jugular Veins ; Nitroglycerin ; Nitroprusside* ; Oxygen ; Pentobarbital ; Sodium* ; Vasodilator Agents ; Vecuronium Bromide

We noted hemoglobinuris during and after extracorporeal circulation for one case of mitral valve replacement. Laboratory results revealed autoimmune hemolytic anemia(AIHA) including a positive direct Coombs test. A patient with AIHA is serologically incompatible with his own red cells and with the red cells of most blood donors. Red cell transfusion is essential for the management of life threatenting anemia especially in this case. So it is essential, therefore, to have efficient clinician blood bank communication in order to arrive at a rational transfusion therapy for these patients.
Anemia ; Anemia, Hemolytic* ; Blood Banks ; Blood Donors ; Coombs Test ; Extracorporeal Circulation* ; Humans ; Mitral Valve

We studied the cardiovascular and intracranial pressure(ICP) effects of Vecuronium in cats with normal and artificially increased ICP. Under pentobarbital and nitrous oxide anesthesia, monitors for ICP, Mean Arterial Pressure(MAP), Heart Rate(HR), and Central Venous Pressure(CVP) were placed in the cats. The cats were then divided into two groups: one with normal ICP( N-ICP) (n=8) and the other with artificially increased ICP (AI-ICP) (n=8). In the AI-ICP group, a size 8F Foley catheter was placed in the epidural space through a 5 mm trephined hole on the right parietal area. In each group, ICP, MAP, HR, CVP, and Cerebral Perfusion Pressure(CPP) were measured after Vecuronium injection(80ug/kg)(CPP=MAP-ICP). Results showed no statistically significant changes in cats with N-ICP and AI-ICP.
Anesthesia ; Animals ; Catheters ; Cats* ; Epidural Space ; Heart ; Hemodynamics* ; Intracranial Pressure* ; Nitrous Oxide ; Pentobarbital ; Perfusion ; Rabeprazole ; Vecuronium Bromide*