BACKGROUND: Hepatic dysfunction may occur after single, or more usually repeated, exposures to the halogenated inhaled anesthetics. The cause may be free radical snd metabolites of inhaled anesthetics, immune reaction and hypoxic damage by decreasing total flows. The purpose of this study is to evaluate postoperative liver function between the general anesthesia and the thoracic epidural blockade supplemented with the light general anesthesia. METHODS: Thirty patients were divided into two groups; 15 patients were aneshtetized with 2 vo1% of enflurane combined with nitrous oxide(2 I/min) and oxygen(1.5 l/min) in the general anesthesia group, and in 15 patients of the thoracic epidural blockade group thoracic epidural blockade with 2% lidocaine and light general anesthesia using nitrous oxide(2 l/min) and oxygen(1.5 l/min) were performed. Serum glutamic oxalacetic transaminase(SGOT), serum glutamic pyruvic transaminase(SGPT) and alkaline phosphatase were evaluated before anesthesia, 1, 3, 5 and 7 days after gastric surgery on both groups. RESULTS: In the general anesthesia group, postoperative SGOT levels were increased above normal range but were within normal limits in the thoracic epidural blockade group. SGPT level was increased above normal range on postoperative one day in the general anesthesia group but no increase of postoperative SGPT levels was observed in the thoracic epidural blockade group. On postoperative seven days the level of alkaline phosphatase was increased within normal range in the general anesthesia but in the thoracic epidural blockade group the levels of alkaline phosphatase were not increased. CONCLUSIONS: We consider that postoperative liver function is not influenced with thoracic epidural blockade supplemented with light general anesthesia for upper abdominal surgery.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Aspartate Aminotransferases ; Enflurane* ; Humans ; Lidocaine ; Liver* ; Reference Values

Between january 1, 1981 and December 31, 1986, 1,310 Cesarean sections (26.7%) were performed among 4,898 paturient women at St. Mary's pospital, Catholic Medical College. The perioperative condition of the newborns along with morbidity and mortality after Cesarean section wha analyzed. The incidencea of Cesarean sections between 1981 and 1986 were 25.0% 27 .6%, 23.4%, 29.5%, 31.2% and 27.1%, respectively. The anesthetic methods employed were inhalation anesthesia with thiopental sodium for induction and nitrous oxide-oxygen-halothane for maintenance of anesthesia. This study did net include the 76 cases of lumbar epidural or spinal technique performed during this Period. Based on one minute Apgar scores, 82 infants (6.26%) were assessed as moderately (score 4-6) depressed, and 44 infants (3.36%) were rated as severely (score 0~3) depressed. Twenty (45.5%) of the severely depressed newborns were promptly resuscitated and given ade- quate treatement, but 11 infants (25.0%) did not survive. The incidence of idiopathic respiratory distress syndrome (IRDS) in this study was 9 cases (0.79%) Ammong 7he total 1,310 cases; this induded 7 cases of premature birth or low birth weight and 2 cases of aspiration pneumonia. The mortality of the IRDS group was 4 of 9 cases (44.4%). Among the severely depressed group, the time from induction to delivery was five minutes in 8 case? (18.2%) , six to ten minutes in 22 cases (57.777) and more than 11 minutes in 14 cases (31.8%) . The pro7n7stic status of newborn babies was evaluated with respect to the anesthetic procedure and the outcome of deliveries by Cesarean sections performed between 1981 and 1986 at St. Mar's Hospital, Catholic Medical College, Seoul, Korea.
Anesthesia ; Anesthesia, Inhalation ; Cesarean Section* ; Female ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn* ; Korea ; Mortality ; Pneumonia, Aspiration ; Pregnancy ; Premature Birth ; Seoul ; Thiopental

Direct surgical repair of complex intracranial vascular lesions is difficult. Sometimes the neurosurgery is performed under circulatory arrest, profound hypothermia and barbiturates cerebral protection. Total ischemia is tolerated for 30~60 minutes because oxygen requirements of the brain decrease exponentially as body temperature is lowered. We experienced that this technique was successfully used for inoperable basilar artery aneurysm. We reviewed the surgical and anesthetic considerations of basilar artery aneurysm.
Aneurysm* ; Barbiturates ; Body Temperature ; Brain ; Hypothermia* ; Intracranial Aneurysm ; Ischemia ; Neurosurgery ; Oxygen

BACKGROUND: Epidural block is known to block sympathetic efferent nerve fiber, resulting in the decrease of catecholamine. We examined the effects of thoracic epidural block on DFT, neuroendocrine responses and hemodynamic changes in dogs. METHODS: Twenty one dogs were divided into three groups. The control group (N = 7) was anesthesized with only alpha-chloralose for general anesthesia, and a high thoracic epidural (T; N = 7) while the thoracolumbar epidural groups (TL; N = 7) were put under general anesthesia with high thoracic or thoracolumbar epidural blocks, respectively. The DFT was determined at 30 mins after surgical manipulation in the control group and at 10 mins after the epidural blocks in the two epidural groups. Four hemodynamic variables, catecholamine, cAMP and lactate were measured at 30 mins after the surgical manipulation (resting period), at 10 mins after epidural blocks and after defibrillation. RESULTS: 1) The DFT levels were significantly higher in the T (6.4 +/- 2.2 J) and TL groups (11.2 +/- 9.3 J) than in the control group (3.2 +/- 1.6 J)(P < 0.05). In the TL group, epinephrine-induced second DFT was lower (3.0 +/- 1.5 J) than the first DFT (11.2 +/- 9.3 J)(P < 0.05). 2) Catecholamine levels and hemodynamic variables including heart rate, mean arterial pressure, and cardiac output significantly decreased in the TL group compared with the control group after epidural block and defibrillation (P < 0.05). The DFT showed a significant correlation with plasma epinephrine levels after the epidural block (r = 0.56, P < 0.05). CONCLUSIONS: Our results show, an increase in transmyocardial DFT by the epidural block which may be caused by a decrease in catecholamine, especially epinephrine.
Anesthesia, General ; Animals ; Arterial Pressure ; Cardiac Output ; Chloralose ; Dogs* ; Epinephrine ; Heart Rate ; Hemodynamics ; Lactic Acid ; Nerve Fibers ; Plasma

BACKGROUND: This study was performed to evaluate the effects of pretreatment with intralipos on the cardiovascular toxicity caused by continuous intravenous infusion with bupivacaine. METHODS: Fourteen healthy white rabbits were selected for this study and divided into the control group (n = 7) (normal saline administered for 30 minutes) and the intralipos pretreated group (n = 7) (intralipos administered for 30 minutes). The cardiovascular toxic effect during the continuous intravenous infusion of bupivacaine was observed between the control and the intralipos group by meaning the changes in mean arterial pressure, heart rate and electrocardiogram. RESULTS: In intralipos group, mean arterial pressure significantly increased after intralipos infusion for 30 minutes as compared with the control values (P < 0.05). The time intervals for 25, 50, 75 and 100% decrease in mean arterial pressure and heart rate and the onset time of the first QRS modification and dysrhythmia during continuous intravenous infusion of bupivacaine were significantly prolonged in the intralipos group compared with the control group (P < 0.05). The time intervals for 100% decrease in heart rate after the stop of bupivacaine administration was significantly prolonged in the intralipos group compared with the control group (P < 0.05). CONCLUSIONS: The present study suggests that prophylactic intravenous infusion with intralipos prevents the cardiovascular toxicity caused by bupivacaine in rabbits.
Arterial Pressure ; Bupivacaine* ; Electrocardiography ; Heart Rate ; Infusions, Intravenous ; Rabbits*

BACKGROUND: Preoxygenation is routine prior to rapid sequence induction of general anesthesia for a cesarean section. The aim of this study was to evaluate the preoxygenation techniques of tidal volume breathing (TVB) and deep breathing (DB) for a cesarean section. METHODS: One hundred twenty ASA I and II patients scheduled for a cesarean section under general anesthesia participated in the study. Preoxygenation was performed with 5, 7, and 10 L/min 100% oxygen. The following techniques were tested: 1) normal TVB for a 5-min period (TVB/5 min) and 2) DB for a 2-min period (4 DB/0.5 min, 8 DB/min, 12 DB/1.5 min and 16 DB/2 min). Inspired (FIO2) and end-tidal oxygen fraction (FETO2), end-tidal carbon dioxide pressure (ETCO2) and oxygen saturation (SpO2) were measured at 0.5-min intervals. RESULTS: During TVB, FETO2 increased rapidly between 0.5 and 3.5 min and plateaued by 3.5 min at 78.5%, 83.3% and 90.8% with 5, 7 and 10 L/min 100% oxygen, respectively. Four DB/0.5 min increased FETO2 to 64.7%, 67.2% and 72.3% at 5, 7, and 10 L/min 100% oxygen, respectively. As compared with four DB/0.5 min, the values of FETO2 with TVB/1.5 min and TVB/2 min were high at 7, 10 and 5 L/min 100% oxygen. CONCLUSIONS: We concluded that TVB/2 min was more effective than four DB/0.5 min in achieving preoxygenation but eight DB/min could be used in case of an emergent operation.
Anesthesia, General ; Carbon Dioxide ; Cesarean Section* ; Female ; Humans ; Oxygen ; Pregnancy ; Respiration* ; Tidal Volume*

BACKGROUND: Tracheal intubation may be difficult in many patients with sleep apnea syndrome because of anatomical abnormalities in their upper airway. METHODS: For 30 patients with obstructive sleep apnea syndrome, we evaluated two classifications; Samsoon-Young and Cormack-Lehane, and five airway examinations; interincisors' distance on mouth opening (DI), angle on cervico-occipital extension (ACO), thyromental distance (TD), and existence of edentulous with atrophic mandible and prominent maxillary incisor. RESULTS: 20 patients (67%) belonged to class III or IV according to the Samsoon-Young classification and 22 patients (73%) to grade III or IV according to the Cormack-Lehane classification. The incidence rate for DI less than 40 mm, ACO less than 160o, TD less than 60 mm, atrophic mandible and prominent maxillary incisor were 30%, 37%, 50%, 13% and 27% respectively. CONCLUSIONS: According to our results, we concluded that most patients with obstructive sleep apnea syndrome are difficult for anesthesiologists to intubate. Therefore, we suggest that anesthesiologists must prepare variable methods for ventilation if there is any suspicion of difficult intubation in those patients.
Classification ; Humans ; Incidence ; Incisor ; Intubation ; Intubation, Intratracheal* ; Mandible ; Mouth ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Ventilation

BACKGROUND: The causes of hepatic dysfunction after exposures to the halogenated inhaled anesthetics may be free radical, metabolites of inhaled anesthetics, immune reaction and hypoxic damage by decreasing total hepatic blood flow. The present study was performed to comparison of estimated hepatic blood flow and systemic hemodynamic changes between the general anesthesia with enflurane and thoracic epidural anesthesia in rabbits. METHODS: In general anesthesia group with enflurane, anesthesia was performed with enflurane 2vol% and 100% oxygen for 60 minutes. In thoracic epidural anesthesia group, epidural block was done at T5 level with 0.4 ml/kg of 1% lidocaine. Hepatic blood flow was estimated by clearance of indocyanine green according to the constant infusion method before and 30, 60 minutes after anesthesia. Heart rate, mean arterial pressure, central venous pressure and splanchnic vascular resistance were measured at the same time in both groups. RESULTS: Heart rate was decreased significantly in thoracic epidural anesthesia group and mean arterial pressure and central venous pressure were decreased significantly in both groups at 30, 60 minutes. Hepatic blood flow was decreased at 30, 60 minutes in both groups. Splanchnic vascular resistance was increased significantly 30, 60 minutes in thoracic epidural anesthesia group. There were significant differences in mean arterial pressure and splanchnic vascular resistance between two groups. There was no difference in hepatic blood flow between two groups. CONCLUSIONS: The decreased hepatic blood flow was caused by decreased mean arterial pressure in general anesthesia group with enflurane and by increased splanchnic vascular resistance in thoracic epidural anesthesia group.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Arterial Pressure ; Central Venous Pressure ; Enflurane ; Heart Rate ; Hemodynamics* ; Indocyanine Green ; Lidocaine ; Oxygen ; Rabbits ; Vascular Resistance

The renin-angiotensin system plays an important role in maintaining blood pressure in various pathologic and physiologic states. To investigate the effects of the sodium nitroprusside (SNP)-induced hypotension on plasma renin activity and serum aldosterone level, SNP 2.0 mg/kg/min was infused to seven unanesthetized rabbits. The mean arterial pressure and heart rate were measured three times; at the start of, 15 and 30 minutes after SNP inusion and 30 minutes after the discontinuation of SNP infusion. The measurement of the plasma renin activity and the serum aldosterone levels during SNP infusion were done by means of radioimmunoassay. The results were as follows: 1) The mean arterial pressure was 117.6+/-6.9 mmHg at zero time ans decreased significantly to 84.0+/-19.6mmHg and 72.9+/-21.6mmHg at 15 and 30 minutes after SNP infusion, respectiely(P<0.01). 2) The heart rate was 124.8+/-9.3 beats/min at zero time and increased significantly to 139.7+/-6.4 beats/minute and 155.6+/-7.9 beats at 15 and 30 minutes after SNP infusion, respectively(P<0.05). 3) The plasma renin activity was 2.31+/-0.53 ng/ml/hr at zero time and increased significantly to 5.17+/-1.39 ng/ml/hr and 4.97+/-1.52 ng/ml/hr in 15 and 30 minutes after SNP infusion, respectively. 4) The serum aldosterone level was 28.8+/-13.5ng/dl at zero time and increased to 42.3+/-14.6ng/dl and 39.5+/-13.9ng/dl at 15 and 30 minutes after SNP infusion and it continued to increase up to 30 minutes after discontinuation of SNP infusion. In conclusion, it was postulated that the plasma renin activity and serum aldosterone level were closely related to the change of the mean arterial pressure and heart rate during SNP-induced hypotension.
Aldosterone* ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hypotension* ; Nitroprusside* ; Plasma* ; Rabbits ; Radioimmunoassay ; Renin* ; Renin-Angiotensin System ; Sodium*

BACKGROUND: Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is known to have analgesic properties in subanesthetic doses and has been used as an analgesic in the postoperative period by variable routes. The effect of adding ketamine to analgesia using intravenous PCA morphine was evaluated in 90 women after cesarean section. METHODS: Ninety parturients were randomly allocated to three groups and each group had 30 women. The parturients in group 1 were given analgesics of morphine only, group 2 were given analgesics of the 2 : 1 mixture of morphine and ketamine, and group 3 were given analgesics of the 1 : 1 mixture of morphine and ketamine. We evaluated the analgesic requirement, numerical rating pain score, side effects and patient's satisfaction. RESULTS: The morphine requirement in group 3 was significantly lower than that in groups 1 and 2 at 3, 6, 12, 24 and 48 hours postoperatively. The pain score in group 2 was lower than that in group 1 at 3 and 6 hours and the pain score in group 3 was lowest of all groups at 3 and 6 hours. The incidence of dizziness was higher in group 3 than in groups 1 or 2. CONCLUSIONS: We concluded that adding ketamine with morphine in using an intravenous PCA can decrease analgesic requirements and improve analgesic property.
Analgesia ; Analgesics ; Cesarean Section* ; Dizziness ; Female ; Humans ; Incidence ; Ketamine* ; Morphine* ; N-Methylaspartate ; Passive Cutaneous Anaphylaxis* ; Postoperative Period ; Pregnancy