There are many reports that d-tubocurarine has marked species and individual variations in the matter of muscle relaxation. Therefore the dose-related neuromuscular blocking effect of d-tubocurarine was studied in anesthetized patients. Eighty adult patients were studied during halothane-N2O-O2 anesthesia for various kinds of surgery. These patients were in good physical shape, without known or suspected liver, kidney, neuromuscular or hormonal disease, and were not taking medication known to influence the action of relaxants. Preanesthetic medication consisted of atropine 0.01mg/kg and valium 0.18 mg/kg intramuscularly 60 minutes before anesthesia. Anesthesia was induced with thiopental 4~5mg/kg. Succinylcholine 1mg/kg was used to faciliate tracheal intubation. Moderate hyperventilation was maintained throughout by a mechanical ventilator and patient temperature was maintained at 35~36 degrees C during the study. Forty patients received a single intravenous d-tubocurarine 0.1mg/kg(group A) after the succinylcholine effect had worn off and the other forty patients received a single intravenous d-tubocurarine 0.2mg/kg(group B) after the succinylcholine effect had disappered. Prior to the administration of d-tubocurarine, the patient's forearm and hand were firmly fixed to a specially constructed metal armboard. The thumb was abducted, fixed and connected to a electrical kymograph, Harvard apparatus. The ulnar nerve was stimulated at the wrist subcutaneous needle electrodes by means of supramaximal stimull from a peripheral nerve stimulator(model 91-M3, Emerson, USA). Square wave of "Train of Four" stimuli of 0.2msec duration were delivered at a frequency of 0.1Hz. The evoked twitch and tracing of the adductor muscle of the thumb was recorded continuously on a electrical kymograph. Upon recovery from the initial dose of succinylcholine, a stable baseline twitch tension was recorded for 15 minuts. At this point a single intravenous injection of d-tubocurarine, either 0.1mg/kg or 0.2mg/kg, was given. The data were plotted as onset time of twitch depression and percentage depression of twitch height and the recovery time of "Train of four" response were analysed in each group. The results were as follows: 1) In d-tubocurarine 0.1mg/kg group: the effect of d-tubocurarine was variable, ranging from no effect on twitch tension to abolition of the twitch response. Mean maximal twitch depression was 59.4%. Recovery index which showed more than 75% twitch depression was 39.9minutes. 2) In d-tubocurarine 0.2mg/kg group: the effect of d-tubocurarine obtained consistent and solid neuromuscular relaxation. Mean maximal twitch depression was 95.2%. Recovery index was 58.1 minutes.
Adult ; Male ; Female ; Humans

Lumbar ligimentum flava obtained from 21 patients of spinal stenosis and 10 patients who underwent surgery for vertebral fracture(control group) were studied with hematoxylin-eosin stain, Verhoff s elastic stain, and immunohistochemical stains for S-100 protein ad fibronectin. The chondroid metaplasia of ligamentum flavum found more frequently and widely in the group of spinal stenosis compared with control group. The elastic fibers were decreased in number and irregu- larly arranged at the bone attached area in the group of spinal stenosis. There was tendency to increase the amount of fibronectin in the stroma of the ligamentum flavum in the group of spinal stenosis. Above findings suggest that chondroid metaplasia and changes of the elastic fiber in the peripheral area of the ligamentum flavum are able to contribute the pathogenesis of spinal stenosis.
Coloring Agents ; Elastic Tissue ; Fibronectins ; Humans ; Ligamentum Flavum ; Metaplasia ; S100 Proteins ; Spinal Stenosis

No abstract available.

Pheochromocytoma are functioning tumors which arise in chromaffin tissue of adrenal gland. The signs and symptoms of pheothromocytoma results from the release of the highly potent amines, epinephrine and norepinephrine by the tumors. This tumor release both epinephrine and norepinephrine into the blood stream for distribution to distant sites of action. Circulating norepinephrine produces widespread vasoconstriction, causing increased peripheral resistance and resulting in increased systolic, diastolic and mean arterial pressures. The direct effect on the heart is to increase the rate and force of contraction. As important effect is the reduction of plasma volume caused by prolonged increases in circulating norepinephrine and epinephrine. These adrenergic aminess have prominet metabolic as well as hemodynamic effects. The increase oxygen consumption and elevation of blood glucose and lactic acid level caused by epinephrine are much more marked than the increase produced by comparable amounts of norepinephrine. Anesthetic management of pheochromocytoma should considered prevent serious alterations in blood pressure. So, We present the case of anesthetic management for pheochromocytoma which control of hypertensive crises by the use of a intravenous infusion of sodium nitroprusside.
Adrenal Glands ; Amines ; Arterial Pressure ; Blood Glucose ; Blood Pressure ; Epinephrine ; Heart ; Hemodynamics ; Infusions, Intravenous ; Lactic Acid ; Nitroprusside ; Norepinephrine ; Oxygen Consumption ; Pheochromocytoma* ; Plasma Volume ; Rivers ; Vascular Resistance ; Vasoconstriction

Sodium nitroprusside(SNP) and nitroglycerin(NTG) have been used as one of the adjuvants that can modify the hemodynamie changes during cross-clamping of thoraco-abdominal aortic surgery. Cardiovascular changes after cross-clamping of aorta were well studied, but the respiratory effects of cross-clamping of aorta were not well defined. And both vasodilators are known to increase the intrapulmonary shunt when administered during anesthesia. So we have evaluated the effects on the arterial oxygenation of combination therapy of SNP and NTG over single use of SNP during cross-clamping of aorta in 12 dogs which anesthetized by halothane. After completion of anesthesia and preparation for cross-clamping of aorta was done at 10 cm distal to left subclavian artery through thoracotomy at 6th intercostal space. In control group, no drug was administered. In SNP group(2.5ug/kg/min) and SNP+NTG group(8 pg/kg/min), the drugs were administered before and after cross-clamping of descending thoracic aorta in each group for 45 minutes. The hemodynamic parameters were measured before aortic eross-clamping and at 1, 15, 30, 45 minutes after aortic cross-clamping. Results were follows, 1) Arterial oxygen tensions were decreased significantly only at 45 minutes after cross-clamping of aorta in SNP+NTG group(P<0.05) and no significant difference between SNP group and SNP+NTG group. 2) Intrapulmonary shunt was increased significantly at l5 minutes after cross clamping in SNP+NTG group(P<0.05), but not significant difference between NTG group and SNP+NTG group. 3) PCWP was significantly decreased at 15, 30, 45 minutes after cross-clamping in SNP and SNP+NTG group compared to control group(P<0.05), but not significant difference between SNP group and SNP+NTG group. 4) PVR were decreased significantly at 15, 30 minutes after cross-clamping of aorta in SNP+ NTG group compared to control group(P<0.05). But there was no significant diffrence between SNP group and SNP+ NTG group. 5) CI were increased at 45 minutes after aortic cross-clamping in SNP group and at 15, 30, 45 minutes after aortic cross-clamping in SNP+NTG groupg<0.05). But there was no significant difference between SNP and SNP+NTG group. These results showed that sodium nitroprusside did not affect the arterial oxygenation during cross-clamping of thoracic aorta and combination use of sodium nitroprusside and nitroglycerin had no additional risk of increasing arterial hypoxemia.
Anesthesia ; Animals ; Anoxia ; Aorta ; Aorta, Thoracic* ; Constriction* ; Dogs* ; Halothane ; Hemodynamics ; Nitroglycerin* ; Nitroprusside* ; Oxygen* ; Sodium* ; Subclavian Artery ; Thoracotomy ; Vasodilator Agents

Succinylcholine chloride is the most commonly used muscle relaxant. Its rapid onset of action and relatively brief duration are unique Despite its wide use, certain pharmacologic aspects of auccinylcholine chloride are not as widely appreciated as they should be. There is marked variation in the responses of patients to clinically used doses. Large doses demonstrate that recovery from succinylcholine chloride is slower than is generally appreciated in man. The dose related neuromuscular blocking effect of succinylcholine chloride in cats was investigated using a cat common peroneal nerve anterior tibial muscle preparation. All experimental cats tracheas were intubated through a tracheostomy under general anesthesia with Nembutal 40 mg/kg intravenously. Respiration was controlled by a Harvard animal respirator. The body temperature was kept at 35~37 degrees C by a thermoblanket. The degree of neuromuscular block following intravenous succinylcholine chloride, 0.5 mg/kg and 1 mg/kg, were measured by single twitch response. The common peroneal nerve was stimulated supramaximally by a single stimulus with square waves, 0. 2 msec duration and at a frequency of 0.1 Hz. The ratio of the twitch height was calculated. The results were as follows: 1) The time of neuromuscular blokade to 100% depression was 30.7 sec and to l00% spontaneous recovery was 1,260 sec (21 min.) in the succinylcholine chloride 0.5 mg/kg intravenous group. The recovery index was 258. 5 sec (4. 3 min.). 2) The time of neuromuscular blockade to 100% depression was 30 sec and to 100% spontaneous recovery was 2,004 sec (33. 4 min.) in the succinylcholine chloride I mg/kg intravenous group. No significant time difference was observed in neuromuscular depression in both groups but spontaneous recovery time was markedly prolonged to 744 sec (59% prolongation). The recovery index was also prolonged to 474 sec (83% prolongation).
Anesthesia, General ; Animals ; Body Temperature ; Cats* ; Depression ; Humans ; Muscle, Skeletal ; Neuromuscular Blockade* ; Pentobarbital ; Peroneal Nerve ; Respiration ; Succinylcholine* ; Trachea ; Tracheostomy ; Ventilators, Mechanical

The use of opioids for chronic noncancer pain has increased in recent years, although evidence for its long-term effectiveness is weak and its potential for harm is significant. Most reports suggest that chronic opioid therapy can be effective for the reduction of chronic pain and for the improvement of functioning and health-related quality of life. However, opioids are also associated with potentially serious harm including pharmacologic adverse effects and socioeconomic problems such as abuse, addiction, and diversion. Physicians should use a structured approach that includes a biopsychosocial evaluation and treatment plan that encourages patients to reach functional goals. There should be a comprehensive evaluation of the cause of pain, assessment for risk of opioid complications (including misuse and addiction), and a detailed treatment history including a review of medical records. Regular monitoring for safety and effectiveness is essential including regular checking of functional improvement and progress towards the pretreatment goals. Ineffective or unsafe opioid therapy should be promptly tapered or stopped. In Korea until now, there are no adequate recommendations for opioid prescription in the management of chronic noncancer pain. A Korean guideline or task force team should be established to provide personalized treatment for carefully selected and monitored patients.
Advisory Committees ; Analgesics, Opioid ; Behavior, Addictive ; Chronic Pain ; Humans ; Korea ; Medical Records ; Prescriptions ; Quality of Life

BACKGROUND: Inhalation anesthetics are known to be bronchodilators. However there are several reports that these effects are not consistant, and depend on the way of experiments. Some reports showed that inhalation anesthetics don't affect broncheal smooth mucle contraction. So, we tried to evaluate the effects of inhalation anesthetics on the histamine induced contraction of broncheal smooth muscles in rabbits. METHODS: Isolated broncheal rings of rabbit were suspended in a Tyrode's solution. Contractions were recorded isometrically using a transducer. Cumulative dose responses of histamine (10(-6), 10(-5) & 10(-4) Mol, histamine group) were observed and also cumulative dose responses of histamine with halothane and enflurane administration (0.5 MAC & 1 MAC) were evaluated. RESULTS: A contraction by histamine was weakened with enflurane administration, but with halothane, the contraction was slightly weakened at 0.5 MAC and no changes were observed at 1.0 MAC compared to a contraction induced by histamine. CONCLUSIONS: At 0.5 MAC of halothane, a contraction induced by histamine was slightly weakened, but at 1 MAC, no changes of contraction occurred. However enflurane weakened the contraction at 0.5 MAC and 1 MAC. It showed that in vitro studies of the direct effect of inhalation anesthetics on smooth muscle contraction are different from the results of in vivo study reports.
Anesthetics, Inhalation ; Bronchodilator Agents ; Enflurane* ; Halothane* ; Histamine* ; Muscle, Smooth* ; Rabbits* ; Transducers

No abstract available.
Arthroplasty, Replacement, Hip*

Nonunion of fractures of forearm bone occurs frequently. These patients usually suffer from pain and functional disturbance of the hand and forearm. With the introduction of compression plate for the treatment of nonunion at the Campbell Clinic in 1959, a modification of the Nicoll graft was advised. The authors analysed 23 cases of the nonunion of forearm bone, in which military injured patients were admitted and treated by bone graft with internal fixation using various devices in Department of Orthopaedic Surgery of Korea Veterans Hospital from Sep. 1983 to Aug. 1988.
Forearm ; Hand ; Hospitals, Veterans ; Humans ; Korea ; Military Personnel ; Transplants