Two selective beta 2-sympathonimetic drugs are presently used to arrest preterm labor ritodrine (Yutopar) and terbutaline. As the use of rltodrine becomes more widespread an increasing number of cases of pulmonary edema is 7eing observed Besides pulmonary edema many other complications such as myocardial ischemia, cardiac arrhyth-mias, hypotension, hypertension, cerebral vasospaun, hyperglycemia and miscellaneous metabolic alterations have been recongnized. We recently experienced a previously healthy parturient who suddenly develeped severe pulmonary edema during a cesarian section under epidural anesthesia. She had been treated wish ritodrine for 4 days in an attempt to arrest preterm labor which ultimately failed. Close, aggresaive patient care, mechanical ventilatory support with PEEP and diuretics could dramatically relieve poteotiatty fatal pulmonary edema within 24 hours. The anesthetist should be aware of the potential, life-threatening complications. It is necessry for the aneathetist to kncw how to screen, monitor and treat a patient with compllcatitans associated with tocolytic agents.
Anesthesia, Epidural ; Cesarean Section* ; Diuretics ; Female ; Humans ; Hyperglycemia ; Hypertension ; Hypotension ; Myocardial Ischemia ; Obstetric Labor, Premature ; Patient Care ; Pregnancy ; Pulmonary Edema* ; Ritodrine* ; Terbutaline ; Tocolytic Agents

Two selective beta 2-sympathonimetic drugs are presently used to arrest preterm labor ritodrine (Yutopar) and terbutaline. As the use of rltodrine becomes more widespread an increasing number of cases of pulmonary edema is 7eing observed Besides pulmonary edema many other complications such as myocardial ischemia, cardiac arrhyth-mias, hypotension, hypertension, cerebral vasospaun, hyperglycemia and miscellaneous metabolic alterations have been recongnized. We recently experienced a previously healthy parturient who suddenly develeped severe pulmonary edema during a cesarian section under epidural anesthesia. She had been treated wish ritodrine for 4 days in an attempt to arrest preterm labor which ultimately failed. Close, aggresaive patient care, mechanical ventilatory support with PEEP and diuretics could dramatically relieve poteotiatty fatal pulmonary edema within 24 hours. The anesthetist should be aware of the potential, life-threatening complications. It is necessry for the aneathetist to kncw how to screen, monitor and treat a patient with compllcatitans associated with tocolytic agents.
Anesthesia, Epidural ; Cesarean Section* ; Diuretics ; Female ; Humans ; Hyperglycemia ; Hypertension ; Hypotension ; Myocardial Ischemia ; Obstetric Labor, Premature ; Patient Care ; Pregnancy ; Pulmonary Edema* ; Ritodrine* ; Terbutaline ; Tocolytic Agents

The hemodynamic response evoked by tracheal intubation was observed in 20 adult normotensive patients undergoing elective surgery. Patients were randomly assigned to receive either thiopental 6 mg/kg(n=10) or fentanyl 6ug/kg with thiopental 3mg/kg(n=10), for induction of anesthesia. Systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP) and heart rate(HR) were measured at 1 min., 3 min. and 5 min. after intubation. In the thiopental group, intubation caused a significant rise in SBP, DBP, MAP, HR(p<0.05) but each parameter returned to normal within 5 min. In the fentanyl thiopental group intubation caused little cardiovascular change, but within 5 minutes MAP decreased significantly from 101 mmHg to 83 mmHg(p<0.05). It is concluded that a low-dose of fentanyl which may cause minimal postoperative respiratory depression, significantly prevents postintubation hypertension when used as an adjunct to thiopental for the induction of anesthesia.
Adult ; Anesthesia ; Fentanyl* ; Heart ; Hemodynamics ; Humans ; Hypertension ; Intubation* ; Respiratory Insufficiency ; Thiopental

Bradycardia* ; Cesarean Section* ; Female ; Pregnancy ; Vecuronium Bromide*

Epidural anesthesia is a popular regional anesthetic technique for total hip replacement (THR). It s benefits are reduced blood loss, less need for transfusion, and decreased chance of deep vein thrombosis, and if necessary, it provides longstanding postoperative analgesia with small dose of epidural narcotics through indwelling epidural catheter. The wellknown cardiovascular effects are bradycardia and hypotension according to the degree of sympathetic blockade. These occur usually early in the anesthetic period and the course is benign and are easily treated. We report a case of sudden extreme bradycardia and hypotension during THR under epidural anesthesia that was not associated with hypoxemia, obvious respiratory depression, or systemic toxic reaction. It is concluded that the most likely cause would be a sudden large increase in vagal activity which results from marked reduction in venous return and inadequate oxygenation of myocardium with the assumption of prolonged iatrogenic hemodilution and undercorrected hypovolemia. The patient who receives epidural anesthesia should require constant monitoring and vigilance throughout all procedure.
Analgesia ; Anesthesia, Epidural* ; Anoxia ; Arthroplasty, Replacement, Hip* ; Bradycardia* ; Catheters ; Hemodilution ; Humans ; Hypotension* ; Hypovolemia ; Myocardium ; Narcotics ; Oxygen ; Respiratory Insufficiency ; Venous Thrombosis

BACKGROUND: The aim of this study was to compare the cardiovascular changes followed by laryngoscopy with the McCoy laryngoscope blade with those followed by laryngoscopy with the Macintosh laryngoscope blade. METHODS: Forty eight patients were randomly divided into two groups. Following induction with fentanyl 2 mcg/kg and thiopental 5 mg/kg, and muscle relaxation with vecuronium 0.1 mg/kg, the vocal cords were visualized with either the McCoy or the Macintosh laryngoscope blade, then tracheal intubation was performed. Heart rate and arterial blood pressure were measured just before and after laryngoscopy, and 1, 3 and 5 min later. RESULTS: There was a significant increase in both heart rate and arterial blood pressure after tracheal intubation using the Macintosh laryngoscope. Also, use of the McCoy blade resulted in a significant increase in both heart rate and arterial blood pressure. CONCLUSIONS: There was no significant difference on arterial pressure and heart rate to laryngoscopy and tracheal intubation with either the McCoy blade or the Macintosh.
Arterial Pressure ; Blood Pressure* ; Fentanyl ; Heart Rate* ; Heart* ; Humans ; Intubation* ; Laryngoscopes* ; Laryngoscopy ; Muscle Relaxation ; Thiopental ; Vecuronium Bromide ; Vocal Cords

BACKGROUND: Laryngoscopy and tracheal intubation for general anesthesia are potent stimuli to the cardiovascular system due to sympathetic stimulation. The aim of this study was to compare the hemodynamic responses with different administration routes of lidocaine on blood pressure and heart rate changes associated with tracheal intubation. METHODS: Sixty patients were randomly assigned to spray group (Group 1, n=20) received 10% lidocaine 1.5 mg/kg spray to intratracheally immediately before tracheal intubation, IV group (Group 2, n=20) received 2% lidocaine 1.5 mg/kg intravenously before 90 sec tracheal intubation and control group (Group 3, n=20). Anesthesia was induced with thiopental 5 mg/kg IV, vecuronium 0.1 mg/kg and 50% N2O-O2- 2vol % enflurane. After 5 minutes, tracheal intubation was performed. Mean arterial pressure and heart rate were measured at preintubation and immediately postintubation, 1, 3, 5 mins after tracheal intubation. RESULTS:The differences of mean arterial pressure which were measured at preintubation and immediately postintubation and 1 minute after intubation in group 1 were significantly lower than those in other group (p<0.05). The differences of heart rate which measured at preintubation and 1 minute after intubation were lower than those in group 3 (p<0.05). CONCLUSIONS: For the suppression of sympathetic stimulation following tracheal intubation, 10% lidocaine spray to the laryngotrachea is an effective method to suppress cardiovascular response.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Enflurane ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation* ; Laryngoscopy ; Lidocaine* ; Thiopental ; Vecuronium Bromide

No abstract available.
Adenocarcinoma* ; Estrogens*

Tracheoesophageal fistula (TEF) occurs in approximately 1 in 3,000 to 5,000 live births. TEF arises from failure of normal division of proximal foregut into separate respiratory and digestive tracts at 4 weeks' gestation. TEF and esophageal atresia are interrelated anomalies, and TEF usually occurs with esophageal atresia. These are usually diagnosed shortly after birth. However, the diagnosis is often delayed in TEF without esophageal atresia, because babies with this anomaly are usually normal in size and seldom have other anomalies. Therefore, sometimes TEF without esophageal atresia is found during operation for an unrelated condition when positive pressure ventilation causes massive inflation of the gastrointestinal tract. We report a case of TEF in adult patient found during general anesthesia for emergency exploratory laparotomy.
Adult ; Anesthesia, General* ; Diagnosis ; Emergencies* ; Esophageal Atresia ; Gastrointestinal Tract ; Humans ; Inflation, Economic ; Laparotomy* ; Live Birth ; Parturition ; Positive-Pressure Respiration ; Pregnancy ; Tracheoesophageal Fistula*

Background; Tracheal intubation for cesarean section is usually performed with rapid sequence induction. Under this light stage of anesthesia, marked hypertensive changes of maternal hemodynamic responses following tracheal intubation may occur, which are the common cause of maternal and neonatal complications. We have studied the maternal cardiovascular blunting effect of magnesium sulfate following tracheal intubation in cesarean section. Methods; After obtaining the written informed consents, ninety ASA class I parturients scheduled for cesarean section were randomly allocated to one of three groups: group 1 received thiopental 4 mg/kg and succinylcholine 1.5 mg/kg, group 2 received fentanyl 1.5 microgramg/kg additionally, and group 3 received fentanyl 1.5 microgramg/kg and MgSO4 40 mg/kg additionally. Systolic, mean, diastolic blood pressure, and heart rate were measured before induction, immediately after intubation. Serum magnesium concentrations were measured before administering magnesium and near the end of surgery. Train of four ratio was monitored during whole period of anesthesia. Neonatal Apgar scores and neurologic and adaptive capacity scores (NACS) were checked. Results; Blood pressure changes were more stable in group 2 and group 3, especially group 3, than group 1 (p<0.05). No statistical differences were found in heart rate changes in all groups. No significant differences were noted in neuromuscular recoveries, neonatal Apgar scores and NACS. Conclusions; Magnesium sulfate may be successfully used for blunting the cardiovascular response to tracheal intubation in parturients undergoing general anesthesia for cesarean section.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Cesarean Section* ; Female ; Fentanyl ; Heart Rate ; Hemodynamics ; Intubation* ; Magnesium Sulfate* ; Magnesium* ; Pregnancy ; Succinylcholine ; Thiopental