BACKGROUND: Lidocaine or verapamil are used as an antiarrhythmic agent or agent blunting the cardiovascular changes induced by intubation or extubation during anesthesia. After recovery from general anesthesia with muscle relaxants, most patients remained in a residual paralytic state, hence it might develop easily recurarization by factors that affect neuromuscular transmission. Lidocaine and verapamil are well known as agents to potentiate the neuromuscular block. We investigated the effects of lidocaine or verapamil on neuromuscular transmission in vitro. METHODS: Square wave, 0.2 ms duration at a frequency of 0.1 Hz supramaximal or train of four stimuli was applied and the twitch height response was recorded mechanomyographically on rat phrenic nerve hemidiaphragm preparations. Dose responses of rocuronium, lidocaine, verapamil, rocuronium pretreated with lidocaine or verapamil, lidocaine pretreated with rocuronium, and verapamil pretreated with rocuronium were observed by cumulative method, and effective doses (Lag dose, ED50 and ED95) between a pretreated and nonpretreated agent were compared statistically. TOF ratios were observed at 80, 70, 40 and 30% of the control twitch height value during the observation of dose responses. RESULTS: Lag dose, ED50 and ED95 of rocuronium were reduced significantly after pretreatment of lidocaine, verapamil or their mixture, and the dose response of lidocaine, verapamil or their mixture were also reduced significantly by rocuronium pretreatment. TOF ratios at the point of each twitch height decreased significantly after pretreatment. CONCLUSIONS: Lidocaine or verapamil itself did not affect the neuromuscular transmission but might have potentiated the neuromuscular blocking effect induced by rocuronium. However, in excessive doses, these agents produced neuromuscular blockade. Consequently, in the residual neuromuscular block induced by rocuronium, lidocaine or verapamil may enhance recurarization.
Anesthesia ; Anesthesia, General ; Animals ; Humans ; Intubation ; Lidocaine* ; Neuromuscular Blockade* ; Phrenic Nerve ; Rats ; Verapamil*

BACKGROUND: The train-of-four(TOF) fade known as expression of prejuntional receptor binding was useful for evaluating the residual neuromuscular blockade(NMB). The present study was undertaken to investigate the effect of the neostigmine(Neo) on TOF ratio during the recovery from vecuronium(V) or atracurium(A) induced NMB under the general anesthesia. METHODS: Forty healthy adult patients were randomly divided into 4 groups as follows; spontaneous recovery from V-induced NMB(V-C group) or A-induced NMB(A-C group), reversed recovery with Neo at 20% recovery of control first twitch height(T) from V-induced NMB(V-R group) or A-induced NMB(A-R group). TOF ratio at 25 and 75% recovery of T and recovery index(RI) defined as time from 25 to 75% recovery of T were measured. RESULTS: TOF ratios at 25 and 75% recovery of T were 3.7 & 35.8%(V-C group), 8.4 & 46.9%(A-C group), 3.7 & 48.7%(V-R group) and 15.2 & 55.6%(A-R group) respectively(P>0.05). RI were 19.2 min(V-C group), 19.5 min(A-C group), 3.5 min(V-R group), and 5.6 min(A-R group) respectively (P<0.05). CONCLUSIONS: RI were significantly shortened in reversed recovery groups with Neo than spontaneous recovery groups (P<0.05). However TOF ratio at 75% recovery of T1 were not significantly different between spontaneous recovery and reversed recovery groups.
Adult ; Anesthesia, General ; Atracurium ; Humans ; Neostigmine* ; Neuromuscular Blockade* ; Vecuronium Bromide

OBJECTIVE: The aim of this study is the determination the value of early decompressive craniectomy in patients with severe cerebral edema. METHODS: We prospectively studied 23 consecutive patients with severe cerebral edema received decompressive craniectomy from July 1999 to March 2001. The indication for decompression was the progressive therapy-resistant intracranial hypertension and edema in patients with clinically and radiologically poor condition. We analyzed the results(GCS score, GOS score) with the variables such as cause(trauma, aneurysmal rupture, infarction), dominant edema side, midline shift on CT scan(<10mm), dilating of pupils, preoperative GCS score(<8). RESULTS: The overall rate of good recovery(GOS score 4 or 5) who underwent craniectomy was 48%(11 of 23 patients), poor recovery(GOS score 2 or 3) was 30%(7 of 23 patients), and mortality rate was 22%(5 of 23 patients). All of survived patients had improved GCS score(mean 12.61) compared with the preoperative GCS score(mean 7.89). The pupilary dilatation was the only statistically significant factor (p<0.05). CONCLUSION: Our results provide favorable evidence that early decompressive craniectomy with duraplasty is effective in patients with progressive therapy-resistant cerebral edema. Early decompression may have an effect in preventing this secondary adverse effect, thus is considered in early cerebral edema.
Aneurysm ; Brain Edema* ; Decompression ; Decompressive Craniectomy* ; Dilatation ; Edema ; Humans ; Intracranial Hypertension ; Mortality ; Prospective Studies ; Pupil ; Rupture

BACKGROUND: The train of four (TOF) stimulation is valuable to study pharmacodynamics associated with the interaction between muscle relaxants and receptors in the neuromuscular junction. TOF fade expresses presynaptic effect diminished output of transmitters. The aim of this study was to examine differences in presynaptic effects of different relaxants by measuring the TOF ratio during the onset and offset of block. METHODS: Eighty four healthy adult patients of ASA grades I or II were included in the study. The muscle relaxants studied were vecuronium (0.08 mg/kg), atracurium (0.5 mg/kg), mivacurium (0.15 mg/kg), rocuronium (0.6 mg/kg) and succinylcholine (1.0 mg/kg, 0.1 mg/kg, 0.2 mg/kg, 0.4 mg/kg). The TOF ratios were measured at approximate height of first response in the TOF (T1) of 75, 50 and 25% during onset and offset. Especially its ratios were measured at first depress of T1 during onset and its corresponding T1 during offset following administration of subclinical doses of succinylcholine. RESULTS: In the non-depolarizing muscle relaxants, TOF fade is more evident during offset than onset (p<0.05). The extent of fade varies between muscle relaxants. The greatest TOF fade has been shown in rocuronium during onset. In the succinylcholine, the TOF fade is apparent during onset and related to doses given (p<0.05). However the significant TOF fade is not seen during offset. CONCLUSIONS: All muscle relaxants, including both depolarizing and nondepolarizing agent, have predominantly postsynaptic and presynaptic effects. Furthermore, the fact that moderate TOF fade after subclinical doses of succinylcholine occurred obviously during onset of block is possibly indicating a greater presynaptic receptor blocking action.
Adult ; Atracurium ; Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents* ; Neuromuscular Junction ; Neuromuscular Nondepolarizing Agents ; Receptors, Presynaptic ; Succinylcholine ; Vecuronium Bromide

In an attempt to relieve postoperative pain after lumbar epidural anesthesia, a small dose of morphine with lidocaine was administered into the lumbar epidural space. It is suggested that the morphine reaehed the subarachnoidal space and produced its effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior horn of the spinal cord. Epidural anesthesia was done in l25 cases from June 1979 through March 1980. These cases were divided into two groups (Control group and Morphine group). The Control group was 46 cases which were injected with 2% lidocaine, and the Morphine group was 79 cases which west injected with 2% lidocaine and morphine (3. 5~6. 5mg). 0.1% epinephrine 0.1mL was mixed to each 10ml of 2% lidocaine in all of both groups, The results of this study were as follows: 1) The cases complaining pain within 12 hours after epidural anesthesia were 36/46(78.2 %) in the Control group and 11/79(13.9%) in the Morphine group. 2) A variable single dose of morphine did not affect the duration of postoperative pain relief. 3) The time of recovery of spontaneous voiding was similar in Control and Morphine groups. Within 24 hours, spontaneous voiding was recovered in 34/46(73,9%) of the Control group and in 64/79(81.0%) of the Morphine group. 4) Blood pressure changed a little within 30 minutes after epidural anesthesia in both groups(56.5% in the Control group and 54.4% in the Morphine group). 5) Complications were similar in both groups except for nausea and vomiting, which occurred more in the Morphine group(8.9% & 7. 6) than in the control group (4.4% & none).
Anesthesia, Conduction* ; Anesthesia, Epidural ; Animals ; Blood Pressure ; Clinical Study* ; Epidural Space ; Epinephrine ; Horns ; Lidocaine ; Morphine* ; Nausea ; Pain, Postoperative* ; Receptors, Opioid ; Spinal Cord ; Substantia Gelatinosa ; Vomiting

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.
Atracurium ; Fasciculation ; Incidence ; Intubation ; Pancuronium ; Plasma ; Succinylcholine* ; Tubocurarine ; Vecuronium Bromide

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.
Atracurium ; Fasciculation ; Incidence ; Intubation ; Pancuronium ; Plasma ; Succinylcholine* ; Tubocurarine ; Vecuronium Bromide

Multiple primary brain tumors of different cell types are rare, accounting for 0.4% of all the primary brain tumors. Phakomatosis, irradiation, trauma and other factors have been associated with multiplicity of brain tumors. When these tumors are close or intermixed, the term "collision" has been used, and in these cases an explanation might be that one tumor stimulating the other. We report a patient with collision tumor of meningioma and anaplastic astrocytoma, who did not have a history of trauma, irradiation, or phakomatosis.
Astrocytoma* ; Brain Neoplasms ; Humans ; Meningioma* ; Neurocutaneous Syndromes

BACKGROUND: The reduction in the plasma cholinesterase (PChE) level results in slow to hydrolysis of succinylcholine (SCC) and mivacurium (MIV). The factors altering the level of the normal enzyme in human could be considered under the several conditions. We investigated in the present study whether the drugs induced decreases in normal PChE activity after administration of various muscle relaxants during anesthesia are evident and how these results should be influenced to the time course of neuromuscular blockade produced by SCC and MIV. METHODS: Young adult patients of ASA class I or II scheduled for elective surgery requiring muscle relaxation were premedicated and anesthesia was maintained with nitrous oxide in oxygen with increment of thiopentone or fentanyl as required. In the neuromuscular monitoring, surface electrodes were applied on the ulnar nerve at wrist. Supramaximal transcutaneous single twitch stimulation (1 Hz) during onset and 0.1 Hz during recovery of neuromuscular blockade induced by various muscle relaxants delivered by a peripheral nerve stimulator was applied. Twitch response of thumb adductor was measured mechanomyographically using 2 kg Load Cell Strain Gauge with thumb piece modification. Recordings were made on a Gould recorder. PChE levels were measured by the modified Garry method after induction of anesthesia and, at 3, 10, 20 and 30 min following administration of 2 x ED95 of pancuronium (PAN), vecuronium (VEC) and atracurium (ATR). Neuromuscular recordings were measured with onset time defined as lag time and manifest time, and recovery time defined as clinical duration, recovery index and total duration. RESULTS: The levels of PChE were significantly reduced after administration of PAN and VEC (p<0.05). Onset times were significantly shorten but recovery time in the group given MIV pretreated by small dose of PAN was significantly prolonged (p<0.05). And there were a evidence to prolong recovery time in the group pretreated by small dose of VEC but not significant. CONCLUSIONS: It is concluded that aminosteroidal derivative neuromuscular blocking agents have presumably evidence induced decreases in PChE activity rather than benzylisoquinolinium derivative neuromuscular blocking agents.
Anesthesia ; Atracurium ; Cholinesterases* ; Electrodes ; Fentanyl ; Humans ; Hydrolysis ; Muscle Relaxation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Nitrous Oxide ; Oxygen ; Pancuronium ; Peripheral Nerves ; Plasma* ; Succinylcholine ; Thiopental ; Thumb ; Ulnar Nerve ; Vecuronium Bromide ; Wrist ; Young Adult

Recently, since muscle relxants has been used routinely, it is very important to understand the state of muscle relaxation during and after anethesia for safe anesthesia. But it is difficult that all patients have the opportunity to be helped by the auto-recording neuromuscular monitor, because of high in price. Therefore, many anesthesiologists have been using the simple tactile neuromuscular monitor for the evaluation of muscle relaxation, but there are many difference to evaluate for the reponse of muscle contraction by tactile or visual sensation. This study was designed to investigate the method of recording on the response of nerve stimulation from simple tactile neuromuscular monitor. The pressure generated from moving of thumb connected with finger ring lock syringe by ulnar nerve stimulation was transmitted to the invasive blood pressure monitor through the arterial pressure transducer. As a result, this method could record the response of single twitch stimulation, train-of-four stimulation, tetanic stimulation, post-tetanic count and double-burst stimulation displaying in the invasive blood pressure monitor, and was exellent in recording compared with auto-record- ing neuromuscular monitor.
Anesthesia ; Arterial Pressure ; Blood Pressure Monitors ; Fingers ; Humans ; Muscle Contraction ; Muscle Relaxation ; Sensation ; Syringes ; Thumb ; Transducers ; Ulnar Nerve