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

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*

No abstract available.
Blood Transfusion*

Many trials to get informations from arterial waveforms have been done. But it was not so simple as expected because of normally fluctuating characteristics of arterial waveform due to respiration, extracardiac neuro-humoral control, etc. By using power spctral analysis we can figure out powers of these extrinsic contribting factors as well as contours of individual pulse wave by harmonic analysis. The purpose of this study is to compare the results of power spectral analysis and some basic parameters of arterial waveform before and after anesthesia to establish the basic changes during halothane anesthesia. The analog informations, obtained from patients undergoing operation with radial artery cannulated for continuous monitoring, was obtained from analog output of the Cardiocap monitor. It was transformed to digital information by A/D converter and saved to IBM compatible computer with mathcoprocessor. The data was processed offline by the signal analysis software DADiSP version 1.05 with the same computer. Results of mean arterial pressure, heart rate, dp/dt, low frequency peak, high frequency peak and harmonic pulse contour analysis were compared before and after anesthesia. We could conclude that halothane anesthesia diminishes all powers of harmonic components of arterial wave and powers of extrinsic components that affect low frequency area.
Anesthesia* ; Arterial Pressure ; Chromonar ; Halothane* ; Heart Rate ; Humans ; Radial Artery ; Respiration

BACKGROUND: Induction of general anesthesia in patients with cardiac disease must guarantee hemodynamic stability and should result in a satisfactory anesthetic level. The purpose of this study was to analyze the hemodynamic effects of midazolam/sufentanil in comparison with etomidate/sufentanil used for induction of anesthesia in patients with cardiac disease. METHODS: All the patients (n = 30) in the study were about to undergo cardiac surgery and were divided into the midazolam group (n = 15) and etomidate group (n = 15). The induction dose of midazolam was 0.18 mg/kg, etomidate 0.3 mg/kg, vecuronium 0.15 mg/kg, sufentanil 3 microgram/kg, hemodynamics and oxygenation were recorded in the awake state (pre-induction), and 10 minutes after intubation (post-intubation). RESULTS: The etomidate group had a shorter time of anesthetic induction, and some myoclonic movement (13%) was observed. After intubation, reductions of heart rate (13.8%), mean arterial pressure (18.4%), cardiac index (14.8%), left ventricular stroke work index (9.7 - 38.5%), oxygen delivery index (7.43%), oxygen consumption index (10.3%), and Qs/Qt (25.6%), and an increase in central venous pressure (0 - 50%) were observed in both groups. Decreases in right ventricular stroke work index and mean arterial pressure were observed in the midazolam group, but no change in right ventricular stroke work index and a decrease in mean arterial pressure was observed in the etomidate group. In the midazolam group the values of right ventricular stroke work index and mean arterial pressure were significantly lower than in the etomidate group. The heart rate of the midazolam group in patients with CABG were significantly lower than in the etomidate group. CONCLUSIONS: The results of this study shows that etomidate was found to be as reliable and effective an agent for induction as midazolam.
Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Central Venous Pressure ; Etomidate ; Heart Diseases* ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam ; Oxygen ; Oxygen Consumption ; Stroke ; Sufentanil ; Thoracic Surgery ; Vecuronium Bromide

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

To compare the respiratory depressant effect of nalbuphine and morphine, six healthy male volunteers (mean age 26 yr) were given the nalbuphine at a dose of 0.15 mg/kg and morphine at a dose of 0.1 mg/kg intravenously, at intervals of 2 weeks in a double-blind laboratory study. Respiratory depression was monitored by ventilatory responses during CO2 rebreathing at 1 min, 30 min, 60 min and 90 min after injection. The displacement (mean intercept at Petco2 60 mmHg) and the slope of the linear relationship between minute ventilation with Petco2 were measured, There were no significant differences in the slope and the displacement of CO2 response curve between nalbuphine group and morphine group. Also, no significant differences in the slope and the displacement among 1 min, 30 min, 60 min and 90 min after injection of nalbuphine and morphine were noted. These findings demonstrate that the respiratory depressant effect of nalbuphine in similar to morphine at equianalgesic dose, and occurs within 10 min, and continues more than 90 min.
Healthy Volunteers* ; Humans ; Injections, Intravenous* ; Male ; Morphine* ; Nalbuphine* ; Respiratory Insufficiency ; Ventilation ; Volunteers

Ten percent pentastarch is a low-molecular weight hydroxyethyl starch with greater on- cotic pressure and shorter intravascular persistence than 6% hetastarch The purpose of this study was to determine the safety and efficacy of pentastarch as a plasma-volume expand- er as compared to plasmanate infusion in patients undergoing heart surgery. We were par- ticularly interested in assesaing hemodynamic responses and effects of pentastarch on bleeding and coagulation, and prospectively studied 24 patients undergoing open heart surgery or coronary revascularization. 12 patients were randomized to receive 10ml/kg of either plasmanate(group I) or 10% pentastarch(group II) and simultaneously to predonate the blood as the same amounts of colloid solution. Hemodynamic and coagulation profiles were measured after induction of anestheaia and 5min and 30min after following colloid infusion. The effects of colloid infusion with pentaatarch on hemodynamic profiles(heat rste, mean arterial p ure, mean pulmonary arterial preasure, cardiac index, pulmonary capillary wedge pressure, central venous pressure, systemic venous resistsnce, pulmonary venous resistance) were not significantly different from those of plasmanate. The studies for five patients in plasmanate group were stopped because of severe hypotension during colloid infusion. The decrease in hemoglobin and platelet count were significantly greater in the pentastarch group than in the plasmanate group. Changes in PT, aPTT, serum osmolarity, PaO2 and PvO2, were similar between tbe two groups. We conclude that pentastarch is a safe and effective colloid as similar to plasmarate to use as a plasma-volume expander.
Central Venous Pressure ; Colloids ; Heart* ; Hemodynamics* ; Hemorrhage ; Humans ; Hydroxyethyl Starch Derivatives* ; Hypotension ; Osmolar Concentration ; Platelet Count ; Prospective Studies ; Pulmonary Wedge Pressure ; Starch ; Thoracic Surgery*