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

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

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

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

BACKGROUND: Propofol is used for sedation during local and regional anesthesia. In order to evaluate the depth of sedation the bispectral index (BIS) and observer's sedation scoring (OAA/S) are widely used. However, there are few studies focused on elderly surgical patients during propofol-induced sedation for regional anesthesia. The goal of this study was to examine the effect site concentration of propofol for conscious sedation using the bispectral index (BIS) and hemodynamic changes in elderly patients. METHODS: Sixteen patients aged 65 yrs or older presenting for elective surgery requiring regional anesthesia were studied. After performing spinal anesthesia, target plasma concentration of propofol was set at 2.5ng/ml. Effect site concentration was titrated by increasing and decreasing the target plasma concentration to maintain a BIS of 75 - 80. Effect site concentration, the OAA/S score, mean arterial pressure (MAP) and heart rate were measured for 1 hour every 5 minutes. Statistical analysis was performed using repeated measurement of ANOVA and correlation analysis. RESULTS: The mean effect site concentrations was 1.3 +/- 0.2ng/ml and OAA/S score was 2.8 +/- 0.5 when the BIS was maintained between 75 - 80. The correlation coefficient for the effect site concentration versus the BIS was r = - 0.79. The MAP significantly decreased with an effect site concentration of propofol 1.0 and 1.2ng/ml and the heart rate significantly decreased at 1.2ng/ml. MAP decreased significantly at the level of conscious sedation. CONCLUSIONS: The mean effect site concentration of propofol was 1.3 +/- 0.2ng/ml when the BIS was 75 - 80. There were significant correlation between the effect site concentration and BIS.
Aged* ; Anesthesia, Conduction ; Anesthesia, Spinal ; Arterial Pressure ; Conscious Sedation* ; Heart Rate ; Hemodynamics ; Humans ; Plasma ; Propofol*

Although cuffed tracheal tubes are available in various sizes(ranging from 5 to 11 mm I.D.), many anesthesiologists are apt to use a limited range of sizes in adult patients. In making a selection, we prefer the ease of insertion of a smaller tube and the better gas flow characteristics of a larger tube. However, when the tube in small perimeter of cuff or over-large cuffed tube is selected to seal the trachea, intracuff pressure exceeds tracheal capillary perfusion pressure and results in tracheal complication during prolonged general anesthesia with N2O-O2 mixture. This study was performed to determine the appropriate size of tubes for men(Group A, n=30) and women(Group B, n=30), using the large-volume, low-pressure cuffed tubes(Portex-Blue Line Tubes, U.K.) during prolonged general anesthesia with N2O-O2 mixture. They were subdivided into A-l(7.5 mm I.D.), A-2(8.0 mm I.D.), A-3(8.5 mm I.D.) in men and B-l(6.5 mm I.D.), B-2(7.0 mm I.D.), B-3(7.5 mm I.D.) in women. Each subgmup included 10 patients in number. They were compared in several factors; residual volume of each tube, sealing volume, sealing pressure and the intracuff pressure changes with time. The results were as follows 1) There were no significant differences in age, height, and weight among the subgroups in men and women respectively. 2) There were significant changes of intracuff pressure every 20 minutes in both groups and the changes of slope of pressure were significantly steep in 7.5 mm I.D. in men and 6.5 mm I.D. in women. 3) Although the values of sealing pressure of all groups were less than 22 mmHg, the intracuff pressure were increased and maintained over 22 mmHg after 100 minutes in 7.5 mm I.D. in men and 20 minutes in 6.5 mm I.D. in women. 4) The changes in volumes(delta V) after 2 hours among 6 subgroups were not statistically significant, but the changes in pressures(delta P) were higher in 7.5 mm I.D.in men and 6.5 mm I.D. in women. 5) According to Spearman's Correlation Coeffients, the smaller the residual volume of tube, the higher the sealing pressure to seal the trachea and the larger the pressure changes to volume changes. In conclusion, intracuff pressure of 7.5 mm I.D. in men and that of 6.5 mm 1.D. in women can easily exceed the tracheal capillary perfusion pressure during prolonged general anesthesia with N2O-O2 mixture and when considering the changes of intracuff pressure alone, it seems that 8.0, 8.5 mm I.D. in men and 7.0, 7.5 mm I.D. in women are preferable to seal the trachea.
Adult* ; Anesthesia, General* ; Capillaries ; Female ; Humans ; Male ; Perfusion ; Residual Volume ; Trachea

BACKGROUND: Induction of anesthesia with propofol is associated with decrease in blood pressure, but changes of heart rates are minimal. However the combination of two centrally acting vagotonic agents, propofol and fentanyl, decreased heart rates on induction, with concomitant decreases in arterial pressure. Thus we evaluated the effect of atropine on these hemodynamic changes. METHODS: Patients were randomly allocated to three group. Group 1 was given no atropine premedication. In group 2, premedication with 0.01 mg/kg of atropine was administered intramusculary about one hour before anesthetic induction. In group 3, pretreatment with 0.01 mg/kg of atropine was administered intravenously about 4 minutes before anesthetic induction. Anesthesia was induced with 1 microgram/kg of fentanyl, 2~2.5 mg/kg of propofol and 0.1 mg/kg of vecuronium and maintained with nitrous oxide, oxygen and enflurane. Heart rate and blood pressure were measured 1, 5 min before induction and 1, 2, 3, 5, 7, 9 min after induction. RESULTS: Heart rates are increased significantly(P<0.001) during the 3 minutes before induction in patients given atropine intravenously and remained significantly higher(P<0.05) during early maintenance of anesthesia than in patients receiving no premedication of atropine. The systolic and diastolic blood pressure weren't changed significantly between the three groups. CONCLUSIONS: Pretreatment of atropine intravenously before induction of anesthesia with propofol and fentanyl attenuates the decreasing the heart rates but does not affect the blood pressure before intubation.
Anesthesia* ; Anesthetics ; Arterial Pressure ; Atropine* ; Blood Pressure ; Enflurane ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Nitrous Oxide ; Oxygen ; Premedication ; Propofol ; Vecuronium Bromide

Background: During cardiac surgery, patients are at risk of intraoperative awareness. We evaluated the Bispectral Index (BIS) to prevent awareness during fentanyl-midazolam anesthesia for cardiac surgery. In addition, the relationship between BIS and hemodynamic responses during precardiopulmonary bypass period was assessed. Methods: Twenty-six patients aged 18-70 years undergoing cardiac surgery were studied. Anesthesia was induced with etomidate 0.3 mg/kg, fentanyl 5 microgram/kg and vecuronium 0.1 mg/kg. After a further bolus dose of fentanyl 200 microgram and midazolam 3 mg prior to the operation, maintenance infusion rates of fentanyl 1.5 microgram/ kg/h, midazolam 0.025 mg/kg/h and were continued throughout the surgery, with intermittent bolus doses depending on the hemodynamic responses. Isoflurane 0.5% was administered until the start of cardiopulmonary bypass. The BIS, mean arterial pressure and heart rate were recorded prior to anesthesia, induction, intubation, skin incision, sternotomy, aorta cannulation, 5 and 30 minutes after cooling, 5, 15, 30 and 45 minutes after rewarming, sternal closure and end of surgery. Patients were asked about intraoperative awareness on the second postoperative day. Results: The mean BIS decreased from 95 prior to anesthesia to 41 postinduction and then remained below 50 throughout the surgery. BIS did not correlate with mean arterial pressure (r = 0.08) or heart rate (r = 0.02) during precardiopulmonary bypass period. No patient reported the recall of an intraoperative event. Conclusions: Continuous infusion of fentanyl and midazolam with intermittent bolus doses during cardiac surgery maintain the BIS below 50 and are effective for preventing of intraoperative awareness. Hemodynamic responses are not related to BIS before the cardiopulmonary bypass.
Anesthesia* ; Aorta ; Arterial Pressure ; Cardiopulmonary Bypass ; Catheterization ; Etomidate ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Intraoperative Awareness ; Intubation ; Isoflurane ; Midazolam ; Rewarming ; Skin ; Sternotomy ; Thoracic Surgery ; Vecuronium Bromide

Backgrounds: It is estimated that 0.75-2% of parturients undergo surgical procedures unrelated to delivery. However, there are few reports on pregnant surgical patients in Korea. This study was undertaken to review the clinical information on patients who have received surgery during pregnancy. METHODS: Of the 11,772 deliveries during the 7-year period 1996-2002, 101 pregnant patients underwent nonobstetric surgery. The medical records and anesthesia records were reviwed for the following data: patient's age, trimester at operation performed, type of surgery and anesthesia, fetal monitoring, preterm labor, and for the delivery of pregnant women undergoing nonobstetrical surgery, except incompetent cervix. RESULTS: As many as 0.86% of pregnant women were found to have undergone surgery, the incidence of nonobstetric surgery, except incompetent cervix, was 0.43%. The 84.3% of patients underwent appendectomies. General anesthesia was administered to 68.6%, and regional anesthesia was administered to 31.4%. The ultrasonographies for fetal monitoring were performed in 96.1% of patients. Of the patients who received abdominal surgery during the second and third trimester, the incidence of preterm labor was 25.0%. There was no premature delivery. CONCLUSIONS: The incidence of nonobstetric surgery for reasons unrelated to pregnancy was 0.43%. Appendectomy was the most common surgical procedure. I recommend the use of uterine monitoring after abdominal surgery.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Appendectomy ; Female ; Fetal Monitoring ; Humans ; Incidence ; Korea ; Medical Records ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Third ; Pregnant Women ; Retrospective Studies* ; Uterine Cervical Incompetence ; Uterine Monitoring

Spinal reflex activity that remains after insult to the spinal cord brings with it significant functional impairment. Our patient had suffered from general spasticity and hyperreflexic neurogenic bladder caused by sixth cervical cord injury. Unfortunately, the use of oral medication (baclofen) was limited by an inadequate effect. So we performed two times of subarachnoid block with 0.5% heavy bupivacaine, the patient experienced improvement in bladder and sphincter function. We concluded that subarachnoid block with 0.5% heavy bupivacaine is an effective and safe modality for spasticity control in patients who are refractory to oral medication before neurolytic block.
Bupivacaine ; Humans ; Muscle Spasticity ; Reflex ; Spinal Cord ; Urinary Bladder ; Urinary Bladder, Neurogenic*