The routine management of head injury includes hyperventilation to produce hypocapnis with arterial CO2 tension 25~30 torr. But a decrease in cerebral blood flow with hypocapnia may result in cerebral ischemia. Our study was to evaluate the change of cerebral blood flow during hyperventilation in halthane anesthesia. The jugular venous oxygen saturation(SjvO2), arterio-venous oxygen content difference(CaO2-CjvO2), and oxygen extraction ratio(O2ER) were used as criteria of cerebral ischemia with reduced cerebral blood flow. The results are as follows: 1) SjvO2 was lower in group 2(PaCO2=22.8torr) than group 1(PaCO2=30.3 torr). 2) CaO2-CjvO2 and O2ER were higher in Group 2 than group 1. 3) No more increased possibility of cerebral ischemia with reduced cerebral blood flow was observed Group 2 than group 1.
Anesthesia ; Brain Ischemia ; Craniocerebral Trauma ; Hyperventilation ; Hypocapnia ; Oxygen*

No abstract available.
Anesthetics, Inhalation* ; Inhalation*

End-tidal PCO2 measurements are less accurate in neonates, infants, and small children than in adults. These in accuracies may by attributed in part to the dilution of end-tidal gas with fresh gas as a result of placing the sampling catheter between the endotracheal tube and a partial rebreathing circuit. To determine the most accurate catheter position for measurements of end-tidal gas tensions, end-tidal PCO2 was measured continuously from the distal and proximal end of the endotracheal tube and these data were compared with simultaneous arterial PCO2 The results were as follows: 1) In children weigthing above 15 kg ventilated with partial rebreathing circuit, both distal and proximal end-tidal PCO2 values approximated arterial PCO2 (p<0.05). 2) In infants and children weigthing below 15 kg ventilated with Ayre's T-piece breathing circuit(Jackson-Rees modification), only distal end-tidal PCO2 approximated arterial PCO2.
Adult ; Carbon Dioxide* ; Carbon* ; Catheters ; Child* ; Humans ; Infant* ; Infant, Newborn ; Respiration

Autoregulation of cerebral blood flow is altered by volatile anesthetics and vasodilators such as nitroglycerin. Forty patients with cerebral aneurysm were anesthetized with halothane or isoflurane, and hypotension (mean arterial pressure: 55 mmHg) was induced with nitroglycerin. Blood gas analysis of radial artery and internal jugular vein during normotension and hypotension was performed. The results were as follows 1) There were no significant changes in juqular venous oxygen saturation, difference of arterial and venous oxygen content and extration rate of oxygen between normotension and hypotension. 2) There were no differences in SjvO2, CaO2, CjvO2, and O2ER between halothane and isoflurane. There is no possibility of cerebral ischemia in induced hypotension by nitroglycerin during halothane and isoflurane anesthesia.
Anesthesia* ; Anesthetics ; Arterial Pressure ; Blood Gas Analysis ; Brain Ischemia ; Halothane* ; Homeostasis ; Humans ; Hypotension* ; Intracranial Aneurysm ; Isoflurane* ; Jugular Veins ; Nitroglycerin ; Oxygen* ; Radial Artery ; Vasodilator Agents

The beneficial effect of morphine in pulmonary edema and congstive heart failure is probably due to a variety of factors, venous pooling of blood, rise in pulmonary arteriorlar resistance protecting the alveoli against plasma transudation, decreased ventilation without dyspnea, sedative effect and reduction of left ventricular work. Some reports suggested that the effects of morphine on the central nervous system may also be important. Nine partients with mitral vavular disease were given 0.1mg/kg morphine after diagnostic heart catheterization. Some, but statistically insignificant, fall in the aortic blood pressure and the systemic vascular resistance, and some, but again statistically insignificant, rise in pulmonary vascular resisstance were observed 10 minutes after the injection of morphine in most of the nine patients. The effects on cardiac output, heart rate, mean pulmonary artery pressure and pulmonary capillary wedge pressure were also within the ranges of statistical insignificance. All nine patients tolerated the intravenous injection of morphine without any ill effects.

Percutaneous radial artery cannulation has become a common technique for continuous monitoring of arterial blood pressure and serial sampling fo arterial blood in critically ill patients and hypotensive anesthesia. Although the method is generally safe and simple it frequently results in temporary radial artery occlusion, which is usually asymptomatic and resolves spontaneously. But occationally which the ulnar arterial collateral circulation is poor, occlusion of the radial artery can cause ischemia or even frank gangrene of the hand. The influence of cannula size or shape, duration of cannulation, frequency of puncture trial and patient's age on the incidence of vessel occlusion remains controversial. We evaluated radial arterial function utilizeing physical examination and Doppler flow measurement in fourty-seven patients following percutaneous cannulation. Arterial occlusion occured in 12.8% and hematoma in 31.9% of fourty-seven patients. The incidences of occlusion and hematoma were more frequent when the attempted puncture was more than three times and the duraion of cannulation was more than six hours. Hematoma disappeared spontaneously several days after and collateral circulation was good without other vascular complication in all six patients who had arteiral occlusion.
Anesthesia ; Arterial Pressure ; Catheterization* ; Catheters ; Collateral Circulation ; Critical Illness ; Gangrene ; Hand ; Hematoma ; Humans ; Incidence ; Ischemia ; Physical Examination ; Punctures ; Radial Artery*

The changes in arterial carbon dioxide tension (PaCO2) during cardiopulmonary bypass reflect changes of temperature and gas flow through an oxygenator. The changes in PaCO2 can be reduced through the frequent analysis of arterial blood gases and subsequent adjustment of total gas flow and CO2 concentration in the gas flow or both. Utilizing a capnometer (CAPNOMAC AGM-103. Datex), we compared end-tidal carbon dioxide tension (PetCO2) from the capnometer with temperature corrected PaCO2 during cardiopulmonary bypass. One end of the sampling port of the capnometer was incorporated into the prime port of the arterial reservoir in a bubbling type oxygenator (William-Harvey). When arterial reservoir temperatures of the oxygenator were 30 degrees C and 35 degrees C, PetCO2 from the capnometer was recorded and two arterial blood gas samplings were done at the same temperatures. The results were as follows: 1) The difference of PetCO2 and temperature corrected PaCO2 was below 3 mmHg in all cases. 2) The relationship between PetCO2 and temperature corrected PaCO2 was significantly linear. The results show that continuous monitoring of PetCO2, using a capnometer is useful to control the changes in PaCO2 during cardiopulmonary bypass.
Carbon Dioxide* ; Carbon* ; Cardiopulmonary Bypass* ; Gases ; Oxygen ; Oxygenators

Sudden deafness may be defined as abrupt onset of sensorineural hearing low without definitive cause and it's pathogenesis is supposed to be a disturbance of blood flow to the inner ear. A Stellate ganglion block induces vasodilation in the head, neck and upper extremity. On this basis we performed stellate ganglion block from 2 to 21 times along with medical treatment on 7 cases of sudden deafness. The resutls were as follows: 1) Of 7 cases, 3 cases(42.9%) had complete recovery; 3 cases(42.9%) had a partial improvement; and 1 case(14.2%) had no response. 2) In patient with vertigo, the prognosis was poor. 3) The signs of a successful block were Horner's syndrome(89.8%), facial flushing (25.4%) and nasal stuffiness(10.2%). 4) The complications after Stellate ganglion block were weakness of the upper extremity(13.6%), hoarscness(10.2%), complaints of a lump in the throat(13.4%), blurred vision (1.7%), and dizziness(1.7%). Therefore, we think that the Stellate ganglion block is a valuable method of treatment in sudden deafness for the purpose of improving the blood supply to the inner ear.
Ear, Inner ; Flushing ; Head ; Hearing ; Hearing Loss, Sudden* ; Humans ; Neck ; Prognosis ; Stellate Ganglion* ; Upper Extremity ; Vasodilation ; Vertigo

Citrate in transfused blood forms a complex with calcium and decreases the free ionized calcium. Serum normalized ionized calcium(nCa2+) concentration was measured in patients receiving resection of brain tumor(Group l) and hepatic lobectomy(Group 2) before and after transfusion The results were as follows; l) nCa2+ concentration decreased from 1.08+/-0.08 mmol/L at baseline to 0.98+/-0.10 mmol/L(p< 0.05) at 10 min after transfusion in Group l. 2) nCa2+ concentration decreased from 1.13+/-0.05 mmol/L at baseline to 0.84+/-0.08 mmol/L(p< 0.01) at 10min and to 0.87+/-0.11 mmol/L(p<0.05) at 2hr after transfusion in Group 2. 3) nCa2+ concentration at 10 min and 2hr after transfusion in Group 2 were significantly lower than those in Group l(p<0.05). nCa2+ concentration decreased significantly after transfusion and didnt returned to baseline at 2hr after transfusion during hepatic lobectomy. We conclude that it is essential to measure ionized calcium(Ca2+) concentration directly and at frequent interval during transfusion in hepatic surgery and we can prevent or treat severe hypocalcemia and cardiovascular depression with measured serum Ca2+.
Blood Transfusion* ; Brain ; Calcium* ; Citric Acid ; Depression ; Humans ; Hypocalcemia

The interruption of hepatic blood flow has been adopted as a method of bleeding control in hepatectomy and liver transplantation. But this occlusion of hepatic inflow may result in significant hepatic injury by various kinds of oxygen radicals produced as a result of hepatic ischemia and following reperfusion. Arterial ketone body ratio(AKBR) is adequatc and convenient parameter by which both acute and prolonged changes of the hepatic function can be estimated. Pharmacological modulation of hepatic injury during warm ischemia and early reperfusion has shown some benefical effects. The authors conducted an experiment to evaluate the inhibitory effect of glutathione and prostaglandin E on hepatic injury due to acute hepatic ischemia and reperfusion. Thirty rabbits were divided into three groups, such as control(n=10), GSH(n=10) and PGE(n=10) groups. Acute hepatic ischemia was induced through the application of portal triad cross-clamping for 30 minutes, and thereafter hepatic reperfusion was induced with the removal of cross-clamping. A single bolus of 200 mg glutathione was injected 10 min before clamp in GSH group, and 200 ng/kg/min of PGE continuously from 10 min before clamp to 30 min after declamp in PGE group. AKBR and hepatic histological findings hefore clamp, 30 min after clamp, 5 min and 30 min after declamp, respectively were compared among 3 groups AKBR was markedly decreased during the clamping period in all groups (P<0.05). In control and PGE groups AKRR was significantly increased after reperfusion than before clamp (P<0.05), but was significantly lower than before clamp. Thirty minutes after reperfusion in GSH group AKBR returned to normal level and was significantly higher than in control group (P<0.05). On light tnicroscopic examination of liver biopsy, mild swollen hepatocytes in the centrilobular zone were seen at ischemia and reperfusion in control and GSH groups, but nearly normal hepatic architectures in PGE group. These results suggest that glutathione has some benefical effect on protection of hepatic dysfunction, and PGE1 on protection of hepatocellular injury during hepatic ischemia and reperfusion.
Alprostadil* ; Biopsy ; Constriction ; Glutathione* ; Hemorrhage ; Hepatectomy ; Hepatocytes ; Ischemia* ; Liver ; Liver Transplantation ; Prostaglandins E ; Rabbits* ; Reactive Oxygen Species ; Reperfusion Injury ; Reperfusion* ; Warm Ischemia