BACKGROUND: Endotoxins play important roles in the pathophysiologic alterations associated with sepsis so the authors examined the effects of hydroxocobalamin, NW-nitro-L-arginine-metyl ester (L-NAME) and aminoguanidine on thiopental-induced contractile responses of lipopolysaccharide (LPS)-treated and control rat aortic rings. METHODS: Aortic ring preparation was obtained from LPS-treated (1.5mg/kg, i.p. for 18h) rats. Cumulative doses of thiopental (10-4~3x10- 3M) were added to construct contraction response curves. Hydroxocobalamin (10-5M), L-NAME (10-6M) or aminoguanidine (10-6M) were added as NO scavenger or as NOS inhibitors. Contraction curves by cumulative doses of thiopental (10-4~3x10-3M) were remeasured after treatment of NO scavenger or NOS inhibitors. Statistical significances (p<00.05) were analyzed according to data characteristics by Student's t-test, paired t-test or ANOVA. RESULTS: The vascular responses of cumulative thiopental (10-4~3x10 3M) administration were dose- dependent contraction and LPS-treated rat was less contracted (p<00.05). There was significant increment on vascular contraction induced by thiopental after hydroxocobalamin pretreatment in LPS-treated rat (p<0.05), in spite of L-NAME, aminoguanidine pretreatment was failed to increase contractile forces in control and LPS-treated rats. CONCLUSIONS: From these results, viewed from maintenance of vasomotor tone in septic state, it is suggested that hydroxocobalamin may be candidate for vasopressor during usual induction of general anesthesia.
Anesthesia, General ; Animals ; Aorta, Thoracic* ; Endotoxins ; Hydroxocobalamin* ; NG-Nitroarginine Methyl Ester ; Rats* ; Sepsis ; Thiopental

BACKGROUND: Recent studies revealed that inhalational anesthetics (IA) attenuate NO production. But the hemodynamic changes produced by IA in septic syndrome patient are still sufficient to threaten patient, surgeon and anesthesiologist. So we examined which IA is proper to maintain vascular contractile force and evaluated the effects of NOS inhibitors on contractile force of septic rat aorta under IA. METHODS: Aortic ring preparation was obtained from LPS-treated (1.5 mg/kg, i.p. for 18h) rats. The development of sepsis was confirmed by iNOS activity and iNOS expression using RT-PCR. Contractile responses of aorta to phenylephrine admministation in the presence or absence of halothane, enflurane and isoflurane were evaluated. We also evaluated the effects of NOS inhibitors, one is NG-nitro-L-arginine methyl ester (L-NAME) and the other is aminoguanidine. Statistical significances (p<0.05) were analyzed according to data characteristics by unpaired t-test and paired t-test. RESULTS: The contractile responses to phenylephrine admministration were attenuated in LPS-treated rings. Isoflurane, even at the dose of 2 MAC, didn't affect the contractile response while both halothane and enflurane decreased the contractile response even at the dose of 1 MAC. The potentiation of contractile responses by NOS inhibitors were not affected during administeration of IA. CONCLUSIONS: From these results, it is suggested that isoflurane is the safest inhalational anesthetic and NOS inhibitors, especially L-NAME, may be very useful in the therapy of septic shock patients during general anesthesia.
Anesthesia, General ; Anesthetics* ; Animals ; Aorta ; Enflurane ; Halothane ; Hemodynamics ; Humans ; Isoflurane ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase* ; Nitric Oxide* ; Phenylephrine ; Rats* ; Sepsis ; Shock, Septic

In order to measure the ocular dimensions with aging, the anterior chamber depth and the lens thickness were measured using contact ultrasonography and anterior chamber photography in normal human eyes. There were 141 women (241 eyes) and 76 men (130 eyes) between the ages of 10 and 70 years. The lens thickness was increased and the anterior chamber depth was decreased with aging in both sexes. The anterior chamber depth showed an accelerated decrease between the 4th and 5th decades in females and the ratio of anterior chamber depth to axial length was smaller in females than in males after the 5th decade. The results suggest that the prevalence of angle closure glaucoma increased in female after middle age.
Aging* ; Anterior Chamber ; Female ; Glaucoma, Angle-Closure ; Humans ; Male ; Middle Aged ; Photography ; Prevalence ; Ultrasonography

BACKGROUND: Various local anesthetics have been shown to cause relaxation of isolated vascular rings contracted by phenylephrine. Recent studies reported that local anesthetics enhance nitric oxide (NO) production by human peripheral neutrophils. The author measured the effects of local anesthetics of nitrite production in LPS-treated rat aortic vascular smooth muscle cells and examined the effects of NW-nitro-L-arginine methyl ester (NAME) on vascular relaxant responses of lidocaine and bupivacaine in LPS-treated rat aortic rings. METHODS: Aortic ring preparations were obtained from LPS-treated (1.5 mg/kg, i. p. for 18hours) rat. Contractile responses of aorta to phenylephrine in dose-dependent administeration of lidocaine and bupivacaine (10(-6)M 10(-3)M) was examined. And also evaluated the effects of NAME (10(-6), 10(-5) and 10(-4)M) on relaxant responses of lidocaine and bupivacaine in LPS-treated rat aortic rings. From the cultured vascular smooth muscle cells, nitrite production of lidocaine and bupivacaine were measured by Griess reaction method. RESULTS: Lidocaine and bupivacaine enhanced the production of nitrite, the stable end product of nitric oxide, in cultured media of the vascular smooth muscle cells of the rat aorta but it didn't enhance significantly. NAME enhanced the contractile responses to lidocaine and bupivacaine in the LPS-treated rats significantly (p<0.05) but it didn't increase dose-dependently. CONCLUSION: These results show that lidocaine and bupivacaine increased NO production slightly in the LPS-treated rats and the vascular relaxant responses of local anesthetics were more enhanced because of NO production in LPS-treated rat.
Anesthetics, Local ; Animals ; Aorta* ; Bupivacaine* ; Humans ; Lidocaine* ; Muscle, Smooth, Vascular ; Neutrophils ; Nitric Oxide Synthase* ; Nitric Oxide* ; Phenylephrine ; Rats* ; Relaxation

BACKGROUND: Depolarizing muscle relaxant, frequently used for rapid sequence endotracheal intubation in clinical field, has serious complication that occur intermittently, such as, hyperkalemia, increased intraoccular pressure and sudden cardiac arrest, especially in infants and adolescents. So the priming principle, i.e., the administration of a subparalyzing dose of a nondepolarizing muscle relaxant (priming dose) prior to the intubating dose, was developed for rapid sequence endotracheal intubation with nondepolarizing muscle relaxant. However, the priming dose sometimes causes complications, such as, swallowing difficulty or pulmonary aspiration, and this can cause patient discomfort or fatal complications. In this study we examined proper atracurium priming dose and evaluated possible complications of priming doses. METHODS: One hundred patients, scheduled for elective surgery were randomly allocated into five groups according to the priming dose used (group 1; 0, group 2; 0.03, group 3; 0.06, group 4; 0.09, group 5; 0.12 mg/kg). Patients received a midazolam and fentanyl injection, the base line TOF ratio was measured, and an intubating dose was given. We also examined changes in vital sign for 20 minutes after injection and noted the time when the twitch height became zero (onset time). RESULTS: In group 1, the onset time was 107 +/- 22.9 sec, and in groups 4 and 5, the onset times were 85.0 +/- 15.6 and 69.9 +/- 19.3 sec, respectively. But, in group 5, some patients showed tachycardia and swallowing difficulty. CONCLUSIONS: The optimal priming dose of atracurium was determined as 0.09 mg/kg, in most cases, however patients sensitivity to the atracurium should be considered.
Adolescent ; Atracurium* ; Death, Sudden, Cardiac ; Deglutition ; Fentanyl ; Humans ; Hyperkalemia ; Infant ; Intubation* ; Intubation, Intratracheal ; Midazolam ; Tachycardia ; Vital Signs

PURPOSE: The effects of the mobile phone speaker function, which makes it possible to communicate continuously and to allows the free use of two hands, during the early phase of cardiopulmonary resuscitation (CPR) by dispatcher-assisted laypersons were investigated through a mannequin-based simulation study. METHODS: Fifty volunteers were randomly assigned to "non-speaker function CPR" (NSFCPR) (n=25) and "speaker function CPR" (SFCPR) (n=25). Fifty compressions of "Hands-only CPR" were performed according to telephone-instructed CPR by dispatchers with or without the speaker function. The quality of CPR administered and interviews from laypersons on the difficulties of performing CPR were examined. RESULTS: There were no significant differences in compression rate, depth, incomplete chest recoil, and time to first compression between the two groups. However, fourteen participants in the NSFCPR group (56.0%) and five participants in the SFCPR group (20.0%) reported interrupted chest compression (p=0.042). There were twenty-eight events of interruption in the NSFCPR group and twelve in the NSFCPR group (p=0.008). The most common cause of interrupted chest compression were difficulties in hearing the dispatcher's instructions (23, 57.5%). All 13 cases for position correction (32.5%) were observed in the NSFCPR group. There were significant differences between the two groups in causes and counts of compression interruption (p=0.004). CONCLUSION: There was difference in the interruption of compression and there were no differences in CPR performance between two groups. Still, the speaker function may reduce the interruption of chest compression due to phone holding, permitting a clearer hearing of instructions.
Cardiopulmonary Resuscitation* ; Cellular Phone* ; Emergency Medical Services ; Hand ; Hearing ; Out-of-Hospital Cardiac Arrest ; Thorax

Serum myoglobin concentrations were studied in 46 patients during orthopedic and plastic operations that required the application of a pneumatic limb tourniquet. Serum myoglobin was measured at preoperation, during tourniquet and after touriquet release. In the general anesthesia patients, serum myoglobin was after tourniquet release(172.72+/-29.49 ng/ml) significantly increased(p<0.01) than at preoperation(103.06+/-24.03 ng/ml). In the regional block patients, serum myoglobin after tourniquet release(117.69+/-10.08ng/ml) also increased(p<0.05) than at preoperation(67.08+/-14.99ng/ml). In the male patients, serum myoglobin was significantly increased(p<0.05) during tourniquet and after tourniquet release(123.36+/-15.42ng/ml & 158.86+/-21.10ng/ml) than at preoperation (93.58+/-17.11ng/ml). In the female patients, there was no significant difference to regardless of tourniquet application. In the patients that tourniquet application time was within one hour, serum myoglohin was significantly increased(p<0.01) during tourniquet and after tourniquet release(125.66+/-18.86 & 126.20+/-14.99ng/ml) than at preoperation(86.12+/-15.29ng/ml). In the patients that tourniquet application time was over one hour, serum myoglobin was sig- nificantly increased(p<0.01) during tourniquet(l05.92+/-21.84ng/ml) than at preoperation(91.16+/-31.17ng/ml) and in the after tourniquet release(183.88+/-40.96ng/ml), serum myoglobin was more significantly(p<0.05) increased than during tourniquet.
Anesthesia, General ; Extremities ; Female ; Humans ; Male ; Myoglobin* ; Orthopedics ; Plastics ; Tourniquets*

PURPOSE: Chronic prostatitis (CP) does not yet have a universally successful therapy. Alternative treatments including thermotherapy have been adopted in the multimodal management of pain and voiding dysfunction. We retrospectively analyzed the therapeutic efficacy of bipolar radiofrequency thermotherapy for patients who were unsatisfied with conventional medication for CP. MATERIALS AND METHODS: A retrospective study between October 2009 and September 2010 of 26 patients who were under 50 years old and diagnosed with CP (National Institutes of Health [NIH]-category III) was performed. Twenty patients were diagnosed with inflammatory CP (NIH-category IIIa) and the rest with noninflammatory CP (NIH-category IIIb). We used the Tempro system at an intraprostatic temperature of 55degrees C for 50 minutes with a medium heating rate. All patients also completed the NIH-Chronic Prostatitis Symptom Index (CPSI) before and after treatment. RESULTS: In the patients diagnosed with CP, the mean serum prostate-specific antigen (PSA) level was 0.9+/-0.3 ng/ml, the prostate volume was 27.1+/-5.5 g, and the average score for all 3 domains on the NIH-CPSI significantly decreased. The total scores decreased from 19.8+/-7.1 to 11.1+/-7.0, the pain domain decreased from 8.6+/-3.1 to 4.8+/-3.1, the voiding symptom domain decreased from 5.1+/-1.8 to 2.9+/-1.8, and the effect on the quality of life decreased from 6.1+/-2.2 to 3.4+/-2.2 (p<0.05). CONCLUSIONS: Bipolar radiofrequency thermotherapy for patients with CP intractable to conventional medication can provide significant improvement in the NIH-CPSI. Large, randomized controlled trials will also be required to confirm the efficacy of this therapy.
Academies and Institutes ; Heating ; Hot Temperature ; Humans ; Hyperthermia, Induced ; Prostate ; Prostate-Specific Antigen ; Prostatitis ; Quality of Life ; Retrospective Studies

BACKGROUND: Recent studies demonstrated that volatile anesthetics suppress the NO-cGMP system in the vascular system. It has been known that the hemodynamic changes produced by volatile anesthetics in septic patients are mediated by upregulation of iNOS leading to excessive release of NO. The mechanisms underlying suppression of the NO-cGMP system by anesthetics are still controversial. It has been elucidated that nitric oxide synthase (NOS) plays a major role in the regulatory function in the L-arginine-NO system. So we examined the effects of NOS inhibitor (L-NAME, aminoguanidine) and NO scavenger (hydroxocobalamin) on vascular smooth muscle contractile function in lipopolysaccharide (LPS)-treated rat aorta during halothane administration. METHODS: Aortic ring preparations were obtained from LPS-treated (1.5 mg/kg, ip, for 18 h) rats. We evaluated the effects of hydroxocobalamin, L-NAME and aminoguanidine on contractile responses to phenylephrine during halothane (1 & 2 MAC) administration respectively. Statistical significances (P<0.05) were analyzed according to data characterictics by repeated measures ANOVA test and student's t-test. RESULTS: The contractile responses to phenylephrine in LPS-treated rats aorta were significantly (P<0.05) increased in the presence of hydroxocobalamin and L-NAME. During the halothane (1 and 2 MAC) administration, the contractile responses to phenylephrine in LPS-treated rats aorta were increased significantly (P<0.05) in the presence of hydroxocobalamin and L-NAME. CONCLUSIONS: From these results, it is suggested that hydroxocobalamin and L-NAME may be useful in the therapy of septic shock.
Anesthetics ; Animals ; Aorta ; Halothane* ; Hemodynamics ; Humans ; Hydroxocobalamin* ; Muscle, Smooth, Vascular ; NG-Nitroarginine Methyl Ester* ; Nitric Oxide Synthase ; Phenylephrine ; Rats* ; Shock, Septic ; Up-Regulation

BACKGROUND: Endotoxins play important roles in the pathophysiologic alterations associated with sepsis so we examined the effects of volatile anesthetics on vascular smooth muscle contractile function in LPS-treated rat aorta. METHODS: Fifty male Sprague-Dawley rats(250~300 gm) were made septic by intraperitoneal injection of lipopolysaccharide(1.5 mg/kg). Cumulative doses of phenylephrine and norepinephrine(10 -8~10 -5M) were added to construct a contraction response curve. Two percent of volatile anesthetics, IBMX (3-isobutyl-1-methylxanthine, phosphodiesterase inhibitor) or L-NAME(Ng-nitro-L-arginine-methylester, Nitric oxide synthase inhibitor) was added and those contractile responses were observed respectively. We also measured nitric oxide synthase (NOS) activity of liver, lung and adrenal gland after 18 hours in the LPS-treated rats. Individual values between the control rats and LPS-treated rats were compared by unpaired t-test. A p-value less than 0.05 was considered statistically significant. RESULTS: Contractile response of 2% halothane to norepinephrine was significantly decreased both in the control rats and LPS-treated rats. The NOS inhibitor enhanced the contractile responses to phenylephrine and norephinephrine in the vessels from LPS-treated rats more significantly than those of control rats. CONCLUSIONS: These results suggest that LPS-treatment impairs vasopressor-induced contractility and doesn't alter the contractile responses during administration of volatile anesthetics.
1-Methyl-3-isobutylxanthine ; Adrenal Glands ; Anesthetics* ; Animals ; Aorta ; Endotoxins ; Halothane ; Humans ; Injections, Intraperitoneal ; Liver ; Lung ; Male ; Muscle, Smooth, Vascular ; Nitric Oxide ; Nitric Oxide Synthase ; Norepinephrine ; Phenylephrine ; Rats* ; Rats, Sprague-Dawley ; Sepsis