BACKGROUND: Intranasal drug administration has been suggested to be method for the treatment of various systemic cardiovascular disorders such as systemic hypertension and angina pectoris. Nifedipine is usually administered sublingually. We examined the efficacy of intranasal nifedipine for the treatment of hypertension during laparoscopic cholesystectomy. METHODS: After CO2 insufflation, we selected patients with blood pressures increased by 25%. Group I (n = 10) received nifedipine 10 mg intranasally and group II (n = 10) nifedipine 10 mg sublingually. Blood pressures and heart rates were recorded at 0, 1, 2, 3, 4, 5, 10, and 15 minutes after nifedipine administration. RESULTS: Significant decreases in blood pressure were observed from 2 to 15 minutes after administration in the intranasal group. Significant decreases in blood pressure in sublingual group were observed later than in the intranasal group. Significant increases in heart rate were observed from 4 to 15 minutes in the intranasal group, but no significant changes of heart rate in the sublingual group. CONCLUSIONS: Our results suggest that the administration of intranasal nifedipine is faster, more effective, and more convenient than sublingual nifedipine for the immediate control of hypertension associated with CO2 insufflation during laparoscopic cholecystectomy.
Administration, Intranasal ; Angina Pectoris ; Blood Pressure ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Humans ; Hypertension* ; Insufflation ; Nifedipine*

BACKGROUND: Atelectasis is an important cause of impaired gas exchange during the perioperative period. The administration of 100% oxygen, even for brief periods, is associated with pulmonary absorption atelectasis, and the addition of N2O to the inspired gas may promote atelectasis. The aim of this study was to evaluate the effect of inspired gas composition on postoperative arterial oxygenation in elderly patients. METHODS: Twenty-six female patients with healthy hearts and lungs, and aged 60 yrs, who were scheduled for laparoscopic cholecystectomy, were divided into two groups. All patients received propofol-fentanyl anesthesia. In the N2O group, patients were ventilated with 100% oxygen during induction, 40% oxygen in N2O during mataintenance, and 100% oxygen during emergence. In the air group, patients received 60% oxygen in air during induction, 40% oxygen in air during maintenance, and 60% oxygen in air during emergence. Arterial blood gases were obtained to evaluate arterial oxygenation by analyzing PaO2 and alveolar arterial oxygen tension differences (AaDO2). RESULTS: In both groups, postoperative PaO2 was lower and AaDO2 higher than preoperative values (P < 0.05), but there were no differences between the two groups. CONCLUSIONS: We conclude that absorption atelectasis during anesthesia is not the main cause of postoperative arterial oxygenation impairment in eldery patients, and that any effect of the inspired gas is likely to be of limited clinical significance.
Absorption ; Aged* ; Anesthesia* ; Cholecystectomy, Laparoscopic ; Female ; Gases ; Heart ; Humans ; Lung ; Nitrous Oxide ; Oxygen* ; Perioperative Period ; Pulmonary Atelectasis

BACKGROUND: The laryngeal mask airway (LMA) has many advantages including easy insertion, less trauma, minimal cardiovascular changes. And the elderly have many problems such as poor dentition, limited cervical extension and age related cardiovascular changes, so endotracheal intubation in geriatric patient is sometimes difficult and harzardous. This clinical study was designed to investigate availability and problems of LMA insertion in geriatric patients. METHODS: 60 geriatric patients undergoing elective surgery were induced with intravenous injection of pentothal sodium or propofol, vecuronium or atracurium and inhalation of O2, N2O, enflurane or isoflurane. After deep anethesia and full muscle relaxation LMA was inserted and cuff was inflated. When blind insertion was failed, laryngoscope was used. Anesthesia was maintained with inhalation of O2, N2O, enflurane or isoflurane under positive pressure ventilation. Thereafter, we observed peak inspiratory pressure and any incident including gas leakage, stomach distension, regurgitation of stomach content intraoperatively and then any complication postoperatively. RESULTS: LMA placement was successful in 98.8%, but LMA insertion in geriatric patient had some difficulty because patient's tongue slided down with LMA due to oropharyngeal dryness, teeth loss. Intraoperatively LMA was well maintained under positive pressure ventilation. There was no critical incident associated with LMA use. CONCLUSIONS: LMA is safe and may have a useful role in the anesthetic management of geriatric patients who have many problems such as poor dentition, limited cervical extension and age related cardiovascular changes.
Aged ; Anesthesia ; Atracurium ; Dentition ; Enflurane ; Gastrointestinal Contents ; Humans ; Inhalation ; Injections, Intravenous ; Intubation, Intratracheal ; Isoflurane ; Laryngeal Masks* ; Laryngoscopes ; Muscle Relaxation ; Positive-Pressure Respiration ; Propofol ; Sodium ; Stomach ; Thiopental ; Tongue ; Tooth ; Vecuronium Bromide

BACKGROUND: Succinylcholine is still the most frequently used muscle relaxant for rapid-sequence intubation despite its well-known side effects. Rocuronium has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence intubation. The purpose of this study was to compare tracheal intubating conditions by following different rocuronium doses and application techniques versus succinylcholine. METHODS: Fifty nine ASA physical status 1 and 2 adult patients scheduled for elective surgeries were anesthetized with thiopental sodium 5 mg/kg and muscle relaxant using a rapid-sequence technique. Group I (n = 12) received succinylcholine 1.0 mg/kg, group II (n = 15) received rocuronium 1.0 mg/kg, group III (n = 16) received rocuronium 0.6 mg/kg as a single bolus dose, and group IV (n = 16) received a priming dose of rocuronium 0.06 mg/kg followed three minutes later by rocuronium 0.54 mg/kg. Intubation was performed 60 seconds after the administration of muscle relaxant and intubating conditions were evaluated by clinical scoring (Table 1), and train-of-four (TOF) count of the adductor pollicis by accelerography. RESULTS: TOF counts of group I were lower than those of groups III and IV, and those of group II were lower than group III (P < 0.0083). Group II had intubating conditions similar to group I. The intubating conditions of groups I and II were better than those of groups III and IV (P < 0.0083). CONCLUSIONS: Rocuronium 1.0 mg/kg may be a suitable alternative for succinylcholine 1.0 mg/kg during rapid-sequence intubation. Priming principle does not produce faster or better intubating conditions than a single bolus injection.
Adult ; Humans ; Intubation* ; Succinylcholine ; Thiopental

Recently, much attention has been paid to the gut mucosal oxygenation in shock resuscitation, because many studies has been reported that the ultimate etiologies of death due to shock are mainly due to multiple organ failure caused by translocation of endotoxins and microorganisms from the ischemic gut mucosa. As there has been persistent controvesies over the relative merits of various kinds of resuscitation fluids in regard to the tissue oxygenation during management of shock, we studied the effects of various kinds of resuscitation fluids on the gut mucosal oxygenation with cats which were in hemorrhagic shcok 24 anesthetized cats were subjected to ge to decrease the mean arterial blood pressure to 40~45 mmHg and this pressure was maintained for 120 minutes (oligemic period). After this period, normal saline, hydroxyethyl starch and hypertonic saline/dextran mixture were administered respectively to raise systolic blood pressure up to 85 mmHg over 30 minutes and this level was maintained for another 120 minutes (post-oligemic period). Mesenteric venous oxygen tension, mesenteric venous-arterial lactate difference, carbon dioxide tension difference and arterial-venous pH difference were measured far evaluating the effects of three groups of resucitation fluids in regard to the gut mucosal oxygenation. There were no statistical significances among three groups by measuring the venous oxygen tension, venous-arterial carbon dioxide difference, arterial-venous pH difference. But venousarterial lactate difference in normal saline resuscitation group was significantly elevated from 5.0 +/-l.l mg/dl immediately after fluid resuscitation to 8.4+/-1.8 mg/dl 1 hour after fluid resuscitation (p<0.05). The difference in normal saline group was significantly high compared to the hydroxyethyl starch group which was 4.4+/-0.5 mg/dl and also compared to the hypertonic saline/dextran mixture group which was 4.1+/-0.9 mg/dl (p<0.05). Hydroxyethly starch and hypertonic saline/dextran mixture are more effective than normal saline in regard to the gut mucosal oxygenation in shock resuscitation, based on changes in venous-arterial lactate difference in each group. Further clinical studies may be needad.
Animals ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Cats* ; Endotoxins ; Hydrogen-Ion Concentration ; Lactic Acid ; Mucous Membrane* ; Multiple Organ Failure ; Oxygen* ; Resuscitation* ; Shock ; Shock, Hemorrhagic ; Starch

Tracheoesophageal fistula (TEF) is a rare disease, which develops as a result of congenital or acquired causes. Moreover, TEF can be caused by an overinflated cuff during respiratory care with a ventilator in the ICU. So, a low pressure high volume cuff is being used to prevent injury of the tracheal mucosa by the endotracheal tube. The use of a low pressure high volume cuff has decreased respiratory complications, but TEF is still being reported. This case concerns a 78-year-olds woman with heart failure. She was hospitalized for hemiarthroplasty because of a right femur fracture. On the day after admission, she had apnea due to heart failure, but recovered on receiving respiratory care by using a ventilator in the ICU. Thereafter, she began to show symptoms such as paroxysmal coughing, vomiting, and aspiration. We investigated using computed tomography, bronchoscopy and esophagography. We observed a 2-3 cm sized fistula along the posterior wall of the trachea. It was located about 10 cm upper side from the carina on bronchoscopy, perfomed was found in the ICU. She was found to have a TEF and was treated surgically. After her symptoms had improved, she was given hemiarthroplasty under epidural anesthesia. However, 4 days after the operation, the TEF relapsed, but was not as severe as it had been previously. She was alert, but ambulation was not possible because of a general weakness due to long-term hospitalization. Even with the danger of aspiration pneumonia, she left the hospital upon her guardian's request. We report upon this clinical experience and include a brief review of the literature.
Aged ; Anesthesia, Epidural ; Apnea ; Bronchoscopy ; Cough ; Female ; Femur ; Fistula ; Heart Failure ; Hemiarthroplasty ; Hospitalization ; Humans ; Mucous Membrane ; Pneumonia, Aspiration ; Rare Diseases ; Trachea ; Tracheoesophageal Fistula* ; Ventilators, Mechanical ; Vomiting ; Walking

The laryngeal mask airway (LMA) is new method for maintaining the airway and has many advantages such as easy insertion without muscle relaxant, decreasing cardiovascular change, decreasing damage of pharynx and larynx and useful in difficult intubation. It has being increasingly used in the management of difficult airway problems, but has not been widely used in tracheal surgery. A 59 year old woman with tracheal stenosis due to tracheal tumor was admitted for tracheal reconstruction. The stenotic lesion was 5 cm above the carina and the length of the stenotic segment was 2 cm. Anesthetic management should be focus on maintenance of the airway and adequate ventilation with the number 3 sized LMA during the tracheal resection. The tracheal segmental resection and primary end-to-end anastomosis were performed without serious hypoxia and hypercarbia. We discuss the advantages and limitations of the LMA in tracheal surgery.
Anoxia ; Female ; Humans ; Intubation ; Laryngeal Masks* ; Larynx ; Middle Aged ; Pharynx ; Trachea* ; Tracheal Stenosis ; Ventilation

The hypoglossal nerve is a motor supply of the tongue. Hypoglossal nerve palsy after general anesthesia is rare but there have been several reports showing an association with oropharyngeal manipulation such as intubation, bronchoscopy, and laryngeal mask airway. The main mechanism considered has been a temporary compression of the nerve along its superficial course at the lateral root of the tongue during oropharyngeal manipulation. We encountered a patient who complained speaking and swallowing difficulties after general surgery. A deviation to the affected side, atrophy, and fasciculation of tongue were observed. Almost all palsies recovered spontaneously. We present a patient with a transient unilateral hypoglossal nerve palsy after an uncomplicated intubation and anesthesia for surgery for humerus fracture in the beach-chair position.
Anesthesia ; Anesthesia, General* ; Atrophy ; Bronchoscopy ; Deglutition ; Fasciculation ; Humans ; Humerus ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve* ; Intubation ; Laryngeal Masks ; Paralysis ; Tongue

BACKGROUND: The Pentax-AWS is a newly developed rigid video laryngoscope. In comparison to the Macintosh laryngoscope, it offers a significantly improved laryngeal view and facilitates endotracheal intubation. The present study was performed to compare the general efficiency and the cardiovascular responses generated by Macintosh and Pentax-AWS systems during endotracheal intubation. METHODS: This study included 120 patients with American Society of Anesthesiologists (ASA) physical status class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups: Pentax-AWS (group P) and Macintosh (group M). Induction of anesthesia was performed using fentanyl, thiopental and succinylcholine intravenously. Systolic, mean and diastolic blood pressure (SBP, MBP, DBP) and heart rate (HR) were recorded just prior to induction, 1, 3, and 5 minutes after intubation. RESULTS: There were no significant differences in SBP, MBP, DBP and HR between both groups. However, group P showed a higher POGO (Percentage of Glottic Opening) score than group M during endotracheal intubation. CONCLUSIONS: Use of Pentax-AWS in endotracheal intubation did not increase hemodynamic changes compared to the use of Macintosh laryngoscope. Furthermore, Pentax-AWS offered an improved laryngeal view during endotracheal intubation.
Anesthesia ; Blood Pressure ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Succinylcholine ; Thiopental

No abstract available.
Catheters ; Paralysis ; Phrenic Nerve