Isoflurane causes little myocardial depression, rapid onset and recovery during controlled hypotensive anesthesia. Nitroglycerin, vasodilating agent, has short plasma half-life and myocardial protective effect, is easy to cantrol, and has no direct toxic effect. Doxapram hydrochloride(doxapram Hcl), respiratory stimulant, has been found to be safe and significantly potent, but also has significant pressor effect when larger doses are administered. The purpose of this study was to evaluate the effects of doxapram on the hemodynamics after isoflurane and nitroglycerin-induced hypotensive anesthesia in dogs. Hemodynamic measurement including the value of left ventricular pressure, aortic pressure, pulmonary eapillary wedge pressure, pulmonary artery pressure, heart rate, cardiac output, maximal and minimal dP/dT were determined in 8 dogs before doxapram Hcl administration, Smin, 15min and 30min after doxapram Hcl administration. 1) Left ventricular pressure and aortic pressure increased at 5min and 15min after doxapram Hcl administration but did not change significantly at 30min compared to the preadministration values. 2) Pulmonary capillary wedge pressure and pulmonary artery pressure increased significantly at Smin and 15min, but did not change significantly 30min compared to the preadministration values. 3) Heart rate increased significantly at Smin, but did not change significantly at 15min and 30min compared to the preadministration value. 4) Cardiac output and body temperature did not change significantly at 5min, 15min compared to the preadministation values. 5) Maximal dP/dT increased signifieantly at Smin and 15min, but did not change at 30min compared to the preadministration value, minimal dP/dT increased significantly at 5min, but did not change at 15min and 30min compared to the preadministration value.
Anesthesia* ; Animals ; Arterial Pressure ; Arteries ; Body Temperature ; Cardiac Output ; Depression ; Dogs* ; Doxapram* ; Half-Life ; Heart Rate ; Hemodynamics* ; Isoflurane* ; Nitroglycerin* ; Plasma ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Ventricular Pressure

Succinylcholine, the short acting depolarizing muscle relaxant, is commonly used for endotracheal intubation. Succinylcholine induced hyperkalemia has been reported in patients with severe burn, massive traums, spinal cord injury, some neuromuscular diseases, and cerebral damage. In the present study, the serum potassium levels and ECG changes following intravenous injection of succinylcholine in three groups were investigated(group l: the patients without head injury, group ll: the patients with head injury with 24 hours, and group lll: the patients with head injury in 10~90 days). The results were as follows: 1) The serum potassium lovels increased significantly at 4 minutes, decreased slightly at 8 minutes and 10 minutes in group ll and lll(p<0.001). 2) The serum potassium levels(peak change ratio) were higher in group ll and lll than group l (between group l and ll, p<0.05: between group ll and lll, p<0.001). 3) Thwere were no significant differences between the maximal increase of K+ according to the degrees of consciousness. 4) Abnormal ECG finding following intubation appeared in fifty-five cases (91.7%). The amjority were sinus tachycardia in group 1 and ll and insignificant tall T wave in group ll.
Burns ; Consciousness ; Craniocerebral Trauma ; Electrocardiography ; Head Injuries, Closed* ; Humans ; Hyperkalemia ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Neuromuscular Diseases ; Potassium* ; Spinal Cord Injuries ; Succinylcholine* ; Tachycardia, Sinus

Opiates have been used as analgesics in obstetrics since the Babylonian Sinee that time, a wide variety of opiates have been employed in an attempt to provide analgesia for childbirh. The effect of opioids on uterine contractility is of considerable interest. Morphine caused a concentration dependent decrease in the frequency of contraction of the estrous uterus, In contrast, both pethidine and pentazocine enhanced the contraction rate. The pregnant uterus showed little response to morphine, but exhibited an enhanced response to the stimulant activity of both pethidine and pentazocine.It has long been recognized that the tension development of uterine muscle is largely dependent on intracellular Ca2+ pools. Smooth muscle contraction is initiated by depolarization induced calcium entry into the myoplasm through voltage dependent calcium channels, The spontaneous or KC1-induced tension development in isolated uterine smooth musele is reduced by lowering the calium ion (Ca2+) concentration of the bathing medium. In our study, the effect of morphine, pethidine and pentazocine on estrous and pregnant uterine activity, and the effect of extracellular calcium on opiate induced uterine motility have been examined in rats in vitro The following results were obtained: 1) The frequency of contraction of the estrous and pregnant rat uteri in the control group decreased gradually with time. 2) Morphine caused a concentration- dependent decrease in the frequency of contraction of the estrous and pregnant rat uteri, but it was not significant 3) Pethidine and pentazocine caused a concentration dependent incrase in the frequency of contraction of the estrous and pregnant rat uteri.but it was not significant.4) Diazepam caused a concentration-dependent decrease in the frequency of contraction of the estrous and pregnant rat uteri. 5) Ketamine casued a concentration- dependent decrease in the frequency of contraction of the estrous and pregnant rat uteri, but it was not significant. 6) Addition of CaCI, to the Krebs Henseleit solution did not make any significant change in the result. 7) According to the condition of the estrous and pregnant rat uteri the change of contraction frequency was statistically significant in the control, morphine, pethidine and pentazocine groups.
Analgesia ; Analgesics ; Analgesics, Opioid ; Animals ; Baths ; Calcium ; Calcium Channels ; Diazepam* ; Female ; Ketamine* ; Meperidine ; Mice ; Morphine ; Muscle, Smooth ; Myometrium ; Obstetrics ; Pentazocine ; Rats* ; Uterus*

Direct laryngoscopy and endotracheal intubation is accompanied by mechanical stimulation of the laryngopharynx & by sympathetic timulation, as reflected by an increase in heart rate and blood pressure. The purpose of this study is to evaluate effects of certain drugs on blood pressure and heart rate during intubation. We intravenously administered some drugs prior to laryngoscopy and endotracheal intubation in adult patients with ASA class 1-2. Seventy-two patients were devided into four groups as follows: Group 1: Control group (none, n=18). Group 2: Lidocaine only (n=18). Group 3: Lidocaine (1 mg/kg) and d-Tubocurarine (3mg)(n=18). Group 4: Lidocaine (1mg/kg), d-Tubocurarine (3mg) and diazepam (0.1mg/kg)(n=18). Blood pressure, heart rate, mean arterial pressure, rate-pressure product, aterial blood gas were measured before induction, after induction, immediately after intubation and at 1, 2, 3 & 5 minutes after intubation. The results were as follows: 1) There were no significant differences in preinduction values of blood pressure, heart rate, rate-pressure product, arterial blood gas. 2) Systolic blood pressure increased significantly 2 minutes after the intubation in all groups and rapidly returned to the preinduction level in group 4, group 3 and then group 2 in that order compared to group l. 3) Diastolic and mean arterial pressure elevated significantly during intubation and rapidly retur- ned to the preinduction level in group 4, group 3 and then group 2 in that order compared to group l. 4) Heart rate increased significantly after the intubation in all groups and more rapidly returned to the preinduction levels 3 minutes after the intubation in group 4. 5) Rate-pressure product following the intubation was over 15,000 mmHg. beat/min in all groups, and more rapidly decreased 15,000 mmHg. beat/min at 2 minutes after the intubtion in group 4, 5 minutes after the intubation in group 3. 6) pH, PaCO2and PaO2values were within normal range following the intubation in all groups. In conclusion, it is suggested that the administration of lidocaine, d-tubocurarine and diazepam prior to the intubation is ideal for those patients with cardiovascular disease & increased intracranial pressure.
Adult ; Arterial Pressure ; Blood Pressure ; Cardiovascular Diseases ; Diazepam* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Intracranial Pressure ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy* ; Lidocaine* ; Reference Values ; Tubocurarine*

Succinylcholine chloride is ordinarily the muscle relaxant of choice for rapid endotracheal intubation, but may produce myalgia, increase in intragastric pressure, increase in intraocular pressure, and it may be associated with malignant hyperthermia and hyperkalemia. Many investigators have tried to find an alternative drug for succinylcholine chloride. Foldes reported that the onset can be shortened by the administration of a subparalyzing dose of vecuronium bromide a nondepolarizing intermediate-acting muscle relaxant, prior to its intubating dose. This has been termed "the priming principle",. Mehta et al, Lennon et al and Schwarz reported similar results. These investigators studied to identify an optimal priming dose, priming interval (the time from the priming dose to the intubating dose) and intubating dose of vecuronium bromide, to perform a rapidsequence induction of anesthesia. We studied 50 healthy adult patients, and results are 1) Group IV (a priming dose of 0.02 mg/kg, a priming interval of 4 min and an intuating dose of 0. 1 mg/kg) had better intubating condition than the control group. 2) The groups with divided doses had significantly shorter onset time compared to the control group (0.1 mg/kg without prime dose). 3) Group II and IV (priming dose 0.02 mg/kg) had shorter onset time compared to group I and III (priming dose 0.01 mg/kg), but the difference was not significant. 4) Group III and IV (priming interval of 4 min) had shorter onset time compared to group I and II (priming interval of 2 min), but the difference was not significant. In conclusion, group IV (priming dose of 0.02 mg/kg and priming interval of 4 min) had the shortest onset time and provided the best intubating condition.
Adult ; Anesthesia ; Humans ; Hyperkalemia ; Intraocular Pressure ; Intubation, Intratracheal* ; Malignant Hyperthermia ; Myalgia ; Research Personnel ; Succinylcholine ; Vecuronium Bromide*

At the end of the operation, residual neuromusular blookade may be antagonized by anticholines-terase (edrophonium, neostigmine and pyridostigmine). Neostigmine is probably commonly used antagonist of nondepolarizing neuromuscular blocking agents. But, because of an apparent longer duration of action and lesser muscarinic effects, pyridos- tigmine has been suggested as possibly superior to neostigmine as an antagonist of nondepolarizing neuromuscular blockade. Accordingly, present study observed the heart rate, systolic and diastolic blood pressure changes following equipotent doses of pyridostigmine and neostigmine given with glycopyrrolate in inhalation anesthesia (halothane and enflurane). Eighty patients were randomly divided in four groups as follows: Group I: halothane, glycopyrrolate + neostigmine Group II: halothane, glycopyrrolate + pyridostigmine Group IIl: enflurane, glycopyrrolate + neostigmine Group IV: enflurane, glycopyrrolate +pyridostigmine The results were as follows: 1) In halothane and enflurane anesthesia, the changes in heart rate were significant in each group after 4 minutes and especially, the group I, III showed more decrease than the group II, IV. 2) Tachycardia were observd until 6 minutes after administration of anticholinesterase in each group. Bradycardia were appeared at 6 minutes in the group I, IIl and at 14 minutes in the group II, IV and, each group showed bradycardia which continued over 20 mintes. 3) Even though the decrease of systolic and diastolic blood pressure showed transiently with time, there were no significant difference in the changes in ach group. 4) When the same anticholinesterase was administered, the cardiovascular responses were no significant difference between the halothane and enfurane anesthesia. In conclusion, pyridostigmine with glycopyrrolate seems to produce minimal changes in the cadiovascular responses in halothane and enflurane anesthesia.
Anesthesia ; Anesthesia, Inhalation* ; Blood Pressure ; Bradycardia ; Cholinergic Agents ; Enflurane ; Glycopyrrolate ; Halothane ; Heart Rate ; Humans ; Inhalation* ; Mentha ; Neostigmine* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pyridostigmine Bromide* ; Tachycardia

BACKGROUND: Endoscopic urologic surgery including transurethral resection of prostate (TURP) requires adequate sacral analgesia for insertion of resectoscope. But epidurally administered local anesthetic does not produce anesthetic effects uniformly. Failure to completely block S1 during epidural anesthesia because of the large size of nerve root has been noted. The purpose of this study to compare the relation between catheter direction and sensory anesthesia. METHODS: Thirty patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L3-4 using a standard 18 gauge Tuohy needle. In group A (n=15), the Tuohy needle with bevel pointed in a cephalad direction during catheter insertion. In group B (n=15), it pointed caudally. And the catheter was introduced 3 cm into the epidural space. After test dose, 2% lidocaine 5 cc, 0.5% bupivacaine 5 cc and 2% lidocaine 3 cc were administered with fractionate dose through it. The extent of the sensory anesthesia to loss of cold sensation and pin prick test was measured every 5minute for 30 minutes. RESULTS: Analgesia spread to loss of cold sensation and pin prick test was no significant statistical difference between the two groups. In 15 minutes after injection of surgical dose, complete blockade in L5, S1 dermatome was present in both groups. CONCLUSION: Our results conclude that epidural catheter direction is not significantly influence the epidural anesthetic spread including sacral area in continuous lumbar epidural anesthesia in elderly patients.
Aged ; Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Anesthetics ; Bupivacaine ; Catheters* ; Epidural Space ; Humans ; Lidocaine ; Needles ; Sensation ; Transurethral Resection of Prostate

To evaluate the results of anesthesia during open heart surgery, the cases of 77 patients in the Department of Anesthesiology, Ewha Womans University Hospital were weviewed from November, 1982 to February, 1985 and from March, 1986 to February 1987. The Results were as follows: 1) Thirty-nine percent of the 77 cases were acyanotic congenital heart anomalies , 18.2% were cyanotic anomalies and 42.8% were valvular heart diseases. The patients' ages ranged from 13 months to 63 years old, and the study included 30 male and 47 female patients. 2) Pethidine given as a premedication in mot cases, also atropine, glycopyrrolate, hydroxyzine, lorazepam and diazepam were utilized. 3) The induction agents included thiopental, ketamine diazepam, and morphine, and were injected singly or in combination. 4) Anesthesia was maintained with diazgepam, pancuronium, ketamine, morphine, and pethidine, N20 inhalation was used in the acyanotic and valvular cases. 5) Serum Na+ and K+ concentrations were lower during bypass than before and after bypass. 6) During bypass, body temperatuer was maintained below 30 degrees C, and the mean values for arterial pressure ranged from 50-80 mmHg. 7) The duration of andsthesia was 481+/- 88.7 minutes in the valvular cases and the duration of bypass was 118+/-18.3 minutes in the cyanotic cases. 8) In the analysis of arterial blood gases, the cyanotic cases displayed a low pH and base excess. In the cyanotic cases, the PaCO2, and PaO2, differed from the other cases before bypass, but not after bypass. 9) Overall mortality was 14.3%, The mortality rate with respect to each disease was 10 10/0% in the acyanotic cases, 28.6% in the cyanotic cases and 12.1% in the valvular cases.
Anesthesia* ; Anesthesiology ; Arterial Pressure ; Atropine ; Diazepam ; Female ; Gases ; Glycopyrrolate ; Heart Valve Diseases ; Heart* ; Humans ; Hydrogen-Ion Concentration ; Hydroxyzine ; Inhalation ; Ketamine ; Lorazepam ; Male ; Meperidine ; Middle Aged ; Morphine ; Mortality ; Pancuronium ; Premedication ; Thiopental ; Thoracic Surgery*

To evaluate the results of anesthesia during open heart surgery, the cases of 77 patients in the Department of Anesthesiology, Ewha Womans University Hospital were weviewed from November, 1982 to February, 1985 and from March, 1986 to February 1987. The Results were as follows: 1) Thirty-nine percent of the 77 cases were acyanotic congenital heart anomalies , 18.2% were cyanotic anomalies and 42.8% were valvular heart diseases. The patients' ages ranged from 13 months to 63 years old, and the study included 30 male and 47 female patients. 2) Pethidine given as a premedication in mot cases, also atropine, glycopyrrolate, hydroxyzine, lorazepam and diazepam were utilized. 3) The induction agents included thiopental, ketamine diazepam, and morphine, and were injected singly or in combination. 4) Anesthesia was maintained with diazgepam, pancuronium, ketamine, morphine, and pethidine, N20 inhalation was used in the acyanotic and valvular cases. 5) Serum Na+ and K+ concentrations were lower during bypass than before and after bypass. 6) During bypass, body temperatuer was maintained below 30 degrees C, and the mean values for arterial pressure ranged from 50-80 mmHg. 7) The duration of andsthesia was 481+/- 88.7 minutes in the valvular cases and the duration of bypass was 118+/-18.3 minutes in the cyanotic cases. 8) In the analysis of arterial blood gases, the cyanotic cases displayed a low pH and base excess. In the cyanotic cases, the PaCO2, and PaO2, differed from the other cases before bypass, but not after bypass. 9) Overall mortality was 14.3%, The mortality rate with respect to each disease was 10 10/0% in the acyanotic cases, 28.6% in the cyanotic cases and 12.1% in the valvular cases.
Anesthesia* ; Anesthesiology ; Arterial Pressure ; Atropine ; Diazepam ; Female ; Gases ; Glycopyrrolate ; Heart Valve Diseases ; Heart* ; Humans ; Hydrogen-Ion Concentration ; Hydroxyzine ; Inhalation ; Ketamine ; Lorazepam ; Male ; Meperidine ; Middle Aged ; Morphine ; Mortality ; Pancuronium ; Premedication ; Thiopental ; Thoracic Surgery*

Conscious awareness with recall has always been of major concern to both patients and anesthesiologists and can, particularly when pain is experienced, lead to serious psychological sequelae characterized by a form of neurosis. And the unconsciousness storing of a traumatic memory may well act as a chronic psychic irritant. This study was designed to evaluate the effects of anesthetic induction with thiopental-ketamine and propofol on maternal awareness and neonatal outcome during cesarean section. Forty pregnant women(ASA class 1 or 11) undergoing cesarean section under general anesthesia were allocated randomly to receive either thiopental(4 mg/kg, 250 mg maximum)-ketamine(20 mg)(n=20) or propofol(2 mg/kg)(n=20). Using the isolated forearm technique, the incidence of maternal intraoperative awareness was assessed. Following recovery from anesthesia and 24 hour later, the patients were interviewed to assess any recall, dream or hallucination. And the Apgar scores of newborn at one and five minutes, as well as their umbilical blood gases also evaluated. The incidence of maternal awareness signaled by flexing fingers in respose to voice commands was significantly lower in thiopental-ketamine group(70%) than propofol group(95%)(p<0.05). And 15% of patients receiving thiopental-ketamine and 20% of propofol group made a fist(indicating pain perception). Nine patients had postoperative recall of intraoperative awareness, four in the thiopental group and five in the propofol group, but only one patient in each group remembered one of six target words. No postoperative hallucination, dream or dysphoria(including pain) were noted. The maternal intraoperative cardiovascular responses among the groups were similar. There were no significant differences in Apgar scores, maternal and umbilical blood gas values. Our data indicate that thiopental-ketamine and propofol as induction agent was associated with very high rate of maternal awareness without unpleasant recall and neonatal depression.
Anesthesia ; Anesthesia, General ; Anesthesia, Obstetrical ; Cesarean Section* ; Depression ; Dreams ; Female ; Fingers ; Forearm ; Gases ; Hallucinations ; Humans ; Incidence ; Infant, Newborn ; Intraoperative Awareness ; Ketamine ; Memory ; Pregnancy ; Propofol* ; Thiopental ; Unconsciousness ; Voice