BACKGROUND: Manual ventilation in pediatric anesthesia limits the anesthesiologist's ability to manage patients suffering from unexpected problems. Although modified Mapleson D systems connected to ventilators have been used for controled ventilation of anesthetized infants and children, the complexity of factors affecting rebreathing within the Mapleson D circuit has resulted in a variety of recommendations for fresh gas flow and minute ventilation. The aim of this study was to devise a formula for ventilator settings which would provide normal tidal volume, respiratory rate, and minute ventilation without rebreathing during mechanical ventilation in pediatric anesthesia and compare this method to manual ventilation. METHODS: 56 infants and small children anesthetized with enflurane and nitrous oxide were studied. We have constructed a formula for ventilator settings which would generate a predictable normocapnia. PetCO2, PaCO2, SpO2, and SaO2 were measured during manual ventilation (control) and during mechanical ventilation. RESULTS: Mean PaCO2 with the mechanical ventilation was within normal range. PaCO2 was significantly lower (P<0.05) with the manual ventilation than with the mechanical ventilation. CONCLUSIONS: We conclude that our formula for ventilator settings can be safely and competently applied to mechanical ventilation with Jackson-Rees system in pediatric anesthesia.
Anesthesia* ; Child ; Enflurane ; Humans ; Infant ; Nitrous Oxide ; Reference Values ; Respiration, Artificial ; Respiratory Rate ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical

BACKGROUND: P300 component of the long latency auditory evoked potentials (LLAEPs) provides information on conscious and cortical funtion. The P300 wave occures only for stimuli that somehow capture the patients attention. Therefore LLAEPs implys a degree of cognitive processing. We studied sedation scale and P300 wave to determine if LLAEPs could be utilized as electrophysiologic predictors of sedation. METHODS: The P300 component of LLAEPs from vertex was recorded from 10 ASA physical status I and II patients undergoing elective surgery while they listened via headphones to a series of clicks which were interrupted unpredictably by a tone burst (2 KHz) before and after diazepam 0.04 mg/kg and 0.08 mg/kg IV. The patients were asked to concentrate on the clicks and to press a button whenever they detected a 2 KHz tone. And sedation scale also was measured. RESULTS: Amplitude of P300 was decreased and latency of P300 was increased in a dose-dependent manner with IV diazepam. Amplitude was greatest and latency was shortest in awake. And sedation scale also was increased according to increased IV diazepam adminstration. CONCLUSIONS: Both amplitude and latency may be highly related to the sedation scale with progressively increasing dose of diazepam. Therefore we conclude that P300 component of LLAEPs can be utilized as an electrophysiologic predictor of awareness and sedation.
Diazepam* ; Event-Related Potentials, P300* ; Evoked Potentials, Auditory* ; Humans

BACKGROUND: Monitoring of PETCO2 in the patients during regional anesthesia may be no less important than under general anesthesia, but will aid in early detection of potentially catastrophic events. However, the utility and accuracy of capnography in non-intubated patients has received little attention. We examined correlation between PETCO2 measured via nasal cannula and PaCO2 values in the sedated spontaneously breathing patients during spinal anesthesia. METHODS: Thirty adult patients who underwent elective surgery were administered optimal doses of tetracaine and epinephrine mixture in their site of operation, length, weight and age. Thereafter, we sampled expired gas by 175ml/min and administered oxygen by 3L/min using oxygen delivery CO2 sampling nasal cannula. End tidal carbon dioxide tension, heart rate, blood pressure and respiratory rate were measured before and 20 min after 0.02 mg/kg midazolam i.v.. And arterial blood gases were once measured 20 min after 0.02 mg/kg midazolam i.v.. RESULTS: The patients, sedation state was asleep or calm in awake. End tidal carbon dioxide tension was significantly increased after midazolam injection (p<0.01), but another values were not different after midazolam injection. Linear regression analysis of arterial carbon dioxide tension and end tidal carbon dioxide tension after midazolam injection yielded y = 0.77x + 4.82 and r2 = 0.76 (p<0.01). CONCLUSIONS: End tidal carbon dioxide tension using oxygen delivery CO2 sampling nasal cannula in the sedated spontaneously breathing patients with midazolam during spinal anesthesia were significantly related with arterial carbon dioxide tension. Therefore, we conclude that monitoring of PETCO2 via nasal cannula is a reliable means during spinal anesthesia.
Adult ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Blood Pressure ; Capnography ; Carbon Dioxide ; Catheters* ; Epinephrine ; Gases ; Heart Rate ; Humans ; Linear Models ; Midazolam ; Oxygen ; Respiration* ; Respiratory Rate ; Tetracaine

During orthotopic liver transplantation (OLT), changes of hemodynamic, electrolytes and acid-base balance are frequently occurred. These changes may influence mortality and prognosis during and after surgery. The purpose of this study was to observe and evaluate the changes of hemodynamics and electrolytes occurring in 14 cases canine OLT. After insertion of endotracheal tube, anesthesia was maintained with 1%enflurane and pancuronium bromide. Swan-Ganz catheter(7.5 Fr.) was inserted into right external jugular vein and 20 gauge angiocatheter was also inserted into left femoral artery. Complete hemodynamic variables and electrolytes were measured 30 minutes after skin incision, anhepatic stage, 5 minutes before reperfusion, 5 and 30 minutes after reperfusion. The results were as follows; On reperfusion of grafted liver, 9 cases(64%) showed postreperfusion syndrome. In 9 cases showing Postreperfusion syndrome, cardiac output, systemic vascular resistance, mean pulmonary arterial pressure were decreased and serum potassium concentration was increased on reperfusion, but there were no significant changes in central venous pressure, pulmonary capillary wedge pressure, heart rate, body temperature and serum ionized calcium concentration when comparing with before reperfusion. Decreased mean arterial pressure during reperfusion in postreperfusion syndrome might be speculated through decrease of myocardial contractility and systemic vascular resistance.
Acid-Base Equilibrium ; Anesthesia ; Animals ; Arterial Pressure ; Body Temperature ; Calcium ; Cardiac Output ; Central Venous Pressure ; Dogs ; Electrolytes ; Femoral Artery ; Heart Rate ; Hemodynamics* ; Jugular Veins ; Liver Transplantation* ; Liver* ; Mortality ; Pancuronium ; Potassium ; Prognosis ; Pulmonary Wedge Pressure ; Reperfusion ; Skin ; Transplants ; Vascular Resistance

BACKGROUND: Although modified Mapleson D systems connected to ventilators have been used for controlled ventilation of anesthetized infants and children, the complexity of factors affecting rebreathing within the Mapleson D circuit has resulted in a variety of recommendations for fresh gas flow and minute ventilation. We constructed a formula for ventilator settings which would provide normal tidal volume, respiratory rate, and minute ventilation without rebreathing during mechanical ventilation in pediatric anesthesia and would like to compare this method to commonly recommended Bain-Spoerel's method. METHODS: Seventy eight infants and small children who anesthetized with enflurane and nitrous oxide were studied. We performed controlled ventilation with each method and measured SpO2, PETCO2 at 10, 20, 30 min after anesthetic induction. At 20 min after anesthetic induction, we drew a arterial blood sample to evaluate PaCO2 and PaO2. RESULTS: In patients above 10 kg, mean PaCO2 was within normal range. But in patients below 10 kg, PaCO2 was significantly higher(p<0.01) with the Bain-Spoerel's method than with the Paik Hosp.'s method. CONCLUSIONS: We conclude that our method for ventilator settings can be safely and competently applied to mechanical ventilation with Modified Mapleson D circuit in pediatric anesthesia.
Anesthesia* ; Child ; Enflurane ; Humans ; Infant ; Nitrous Oxide ; Reference Values ; Respiration, Artificial* ; Respiratory Rate ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

BACKGROUND: During hemorrhagic shock, acidosis was frequently treated with sodium bicarbonate, but various adverse reactions were reported. Most adverse effects of sodium bicarbonate have been attributed to increased CO2 production and paradoxical intracellular acidosis. This study was designed to compare the effects of Carbicarb and sodium bicarbonate on hemodynamics and acid base states in canine hemorrhagic shock. METHODS: 12 mongrel dogs were randomly divided as sodium bicarbanate group (group 1, n=6) and Carbicarb group (group 2, n=6). The study was divided into three successive phases as prehemorrhagic phase (I), hemorrhagic shock phase (II), acid-base correctoin phase (III+1 min, III+5 min, III+15 min, III+30 min). At the beginning of phase III, group 1 received sodium bicarbonate 2.5 ml/kg and group 2 received Carbicarb 2.5 ml/kg. During each phase a complete set of hemodynamic parameters, arterial and mixed venous blood gas measurements were recorded. RESULTS: 1) Arterial and end-tidal CO2 of sodium bicarbonate treated group were increased significantly compared with that of Carbicarb treated group after treatment. 2) Acidosis was improved in both groups, but pH of Carbicarb treated group showed more increase compared with pH of sodium bicarbonate treated group (P <0.05). 3) There was significant hemodynamic improvement on both group after treatment, but there was no statistical significance between groups. CONCLUSION: The treatment of Carbicarb shows more increase in arterial pH and less increase in carbon dioxide compared with sodium bicarbonate to treat metabolic acidosis due to hemorrhagic shock in mongrel dogs. So we suggest that Carbicarb is useful in the treatment of metabolic acidosis during hemorrhagic shock.
Acidosis ; Animals ; Carbon Dioxide ; Dogs ; Hemodynamics* ; Hydrogen-Ion Concentration ; Shock, Hemorrhagic* ; Sodium Bicarbonate* ; Sodium*

BACKGROUND: Intravenous injection of rocuronium is associated with withdrawal responses which are attributable to the pain from the injection of rocuronium. Several methods have been proposed to abolish and attenuate rocuronium-induced pain. We hypothesized priming dose of rocuronium could reduce withdrawal responses associated with administering a second large dose of rocuronium for tracheal intubation. We compared the efficacy of the priming dose technique of rocuronium with intravenous lidocaine as a pre-treatment for the prevention of withdrawal responses associated with rocuronium injection. METHODS: We recruited 150 patients aged between 18 and 60 years, ASA physical status 1 or 2, who were going to undergo elective surgery requiring general anesthesia. Patients were allocated into three groups. Group C received normal saline, Group L received lidocaine 1 mg/kg, and Group P received rocuronium 0.06 mg/kg 2 minutes before administering a second large dose of rocuronium for tracheal intubation. After the loss of consciousness, rocuronium 0.6 mg/kg was administered intravenously over 10 seconds for tracheal intubation. The withdrawal responses to the injection of rocuronium were evaluated. RESULTS: The incidence of withdrawal responses associated with rocuronium injection for tracheal intubation was 56, 50, 24% in group C, group L, and group P, respectively. The incidence of withdrawal responses was lower in group P than group C and group L, but there was no difference between group L and group C. CONCLUSIONS: Priming dose technique is a useful clinical method to alleviate withdrawal responses associated with rocuronium injection.
Administration, Intravenous ; Aged ; Androstanols ; Anesthesia, General ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Lidocaine ; Unconsciousness

Since 1920, when Harvey Cushing first used radiofrequency in electrosurgery, the procedural technique has developed rapidly. Even though this procedure is minimally invasive and safer than other neurodestructive procedures, it is still not free of complications. A 72-year-old female patient had constant facial pain, despite several operations and radiotherapies for her maxillary cancer. The region innervated ophthalmic branch and maxillary branch of the trigeminal nerve was involved, with radiofrequency procedure of the gasserian ganglion for pain control also performed at the area. After the procedure, her blood pressure became elevated and she complained of a headache, and six hours later, she became irritable and distracted. Bacterial meningitis was diagnosed by a spinal tap, with third-generation cephalosporin administered as the treatment. The following day, her symptoms had improved and the pain was also reduced. She was discharged from hospital after 14 days, without any sequelae.
Aged ; Blood Pressure ; Electrosurgery ; Facial Pain ; Female ; Headache ; Humans ; Meningitis ; Meningitis, Bacterial* ; Radiotherapy ; Spinal Puncture ; Trigeminal Ganglion ; Trigeminal Nerve

No abstract available.
Lymph Nodes* ; Lymphocytes* ; Lymphocytes, Tumor-Infiltrating* ; Stomach Neoplasms* ; Stomach*

BACKGROUND: Remifentanil combined with propofol is usually used to induce anesthesia. However, remifentanil and propofol depress the cardiovascular system. This study investigated the effects of a continuous infusion of remifentanil on the propofol dose and hemodynamics using the bispectral index (BIS) during anesthetic induction. METHODS: Sixty female ASA physical status class I or II patients, who were scheduled to undergo gynecologic surgery were randomly assigned to one of three groups (n = 20). Normal saline 20 ml/hr (Group S), remifentanil 0.25microgram/kg/min (Group 0.25), or remifentanil 0.5microgram/kg/min (Group 0.5) was infused intravenously. Propofol was administered slowly two minutes after administering remifentanil or normal saline. The heart rate, mean arterial pressure (MAP) and BIS were measured at baseline, preintubation and postintubation. RESULT: There were no significant differences in the changes in the BIS among the groups. The MAP and heart rate decreased at preintubation compared with baseline (P < 0.05). The MAP of Group 0.5 at postintubation was lower than that in the other groups (P < 0.05). The heart rate in all groups increased at postintubation compared with baseline (P < 0.05). The heart rate of Group 0.5 at postintubation was lower than that of Group S (P < 0.05). The propofol requirement for unconsciousness was lower in Groups 0.25 and 0.5 than in Group S. The propofol requirement in Groups S, 0.25 and 0.5 was 1.56+/-0.2 mg/kg, 1.07+/-0.2 mg/kg and 0.9+/-0.1 mg/kg, respectively. CONCLUSIONS: A combined injection of 0.5microgram/kg/min remifantanil with 0.9 mg/kg of propofol decreases the heart rate and MAP at preintubation without adverse effects and appropriately prevents the cardiovascular responses to tracheal intubation, and reduces the propofol dose needed for a loss of consciousness.
Anesthesia ; Arterial Pressure ; Cardiovascular System ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Propofol* ; Unconsciousness