BACKGROUND: Induction of general anesthesia with tracheal intubation and skin incision are potent stimuli that can induce increased sympathetic activity, heart rate and blood pressure. We compared the hemodynamic response and catecholamine concentration during general anesthesia with intravenous clonidine pretreatment, a centrally acting -2 adrenoceptor agonist, and without pretreatment. METHODS: Forty ASA I or II patients aged from 20 to 60 years undergoing elective surgery were randomly allocated to two groups. In group I, 5 ml of 0.9% normal saline as control administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O (2.5L/min)-O2 (2.5L/min)-enflurane (1.3~1.8 vol%). In group II, 4 g/kg clonidine diluted in 5ml of normal saline administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O-O2-enflurane (0.5~1.0vol%) and 2 g/kg/hr clonidine was continuously infused. We measured blood pressure, heart rate and plasma catecholamine at preinduction, 1 minute after intubation (T1), 1 (T2) and 30 minutes after skin incision (T3) and compared with group I. RESULTS: There was statistical significance in systolic and diastolic pressure at T1 between two groups. There was statistical significance in heart rate, epinephrine and norepinephrine at T1, T2 and T3 between two groups. CONCLUSION: The elevation of blood pressure, heart rate and plasma catecholamine accompanying tracheal intubation and skin incision may be prevented by administration of intravenous clonidine.
Adult ; Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Brain ; Clonidine* ; Epinephrine ; Heart Rate* ; Heart* ; Hemodynamics ; Hemorrhage ; Hope ; Humans ; Incidence ; Intubation* ; Larynx ; Male ; Norepinephrine ; Plasma* ; Skin ; Spondylitis, Ankylosing ; Succinylcholine ; Thiopental

Moyamoya disease is a rare, progressive, occlusive cerebrovascular disorder characterized by bilateral stenosis of the intracranial portion of the internal carotid artery. Symptoms including transient ischemic attacks, seizures, intracranial hemorrhage and cerebral infarction, are variable. There are few case reports of moyamoya disease in pregnancy. Since hyperventilation-induced cerebral ischemia and hypertension are provoked by active labor, cesarean section has been recommended to avoid neurologic complications for pregnant women with moyamoya disease. The optimal anesthetic management for cesarean section in these patients has not been discussed. We report a case of moyamoya disease in a patient presenting for cesarean section at 40 weeks' gestation. Epidural anesthesia was administered using 0.5% bupivacaine and fentanyl. Intraoperative hemodynamic state was stable. The patient has no significant postoperative complications.
Anesthesia* ; Anesthesia, Epidural ; Brain Ischemia ; Bupivacaine ; Carotid Artery, Internal ; Cerebral Infarction ; Cerebrovascular Disorders ; Cesarean Section* ; Constriction, Pathologic ; Emergencies* ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypertension ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Moyamoya Disease* ; Postoperative Complications ; Pregnancy ; Pregnant Women ; Seizures

A thirty nine year-old male patient was scheduled for emergent craniotomy and epidural hematoma evacuation under general anesthesia. All data of the preoperative check lists for emergent operation were within normal limits and vital signs of the patient were stable. During the induction of anesthesia an armored tube was inserted into the trachea for this operation. Approximately 110 minutes after the induction of anesthesia, signs of complete airway obstruction developed abruptly. At that time we deflated the cuff balloon to exchange the tube. Then, the signs of airway obstruction disappeared completely. Therefore the deflation of cuff balloon is recommended in order to exclude the obstruction by the displaced cuff.
Airway Obstruction* ; Anesthesia ; Anesthesia, General ; Craniotomy ; Hematoma ; Humans ; Intubation ; Male ; Trachea ; Vital Signs

Epidurally administered clonidine, a selective alpha2-adrenergic agonist, has been reported to produce postoperative analgesia. The aim of this study was to see if the addition of a small dose of clonidine to a mixture of bupivacaine, fentanyl and epinephrine prolonged the duration of analgesia and reduce the number of injections or the total bupivacaine requirement and the incidence of side effects. Forty patients presenting for TAH in ASA physical status 1 or 2, were randomly divided into two groups group 1 was given a 10 ml epidural solution of bupivacaine 12.5 mg combined with fentanyl 50 pg and epinephrine 50ug ; group 2 was given the same solution with clonidine 75 ug. Changes in the systolic and diastolic blood pressure and the pulse rate were recorded at 5, 10, 20, 30, 45, 60, 75, 90, 105 and 120 minutes after drug administration, and the analgesic effects were assessed by measuring pain score (Prince Henry Score), analgesic duration, total bupivacaine requirement for 24 hours and side effect. The results were as follows; 1) Heart rate changed little in group 1 and decreased significantly in group 2. 2) Systolic and diastolic blood pressure decreased significantly in all groups (earlier in group 2 than in group 1). 3) The mean duration of analgesia was significantly prolonged in group 2, compared with group 1 (437 min in group 2; 229 min in group 1). For 24 hours after the first injection, numbers of injections (6 in group 1; 3.15 in group 2) and total bupivacaine requirements (75.0 mg in group 1 ; 39.1 mg in group 2) were significantly reduced. 5) The side effects including hypotension, nausea and vomiting, pruritus, and respiratory depression were not significantly different from each other. These results show that epidurally administered clonidine helps to prolong analgesic duration, and decreased need for supplemental bupivacaine, after lower abdominal surgery.
Analgesia ; Blood Pressure ; Bupivacaine* ; Clonidine* ; Epinephrine* ; Fentanyl* ; Heart Rate ; Humans ; Hypotension ; Hysterectomy* ; Incidence ; Nausea ; Pruritus ; Respiratory Insufficiency ; Vomiting

Clinically, neostigmine is most commonly used as the reversal agent for to the competitive muscle relaxants. Atropine (group 1) and glrcopyrrolate (group 2) were studied in doses of 15ug/kg, 20 ug/kg and 77ug/kg, 10ug/kg given intravenously in a mixture with neostigm-ine 40ug/kg, during operation and at the end of operation 20 ASA class I patients, aged between 15 to 60, were selected in each group. Anesthesia was maintained with enflurane (1-1.5%), N2O (2L/min), O2(2L/min) and pancuronium (50ug/kg) was used as a muscle relaxant. The results were as fellows : 1) Group 1 showed significant increase and decrease in purse rate compared with group 2. 2) Atropine neostigmine mixture significantly showed initial increase and late decrease in pulse rate than glycopyrrolate-neostigmine mixture. 3) In group 2, 20ug/kg dose of atropine, when administered in a mixture with neostigmine, showed significant initial increase in pulse rate, 15ug/kg dose of atropine showed significant late bradycardia. 4) In group 2, 7 ug/kg, 10 ug/kg dose of glycopyrrolate was not associated with initial tachy cardia but late bradycardia was obserred and 10 ug/kg dose of glycopyrrolate was associated with more stable heart rate.
Anesthesia ; Atropine ; Bradycardia ; Cardia ; Enflurane ; Glycopyrrolate ; Heart Rate* ; Heart* ; Humans ; Neostigmine ; Pancuronium

It is well known that most anesthectis and drugs are metabolized and excreted in the liver. There are many controversies regarding postoperative halothane hepatotoxicitr and often reported postoperative hepatic dysfunction following enflurane anesthesia. It appears that the development of hepatic necrosis after anesthesia depends on a chance combination of events but not anesthetics itself. Common causes of postoperative hepatic damages ia possibly due to viral heatitis, since in oar country viral hepatitis B are increasing in frequency recently. This study was performed to evaluate the effect of enflurane on liver function in 25 asy-mptomatic patients hepatitis B surface antigen positive. The results seems favorable for anesthesia and sureery. on asymptomatic viral hepatitis B patients.
Anesthesia ; Anesthesia, General* ; Anesthetics ; Enflurane ; Halothane ; Hepatitis B ; Hepatitis B Surface Antigens* ; Humans ; Liver* ; Necrosis

Thie study was conducted in the Anesthesiology Department of Chosun University Hospital from March to August 1987 using 0.5% isobaric bupivacaine and 0.4% hyperbaric bupivacaine as agents for spinal anesthesia. The following results were obtained. 1) The segmental heights and the highest level of sensory loss were significantly increased with increased dosage. In the hyperbaric bupivacaine groups of 15 mg and 20 mg respectively, the sensory lose in comparison with isobaric groups was significantly increased. 2) Less time was needed to achieve, complete motor blockade in the 15 mg hyperbaric bupivacaine group than in the isobaric groups but there were no significant differences between the other groups. The duration of motor blockade was more prolonged in the isdobaric bypivacaine groups using 15mg And 20 mg than in the hyperbaric groups. 3) The Group using 20 mg of hyperbaric bupivacaine demonstrated a significant decrease in blood pressure as coupared wish the group using 20 mg of isobaric bupivacaine. 4) Following spinal anesthesia, headache developed in 5 cases (5.6%). From the above results we conluded that isobaric bupivacaine and hyperbaric bupivacaine are appropriate anesthesia agents for surgery on the lower abdomen and lower extremities.
Abdomen ; Anesthesia ; Anesthesia, Spinal* ; Anesthesiology ; Blood Pressure ; Bupivacaine* ; Headache ; Lower Extremity

Hemostasis and clear operative field is obtained by local infiltration of local anesthetic mixed with epinephrine. Small amount of diluted solution is usually used to decrease incidence of arrhythmia which can be induced by myocardium sensitizing anesthetics. We experienced a case of cardiac arrest during anesthesia with halothane due to the inadvertent use of a large dose of epinephrine to achieve hemostasis, the patient was resuscitated after 2 hours of CPR.
Anesthesia ; Anesthetics ; Arrhythmias, Cardiac ; Cardiopulmonary Resuscitation ; Epinephrine* ; Halothane ; Heart Arrest* ; Hemostasis ; Humans ; Incidence ; Myocardium

BACKGROUND: Spinal anesthesia is a simple technique requiring a small dose of local anesthetic to provide intense and reliable block. And epidural anesthesia with the catheter technique gives a better control of the level of analgesia and a good postoperative pain relief using opioids, local anestheties or both. Therefore, the combined spinal epidural (CSE) anesthesia was evaluated to provide rapid onse of action, good muscle relaxation, prolonged duration of the block and postoperative pain relief. METHODS: All patients were placed in a lateral position. Using a midline approach at L interspace, a 18G Tuohy needle was introduced into the epidural space. A 27G Whitacre spinal needle was passed through the Tuohy needle until free flow cerebrospinal fluid, and than 0.5% heavy bupivacaine 3ml(15mg) was injected. The spinal needle was withdrawn and the epidural catheter was inserted. The dermatome level and time of sensory block was evaluated using loss of sensation of pinprick test every 1 minute for 30 minutes, until the maximum sensory block was established. Motor block was assessed using the Bromage scale. And postoperatively we interviewed the patients for opinioes on the blockade and complication. RESULTS: The mean values of maximum sensory block level were T8 (T8.0+/-1.7 dermatome) and at that time was 8min 30sec (8.5+/-1.2min). The motor blockade of lower extremity was Bromage 3 in all patients. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Subjective evaluation by the patients about postoperative pain control was excellent. CONCLUSIONS: CSE anesthesia appears to combine the reliabiIity and rapid onset of spinal block, and the ability to extend the block and postoperative analgesia by using the epidural catheter while minimizing their drawbacks.
Analgesia ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Bupivacaine ; Catheters ; Cerebrospinal Fluid ; Epidural Space ; Humans ; Lower Extremity* ; Muscle Relaxation ; Needles ; Pain, Postoperative ; Sensation

It is a well known that cardiac arrest can occur during general anesthesia. We had experienced of a cardiac arrest during anesthsia in a child with halothane just after the use of a thiopental sodium and vecuronium bromide. When the cardiac asystole was noted by E.C.G., immediate treatment was performed. In this case, We think that Cardiac arrest being related to several factors, anxiety about operation, rough sugical maniplation, light anesthesia and drugs.
Anesthesia* ; Anesthesia, General ; Anxiety ; Child ; Halothane ; Heart Arrest* ; Humans ; Thiopental ; Vecuronium Bromide