The effects of fentanyl anesthesia on the changes of hemodynamic(HR, BP), blood suger, electrolytes and ABGA during induction of anesthesia and cardiopumonary bypass under fentanyl anesthesia were studied in three groups of 30 patients. The results were as follows: 1) The changes of HR & BP were significatly decreased under fentanyl anesthesia compaired to morphine anesthesia. 2) The level of blood sugar was increased during whole procedures in all groups and it was the least in large dose fentanyl group. 3) The changes of electrolyte and arterial blood gas value during CPB were not remakable.
Anesthesia* ; Blood Glucose* ; Electrolytes ; Fentanyl* ; Humans ; Morphine

BACKGROUND: Tracheal intubation can cause sympathetic stimulation such as hypertension and tachycardia. Many drug are used for reducing the incidence of hypertension and tachycardia induced by intubation. Among these drugs, fentanyl can be used with good result. The purpose of this study was to find the appropriate fentanyl injection time before intubation when a small dose (3 microgram/kg) was used. METHODS: We studied 82 ASA class 1 2 patients, scheduled for gynecological elective surgery, randomized into 5 groups. Group 1 received no fentanyl before intubation, and groups 2, 3, 4 and 5 received 3 microgram/kg fentanyl at 7 min, 5 min, 3 min and 1 min before intubation, respectively. The blood pressure and heart rate were checked at preinduction and post-intubation periods for 5 minutes. RESULTS: The increase of the heart rate was significantly lower in groups 2 and 3 than in group 5 just after intubation. Furthermore the increase of the mean blood pressure was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. The incidence of tachycardia and hypertension was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. CONCLUSIONS: When a small dose of fentanyl was used to blunt the intubation induced sympathetic stimulation, the appropriate time was prior to 3 minutes before intubation.
Blood Pressure ; Fentanyl* ; Heart Rate ; Humans ; Hypertension* ; Incidence* ; Intubation* ; Tachycardia*

BACKGROUND: Midazolam is often used as an anxiolytic premedication before surgery, but it is difficult and complex to assess its effect. This study evaluated the bispectral index as an objective indicator of midazolam premedication and the relation of cardiovascular response to anesthetic induction. METHODS: Forty patients (aged 20 to 60 and in ASA class I or II) to undergo simple elective surgery under general anesthesia entered the study. The patients were divided into the midazolam group (n = 20) that received midazolam (0.08 mg/kg IM) and glycopyrrolate (0.2 mg IM) premedication, and the control group (n = 20) that received glycopyrrolate (0.2 mg IM) only. Then, anesthetic induction (fentanyl 1 microgram/kg, propofol 2 mg/kg, succinylcholine 1 mg/kg) was done. The bispectral index of the electroencephalogram, blood pressure, and heart rate were measured under unanesthetized conditions, after fentanyl, propofol injection, and intubation. RESULTS: The bispectral index was significantly lower in the midazolam group as compared with the control group before anesthetic induction, after fentanyl injection, and intubation. Blood pressure was not significantly different in the two groups. Heart rate was significantly lower in the midazolam group compared with the control group before anesthetic induction and after fentanyl injection. CONCLUSIONS: Midazolam-premedicated patients appear to maintain stable hemodynamics during anesthetic induction and intubation. The bispectral index can be objectively used in midazolam-premedicated patients when evaluating the degree of sedation. (Korean J Anesthesiol 2000; 38: 947~953)
Anesthesia, General ; Blood Pressure ; Electroencephalography ; Fentanyl ; Glycopyrrolate ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam* ; Premedication* ; Propofol ; Succinylcholine

BACKGROUND: Remifentanil is a new member of fentanyl family and a short-acting, esterase-metabolized opioid.This study compared the perioperative characteristics of a remifentanil infusion with those of fentanyl bolus administration as an adjuvant to propofol infusion for the anesthetic management of patients undergoing ureteroscopic lithotripsy. METHODS: Eighty patients were randomly assigned to receive either remifentanil target controlled infusion (R group, effect-site concentration of 4.0 ng/ml for induction followed by 2.0 ng/ml) or fentanyl bolus (F group, 2.0microgram/kg before induction).All patients received propofol infusion as the part of the induction and maintenance.We investigated recovery profiles, adverse events and the ease of insertion of laryngeal mask airway (LMA) between the two groups.Heart rate (HR) and mean blood pressure (MBP) were also compared at baseline (T0), loss of consciousness (T1), insertion of LMA (T2), beginning and end of operation (T3, T4) and removal of LMA (T5). RESULTS: The time from the end of anesthesia to spontaneous respiration, eye opening and LMA removal were significantly shorter for patients receiving remifentanil than for those receiving fentanyl.HR at T3 and T4 were lower in the R group than in the F group.Aldrete recovery score, time to discharge from recovery ward, the ease of insertion of the LMA, MAP and adverse events did not differ significantly between the two groups. CONCLUSIONS: Target controlled infusion of remifentanil combined with propofol can significantly shorten the early recovery time than fentanyl bolus administration without increasing adverse events in patients undergoing ureteroscopic lithotripsy.
Anesthesia ; Blood Pressure ; Eye ; Fentanyl ; Humans ; Laryngeal Masks ; Lithotripsy ; Piperidines ; Propofol ; Respiration ; Unconsciousness

BACKGROUND: To test whether smokers have exaggerated hemodynamic responses to induction and intubation, we investigated the changes in blood pressure (BP) and heart rate (HR) on induction and intubation in smokers and nonsmokers. METHODS: Healthy male patients (25 smokers and 25 nonsmokers, aged 20 to 29 yrs) for elective surgery were studied. Anesthesia was induced with thiopental 3 mg/kg, fentanyl 1.5 microgram/kg, vecuronium 0.1 mg/kg and maintained with enflurane 1 % in N2O and O2 for the period of observation. After three minutes, orotracheal intubation was performed. Noninvasive BP and HR were recorded one minute before induction (baseline), immediately before intubation, and then every minute until five minutes after intubation. RESULTS: Systolic BP of smokers decreased significantly immediately before intubation, and at 4 and 5 min after intubation as compared to that of nonsmokers (Mean +/- SEM, 120.8 +/- 3.0 vs. 109.9 +/- 2.8, 116.7 +/- 2.4 vs. 108.9 +/- 2.3, and 114.8 +/- 2.2 vs. 106.7 +/- 2.3 mmHg, respectively, P < 0.05). Diastolic BP of smokers decreased only immediately before intubation compared with that of nonsmokers (Mean +/- SEM, nonsmoker 64.6 +/- 2.4 vs. smoker 58.6 +/- 1.8 mmHg, P < 0.05). However, there was no significant difference of HR between smokers and nonsmokers during the observational period. CONCLUSIONS: Hemodynamic response is different in smokers compared with nonsmokers. Our results indicate that smoking affects the hemodynamic response to induction and intubation.
Anesthesia ; Blood Pressure ; Enflurane ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Male ; Smoke ; Smoking ; Thiopental ; Vecuronium Bromide

BACKGROUND: Tracheal intubation is accompanied by varing degrees of sympathetic stimulation as reflected by increases in heart rate, and blood pressure and several clinical trials to reduce the effects on blood pressure and heart rate by pharmacologic agents such as and blockers, calcicum channel blockers, narcotics and lidocaine, have been reported. METHODS: To evaluate the effect of fentanyl, lidocaine, esmolol on the hemodynamic changes induced by intubation, we administered thiopental 5 mg/kg only (group 1, n=12), fentanyl 2 g/kg with thiopental 5 mg/kg (group 2, n=12), lidocaine 1 mg/kg with thiopental 5 mg/kg group 3, n=12) or esmolol 0.5 mg/kg with thiopental 5 mg/kg (group 4, n=12) for induction of anesthesia, and measured heart rate, systolic blood pressure, diastolic blood pressure, mean arteiral pressure, and rate-pressure products (RPP) before induction, after induction, after intubation and at 1, 2, 3, and 5 minutes after intubation. RESULTS: There was a significant increase in heart rate, systolic blood pressure and RPP after intubation and 1 min after intubation in all groups, but in group 2, group 3 and group 4, the cardiovascular responses were more attenuated compared to group 1. CONCLUSION: The preintubation intravenous injection of fentanyl, lidocaine and esmolol may offer important roles in the hemodynamically unstable patients because it attenuate cardiovascular responses with intubation.
Anesthesia ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Injections, Intravenous ; Intubation ; Lidocaine* ; Narcotics ; Thiopental

BACKGROUND: The spinal opioid is one of the excellent analgesic methods for acute postoperative pain and intractable terminal cancer pain, but some side effects limit its use. Many studies had been continued to decrease the frequency and severity of these side effects and to reinforce the analgesic potency of spinal opioid by administering of other drugs. METHODS: Ninety healthy patients who received perianal surgery were divided into 3 groups randomly and we observed VAS, sedation score, blood pressure, pulse rates and SpO2 after epidural clonidine (Group 1), fentanyl (Group 2) and combination of two drugs (Group 3) were injected. The ED50 of epidural clonidine and fentanyl were evaluated from VAS of Group 1 and 2 using the linear regression on log dose versus %MPE(Percent Maximal Possible Effect). We injected epidurally 1/4, 1/2, full dosage of ED50 to Group 3 patients and isobologram was constructed for evaluating the interaction of two drugs. RESULTS: The ED50 and 95% confidence limit of clonidine were 119 mcg, 78~161 mcg and those of fentanyl were 105 mcg, 68~204 mcg. At the ED95 level, the isobologram is nearly straight, suggesting additive interaction. At the lower level, the isobologram was bent toward the origin, a sign of synergy, the interaction below the ED80 was synergistic. CONCLUSION: At the large dose(ED95) to achieve nearly complete pain relief, epidural fentanyl and clonidine showed additive interaction and the other hand, at the smaller dose(below the ED80)which relieves most pain but not all pain, they showed synergistic interaction.
Analgesics ; Blood Pressure ; Clonidine* ; Fentanyl* ; Hand ; Heart Rate ; Humans ; Linear Models ; Pain, Postoperative

BACKGROUND: Arthroscopic shoulder surgery has been performed in the sitting position under interscalene block (ISB). Bradycardia hypotension (BH) episodes have a reported incidence of 13-29% in this setting. We performed a retrospective study to investigate contributing factors to the occurrence of BH episodes. METHODS: According to BH episodes, we divided 63 patients into two groups: BH group (n = 13) and non-BH group (n = 50). Anesthetic records and block data sheets were reviewed for demographic data, intraoperative medications, sites of ISB, use of epinephrine in local anesthetics, degree of sensory blockade, and percent change of heart rate or systolic blood pressure (SBP). Statistical analysis was done using Chi square test and Student's t-test. RESULTS: There were no significant differences in the use of epinephrine in local anesthetics between the two groups. The location of ISB site was different between the two groups in that there were relatively more right-sided ISBs in the BH group than in the non-BH group (P = 0.048). The degree of sensory blockade was lower, but not significantly, in the C8 and T1 dermatomes of the BH group than in the non-BH group (P = 0.060 and 0.077, respectively). There was a relatively higher incidence of fentanyl supplementation in the BH group than in the non-BH group (P = 0.000). CONCLUSIONS: These results suggest that right ISB and perioperative supplementation of fentanyl due to incomplete block are possible contributing factors to the occurrence of BH episodes in the sitting position during shoulder surgery using ISB.
Anesthetics, Local ; Arthroscopy ; Blood Pressure ; Bradycardia ; Epinephrine ; Fentanyl ; Heart Rate ; Humans ; Hypotension ; Incidence ; Retrospective Studies ; Shoulder

BACKGROUND: The various methods have been used to prevent or minimize the increase of blood pressure and heart rate to endotracheal intubation. Opioids are the most widely used drug for hemodynamic stability. The purpose of this study was to compare the effects of fentanyl with those of alfentanil on hemodynamic changes to induction of anesthesia and endotracheal intubation. METHODS: Forty five patients were divided into three groups. They received intravenous fentanyl 1.0 microgram/kg, alfentanil 5 microgram/kg or saline 10 ml (control group), respectively. Baseline mean arterial blood pressure and heart rate were measured before the induction of anesthesia. Tracheal intubation was done 3 min after the injection of muscle relaxant. Mean arterial blood pressure and heart rate were measured every minute for 3 min after the induction of anesthesia and tracheal intubation and the results were compared with baseline value. RESULTS: Mean arterial blood pressure decreased significantly compared with baseline value after the induction of anesthesia, but there were no significant differences among the three groups. Heart rate initially increased and then decreased. After tracheal intubation, mean blood pressure and heart rate increased significantly in all groups. The extent of this was significantly lower in the alfentanil group and slightly lower in the fentanyl group than in the control group. CONCLUSIONS: Alfentanil is more effective than fentanyl at inhibiting cardiovascular responses following intubation, but further studies are needed to define the optimal injection time and drug dosage.
Alfentanil* ; Analgesics, Opioid ; Anesthesia* ; Arterial Pressure ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal*

Induction of general anesthesia with tracheal intubation is routine procedure but causes significant tarchycardia and hypertension. Many approaches have been tried to attenuate these circulatory response. The effects of small dose fentanyl on arterial pressure and heart rate increase during intubation were studied in 40 normotensive patients, who were randomly allocated to two groups, receiving saline (Control group) or fentanyl 2ug/kg (Fentanyl group), in a double blind fashion during anesthetic induction with thiopental 5mg/kg. Systolic, diastolic, mean arterial pressure and heart rate were measured and rate pressure product was calculated. All parameters were significantly different between two groups (p<0,05) and control group was significant increase in blood pressure and heart rate compared with pre-induction value but fentanyl group was relatively small changes of blood pressure and heart rate (p<0.01). After tracheal intubation, incresed blood pressure was returned to pre-induction value within two to three minutes in fentanyl group but heart rate was not returned pre-induction value within 5 minutes. Dose of fentanyl that are low enough to cause any side effects of drug itself, no notable side effects were observed during study and recovery.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Fentanyl* ; Heart Rate ; Humans ; Hypertension ; Intubation* ; Thiopental