No abstract available.
Aneurysm, Infected* ; Endocarditis* ; Mesenteric Artery, Superior*

The continuous perineural, perivascular compartment surrounding the brachial plexus from the tip of the cervical transverse process to the axilla may be entered at virtually any level, and the extent of anesthesia depends upon the level of entry and volume of local anesthetics injected. Various approaches of brachial plexus block were introduced to produce a successful block with the least complications. In this study, 25 ml of 0.5% bupivacaine hydrochloride solution was injected by subclavian perivasular approach to illustrate the effect of various locations of paresthesia on the distribution of analgesia in 50 patients who had an operation of the hand or forearm. The location of paresthesia evoked by insertion of a 23-gauge scalp needle during performance of brachial plexus block was checked at the distribution of the superior, middle, and inferior trunks. A pin prick test was performed at 15 min, 30 min and 45 min after injection of bupivacaine hydrochloride to evaluate the distribution of analgesia in the superior, middle and inferior trunk of the brachial plexus. The incidence of analgesia in all three trunks was the highest when paresthesia of the middle trunk distribution was elicited. The incidence of analgesia in the superior trunk distribution was significantly lower when inferior trunk paresthesia was elicited than when superior trunk paresthesia was elicited. Superior trunk paresthesia was the most frequently elicited. Complications were arterial puncture (32%), Horner's syndrome (8%) and hematoma (2%). The results indicates that brachial plexus block by supraclavicular subclavian perivascular approach is a relatively safe technique. Injection of local anesthetics following the confirmation of middle trunk paresthesia is desirable to obtain the successful block. Especially when analgesia of superior trunk distribution is required, the direction of needle insertion should be adjusted to avoid the inferior trunk paresthesia elicited.
Analgesia ; Anesthesia ; Anesthetics, Local ; Axilla ; Brachial Plexus* ; Bupivacaine ; Forearm ; Hand ; Hematoma ; Horner Syndrome ; Humans ; Incidence ; Needles ; Paresthesia ; Punctures ; Scalp

BACKGROUND: Anesthetic technique for laryngeal microscopic surgery should be focused on rapid recovery of deep anesthesia and full muscle relaxation. This study was taken to evaluate the effect of continuous infusion of propofol and succinylcholine for this kind of anesthetic goal. METHODS: Forty patients scheduled for laryngeal microscopic surgery of short duration(15 min) were randomly allocated into two groups. Anesthesia was induced and maintained with either propofol(2.5 mg/kg followed by a continuous infusion of 0.1 mg/kg/min) in group P or with thiopental (5.0 mg/kg) and inhalation of 1~2 vol % enflurane for maintenance of anesthesia in group T/E. Succinylcholine(1 mg/kg followed by continuous infusion of 0.1 mg/kg/min) was administered to facilitate tracheal intubation and maintain neuromuscular blockade. RESULTS: No significant difference of duration of anesthesia appeared between two groups. Additional doses of succinylcholine were needed in 10% of group P and 30% of group T/E (p<0.05). In group P, time to response to suction catheter(136+/-54 vs 232+/-116 sec), time to eye open spontaneously or to verbal commands (368+/-142 vs 549+/-165 sec) and time to extubation (454+/-117 vs 647+/-181 sec) were significantly shorter comparing to group T/E. The quality of awakening was more favorable in group P(p<0.05). Laryngeal suspension induced bradycardia in 15% of group P and in 5% of group T/E. Both group P and group T/E (10% vs 30%) needed esmolol infusion to control the blood pressure during surgical procedure. CONCLUSIONS: Rapid recovery of anesthesia and muscle relaxation can be expected after continuous infusion of propofol(2.5 mg/kg followed by 0.1mg/kg/min) and succinylcholine(1 mg/kg followed by 0.1 mg/kg/min) supplemented with 50% N2O in 50% O2 for short duration of laryngeal microscopic surgery.
Anesthesia ; Anesthetics ; Blood Pressure ; Bradycardia ; Enflurane ; Humans ; Infusions, Intravenous* ; Inhalation ; Intubation ; Muscle Relaxation ; Neuromuscular Blockade ; Nitrous Oxide* ; Propofol* ; Succinylcholine* ; Suction ; Thiopental

The recording of middle cerebral artery (MCA) flow veloeity by transcrsnisl Doppler technique offers s new, noninvasive, and continuous technique for studies of cerebral circu lation. The influence of changes in PaCO2 on MCA flow velocity were observed during hypothermic cardiopulmonary bypass(CPB) surgery by means of transcranial Doppler tech- niques. In ten patients who were undergoing hypothermic CPB surgery, the right MCA flow velocity was measured before initiation of CPB(prebypass period) and after the termination of CPB (postbypass period). During steady state CPB(constant hematocrit, constant temperature, and constant total pump flow), baseline MCA flow velocity(CPB I period) was measured and then repeated after specific alteration of PaCO2 achieved by changing of fresh gas flow to oxygenetors(CPB II period). And carbon dioxide reactivity defined as percent change of MCA flow velocity per mmHg changes in PaCO2 was observed during stable hypothermic CPB. MCA flow veocity showed no statistical difference between the prebypass value(56.9+/-13.5 cm/sec) and the postbypass value(64.7+/-29.7 cm/sec). PaCO2 of 20.5+/-2.5 mmHg was associated with MCA flow velocity of 25.2+/-10.1 cm/sec in the CPB I period while PaCO2 of 27.1+/-3.5 mmHg was associated with MCA flow velocity of 35.3+/-12.9 cm/sec. MCA flow velocity carbon dioxide reactivity during steady state hypothermie CPB was 6.68+/-2.26 %/ mmHg. These results have demonstrated that the response of MCA flow velocity to changes in PaO2 was well maintained during hypothermic CPB and the use of transcrsnial Doppler would give valuable results in the study of cerebral circulation during hypothermic CPB.
Blood Flow Velocity* ; Carbon Dioxide* ; Carbon* ; Cardiopulmonary Bypass* ; Hematocrit ; Humans ; Middle Cerebral Artery

We studied the effect of stellate ganglion block on the mean blood flow velocity and carbon diaxide reactivity of the middle cerehral artery in nine healthy volunteers. Mean blood flow velocity of the right middle cerebral artery was measured under normocapnia and carbon dioxide reactivity to end-tidal PCO2 of 30 mmHg, 40 mmHg, and 50 mmHg was assessed before and after right stellate ganglion block. End-tidal PCO2 was controlled by hyperventilation and rebthing technique. Mean blood flow velocity was measured using transcranial Doppler sonography, and carbon dioxide reactivity was expressed as the percentage change in mean blood flow velocity per unit change in end-tidal PCO2. There was no difference in mean blood flow velocity under normocapnia (37.7+/-1.1 mmHg) between the values measured before stellate ganglion block (60.3+/-4.9 cm/sec) and the values measured after stellate ganglion block (58.6+/-4.9 cm). Mean blood flow velocity increased as end-tidal PCO2 increased from 30 mmHg to 40 mmHg, and from 40 mmHg to 50 mmHg (p<0.01) both before and after stellate ganglion block. Carbon dioxide reactivity of mean blood flow velocity did not change after stellate ganglion block. Heart rate decreased from 77.1+/-3.5 beats/min to 70+/-2.5 beats/min when end-tidal PCO2 was controlled from 30 mmHg to 40 mmHg after stellate ganglion block (p<0.05). Mean arterial blood pressure did not change after stellate ganglion block at any end-tidal PCO2 level. These results suggest that stellate ganglion block does not induce the change of mean blood flow velocity and carbon dioxide reactivity of the middle cerebral artery.
Arterial Pressure ; Arteries ; Blood Flow Velocity* ; Carbon Dioxide* ; Carbon* ; Healthy Volunteers ; Heart Rate ; Hyperventilation ; Middle Cerebral Artery* ; Stellate Ganglion* ; Ultrasonography, Doppler, Transcranial

PURPOSE: To study the unaffected fellow eye in patients with normal tension glaucoma and unilateral visual field defect in conventional white-on-white automated perimetry, using scanning laser polarimetry and frequency-doubling perimetry. METHODS: Thirty patients with a unilateral glaucomatous visual field defect detected on conventional perimetry (Humphrey field analyzer) were selected. The contralateral eyes with normal conventional perimetry results were studied using scanning laser polarimetry and frequency-doubling perimetry. Twenty eyes of 20 age- (+/-5 years), sex-, refractive error- (+/-2 D) matched persons without glaucoma were selected as a control group. RESULTS: Of the 30 contralateral eyes, 18 eyes (60%) showed a defect of the nerve fiber layer when evaluated with SLP. In the control group, 2 eyes (8.3%) showed a defect of the nerve fiber layer. Of the 20 contralateral eyes, 14 eyes showed abnormal FDP results. In the 17 control group, 2 eyes (2%) showed abnormal FDP results. CONCLUSIONS: These findings suggest that what appeared to be unilateral visual field defects by conventional white-on-white automated perimetry may in fact underestimate structural as well as functional glaucomatous damage in the contralateral eyes. These results may be important for early detection of glaucoma and future treatment.
Glaucoma ; Humans ; Low Tension Glaucoma* ; Nerve Fibers ; Scanning Laser Polarimetry ; Visual Field Tests ; Visual Fields*

Pseudocholinesterase is known to be involved in the metabolism of succinylcholine, mivacurium, procaine, chloroprocaine, tetracaine, cocaine, heroin, and other drugs, although the physiologic function has not been well established. Prolonged neuromuscular block following administration of succinylcholine correlates with very low or genetically variant cholinesterase activity. The determination of pseudocholinesterase activity is of importance to the anesthetist in order to predict the susceptibility of the patient to the muscle relaxant, succinylcholine. The purpose of this study was to investigate the change of pseudocholinesterase level during cardiopulmonary bypass(CPB) for open heart surgery with hemodilution and hypothermia. Seven venous blood samples before induction of anesthesia(control), during CPB, and until the fifth postoperative day in 12 patients who underwent open heart surgery were taken. The pseudocholinesterase level was measured by Wako kit and JASCO UVIDEC 77 clinical spectrophotometer. The results were as follows ; 1) The control hematocrit was 40.32+/-6.21% and decreased to 23.72+/-1.86% immediately after the start of CPB(p<0.01) and to 22.42+/-1.93 % 30 minutes after the start of CPB(p<0.01). 2) The control pseudocholinesterase value of 1296.67+/-251.03 IU/L decreased to 915.67+/-228.16 IU/L immediately after the start of CPB(p<0.01), and to 727.83+/-197.58 IU/L 30 minutes after the start of CPB(p<0.01). 3) The mean values of pseudocholinesterase level immediately posteratively, on the first postoperative, and the third postoperative days were 1488.50+/-333.52 IU/L, 1913. 17+614.50 IU/L and 1620.92+/-458.82 IU/L, respectively, and those were significantly increased from the control value(p<0.05, p<0.01, and p<0.01, respectively). 4) The mean value of pseudocholinesterase level on the fifth postoperative day was 1392.25+/-271.69 IU/L, which was not significantly different from the control valule. 5) Transfused units of whole blood, packed red cells, and fresh frozen plasma were 2.8+/-1.4, 3.2 +/-1.0, 3.4+/-0.9, respectively.
Cardiopulmonary Bypass* ; Cholinesterases ; Cocaine ; Hematocrit ; Hemodilution ; Heroin ; Humans ; Hypothermia ; Metabolism ; Neuromuscular Blockade ; Plasma ; Procaine ; Pseudocholinesterase* ; Succinylcholine ; Tetracaine ; Thoracic Surgery

PURPOSE: To present long-term results of intraocular pressure control and graft survival of eyes with penetrating keratoplasty(PKP) and Ahmed valve implant METHODS: We retrospectively reviewed medical records of 18 patients who underwent both PKP and Ahmed valve implant at Asan medical center between July of 1993 and June of 2000. Ahmed valve implant surgery was performed either before PKP (3 eyes), after PKP (12 eyes), or at the same time as PKP (3 eyes). Mean patient age was 40.7 years (range, 18 to 77 years) and mean follow up was 32 months (range, 5 to 120 months). Glaucoma outcome was assessed by postoperative intraocular pressure. Corneal outcome was assessed by graft rejection, failure and visual acuity. RESULTS: The average preoperative intraocular pressure for all of the eyes was 35 mmHg. Eighty nine percent of them (16 eyes) achieved a final intraocular pressure of less than 20 mmHg (average, 15 mmHg on a mean of 0.9 medications). Graft failure occurred in 13/16 (72%). The overall PKP success rate, including the eyes that underwent repeat PKP, was 44 %. Visual acuity improved in 8 eyes, remained stable in 5 eyes and decreased in 5 eyes. CONCLUSIONS: Ahmed valve implant can successfully control glaucoma in a majority (89%) of PKP eyes. However, the success of corneal grafts is relatively low (44%).
Chungcheongnam-do ; Follow-Up Studies ; Glaucoma ; Graft Rejection ; Graft Survival ; Humans ; Intraocular Pressure ; Keratoplasty, Penetrating* ; Medical Records ; Retrospective Studies ; Transplants ; Visual Acuity

Recently there has been renewed interest in the use of highly concentrated saline solutions and colloidal fluid to resuscitate animals and humans from hypovolemic shock. In this study, effects of resuscitation with various fluids were compared in a cat model of acute hemorrhage. After anesthesia, the cat was exanguinated from the femoral artery, and an equivalent amount of fluid was injected through the femoral vein. Therefore this study was performed to evaluate the effects of gelatin in comparison with others. The results were as follows 1) Compared to crystalloid solution, colloidal soluions were more effective in restoring hemodynamic disturbance but there were no significant differences between Gelatin and Dextran group at same dosage level. 2) Mean arterial pressure was significantly increased in dextran and gelatin group after 30 minutes of fluid resuscitation(p<0.05). 3) Decreased hemoglobin due to plasma volume expansion was noticed in all group's(p<0.05) 4) After replacement of dextran and gelatin, central venous pressure was restored effectively(p < 0.05). 5) Decreased ETCO was recovered after replacement of fluid, but no difference among three groups. 6) Increased potassium level was redecreased 30 minutes after replacement of gelatin(p < 0.05). 7) Sodium level was decreased after hemorrhange in all three groups and after replacement of H/D and dextran, but no change in gelatin group(p<0.05). 8) Increased lactate after hemorrhage was decreased in gelatin and dextran group. 8) Decreased pH restored after replacement of dextran and gelatin.
Anesthesia ; Animals ; Arterial Pressure ; Cats* ; Central Venous Pressure ; Colloids ; Dextrans ; Femoral Artery ; Femoral Vein ; Gelatin* ; Hemodynamics ; Hemorrhage* ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Plasma Volume ; Potassium ; Resuscitation ; Shock ; Shock, Hemorrhagic ; Sodium

BACKGROUND: Premedication traditionally has several goals: reduction of anxiety,pain, and secretions and provision of basal or background sedation. The purpose of this study was to evaluate the efficacy and side effects of nalbuphine, midazolam and buprenorphine as premedication agents. METHODS: Two hundred thirty three patients who were scheduled to have an elective operation were included in this randomized, double-blind study. Nalbuphine 0.2 mg/kg, midazolam 0.05 mg/kg or buprenorphine 0.005 mg/kg was given intramuscularly with atropine(0.01 mg/kg) one hour before arriving at operating room. Sedation, level of anxiety, subjective rating on the effect of premedication and side effects including emesis and etc. were evaluated. RESULTS: The sedation score and the level of anxiety were not significantly different among three groups. The subjective rating on the effect of premedication was significantly higher in midazolam group than other two groups(p<0.05). The frequency of preoperative emesis was not significantly different among three group. The frequency of postoperative emesis was significantly higher in buprenorphine group than other two groups(p<0.05). Buprenorphine group showed dizziness and flushing more frequently than the other two groups(p<0.05). CONCLUSION: The present study demonstrated that, as a premedicant, midazolam increase the patient's satisfaction and decrease lessen the incidence of postoperative emesis and buprenorphine increase the incidence the side effects such as postoerative emesis, dizziness and flushing.
Anxiety ; Buprenorphine* ; Dizziness ; Double-Blind Method ; Flushing ; Humans ; Incidence ; Midazolam* ; Nalbuphine* ; Operating Rooms ; Postoperative Nausea and Vomiting ; Premedication* ; Vomiting