No abstract available.
Bone Plates* ; Spine*

BACKGROUND: Propofol is useful agents for anesthesia induction and maintenance, but pain on injection and possible hypotension are a commonly encountered problems during induction. Meanwhile, ketamine has potent analgesic and sympathomimetic effect. Therefore, we evaluated the effect of ketamine pretreatment on injection pain and hemodynamic changes during induction with propofol. METHODS: Premedicated one hundred and twenty ASA physical status I or II patients scheduled for elective surgery were randomly allocated into one of four groups (group 1; propofol only, group 2, 3, 4; pretreatment with 25%, 50%, 75% dose of hypnotic ED50 of ketamine, respectively) groups. Intensity and frequency of injection pain, mean arterial pressure and pulse rate were checked for evaluation of ketamine pretreatment on injection pain and hemodynamic changes during induction with propofol. RESULTS: Incidence of pain on injection was significantly reduced in group 2,3 and 4 compared with group 1. Group 2 and 3 showed more stable hemodynamic changes than Group 1 and 4. CONCLUSIONS: 25-50% of hypnotic ED50 of ketamine (0.17-0.33 mg/kg) pretreatment reduced pain on injection and hemodynamic changes during propofol induction significantly.
Anesthesia* ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Incidence ; Ketamine* ; Propofol* ; Sympathomimetics

BACKGROUND: Both propofol and ketamine are useful hypnotics for induction of anesthesia, and the combination of propofol and ketamine has been used for total intravenous anesthesia. The aim of this study was to evaluate the dose response of propofol, ketamine and combination of these drug, and determine possible interaction between two drugs in patients. METHODS: The effect of ketamine on the dose response curve for propofol was studied in unpremedicated 165 ASA physical status I or II patients who were scheduled for elective operation. As an endpoint of hypnosis, ability to open eyes on verbal command was checked. Dose response curves for propofol and ketamine were determined with a probit procedure and their type of pharmacologic interaction was determined by fractional and isobolographic analysis. RESULTS: At the hypnotic endpoint, the ED50s were 1.13 mg/kg propofol, 0.66 mg/kg ketamine, and the ED95s were 1.67 mg/kg propofol, 1.09 mg/kg ketamine. The type of interaction between two drugs for hypnosis was found to be additive and ketamine was 1.7 times potent than propofol as an equieffective dose of hypnosis. CONCLUSIONS: The type of interaction between propofol and ketamine for hypnosis was additive.
Anesthesia* ; Anesthesia, Intravenous ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Ketamine* ; Propofol*

BACKGROUND: Total intravenous anesthesia (TIVA) is by definition a technique involving the induction and maintenance of the anesthetic state with intravenous drugs alone. In particular, propofol and opioid and muscle relaxants allow enhanced control of the state of anesthesia for the entire duration of the surgical procedure. We evaluated the clinical usefulness of TIVA with fixed fentanyl concentration 3 ng/ml using isoconcentration nomogram and titrated propofol for coronary artery bypass graft. METHODS: Anesthesia was induced using 1% propofol mixed with lidocaine 0.5 mg/kg and ephedrine 10 mg (150 ml/hr) until loss of consciousness in 19 patients undergoing coronary artery bypass graft. Infusion rate of propofol was adjusted in response to blood pressure and pulse rate. To achieve constant fentanyl concentration, infusion rate of fentanyl was changed timely according to isoconcentration nomogram. Infusion of propofol and fentanyl was discontinued 15 and 30 min before predictable end of surgery, respectively. Intraoperative hemodynamics, recovery profile and postoperative analgesic requirements were checked. RESULTS: Overall intraoperative hemodynamics including cardiac index and PCWP showed no significant changes compared with preinduction control value except during CPB period. Average flow rate of propofol and fentanyl was 3.4 0.2 mg/kg/hr and 2.8 0.4 g/kg/hr, respectively. Spontaneous eye opening time was 96.4 min after discontinuation of fentanyl. More than 80% (16/19) of patients did not require any analgesic during first postoperative 24hrs for pain relief. CONCLUSIONS: TIVA with propofol and fentanyl (3 ng/ml) could be a suitable and safe anesthetic technique for coronary artery bypass graft.
Anesthesia ; Anesthesia, Intravenous* ; Blood Pressure ; Coronary Artery Bypass* ; Coronary Vessels* ; Ephedrine ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Lidocaine ; Nomograms ; Propofol ; Transplants ; Unconsciousness

BACKGROUND: Pretreatment or addition of lidocaine or ketamine have been reported to reduce pain on injection. However, the stability of propofol following the addition of lidocaine or ketamine is not yet known. Therefore, we checked compatibility and stability of propofol-lidocaine or propofol-ketamine mixtures. METHODS: After mixing 9 ml of 1% propofol and 0, 5, 10, 15, or 20 mg of 2% lidocaine or 10, 20 mg of ketamine, the samples (0.9 ml) were divided into 10 glass vials and stored at room temperature. Macroscopic and microscopic changes, and propofol concentrations were measured at 0, 1/4, 1/2, 1, 2, 3, 4, 5, 6, and 24 hours after mixing. Premedicated 100 ASA classification I or II patients scheduled for elective surgery were randomly allocated into one of three groups(Group 1: propofol only, Group 2: propofol + lidociane 20 mg, Group 3: propofol + ketamine 10 mg). Intensity and frequency of injection pain was checked during induction (150 ml/hr). Intensity of injection pain was evaluated with a pain score (1: no pain, 2: mild, 3: moderate 4: severe). RESULTS: Macroscopic and microscopic changes were only seen in propofol-lidocaine mixtures (more than 15 mg after 1 hour) in a time-dependent manner. In the mixtures with lidocaine 15 or 20 mg, the propofol concentration decreased linearly and significantly compared to the control (time 0) in a time-dependent manner from 1 hour to 24 hours. However, the propofol concentration was not changed in the propofol-ketamine mixtures. The pain score at 20 mg of lidocaine or 10 mg of ketamine were significantly lower than propofol only group and there was no difference in pain score between group 2 and group 3. CONCLUSIONS: Lidocaine (more than 15 mg), but not ketamine, added to 90 mg of propofol reduced the propofol concentration linearly in a time-dependent manner and showed microscopic changes from l hour after mixing. Therefore, this mixture seems to be inappropriate for long-standing storage and thus propofol-ketamine mixtures are more appropriate for this purpose.
Classification ; Glass ; Humans ; Ketamine ; Lidocaine ; Propofol*

BACKGROUND: Propofol is a widely used hypnotic, however hyperlipidemia is one of the disadvantages caused by its formulation. The aim of this study was to investigate the concentration of total cholesterol, high density lipoprotein (HDL-cholesterol) and triglycerides during general anesthesia with propofol using a target controlled infusion. METHODS: With Institutional Review Board approval and informed consent, thirty premedicated (atropine 0.5 mg, I.M) adult patients (ASA class I or II, 18 - 55 yrs) scheduled for elective surgery were studied. A TCI of propofol was started at a target concentration of 6.0ng/ml. After intubation with the aid of vecuronium (0.15 mg/kg), anesthesia was maintained with propofol in combination with 67% N2O and 33% O2. Blood was sampled from the median cubital vein for total cholesterol, HDL- cholesterol, and triglycerides at 0, 1, and 2 hours during anesthesia, the end of surgery, and 24, 48, and 72 hours after anesthesia. RESULTS: At 1 and 2 hours, and the end of surgery, triglyceride concentrations showed a significant increase compared to the control (P < 0.05), however it declined steeply to normal range during the next 24 hours. The total cholesterol and HDL-cholesterol concentrations were within a normal range throughout the study period. There was a correlation between triglyceride concentrations (peak triglyceride concentration-control triglyceride concentration) and amount of infused propofol (Spearman's r = 0.42, P < 0.05). CONCLUSIONS: Because the infusion of propofol during anesthesia results in a significant increase in triglyceride concentrations, we should consider checking the triglyceride concentrations intermittently in critically ill patients who receive propofol. However, propofol may be safe to healthy patient for general anesthesia.
Adult ; Anesthesia ; Anesthesia, General* ; Cholesterol ; Critical Illness ; Ethics Committees, Research ; Humans ; Hyperlipidemias ; Informed Consent ; Intubation ; Lipoproteins ; Propofol* ; Reference Values ; Triglycerides ; Vecuronium Bromide ; Veins

BACKGROUND: To estimate real time concentration of drugs during TIVA is theoretical, but it is not easy and inefficient. To maintain designed target concentration with continuous infusion using methods that account for the multicompartmental pharmacokinetic profile of fentanyl, isoconcentration nomogram is one of the methods. We evaluated the clinical usefulness of the isoconcentration nomogram using two different expected concentration of fentanyl. METHODS: Thirty ASA class I or II adult patients scheduled for spine fusion were randomly allocated into two groups according to 1.5 or 3 ng/ml of expected fentanyl concentration. Using isoconcentration nomogram, fentanyl concentration was adjusted and the propofol concentration was fixed to 3.5 g/ml according to Prys-Roberts method. Vital signs were titrated using variable flow rate of propofol. Fentanyl and propofol were discontinued 15 min before the end of operation. And, IV-PCA using fentanyl were applicated for postoperative pain control. The dosage of propofol and fentanyl, recovery time of consciousness and orientation were checked. Also, first buttoning time and 24hr fentanyl dosage in IV-PCA were checked. RESULTS: Average flow rate of propofol used were 7.5 1.2 mg/kg/hr in group 1, 5.7 1.1 mg/kg/hr in group 2 which was significantly lower than group 1 (p<0.05). Spontaneous eye opening and recovery of orientation was delayed 1.8 times in group 2. First buttoning time and 24hr fentanyl requirement for postoperative pain control using IV-PCA was delayed by 2 and decreased 60% in group 2, respectively. CONCLUSIONS: Isoconcentration nomogram was useful tool to control the expected concentration of fentanyl during TIVA and postoperative pain control using fentanyl IV-PCA.
Adult ; Anesthesia, Intravenous* ; Anesthetics ; Consciousness ; Fentanyl* ; Humans ; Nomograms* ; Pain, Postoperative ; Propofol ; Spine ; Vital Signs

BACKGROUND: Induction of anesthesia with propofol commonly associated with reduction in systemic arterial pressure, especially in elderly and high risk patients. This reduction is influenced by the dose and rate of propofol injection. The aim of this study was to examine the effect of different injection rate of propofol on vital signs, dose requirement and induction time during induction period. METHODS: Unpremedicated one hundred and twenty ASA physical status I and II patients aged 20~60 years scheduled for elective surgery were randomly allocated into one of four (150, 300, 600, 1200 ml/hr) groups according to speed of injection of propofol during induction period. Loss of verbal contact was taken as the end-point of induction. Vital signs, SpO2, dose requirement of propofol and induction time were checked. RESULTS: As the injection rate of propofol became slower, there were significant reduction in induction dose and increase in induction time (p<0.05). For example, induction dose and time were 1.82 mg/kg, 223 +/- 58 sec in 150 ml/hr group and 3.14 mg/kg, 50 +/- 11 sec in 1200 ml/hr group, respectively. Also, decrease in systolic and diastolic pressure were less marked at lower injection rates. CONCLUSIONS: Slower injection of propofol produces less vital sign changes and dose requirement for the induction of anesthesia.
Aged ; Anesthesia* ; Arterial Pressure ; Blood Pressure ; Humans ; Propofol* ; Vital Signs*

BACKGROUND: Etomidate is a rapid-acting sedative/hypnotic agent with little or no cardiovascular effect and a high therapeutic index. For this reason, etomidate has been used as an anesthetic induction and maintenance agent in patients with poor cardiovascular reserve. Bispectral index (BIS), a parameter derived from electroencephalography (EEG), has been proposed as a measure of anesthetic effect and is shown to correlate with increasing sedation and loss of consciousness. To establish its utility for this purpose, it is important to determine the correlation among BIS, measured drug concentration, and increasing levels of sedation. This study was designed to evaluate this relation for etomidate. METHODS: Eighteen adult patients scheduled for elective surgery, ASA physical status I or II, were included. Etomidate was administerd until loss of consciousness (loss of verbal contact) using syringe pump with a constant rate (150 ml/h) and patients were observed until regaining consciousness as decided by prompt verbal response on command of "open your eyes". A BIS was monitored, arterial blood samples were obtained for analysis of drug concentration, and the patients were evaluated for level of sedation by the responsiveness portion of the modified observer's assessment of alertness/sedation (OAA/S) scale. RESULTS: The BIS (r = 0.86) correlated significantly with the OAA/S more than the etomidate plasma concentration (r = 0.57). The BIS values, OAA/S, and blood concentrations were 50, 1.26, and 1337 ng/ml at induction and 75, 4.6, and 236 ng/ml at awakening, respectively. CONCLUSIONS: We concluded that the BIS accurately predicted level of sedation with etomidate during anesthesia induction, but the correlation between blood concentration and level of sedation was less strong.
Adult ; Anesthesia* ; Anesthetics ; Consciousness ; Electroencephalography ; Etomidate* ; Humans ; Plasma ; Syringes ; Unconsciousness

No abstract available.
Brain Ischemia* ; Glutamic Acid* ; Microdialysis ; Nitric Oxide Synthase* ; Nitric Oxide*