Fentanyl-O2 anesthesia has gained wide popularity as an anesthetic technique for patients undergoing cardiac surgery because of its minimal cardiovascular effects and total amnesia for intraoperative events. But, some authors recently reported intraoperative awareness and the excessive cardiovascular response to surgical stimulation during high dose fentanyl-oxygen anesthesia far cardiac operation and suggested the necessity of supplementary anesthetic agent in addition to fentanyl to prevent the intraoperative awareness and maintain hemodynamic stability during the surgical procedure. A variety of supplementary drugs have been used in combination with the opioids in an effort to reduce the incidence of awareness, to control hypertension, and to attenuate the extent of postoperative respiratory depression. One of supplementary drugs, diazepam has little cardiovascular effects by itself, but causes significant depression of arterial blood pressure and cardiac output when given to patients who have received fentanyl or morphine. We measured the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and rate pressure product (RPP) at induction, tracheal intubation, skin incision, and sternotomy time to evaluate the effects of the diazepam on reduction of the excessive cardiovascular response to anesthetic and surgical stimulation and observed the presence of the intraoperative awareness, under fentantyl-diazepam-O2 anesthesia for open heart surgery on 12 patients with cardiac disease. Anesthesia was induced with fentanyl 20 ug/kg + diazepam 0.1 mg/kg and maintained with continuous infusion of fentanyl (1.5 ug/kg/min. prior to sternotomy and 0.3 ug/kg/min. until the end of cardiopulmonary bypass) and diazepam 0.1 mg/kg was injected just before sternotomy and at the end of cardiopulmonary bypass. The patients required the total dose of fentanyl 76+13.1 ug/kg and diazepam 0.3 mg/kg for the entire operation. These measurements were compared with control data (before induction). The results were as followings: 1)During induction period (infusion of fentanyl 20 ug/kg with diazepam 0.1 mg/kg); HR, SBP, DBP, and MAP slightly decreased compared with control data, but there were not statistically significant. RPP decreased significantly from 15898+/-5099 torr. beatsmin. to 12371+/-2407 torr. beatsmin. and there was statistical significance (p<0.05). 2) During intubation and skin incision; HR, SBP, DBP, MAP and RPP revealed no significant change compared with control data. 3) During sternotomy; HR, SBP, DBP, MAP, and RPP slightly increased, but there were not statistically significant. 4) There was no patient who had the recall or awareness for intraoperative events. 5) Duration of controlled or assisted ventilatory support. postoperatively, was 216+/-36 min. These results suggest that fentanyl-diazepam-O2 anesthesia might be more useful than fentanyl-O2 anesthesia for prevention of intraoperative awareness and attenuation of excessive cardiovascular response during open heart surgery. But, continuous and careful monitoring for hemodynamic changes of patients will be needed necessarily to prevent the significant depression of arterial blood pressure and cardiac output throughout the entire operative procedures.
Amnesia ; Analgesics, Opioid ; Anesthesia* ; Anesthetics ; Arterial Pressure ; Benzodiazepines ; Blood Pressure ; Cardiac Output ; Cardiopulmonary Bypass ; Depression ; Diazepam* ; Fentanyl* ; Heart Diseases ; Heart Rate ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Hypnotics and Sedatives ; Incidence ; Intraoperative Awareness ; Intubation ; Morphine ; Respiratory Insufficiency ; Skin ; Sternotomy ; Surgical Procedures, Operative ; Thoracic Surgery*

Tissue engineering can serve as an alternative treatment for a malfunctioning or lost organ. Isolated and expanded cells adhere to a temporary scaffold, proliferate, and secrete their own extracellular matrices (ECM) replacing the biodegrading scaffold. The genitourinary system, composed of the kidney, ureter, bladder, urethra, and genital organs, is exposed to a variety of possible injury sites from the time of fetal development. All the urinary organs are mainly composed of smooth muscle and uroepithelial cells and which may be approached by tissue engineering techniques. A large number of materials, including naturally-derived and synthetic polymers have been utilized to fabricate prostheses for the genitourinary system. Usually, whenever there is a lack of native urologic tissue, reconstruction is considered with native non-urologic tissue, such as, gastrointestinal segments, or skin or mucosa from multiple body sites. Engineering tissues using selective cell transplantation may provide a means to create functional new genitourinary tissues. This review concerns urinary tissues reconstructed with bladder uroepithelial cells and smooth muscle cells (SMCs) implanted on biodegradable polymer matrices.
Animal ; Biomedical Engineering*/methods ; Bioreactors ; Cytological Techniques/trends ; Human ; Stem Cells/physiology ; Urinary Tract*

Ketamine may increase blood pressure and heart rate and should be avoided in hypertensive patients. However, in hypovolemic and asthmatic patients, ketamine is used as an induction agent because of its cardiovascular stimulating effect and bronchodilating effect. This study aims to assess the effects of clonidine and lidocaine on the cardiovascular response of intravenous ketamine administration during induction of anesthesia. sixty patients were divided into 3 groups as followed: group I: control ( received no lidocaine or no clonidine) group II: received lidocaine (1.5 mg/kg IV) 3 minutes before intubation group IIl: received clonidine (0.3 mg PO) 90 minutes before induction of anesthesia The changes of blood pressure, heart rate and rate pressure product following intubation were measured at different time interval (before induction,before intubation just after intubation, postintubation 1, 3, 5, 10 min) and compared with the value of control (2 hours before induction of anesthesia). The results are as follows 1) Group I and Group II: The systolic and diastolic blood pressure increased significantly compared to the control value from preinduction to 5 minutes after intubation(p<0.05). It recovered to the control value in 10 minutes, but heart rate and rate-pressure product increased significantly for 10 minutes after intubation(p<0.05) 2) Group III: The systolic and diastolic blood pressure, heart rate and rate-pressure product of preinduction and preintubation values decreased significantly compared to control values but 1 minute after intubation,all values increased significantly(p<0.05). The systolic and diastolic blood pressure and rate-pressure product values recovered to control value in 3 minutes after intubation and heart rate recovered in 5 minutes. Comparing group III with group I and II, it showed significant changes(p<0.05). From the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia. the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia.
Anesthesia* ; Blood Pressure ; Clonidine* ; Heart Rate ; Humans ; Hypovolemia ; Intubation ; Ketamine* ; Lidocaine* ; Premedication*

BACKGROUND: Experience of wakefulness and pain perception during general anesthesia can be distressful to patients. For cesarean section, a light plane of general anesthesia is chosen for fetal safety and rapid recovery; there is an increased incidence of maternal wakefulness. Propofol may be the choice if smooth induction and rapid maternal recovery are desired. We compared propofol with thiopental sodium as an induction agent of anesthesia in cesarean section, noting in particular the patients wakefulness during operation. METHODS: Twenty six patients who underwent cesarean section received either thiopental sodium 4 mg/kg (n=13) or propofol 2.5 mg/kg (n=13) as an induction agent. To assess intraoperative wakefulness, a tourniquet was applied before the administration of succinylcholine for maintaining motor function in one arm. Wakefulness during anesthesia could be assessed by asking the patient to move her hand. RESULTS: Although the changes in blood pressure and heart rate were similar in both groups, the propofol group had a less increasing systolic blood pressure from the period immediately and 1 minute after intubation (P<0.05). The patients administered with propofol showed significantly higher incidences of "followed commands" and "made reaching movements" (P<0.05). The incidence of dreams was higher in the propofol group than thiopental sodium group. CONCLUSIONS: Propofol was similar to thiopental sodium in hemodynamic effects on mother, but incidence of intraoperative wakefulness was significantly increased in the propofol groups.
Anesthesia ; Anesthesia, General ; Anesthetics ; Arm ; Blood Pressure ; Cesarean Section* ; Dreams ; Female ; Hand ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Memory ; Mothers ; Pain Perception ; Pregnancy ; Propofol* ; Succinylcholine ; Thiopental* ; Tourniquets ; Wakefulness*

Propofol is limited in clinical use for induction of anesthesia, because of its high incidence of pain on injection. We sought to determine whether different methods could prevent this pain. 150 patients were allocated randomly into five groups. Group 1 was received room-air temperature propofol 2.5 mg/kg. Group 2 was received room-air temperature propofol 2.5 mg/kg mixed with 1 ml of 1%(10 mg) lidocaine. Group 3 was received room-air temperature propofol 2.5 mg/kg just after the injection of l ml of 1%(10 mg) lidocaine. Group 4 was received room-air temperature propofol 2.5 mg/kg mixed with 1 ml of 0.5%(5 mg) lidocaine. Group 5 was received propofol 2.5 mg/kg cooled to 0-4degrees C. The pain was classified as none, mild, moderate, or severe. All patients were questioned the degree of pain in an identical manner both at induction of anesthesia and as recalled in the recovery room. There was a significant reduction in the incidnce and severity of pain in the Groups 2 and 3, which were used 10 mg of lidocaine. But 23.3% of patients in the Group 2 and 30.0% of patients in the Group 3 still suffered unpleasant pain during the induction, and 20.0% and 26.7% of patients, respectively recalled in the recovery room. From the above results, we concluded that the pain from injection of propofol can be prevented by 1 ml of 1%(10 mg) lidocaine mixed with propofol or preinjection before propofol.
Administration, Intravenous* ; Anesthesia ; Humans ; Incidence ; Lidocaine ; Propofol* ; Recovery Room

As an alphs-2 adrenergic agonist, clonidine, which is an antihypertensive drug, can reduce central sympathetic outflow. By regulation of presynaptic transmitter release, it also lowers blood pressure and amounts of anesthetic drugs used during anesthesia, causes sedation, and attenuates postoperative shivering. The authors studied the effects of transdermal clonidine as a premedicant, which is easy and simple to use and maintains constant plasma level. Sixty patients undergoing elective orthopedic surgery, with preoperative normal blood preesure, were seleeted and randomly divided into 2 groups, 30 subjects each. Placebo patch was placed on the shoulder of patients belonging to the placebo group, and clonidine patch for the clonidine group just 48 hours before operation. Cardiovascular effects such as changes in perioperative blood pressure and heart rate, the degree of sedation before to induction, amounts of anesthetic drugs during anesthesia, postoperative analgesic requirements, ratio of patients who experienced postoperative shivering were observed and compared between the two groups. Patients in the clonidine group showed more stable cardiovascular response perioperatively and amounts of anesthetic drugs required during operation were reduced as compared to the placebo group(p<0.05). Preinduction sedation score of clonidine group was definitely higher than that of placebo group. (p <0.05) All 30 patients in the placebo group required analgesics for 48 hours after operation(100%) and only 19 patients of the clonidine group required analgesics(63%). The amounts of postoperative analgesics were definetely reduced in the clonidine group(p<0.05). Postoperative shivering occurred in 12 patients of the placebo group(40%) and 5 patients of the clonidine group(16.6%). We concluded that transdermal clonidine can be used effectively as a premedicant privided close regulation of anesthetic drugs used during anesthesia is possible.
Adrenergic Agonists ; Analgesics ; Anesthesia ; Anesthetics ; Blood Pressure ; Clonidine* ; Heart Rate ; Humans ; Orthopedics ; Plasma ; Shivering ; Shoulder

The antiphospholipid syndrome (APS) is characterized by vascular thrombosis despite of prolongation of coagulation profile in laboratory findings and pregnancy morbidity in the presence of antiphospholipid antibody. It occurs primarily or secondarily to autoimmune disease. This case report concerns a pelviscopic left ovarian cystectomy in a 32-year-old female with APS and systemic lupus erythematosis. To manage the hypercoagulability, oral warfarin and low molecular weight haparin were given pre- and postoperatively. In perioperative period, we monitored activated clotting time to prevent intraoperative thrombosis and tried to avoid dehydration, hypothermia and infection.
Adult ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome ; Autoimmune Diseases ; Cystectomy ; Dehydration ; Female ; Humans ; Hypothermia ; Critical Care ; Molecular Weight ; Perioperative Period ; Pregnancy ; Thrombophilia ; Thrombosis ; Warfarin

In obsterics and gynecology laparoscopic surgery is increasing in numbers and gaining wide popularity replacing classical laparotomy and is becoming new trend in surgical fields. Laparoscopic surgery is favoured over the classical laparotomy because of numerous advantages but it can cause complications by insuffulatory CO2 to induce artificial pneumoperitoneum. Therefore, wide knowledges and thorough understandings of anesthesiologist on the prevention of complications and their treatments are essential. Authors present one case that the patient developed subcutaneous emphysema and ateleciasis on right upper lobe, pulmonary edema in left side lung resulting from inadvertent one lung ventilation during laparoscopic hysterectomy under general anesthesia and on trendelenberg position.
Anesthesia, General* ; Gynecology ; Humans ; Hysterectomy* ; Laparoscopy ; Laparotomy ; Lung ; One-Lung Ventilation* ; Pneumoperitoneum, Artificial ; Pulmonary Edema ; Subcutaneous Emphysema*

Rapid induction,complete loss of conciousness,and stability of cardiovascular system are the variables that should be considered in choosing anesthetics and method of induction for patients with cardiovascular diseases. The great attention should be given because elevation of blood pressure and tachycardia during induction of anesthesia can deteriorate patients cardiovascular system. High-dose of fentanyl was used for the induction of open heart surgery since 1978 and showed effectiveness in stabilizing cardiovascular changes. Many authors argued that fentanyl may not induce unconciousness. As endeavor to shorten the oneset time of unconsciousness, commonly used intravenous anesthetics with fentanyl were tried. Among patients scheduled for open heart surgery, 30 patients with ejection fraction higher than 0.5 were randomly selected and divided into three groups. For the induction of anesthesia, group 1 was given fentanyl alone; group 2 fentanyl with diazepam(0.1mg/kg); and group 3 fentanyl with thiopental sodium (0.2mg/kg). Loss of conciousness (oneset time of unconciousness and dosage of fentanyl) and cardiovascular responses(systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and rate pressure product) just before induction,before intubation, and immediately after intubation were compared and results were as followes. l. It took 322 seconds to induce unconciousness in group 1, 213 seconds in group 2,and 87 seconds in group 3. It was shortened significantly in group 2 and group 3 as compared to group 1 and in group 3 as compared to group 2(p<0.05). 2. Dosage of fentanyl was 30 mcg/kg in group 1, 20 mcg/kg in group 2, and 8 mcg/kg in group 3. As compared to group 1 and group 2, it was significantly decreased in group 3 (p<0.05). 3. Systolic blood pressures before tracheal intubation in gmup 2 and group 3 significantly decreased as compared to the level of preinduction(p<0.05), 4. Diastolic blood pressure before tracheal intubation in group 3 significantly decreased as compared to the level of preinduction(p<0.05). 5. Mean arterial blood pressure before tracheal intubation in group 2 and group 3 significantly decreased as compared to the level of preinduction(p<0.05). 6. There was no significant change in heart rate. 7. Rate pressure product before tracheal intubation in group 3 significantly decreased as compared to the level of preinduction and rate pressure product after tracheal intubation in group 1 significantly increased as compared to the level of preinduction(p<0.05). Considering above results, it is difficult to choose specific anesthetics and methods for the induction of open heart surgery. It depend on the patients cardiovascular function and physicians experience and their preference. Meticulous observation and continuous monitoring of cardiovascular response are very important when intravenous anesthetics are used with fentanyl.
Anesthesia ; Anesthetics ; Anesthetics, Intravenous ; Arterial Pressure ; Blood Pressure ; Cardiovascular Diseases ; Cardiovascular System ; Fentanyl ; Heart Rate ; Heart* ; Humans ; Intubation ; Tachycardia ; Thiopental ; Thoracic Surgery* ; Unconsciousness*

BACKGROUND: During total hip arthroplasty, replacement of a substantial amount of blood loss is necessary. The adverse effects of homologous blood transfusion have been documented consequently and the intraaperative autotransfusion has attracted considerable interest. The authors have attempted to reduce the amount of the homologous blood transfusion by inducing hypotension and autotransfusion. METHODS: Twenty patients who underwent revision total hip arthroplasty were divided into two groups. Group1 received homologous blood perioperatively. Group2 was transfused with predonated autologous blood and intraoperative salvage technique with Cell Saver apparatus, were used along with sodium nitroprusside for hypotensive anesthesia to decrease intraoperative bleeding. We observed the amount of blood loss and transfused blood, and hematologic laboratory data, and complications. RESULTS: The mean requirement for transfusion was 3080 ml in group1 and 1289 ml in group2. In the level of the hematocrit, there was a significant smaller hematocrit drop (8%) over the first two postoperative days in group2I. There were no complications such as disseminated intravascular coagulopathy, severe thrombocytopenia, microemboli, and nephrotoxicity. CONCLUSIONS: The autologous transfusion and induced hypotension in the total hip arthroplasty is thought to be an effective method to reduce the amount of homologous blood transfusion.
Anesthesia ; Arthroplasty, Replacement, Hip ; Blood Pressure ; Blood Transfusion ; Blood Transfusion, Autologous* ; Hematocrit ; Hemorrhage ; Hip* ; Humans ; Hypotension* ; Nitroprusside ; Orthopedics ; Thrombocytopenia