BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

BACKGROUND: Oculocardiac reflex (OCR) and postoperative nausea/vomiting are major complications of pediatric strabismus surgery. The aim of the study was to assess, in children undergoing strabismus surgery, the incidence of OCR and postoperative emesis with a inhalational and a intravenous technique. METHODS: 44 healthy children undergoing elective strabismus surgery as inpatients were randomly allocated to four anesthetic techniques: (1) induction with propofol, maintenance with propofol infusion and 50% N2O-O2 (propofol-N2O); (2) induction with propofol and fentanyl 1 microgram/kg bolus, maintenance with propofol infusion and 50% air-O2 (propofol-fentnyl-air); (3) induction with thiopental, maintenance with enflurane and 50% N2O-O2 (enflurane-N2O); (4) induction with thiopental and fentanyl 1 microgram/kg, maintenance with enflurane and 50% air-O2 (enflurane-fentanyl-air). RESULTS: The incidence of an OCR significantly increased in the propofol-fentanyl-air group as compared to the enflurane-N2O or enflurane-fentanyl-air groups. Times to extubation were shorter in the propofol- N2O group than in the propofol-fentanyl-air or enflurane-fentanyl-air groups. Alertness scores were lower in the propofol-N2O group than in the enflurane-N2O or enflurane-fentanyl-air groups. Postanesthetic recovery scores and nausea/vomiting during the 24 hr after the operation did not show any differences among the groups. CONCLUSIONS: We concluded that children undergoing strabismus surgery anesthetized with propofolfentanyl-air had more episodes of OCR, propofol-N2O had shorter times to extubation and higher alertness scores, and the addition of N2O or fentanyl to anesthetic regimen was not associated with nausea and vomiting.
Child ; Enflurane ; Fentanyl ; Humans ; Incidence ; Inpatients ; Nausea ; Postoperative Nausea and Vomiting ; Propofol ; Reflex, Oculocardiac* ; Strabismus* ; Thiopental ; Vomiting

BACKGROUND: It has been said that anesthesia and surgery tend to increse 'stress hormone' followed by reduction of GFR and urine flow. We have been noticed a polyuria during mastoidectomy with anesthesia. We hypothesized that a reduction of ADH secretion related to operative procedure might be a cause of a transient polyuria. METHODS: In 41 patients who were in ASA class I, mean arterial pressure (MAP), heart rates (HR), temperature, central venous pressure (CVP) were measured at before induction, just before drilling with irrigation, 30 minutes and 60 minutes after drilling with irrigation, and on arrival in recovery room by groups (room temperatured irrigating fluid and warm fluid were used in group 1 and group 2) during procedures. In 7 of 41, blood samples for antidiuretic hormone (ADH) and plasma osmolalities (Posm) were withdrawn at the same time points. In all patients, fluid were administered with 4 ml/kg/hour throughout the procedures. RESULTS: In group 1, mean urine volume were 5.0 and 6.4 ml/min during anesthesia and drilling with irrigation that was significantly more than in group 2 (3.6 and 4.2 ml/min). In 7 patients, ADH concentration was decreased during surgery compared to pre-induction level, while the Posm were in normal ranges. None of the MAP, HR and CVP showed significant changes. ADH concentrations were not significantly correlated to Posm. CONCLUSIONS: We suggest that a reduction of ADH secretion may have a major role in transient polyuria during mastoidectomy, which might be related to the mechanism that; 1) lowered temperature of hypothalamo-pituitary system by cold irrigating fluid may induce a transient ischemic changes of pituitary gland, 2) absorption of hypoosmolar irrigating fluid to central circulation may reduce central osmotic pressure.
Absorption ; Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Central Venous Pressure ; Heart Rate ; Humans ; Osmolar Concentration ; Osmotic Pressure ; Pituitary Gland ; Plasma* ; Polyuria ; Recovery Room ; Reference Values ; Surgical Procedures, Operative

BACKGROUND: We observed fentanyl known as centrally-acting antitussive agents provoke a cough response in some patients at induction of anesthesia. This may be of clinical importance. METHOD: 121 patients (ASA class I) were assigned randomly to 4 groups. Each group was given different doses of fentanyll Group 1 (n=30); 0.5ug/kg, Group 2 (n=30); 1ug/kg, Group 3 (n=33); 2ug/kg, Group 4 (n=28); 4 g/kgl, within 1 second through a peripheral venous cannula before induction of anesthesia. All patients were observed carefully in order to detect a cough response and any side effects. RESULT: The incidences of FCR (Fentanyl Cough Response) were 0% in Group 1, 10.0% in Group 2, 30.3% in Group 3, and 39.3% in Group 4. The ED50 of FCR was 4.25ug/kg. The mean onset-time from the end of fentanyl administration to the beginning of coughing was 12.5 seconds. FCR was decreased with aging, but not affected by weight, height, or smoking. Other serious side effects were not accompanied. CONCLUSION: Fentanyl can evoke the pulmonary chemoreflex dose-dependently and the ED50 was 4.25 g/kg.
Aging ; Anesthesia ; Antitussive Agents ; Catheters* ; Cough* ; Fentanyl* ; Humans ; Incidence ; Reflex* ; Smoke ; Smoking

BACKGROUND: Korean Journal of Anesthesiology was published in 1968 and its volume has been increased every year. The purpose of this study was to investigate and to clarify the trend of increasing volumes for 28 years (1968~1996) as quantitative analysis. METHODS: Using computerized index of Korean Journal of Anesthesiology (""ART""), the trend, volumes and cumulative records (top ranked 22 frequently cited key words, 16 persons and 10 departments of University) were calculated. Some key words such as ""Anesthetic techniques: spinal, Anesthetics, intravenous:, Anesthetics, volatile: halothane, Complications:"" was traced every year for grasping the trend of academic concerns. RESULTS: 1. Total volumes of articles were about 3,000 (1968~1996). The volumes were increased slowly until 1976 and steeply since 1986. 2. The ratio of clinical case reports has been decreased every year. 3. Key words ""Anesthetic techniques"", ""Surgery"" and ""Complications"" were more frequently cited than the others. 4. Tracing some key words showed their vitality in anesthetic fields. 5. The personal top ranked number of records revealed each author's contribution to Korean Journal of Anesthesiology and the number of records in each department of University could be used as an index of academic activity. CONCLUSIONS: The extent of the increasing volumes was great especially from 1986 to 1996 and the proportion of original articles has been increased every year. The frequency of the investigated key words showed their own vitality in the field of anesthesiology. The rank according to personal and departmental records suggested the possibility of reflecting a measure of academic concerns and activity.
Anesthesiology* ; Anesthetics ; Anesthetics, Intravenous ; Halothane ; Hand Strength ; Humans

Nausea and vomiting are common problems after strabismus surgery in pediatric patients. We compared the effect of propofol with N2O with the effect of a conventional regimen consisting of halothane - N2O on the occurrence of oculocardiac reflex(OCR), recovery characteristics and the incidence of postoperative emesis after strabismus surgery in 46 ASA physical status I children. After intravenous injection of atropine(0.02 mg/kg), patients were randomly assigned to one of two groups. Group l(conrol) received thiopental, vecuronium, halothane and N2O; Group 2(study), propofol 2 mg/kg and vecuronium bolus followed by infusion of propofol 160 mg/kg/min. Patients in group 2 had more episodes of OCR response than group 1, but had shorter time to recovery from anesthesia(p<0;05). But there was no significant difference in the incidence of postoperative nausea and vomiting between two groups. We conclude that the sufficient doses of propofol only regimen and atropine preadministration(0.02 mg/kg) will be necessary in the strabismus surgery of children for the purposes of the prevention of intraoperative OCR, rapid recovery from anesthesia and reduction of postoperative emesis.
Anesthesia ; Atropine ; Child ; Halothane ; Humans ; Incidence ; Injections, Intravenous ; Nausea ; Postoperative Nausea and Vomiting* ; Propofol* ; Reflex, Oculocardiac ; Strabismus* ; Thiopental ; Vecuronium Bromide ; Vomiting

Single dose glass ampules have been developed for ease of administration, accuracy of measurement of dosage, sterility and use in prepackaged kits. Glass particle contamination of the contents of single dose glass ampules can occur upon opening. In our study, we determined whether different ampule size, different aspiration techniques or different methods of ampule opening had any effect on glass particle contamination. Different ampule sizes (1, 2, 20 ml), different aspiration techniques (19G, 22G needle) and different methods of ampule opening (one point ampule, cutting with circular etching, cutting with one plane etching) were evaluated. There was no signifcant difference in the number of particles aspirated by any given aspiration technique, ampule size and method of ampule opening. But intravenous glass particle administration is associated with patholagic responses, so the use of a filter needle, and in-line filter devices and a low pressure infusion system is advised.
Glass* ; Infertility ; Needles

Nausea and vomiting are common problems after strabismus surgery in pediatric patients. We compared the effects of droperidol and ephedrine with conventional regimen consisting of halothane-N2O to the effects of conventional regimen itself, 69 children. ASA physical status l, ages 1-12yrs, were studied. Each child was randomly assigned to receive droperidol 0.04mg/kg., ephedrine 0.5mg/kg or normal saline 2ml intramuscularly, 10 minutes before the end of surgery. The incidence of postanesthetic nausea and vomiting was 17% in the droperidol group(p<0.05)., 13% in the ephedrine group(p<0.05), which were significantly less than the control group(43%). But there was no significant difference between droperidol group and ephedrine group. We concluded that droperidol and ephedrine have significant postoperative antiemetic effect in patients undergoing strabismus surgery.
Antiemetics ; Child* ; Droperidol ; Ephedrine ; Humans ; Incidence ; Nausea ; Postoperative Nausea and Vomiting* ; Strabismus* ; Vomiting

Propofol(2, 6-diisopropylphenol) represents a new class of intravenous anesthetic agent, being chemically unrelated to barbiturate, steroid or eugenol agents. It has been reported as a suitable induction agent for short procedures and day case surgery due to its property of rapid induction and recovery from anesthesia. Induction of anesthesia with propofol 2.0~2.5mg/kg frequently causes decreasing blood pressure and causes apnea that may last 60s or more. And it is well recognized that propofol may causes pain on injection when administered intravelnously. In the present study, we evaluated the hemodynamic and SpO2 changes after propofol injection and the dos-responses to the loss of verbal command response, eyelid reflex and trapezius reflex in premedicated patients. Also we assessed the degree of pain on injection .Patients were divided into five groups with the doses the degree of pain on injection. Patients were divided into five groups with the doses of 1.0, 1.2, 1.5, 2.0 and 2.5mg/kg(group1,2,3,4 and 5, respectively). The systolic, diastolic blood pressure, heart rate and SpO2 were measured after 60 seconds propofol injection in all the patients. And response, to verbal command, eyelid and trapezius reflex and pain complaint were checked. The systolic and diastolic blood pressure were mostly decreased(17.34 and 21.92%) in group5(propofol 2.5mg/kg)(p<0.05). Heart rate increased 10% in group 4 and 5(p<0.05). There was a dose-dependent decreasing tendency of blood pressure and increasing tendency of heart rates. SpO2 was also more reduced in group 4 and 5 (p<0.05). The overall incidence of pain on injection was 47% of the injection sites, the incidence of pain was highest on the dorsum of hand(23%). Also, the degree of pain on injection was wevere on the dorsum of hand. The value of ED50 and ED95 for loss of verbal command response, eyelid reflex and trapezius reflex were 0.81, 1.35, 2.02, 1.91 and 3.60mg/kg. We concluded that the ED95 for loss of eyelid reflex is 2.02mg/kg and it is a sufficient dosage to induction of anesthesia in premedicated patients with little significant hemodynamic changes.
Anesthesia* ; Apnea ; Blood Pressure ; Eugenol ; Eyelids ; Hand ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Propofol* ; Reflex ; Superficial Back Muscles

The purpose of this study was undertaken to test if alteration of calcium flux across the sarcolemma or sarcoplasmic reticulum change subsequent relaxation of rat aorta in tissue model of ischemia. Thoracic aorta ring segments(2-3mm wide) were studied with solution that mimicked real ischemia condition(hypoxia, acidosis, elevated lactate levels and zero sub strate). During ischemic condition, the effect of treatments thought to decrease cytosolic cal cium were tested. Half time(t(1/2)) and degree of stabilized relaxation were 2.4+/-0.9 minutes and 17.6+/-12.1%(NE 10-7 M precontraction as 100%) for verapamil(10-6 M), 3.3+/-0.7 min- utes, 22.2+/-3.9% for low Ca2+(0.75mM) in ischemic solution. Interventions aimed to elevat- ing cytosolic calcium were also tested. 3.8+/-0.9 minutes and 68.6+/-8.1% for high (10.0 mM) Ca2+ in ischemic solution, 3.7+/-0.7 minutes, 72.8+/-3.9/. for ryanodine(3X10-9 M). 3.8+/-0.5 minutes, 53.4+/-2.6% for isoproterenol. Without any treatment or agents during ischemia, hlaf time and degree of relaxation were 4.0+/-1.7 minutes, 74.6+/-13.2%, enothelium and time independent. These data support that treatment or agent thought to reduce influx of cytosolic calcium levels exaggerated the severity of relaxation. The mechanism of relaxation in ischsmia is not completely clear, but it is suggested that a reduction of calcium influx may involved and directly related.
Acidosis ; Animals ; Anoxia ; Aorta ; Aorta, Thoracic ; Calcium ; Cytosol ; Ischemia* ; Isoproterenol ; Lactic Acid ; Rats* ; Relaxation* ; Sarcolemma ; Sarcoplasmic Reticulum