BACKGROUND: Coronary perfusion pressure(CPP) is the most important factor for the success of cardiopulmonary resuscitation(CPR). Therefore, CPP must be optimized during the resuscitation. The purpose of this study is to investigate the effects of isosorbide dinitrate(Isoket(R)) on CPP during CPR. METHODS: 10 Korean dogs were divided into two groups: Group I(N=5) was resuscitated with infusion of isosorbide dinitrate(1 microgram /kg/min) and Group II(N=5) was resuscitated without using isosorbide dinitrate. Following CPR, the heart rate(HR), blood pressure(BP), pulmonary capillary wedge pressure, cardiac output(CO), CPP and endocardial viability ratio(EVR) were measured repeatedly. RESULTS: The changes in HR were not significantly different between the two groups but systolic and diastolic BP, CO, CPP and EVR were well maintained in group 1. CONCLUSIONS: These results suggest that the usual dosage of isosorbide dinitrate is effective in improving CPP and EVR on CPR after impending cardiac arrest.
Animals ; Cardiopulmonary Resuscitation* ; Dogs ; Heart ; Heart Arrest ; Isosorbide Dinitrate ; Isosorbide* ; Perfusion* ; Pulmonary Wedge Pressure ; Resuscitation

Dialysis and transplantation are the only therapies available for patients with the end stage of renal diseases. Transplantation offers several distinct advantages; the trans-plantation patient has an opportunity of regaining normal kidney functions, he can avoid the recurrent and enervating need for twice weekly dialysis, dieary and fluid restrictions can be removed, anemia, bone disease and neuropathy may be rapidly reversed, growth may occur in children and the long term costs of treatment are substantially reduced. Since the initial report on anesthesia for renal transplantation from the peter Bent Brigham Hospital in 1962, anesthesia for kidney transplantation has been reviewed and discussed by many authors. This report is concerned with our clinical experience of 55 cases of anesthesia for living donor renal transplantations at Dong San Medical Center during the period between November 1982 and December 1987. The results are summarized as follow: 1) The age incidence of recipients was prevalent in the 3rd to 4th decade and the ratio of males to females was 37:18. 2) The age incidence of donors was prevalent in the 3rd to 4th decade and the ratio of males to females was 22:33. Of 55 cases, 30 cases involved a parent to child donor relationship, younger brother, elder and younger sister were donors in 18 cases and 6 cases were non-related. 3) The overall one and two year transplantation survivals were 91.9% and graft survivals were 87.2% and 75.9% respectively. 4) Succinylcholine and vecuronium were used for intubation and maintenance of muscle relaxation. 5) Lower concentrations of halothane and nitrous oxide were used as inhalation anesthetics in most, except in HBs Ag(+) patients. In hepatitis patients, enflurane were used.
Anemia ; Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Bone Diseases ; Child ; Dialysis ; Enflurane ; Female ; Graft Survival ; Halothane ; Hepatitis ; Humans ; Incidence ; Intubation ; Kidney ; Kidney Transplantation* ; Living Donors ; Male ; Muscle Relaxation ; Nitrous Oxide ; Parents ; Siblings ; Succinylcholine ; Tissue Donors ; Transplantation ; Vecuronium Bromide

Arytenoid cartilage dislocation is a very rare complication of endotracheal intubation. This change can occur as a result of compressing the cryco-arytenoid joint by inflated cuff of endotracheal tube. A 21-year old male, ASA physical status I with chronic otitis media underwent tympanoplasty with mastoidectomy. Anesthesia was induced with thiopental-succynylcholine and was maintained with nitrous oxide-oxygen-enflurane. On the first postoperative day, the patient complained of hoarseness, and on the second postoperative day, the right arytenoid was found dislocated under indirect laryngoscopy. Five days postoperatively, endoscopic reduction was performed under direct laryngoscopy, thereafter his symptom gradually disappeared.
Anesthesia ; Anesthesia, General* ; Arytenoid Cartilage ; Dislocations ; Hoarseness ; Humans ; Intubation, Intratracheal ; Joints ; Laryngoscopy ; Male ; Otitis Media ; Tympanoplasty ; Young Adult

This investigation was undertaken to examine the effect of nonrebreathing oxygen mask on arterial blood gas tension during epidural anesthesia. 35 patients who were undergone total hystrectomies were studied. After the induction of epidural anesthesia, thiopental 200 mg and Entobar 25 mg were intravenouly injected. 35 patients were divided into four groups i. e:group 1(n=9) with no oxygen mask (contol), group 2(n=12) with oxygen of 3L/min, group 3(n=8) with 4L/min, and group 4(n=6) with 5L/min through the non-rebreathing oxygen mask. Arterial blood samples were taken one hour after the start of surgery for the measurement of PaO2, PaCO2 and O2 sat. The results were as follows: 1) In control group, the mean value of PaO2, was 86.6(13.4) torr but two patients showed less than 70 torr. 2) In group 2, 3, 4, PaO2, and 02, sat increased significantly compared with the control group (P< 0.05). 3) PaO2, and 02, sat were not significantly different in connection with oxygen flow rates between group 2, 3, 4. 4) The changes of PaCO2, were not significant in comparison with the control group between group 2, 3, 4 but PaCO2, was above 45 torr in eleven patients due to respiratory depression. Non-rebreathing oxygen mask increased PaO2, significantly at the oxygen flow rates of 3-5 L/min. However, PaCO2 did not seem to be influenced by the oxygen flow rates but the minute ventilation. Therefore, we concluded that the most important thing we should do for CO2 accumulation is careful observation to the patients for respiratory depression and obstruction.
Anesthesia, Epidural* ; Humans ; Masks* ; Oxygen* ; Respiratory Insufficiency ; Thiopental ; Ventilation

This investigation was undertaken to examine the effect of nonrebreathing oxygen mask on arterial blood gas tension during epidural anesthesia. 35 patients who were undergone total hystrectomies were studied. After the induction of epidural anesthesia, thiopental 200 mg and Entobar 25 mg were intravenouly injected. 35 patients were divided into four groups i. e:group 1(n=9) with no oxygen mask (contol), group 2(n=12) with oxygen of 3L/min, group 3(n=8) with 4L/min, and group 4(n=6) with 5L/min through the non-rebreathing oxygen mask. Arterial blood samples were taken one hour after the start of surgery for the measurement of PaO2, PaCO2 and O2 sat. The results were as follows: 1) In control group, the mean value of PaO2, was 86.6(13.4) torr but two patients showed less than 70 torr. 2) In group 2, 3, 4, PaO2, and 02, sat increased significantly compared with the control group (P< 0.05). 3) PaO2, and 02, sat were not significantly different in connection with oxygen flow rates between group 2, 3, 4. 4) The changes of PaCO2, were not significant in comparison with the control group between group 2, 3, 4 but PaCO2, was above 45 torr in eleven patients due to respiratory depression. Non-rebreathing oxygen mask increased PaO2, significantly at the oxygen flow rates of 3-5 L/min. However, PaCO2 did not seem to be influenced by the oxygen flow rates but the minute ventilation. Therefore, we concluded that the most important thing we should do for CO2 accumulation is careful observation to the patients for respiratory depression and obstruction.
Anesthesia, Epidural* ; Humans ; Masks* ; Oxygen* ; Respiratory Insufficiency ; Thiopental ; Ventilation

BACKGROUND: This study examined hemodynamic variables, oxygen delivery, extraction, and consumption in response to acute progressive hypoxia and hypercarbia in the setting of apnea. METHODS: Apnea was induced in 9 healthy mongrel dogs by disconnecting animals from mechanical ventilation of 30 minutes with pure oxygen. Hemodynamic variables, oxygen transport, extraction, and consumption were rapidly and repeatedly measured using pulmonary arterial and arterial catheters until cardiac output was undetectable. RESULTS: The baseline PaO2, PaCO2, pH, base excess were 318 +/- 137 mm Hg, 36 +/- 3.5 mm Hg, 7.30 +/- 0.06, 6.81 +/- 2.65 mmol/l respectively. Hypercarbia and hypoxemia (76 +/- 33 mm Hg) was first noted at 1 and 4 minute respectively. Base excess was not changed. Indices of preload (PCWP and CVP) were increased early in the time course (p<0.05). In contrast, indices of afterload (SVR) increased later, just before cardiac decompensation began (p<0.05). No significant reduction of cardiac output, oxygen delivery, extraction, and consumption was detected just until abrupt cardiac decompensation started, 5 minute. CONCLUSIONS: These data suggest that the early increase in preload was primarily due to hypercarbia whereas the late increase in afterload was due to hypoxemia, but the main cause of acute cardiac decompensation was a critical decrease in arterial oxygen tension with some contribution of increased preload and afterload.
Animals ; Anoxia ; Apnea* ; Cardiac Output ; Catheters ; Dogs* ; Hemodynamics* ; Hydrogen-Ion Concentration ; Oxygen* ; Respiration, Artificial

Epidural anesthesia has been greatly substitued for spinal anetshesia because epidural aneshtesia can eliminate the most common and agonizing problems of headache and other neurologic sequelae resulting from spinal anesthesia. Many anesthetists are reluctant to give spinal anetshesia to the patients for gynecologic surgery because of the high incidence of postspinal headache in the middle age group of women. On the contrary, epidural anesthesia provides several advantages compared to spinal anetshesia such as eliminating complications of dural puncture and easy management of postoperative pain control. This investigation was primarily undertaken to observe the effectiveness of epidural anesthesia as well as postoperative pain controllability in gynecologic surgery. Out of total 526 cases who had gynecologic surgery, We had 275 cases (53%) who received epidural anesthesia during the last year. 2% lidocaine 400-500 mg, with 4 mg of morphine were used epidurally for total abdominal hysterectomies, ovarian cystectomies, and some cases of tuboplasty, and 2% lidocaine 300-400 mg, with 3 mg of morphine was used for vaginal hysterectomies. Continuous epidural anesthesia in association with general anesthesia was used for tubal anastomosis and radical hysterectomy, and 4 mg morphine was given through the catheter at the end of surgery. The results are as follows: 1) The duration of postoperative analgesic effect was 21.1+/-5.5 hours. 2) The adverse effects from epidural morphine administration showed 42 (15%) patients had nausea and/or vomiting and 58 (21%) patients had itching. 3) Complications of epidural anesthesia were dural puncture-4 cases (1.4%), convulsion-1 case (0.3%), backache-48 cases (17%), and hypotension-44 cases (16%). The results of this study suggest that epidural anesthesia with 3-4 mg of epidural morphine can be satisfactory for gynecologic surgery and postoperative pain control.
Anesthesia, Epidural* ; Anesthesia, General ; Anesthesia, Spinal ; Catheters ; Cystectomy ; Felodipine ; Female ; Gynecologic Surgical Procedures* ; Headache ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Incidence ; Lidocaine ; Middle Aged ; Morphine ; Nausea ; Pain, Postoperative* ; Pruritus ; Punctures ; Vomiting

Surgery represents a noxious stimulus to the body, which responds to the injury in the form of an endocrine metabolic reaction. This stress responsehas usually been considered to be a homeostatic defence mechanism by which the body protects itself against injury. This study was primarily undertaken to observe the modulation of stress response to the surgical stimuli under the effects of general and spinal anesthesia by measuring endogenous catecholamines. Fifteen pateints scheuled for elective surgical procedures on the lower half of the body were divided into two group: general and spinal anesthesia groups. No premedication was given to any patient. After the patient was laid down the surgical table, intravenous line was placed and secured in an antecuhital vein for maintenance of fluid and obtaining blood samples. After the intravenous cathether was inserted and a 10-minute rest period was allowed for reassurance, the first baseline sample was obtained for measurement of catecholamines and then anesthesia was induced. .General anesthesia group: Anesthesia in five patients was induced with sodium thiopental (5 mg/ kg), succinylcholine (1 mg/kg) followed by endotracheal intubation and was maintained with halothane, N2O and muscle relaxation using pancuronium. Spinal anesthesia group: Spinal anesthesia in ten patients was performed in a sitting position at L3-L4 intervertebral space using lidocaine 50-150 mg. The anesthesia level was determined by a pinprick test. Subsequent samples were obtained at 30 minutes after the surgical incision and in the recovery room at least 60 minutes after the discontiuation of inhalational anesthesia or after recovery of senastion and motor function of the lower extremites. Mean arterial pressure was measurd by a noninvasive automatic blood pressure monitor. Plasma epinephrine and norepinephrine were measured by Peuler and Johnson radioenzymatic method. The results are summerized as follows: Inhalation anesthesia group: Plasma norepinephrine was increased during surgery and epinephrine was increased during the postoperative recovery period. Spinal anesthesia group: Plasma norepinephrine and epinephrine were not increased during the intra and postoperative periods. High spinal anesthesia resulted in a suppression of both plasma norepinephrine, epinephrine with a fall of mean arterial pressure but no changes of norepinephrine, epinephrine, or mean arterial pressure were observed in the patients receiving low spinal anesthesia. There was a relationship between the sensory dermatome anesthesia level and changes of both plasma norepinephrine (r=0.748, P<0.01)and epinephrine (r=0.667, P<0.05). There is a relationship between changes of blood pressure and plasma norepinephrine levels during spinal anesthesia and inhalational anesthesia (r=0.827, p<0.01). The effect of spinal anesthesia on adrenergic tone depends on the level of anesthesia. The catecholamine responses to surgical stress were prevented by low spinal anesthesia which had no supression of efferent adrenergic tone. Therefore, low spinal anesthesia maybe useful to prevent adrenergic responses to surgical stress in high-risk patients scheduled for surgery on the lower half of the body.
Anesthesia* ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Spinal ; Arterial Pressure ; Blood Pressure ; Blood Pressure Monitors ; Catecholamines ; Epinephrine ; Halothane ; Humans ; Intubation, Intratracheal ; Lidocaine ; Muscle Relaxation ; Norepinephrine ; Pancuronium ; Plasma* ; Postoperative Period ; Premedication ; Recovery Room ; Sodium ; Succinylcholine ; Surgical Procedures, Elective ; Thiopental ; Veins

Background: Cardiac tamponade results in a hemodynamic disorder associated with decreased cardiac output and blood pressure. To improve cardiac output in a subject with cardiac tamponade, cardiotonic drugs and vasodilators with blood volume expander can be used. The purpose of this study was to observe the hemodynamic effects of cardiotonic drugs and vasodilators following administration of plasma expander in the dogs with cardiac tamponade. Method: Three groups of dogs were studied during the induced cardiac tamponade. Following infusion of pentastarch, group I received dobutamine by dripping of 10 microg/kg/min, followed by injection of 20 microg/kg/min, group II received hydralazine (20 mg, 40 mg) and group III received sodium nitroprusside (5 microg/kg/min, 10 microg/kg/min). The heart rate, blood pressure, cardiac output and pulmonary arterial occluded pressure were measured. The atrial transmural pressure was calculated by subtracting intrapericardial pressure from mean atrial pressure. Results: Cardiac output was increased in the groups I and II, but mean arterial pressure was increased in only the group I. Atrial transmural pressure was not changed in all three groups. Conclusion: The most pronounced hemodynamic improvements during the cardiac tamponade is observed in group I with pentastarch-dobutamine combination.
Animals ; Arterial Pressure ; Atrial Pressure ; Blood Pressure ; Blood Volume ; Cardiac Output ; Cardiac Tamponade* ; Cardiotonic Agents ; Dobutamine* ; Dogs* ; Heart Rate ; Hemodynamics* ; Hydralazine* ; Hydroxyethyl Starch Derivatives* ; Nitroprusside* ; Plasma ; Vasodilator Agents

Dural puncture in a well recognised complications of lumbar epidural anesthesia, as is extensive block after extradural injection of local anesthetic solutions in patients in whom the dura has been punctured. A healthy 43-year-old woman entered for trans-abdominal hysterectomy under lumbar epidural anesthesia. After an accidental dural puncture was noticed then the epidural puncture was reattempted at the same site and a catheter was inserted succesfully. An extensive segmental anesthesia along with hypotension and pupil dilatation developed about 45 minutes after the first injection of lidocain. Such extensive segmental anesthesia may be the result of injection into the subdural space. However, it was not confirmed in this case radiologically.
Adult ; Anesthesia ; Anesthesia, Epidural* ; Catheters ; Dilatation ; Female ; Humans ; Hypotension ; Hysterectomy ; Injections, Epidural ; Punctures ; Pupil ; Subdural Space