No abstract available.
Hypertension, Portal*

BACKGROUND: To estimate real time concentration of drugs during TIVA is theoretical, but it is not easy and inefficient. To maintain designed target concentration with continuous infusion using methods that account for the multicompartmental pharmacokinetic profile of fentanyl, isoconcentration nomogram is one of the methods. We evaluated the clinical usefulness of the isoconcentration nomogram using two different expected concentration of fentanyl. METHODS: Thirty ASA class I or II adult patients scheduled for spine fusion were randomly allocated into two groups according to 1.5 or 3 ng/ml of expected fentanyl concentration. Using isoconcentration nomogram, fentanyl concentration was adjusted and the propofol concentration was fixed to 3.5 g/ml according to Prys-Roberts method. Vital signs were titrated using variable flow rate of propofol. Fentanyl and propofol were discontinued 15 min before the end of operation. And, IV-PCA using fentanyl were applicated for postoperative pain control. The dosage of propofol and fentanyl, recovery time of consciousness and orientation were checked. Also, first buttoning time and 24hr fentanyl dosage in IV-PCA were checked. RESULTS: Average flow rate of propofol used were 7.5 1.2 mg/kg/hr in group 1, 5.7 1.1 mg/kg/hr in group 2 which was significantly lower than group 1 (p<0.05). Spontaneous eye opening and recovery of orientation was delayed 1.8 times in group 2. First buttoning time and 24hr fentanyl requirement for postoperative pain control using IV-PCA was delayed by 2 and decreased 60% in group 2, respectively. CONCLUSIONS: Isoconcentration nomogram was useful tool to control the expected concentration of fentanyl during TIVA and postoperative pain control using fentanyl IV-PCA.
Adult ; Anesthesia, Intravenous* ; Anesthetics ; Consciousness ; Fentanyl* ; Humans ; Nomograms* ; Pain, Postoperative ; Propofol ; Spine ; Vital Signs

BACKGROUND: Induction of anesthesia with propofol commonly associated with reduction in systemic arterial pressure, especially in elderly and high risk patients. This reduction is influenced by the dose and rate of propofol injection. The aim of this study was to examine the effect of different injection rate of propofol on vital signs, dose requirement and induction time during induction period. METHODS: Unpremedicated one hundred and twenty ASA physical status I and II patients aged 20~60 years scheduled for elective surgery were randomly allocated into one of four (150, 300, 600, 1200 ml/hr) groups according to speed of injection of propofol during induction period. Loss of verbal contact was taken as the end-point of induction. Vital signs, SpO2, dose requirement of propofol and induction time were checked. RESULTS: As the injection rate of propofol became slower, there were significant reduction in induction dose and increase in induction time (p<0.05). For example, induction dose and time were 1.82 mg/kg, 223 +/- 58 sec in 150 ml/hr group and 3.14 mg/kg, 50 +/- 11 sec in 1200 ml/hr group, respectively. Also, decrease in systolic and diastolic pressure were less marked at lower injection rates. CONCLUSIONS: Slower injection of propofol produces less vital sign changes and dose requirement for the induction of anesthesia.
Aged ; Anesthesia* ; Arterial Pressure ; Blood Pressure ; Humans ; Propofol* ; Vital Signs*

BACKGROUND: Propofol is a useful induction agent, but it can cause hypotention and bradycardia. Meanwhile, ephedrine has alpha-vasoconstriction and beta-cardiac stimulant effect. The purpose of this study was to assess the hemodynamic effects of adding various doses of ephedrine to propofol to obtund adverse hemodynamic response and to determine the optimal dose. METHODS: Unpremedicated 120 ASA physical status I adult patients (20~50yrs) scheduled for elective surgery were randomly allocated into four groups according to the doses of ephedrine added to propofol (1%, 20 ml). Group 1 (control group) was given propofol alone and 10, 15 and 20 mg of ephedrine was added to propofol in Group 2, 3 and 4, respectively (n=30 for each group). Propofol was loaded at 150 ml/hr using a syringe pump and no response to verbal command was ascertained as the end-point of induction. Vital signs and SpO2 were checked every 1 min during the induction period. RESULTS: In group 1, there was a significant decrease in both systolic and diastolic pressure prior to intubation. Group 2 and 3 showed relatively stable hemodynamic changes and significant systolic or diastolic changes occured only in the pre or post 1 min periods of intubation. But, in pulse rate, group 3 showed significant change 1 and 2 min after intubation, in contrary to group 2. Group 4 showed significant changes in systolic and diastolic pressure 1 and 2 min after intubation, and in pulse rate throughout the postintubation period. CONCLUSIONS: Ephedrine 10mg may be safely employed to reduce the hemodynamic changes during induction preiod with propofol.
Adult ; Anesthesia* ; Blood Pressure ; Bradycardia ; Ephedrine* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Propofol* ; Syringes ; Vital Signs

BACKGROUND: Because of wide individual variations in response to sedative and the level of sedation desired by different patients, inadequate sedation is frequent during surgery. Patient-controlled sedation is a logical extension of patient-controlled analgesia to find and maintain their own steady-state of sedation by self-administration of sedatives during surgery. The purpose of this study was to evaluate the feasibility of patient-controlled sedation compared with anesthesiologist-controlled sedation during surgical spinal anesthesia. METHODS: Unpremedicated forty adult patients who received spinal anesthesia for lower extremity surgery were randomly allocated into two groups (n=20 for each group). After selection of target state of sedation according to sedation scale, patient-controlled sedation (PCS) group self-administered 0.5 mg (1 ml) intravenous midazolam in increments using a Walkmed PCA infusor and anesthesiologist- controlled sedation (ACS) group administered by the anesthesiologist as the same manner to achieve previously selected sedation state. Sedation score, vital signs, SpO2 were checked 5, 10, 20, 30, 40min after start of drug injection. RESULTS: The sedation scores patient desired were 4.4 +/- 0.8 in PCS group and 4.3 +/- 0.7 in ACS group. These scores were achieved 20min after start of injection in PCS group and 40 min in ACS grou p (p<0.05). Degree of satisfaction was higher in PCS group compared with ACS group (1.5 +/- 0.6 vs 2.1 +/- 0.8, p<0.05). No complications were detected in two groups. CONCLUSIONS: PCS using midazolam was better than ACS in terms of early achievement of sedation state patient desired and degree of satisfaction.
Adult ; Analgesia, Patient-Controlled ; Anesthesia, Spinal ; Humans ; Hypnotics and Sedatives ; Infusion Pumps ; Logic ; Lower Extremity ; Midazolam* ; Passive Cutaneous Anaphylaxis ; Vital Signs

BACKGROUND: In TIVA, it was controversy which was more appropriate to increase the concentration of the analgesic or of the hypnotic according to the intensity of the surgical stimulus. We used preset infusion dose of propofol and fentanyl mixed with pancuronium through a single syringe for expected better control of hemodynamics. METHODS: Vital signs and recovery scores were observed in thirty patients undergoing total abdominal hysterectomy using one-syringe TIVA in which we used premixed fentanyl(150mcg), propofol(450mg) and pancuronium(2 mg) in one syringe. Induction of anesthesia was performed by injection of propofol 1.5~2 mg/kg, fentanyl 1.5~2 mcg/kg, pancuronium 0.1 mg/kg and ventilated with 100% oxygen after endotracheal intubation. Infusion was started by 1 ml/kg/hr of mixed solution immediately after intubation. If the vital sign changed more than 15% compared with preoperative value, flow rate either increased or decreased by 50%. If stable vital signs were maintained for more than 15 minutes, the flow rate decreased by 20% every 15 min, but were maintained above 0.5 ml/kg/hr. Two to four minutes before skin incision and peritoneal traction, an additional 10 ml of mixed solution was infused. Solution without fentanyl and pancuronium was infused after peritoneal closure for early recovery. Ten to fifteen minutes before the operation was completed, infusion was discontinued and neuromuscular block was reversed. RESULTS: Blood pressure and pulse rate were stable and did not significantly change even after intubation or peritoneal traction compared with preoperative value. And, recovery from anesthesia was prompt 15 min after extubation except 2 cases of respiratory depression. CONCLUSIONS: One-syringe TIVA may be an feasible alternative method to replace conventional multi-syringe TIVA.
Anesthesia ; Anesthesia, Intravenous* ; Blood Pressure ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Hysterectomy ; Intubation ; Intubation, Intratracheal ; Neuromuscular Blockade ; Oxygen ; Pancuronium ; Propofol ; Respiratory Insufficiency ; Skin ; Syringes* ; Traction ; Vital Signs

No abstract available.
Cyclosporine* ; Humans

No abstract available.
Biopsy* ; Child* ; Humans

No abstract available.
Animals* ; Brain* ; Hypothermia* ; In Situ Nick-End Labeling* ; Models, Animal*

OBJECTIVES: The dopamine-blocking effects and the associated side effects(amenorrhea, lactation, sexual dysfunct of classical antipsychotics in schizophrenic patients have been studied for a long time. The purpose of this study to find out these effects of new antipsychotics(risperidone, olanzapine) in schizophrenic patients treated with clinical relevant doses. METHOD: Plasma levels of both prolactin and testosterone were measured in 91 schizophrenic patients(28 taking haloperidol, 4-20mg/day ; 31 taking risperidone, 2-6mg/day/ 32 taking olanzapine, 5-20mg/day). RESULTS: In male schizophrenic patients, the prolactin levels of risperidone group(76.44+/-38.85ng/ml) and haloperidol group(60.26+/-20.74ng/ml) had no significant difference, but were significantly higher than that of olanzapine(26.90+/-5.36ng/ml). In female, the prolactin level of olanzapine group(36.66+/-17.55) was significantly lower than those of risperidone(121.7+/-.33) and haloperidol group(161.66+/-37.53). And prolactin level of risperdone group was lower than that of haloperidol group. While the testosterone plasma level of risperidone, haloperidol and olanzapine in both male and female schizophrenic patients had no significant difference. CONCLUSIONS: At doses known to be effective in popular clinical setting, prolactin level in patients taking risperidone we higher than that of haloperidol, while olanzapine showed no significant difference in terms of prolactin plasma level haloperidol. New antipsychotics may not influence the testosterone plasma level.
Antipsychotic Agents* ; Female ; Haloperidol ; Humans ; Lactation ; Male ; Plasma ; Prolactin* ; Risperidone ; Testosterone*