BACKGROUND: The use of anesthesia during assisted reproductive technology (ART) such as TEST (Tubal Embryo Stage Transfer) may expose early embryo to anesthetics in tubal fluid. The effects of anesthetic agents on the development of early embryo in ART are yet unclear. The purpose of this study was to evaluate the effects of narcotics on mouse two-cell embryo development using in vitro growth model of mouse embryo. METHODS: Mouse two-cell embryos were exposed to narcotics, fentanyl (6.0 nM; 30.0 nM) and meperidine (1.0 M; 3.6 M) respectively. Mouse two-cell embryos unexposed to any drugs were served as controls. In vitro developmental patterns were observed on the third and fifth day of culture. RESULTS: There were no significant differences in the rates of embryos arrested at 2~8 cell stage on the third day after culture and blastocysts development and their hatching on the fifth day after culture among three groups. CONCLUSION: We conclude that fentanyl and meperidine in clinical therapeutic concentration have no detrimental effects on the in vitro two-cell mouse embryo development. But further investigations are required to determine whether narcotics have any adverse toxic effects in human reproductive medicine.
Anesthesia ; Anesthetics ; Animals ; Blastocyst ; Embryonic Development* ; Embryonic Structures* ; Female ; Fentanyl ; Humans ; Meperidine ; Mice* ; Narcotics* ; Pregnancy ; Reproductive Medicine ; Reproductive Techniques, Assisted

Background: Positive end-expiratory pressure(PEEP) ventilation causes reduction in cardiac output and increase of intra-thoracic pressure, hence reduction of hepatic blood flow. The purpose of this study is to evaluate the changes of hepatic venous oxygen saturation, tension and content during increase and removal of PEEP and to evaluate hemodynamic variable which has the greatest effect on hepatic oxygenation. Method: Eight dogs were anethetised with 1.0 vol% isoflurane and 100% oxygen. After 30 minutes of stabilization of vital signs, PEEP were increased from 0 cmH2O to 5 cmH2O and 10 cmH2O and lowered to 0 cmH2O again, and hemodynamic data (heart rate, arterial blood pressure, central venous pressure(CVP), pulmonary arterial pressure, pulmonary arterial occlusion pressure and cardiac output(CO)) and hepatic venous oxygenation data (hepatic venous oxygen saturation(ShvO2), tension(PhvO2) and content(ChvO2)) were measured at each step. Results: CO, ShvO2, PhvO2 and ChvO2 decreased significantly at 10 cmH2O PEEP compared to the baseline and 5 cmH2O PEEP and CO, ShvO2 and ChvO2 increased signicantly with removal of PEEP. CVP increased significantly at 10 cmH2O PEEP and decreased significantly with PEEP removal. PEEP showed close correlationship with CO and CVP considering all steps of PEEP and PEEP removal. ShvO2 and PhvO2 showed most close correlationship with CO considering all steps of PEEP and PEEP removal. Conclusion: ShvO2 with PEEP therapy is dependent upon CO. Therefore cardiac output maintenance is essential during PEEP therapy. For exact evaluation of hepatic oxygenation, it is valuable to monitor ShvO2.
Animals ; Arterial Pressure ; Cardiac Output ; Dogs* ; Hemodynamics ; Isoflurane ; Oxygen* ; Positive-Pressure Respiration* ; Ventilation ; Vital Signs

No abstract available.
Hepatitis B Surface Antigens* ; Interferons* ; Lymphocytes*

BACKGROUND: The purpose of this study is to compare the clinical effects of isobaric 0.5% bupivacaine 8 mg and hyperbaric 0.5% bupivacaine 8 mg on sensory and motor block in aged patients undergoing spinal anesthesia. METHODS: Thirty patients, aged 65 years or more, undergoing orthopedic surgical operation of the lower extremities were randomly assigned to two groups for spinal anesthesia. In the isobaric group (n = 15), isobaric 0.5% bupivacaine 8 mg was administered and in the hyperbaric group (n = 15), hyperbaric 0.5% bupivacaine 8 mg was administered. We measured the maximal sensory level, the time to maximal sensory block, the duration of sensory block, the time to complete motor block, degree of motor block and hemodynamic variables every 2 minutes for 10 minutes in lateral decubitus position and then every 5 minutes for 20 minutes in supine position after spinal anesthesia. RESULTS: The maximal sensory block level and the duration of sensory block were not significantly different between the two groups. The time to maximal sensory block was significantly shorter in the hyperbaric group than in the isobaric group in both lower extremities. The time to complete motor block was significantly longer in the hyperbaric group than in the isobaric group in the nondependent extremity. CONCLUSIONS: These results suggest that isobaric 0.5% bupivacaine 8 mg for spinal anestheisa is more suitable for orthopedic operations requiring rapid and complete motor block than hyperbaric 0.5% bupivacaine 8 mg and that it can be performed in lateral decubitus position with the operating site up.
Anesthesia, Spinal* ; Bupivacaine* ; Extremities ; Hemodynamics ; Humans ; Lower Extremity* ; Orthopedics ; Supine Position

BACKGROUND: The incidence of hip fractures in the elderly is increasing because of the expanding elderly population. These patients usually have accompanying chronic illness. We have reviewed 108 cases for hip fracture surgery to determine the factors which influence the intraoperative and postoperative outcome. METHODS: One hundred eight patients, aged 65 year or more, undergoing surgery for hip fracture were reviewed retrospectively according to age, sex, preoperative laboratory findings, pre-existing concomittent disease, type of anesthesia, amount of estimated blood loss during operation, changes of blood pressure, heart rate during anesthesia and postanesthesia care unit, one month morbidity and mortality. RESULTS: Seventy-one patients had pre-existing concomittent disease. Decrease in mean arterial pressure and tachycardia were less frequent in combined spinal epidural anesthesia than spinal anesthesia. Increase in mean arterial pressure was less frequent in combined spinal epidural anesthesia than epidural and general anesthesia during surgery. There was a significantly high postoperative morbidity among patients with concomittent disease. One month mortality increased with increasing age. CONCLUSIONS: We recommend the combined spinal epidural anesthesia in patients who could aggravate the pre-existing concomittent disease when hypotension, hypertension or tachycardia occurs during operation. One month morbidity was related to pre-existing concomittent disease, whereas mortality was related to age. More studies are needed to focus on well-defined risk groups in the elderly patients.
Aged* ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Arterial Pressure ; Blood Pressure ; Chronic Disease ; Heart Rate ; Hip Fractures ; Hip* ; Humans ; Hypertension ; Hypotension ; Incidence ; Mortality ; Retrospective Studies ; Tachycardia

The effects of morphine in bringing sleep and an end to pain have been known from the beginning of recorded history. But the existence of endogenous opiates(endorphin) has been demonstrated only in the last decade. Endorphin bind to opiate receptors and exhibit potent opiate-like activity. In the corticotroph cells of the anterior lobe of pitultary, ACTH and beta-endorphin are synthesized simultaneously. There is a hypothalamic releasing factor which causes the secretion both beta-endorphin and ACTH, but ACTH and beta-endorphine are also released simultaneously by stress. Endorphins adversely affect the circulatory status and these effects are reversed by the intravenous injection of the narcotic antagonist, naloxone. The author studied Dirksen's hypothesis that endorphins may be involved in the pathophysiology of hemorrhagic shock. In this experiment, the author divided in the pathophysiology of hemorrhagic shock. In this experiment, the author divided laboratory animals into 3 groups and administered normal saline, salicylate or hyprocortisone, respectively. l. normal saline pretreated group. ll. salicylate pretreated group. lll. hydrocortisone pretreated group. Each group was then divided into 4 subgroups and treated as follows: 1) hypovolemic shock + normal saline. 2) hypovolemic shock + naloxone. 3) hypovolemic shock + hydrocortisone. 4) hypovolemic shock + PGE1. The following results were obtained: 1) MAP was significantly increased after naloxone and PGE1 adminitration in the normal saline pretreated group. 2) MAP was not changed in the salicylate pretreated group. 3) MAP was significantly increased after naloxone and PGE1 administration in the hydrocortisone pretreated group. 4) Pulse pressure was significantly increased after anloxone, hydrocortisone and PGE1 administration in the normal saline and hydrocortisone pretreated groups. From the above experiment, it may be inferred that endorphins and prostaglandin may play a role in the pathophysiology of hypovolemic shock.
Adrenocorticotropic Hormone ; Alprostadil ; Animals ; Animals, Laboratory ; beta-Endorphin ; Blood Pressure ; Corticotrophs ; Endorphins ; Hydrocortisone ; Hypovolemia* ; Injections, Intravenous ; Morphine ; Naloxone* ; Pituitary Hormone-Releasing Hormones ; Rats* ; Receptors, Opioid ; Shock* ; Shock, Hemorrhagic

The Ewha Womans University Hospital performed 1757 cases of Spinal anesthesia for Cesarean: section out of a total of 9044 anesthetic experiences which had been performed during the 12 years up to August 1972. The following is a summary of observations on 1757 pregnant women conducted by statistical comparison between primary Cesarean section and repeat Cesarean section, between anesthetic dosages, spinal anesthetic level, initial time of fall in blood pressure upon the induction of spinal anesthesia and Apgar score of newborns. 1) General and spinal anesthesia were observed to have been increasing gradually up to 1970. Spinal anesthesia had increased more than general anesthesia and in 1971 general anesthesia increased considerably. 2) Ages of pregnant women ranged from 18 to 49 years. The number in the third decade of pregnant women who had Cesarean section under spinal anesthesia exceeded those in the fourth decade. Primary Cesarean sections performed by this hospital were 1337 cases, more than 3 times the 420 cases of repeat Cesarean section. Primary Cesarean section was done more in the third decade than in the fourth decade. However, repeat Cesarean section was performed more in the fourth decade than in the third decade. 3) The dosage of the local anesthetic, tetracaine hydrochloride, during the period varied from 4.1 mg to 15.0 mg. Before 1968, the dosage was given in large quantities, but since then tearacine hydrochloride 6.0 mg to 7.0 mg has been given to most cases. 4) As to anesthetic level, 96.6% was performed to T6 and T6 properly. 5) Blood pressure initiated a drop within 10 minutes in 85.1% of cases after the induction of anesthesia. 6) Apgar scores of 8 or above were reached in 94.2%.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Apgar Score ; Blood Pressure ; Cesarean Section* ; Cesarean Section, Repeat ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Pregnant Women ; Tetracaine

Transient increases in blood pressure and heart rate following laryngoscopy and endotracheal intubation are well documented in normotensive patients. These circulatory effects are alicited by mechanical stimulation of the laryngopharynx and traches via efferent cervical sympathetic fibers. The hypertension during induction of anesthesia in hypertensive patients can be sccompanized by cerebreal hemorrhage, left ventricular failure and life breatening cardiac arrhythmia. The present study was undertaken to observe the effects of sodium nitroprusside(SNP) on the change in systolic blood pressure and heart rate during and after laryngoscopy for tracheal intubation. Eight adult patients who had received elective operation under general anesthesia with endotracheal intubation were randomly selected and devided into 3 groups. Group l served as a normotensive group. Group ll served as a hypertensive group withou SNP. Group lll served as a hypertensive group receiving 1ug/kg of SNP 15 seconds before starting laryngoscopy. The changes of systolic blood pressure and pulse rate were analysed and data were compared between groups. The results were as follows: 1) Attenuation of increase in blood pressure was statistically significant in the hypertensive group with prior SNP compared with the group not receiving SNP (p<0.05). The magnitude of blood pressure increase in the hypertensive group without prior SNP was significantly greater than in the normotensive group(p<0.001). 2) SNP had no effect on the increase in heart rate associated with tracheal intubation. In conclusion, it is suggested that a single rapid intravenous injection of SNP is a practial pharmacological method to attenuate blood pressure increase during direct laryngoscopy and tracheal intubation in hypertensive patients.
Adrenergic Fibers ; Adult ; Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiovascular System* ; Heart Rate ; Hemorrhage ; Humans ; Hypertension ; Hypopharynx ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Nitroprusside* ; Sodium*

BACKGROUND: It is generally accepted that propofol does not inhibit hypoxic pulmonary vasoconstriction (HPV). However, because the previous studies for the effects of propofol on HPV were established in vivo, the effects of physiologic variables could not be ruled out. Therefore, we investigated the effects of various concentrations of propofol on HPV at isolated rat lungs and the relationship of these effects of propofol on HPV and endothelium-derived relaxing factor (EDRF) and an ATP-dependent K+ channel which were candidates as the mechanism of HPV. METHODS: In 30 isolated rat lungs, after three hypoxic challenges for 5 minutes, we administered saline in the control group, N(G)-nitro-L-arginine methyl ester (L-NAME) in the L group and glibenclamide in the G group followed by three hypoxic challenges for 5 minutes. In addition, we studied the effects of various concentrations of propofol on HPV in the three groups. RESULTS: L-NAME and glibenclamide did not alter baseline pulmonary arterial pressure but L-NAME significantly enhanced HPV. Clinical concentrations of propofol did not affect HPV and high concentrations of propofol inhibited HPV. The pretreatment of L-NAME and glibenclamide did not alter the inhibition of HPV even at high concentrations of propofol. CONCLUSIONS: The EDRF and ATP-dependent K+ channel did not largely contribute to baseline pulmonary arterial tone but EDRF might be released and downregulate HPV. Clinical concentrations of propofol did not inhibit HPV but high concentrations of propofol inhibited HPV. In addition, the mechanism of inhibition of HPV at high concentrations of propofol did not relate to the EDRF pathway and ATP-dependent K+ channel.
Animals ; Arterial Pressure ; Endothelium-Dependent Relaxing Factors ; Glyburide* ; Lung* ; NG-Nitroarginine Methyl Ester* ; Propofol* ; Rats* ; Vasoconstriction*

A new intravenous anesthetic agent, propofol reduces arterial blool pressure and reduces cardiovascular changes of tracheal intubation. The purpose of this study is to evaluate the effects of administration of thiopental 5 mg/kg and propofol 2.5 mg/kg on cardiovascular changes of tracheal intubation. Systolic arterial presure, diastolic arterial pressure, mean arterial pressure, heart rate and rate-pressure product were determined in healthy patients seheduled for tracehal intubation for general anesthesia before induction, after induction, 1, 3, and 5 minute after tracheal intubation. 1) After induction of anesthesia, above cardiovascular measurements except heart rate decreased significantly in both groups, but more profoundly in the propofol group. Heart rate did not change significantly in both groups. 2) Systolic arterial pressure, diastolic arterial pressure and mean arterial pressure increased significantly in the thiopental group after tracheal intubation, but decreased significantly in the thiopental group after tracehal intubation, but decreased significantly in the propofol group. After tracheal intubation, heart rate and rate-pressure product increased significantly in both groups, but the propofol group returned to the control value faster than the thiopental groups. In conclusion, in healthy adult patients, rise in the arterial blood pressure and heart rate after tracheal intubation decreased significantly in the propofol group compared with the thiopental group.
Adult ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Heart Rate ; Humans ; Intubation* ; Propofol* ; Thiopental