Background: The major complications of spinal anesthesia are hypotension and bradycardia. In normal condition, hypotension stimulates baroreceptor reflex and compensatory tachycardia is occured. But during spinal anesthesia, there is possibility of a blockade of cardiac sympathetic nerve fibers which would result in increased vagal tone and depress compensatory baroreceptor reflex which is activated during hypotension. Atropine is an anticholinergic agent whose predominant cardiovascular effect was known as increasing heart rate at clinical dose. The purpose of this study was to evaluate hemodynamic effect of atropine during spinal anesthesia. Methods: We compared heart rate, systolic, diastolic and mean arterial pressures and cardiac output in 26 patients of ASA physical status 1, 2 before and after intravenous injection of atropine sulfate 0.01 mg/Kg during spinal anesthesia. Hemodynamic parameters were measured just prior to and 1, 2, 3, 4, 5, 10 minutes after atropine sulfate intravenous injection. The data were analyzed by repeated measures ANOVA. Results: Heart rate, mean blood pressure and diastolic blood pressure after atropine sulfate injection increased with significance. Conclusion: These findings suggest that during spinal anesthesia atropine is effective to produce tachycardia with a dosage of 0.01 mg/Kg in humans. Also hypotension might be improved because atropine makes mean blood pressure and diastolic blood pressure increase.
Anesthesia, Spinal* ; Arterial Pressure ; Atropine* ; Baroreflex ; Blood Pressure ; Bradycardia ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Injections, Intravenous ; Nerve Fibers ; Tachycardia

BACKGROUND: The prolonging effects of oral clonidine premedication on spinal anesthesia are known. We hypothesized that intravenous clonidine might have the same effect even if administered after an intrathecal local anesthetics injection. METHODS: To assess the prolonging effect of intravenous clonidine on spinal anesthesia, we designed a double-blinded, placebo-controlled, prospective study. Patients scheduled for orthopedic surgery were studied. All patients received 12 mg of hyperbaric bupivacaine intrathecally and were allocated to three groups. Group 1 (n = 26) was the control. Group 2 (n = 26) and Group 3 (n = 26) received 3mug/kg intravenous clonidine at the same time and 50 minutes after intrathecal hyperbaric bupivacaine injection. Sensory block was evaluated by pinprick and the duration was defined as the time needed for regression to L1 dermatome. Duration of motor blockade was defined as the time needed for recovery of knee flexion. RESULTS: The duration of sensory block was longer in Group 2 (196+/-42 minutes) and 3 (179+/-41 minutes) than Group 1 (125+/-25 minutes). The Duration of motor blockade was longer in Group 2 (153+/-26 minutes) than Group 1 (131+/-29 minutes). The lowest heart rate and mean blood pressure were not different among the groups. CONCLUSIONS: Intravenous clonidine after an intrathecal hyperbaric bupivacaine injection prolonged spinal anesthesia without added complications.
Anesthesia, Spinal* ; Anesthetics, Local ; Blood Pressure ; Bupivacaine* ; Clonidine* ; Heart Rate ; Humans ; Knee ; Orthopedics ; Premedication ; Prospective Studies

BACKGROUND: The administration of low dose heparin and dextran therapy in patients with arterial bypass surgery is thought to prevent thrombosis and graft occlusion. The purpose of this study was to evaluate the effectiveness of low dose heparin and dextran in atherosclerosis patients presenting hypercoagulability. METHODS: Whole blood coagulation was evaluated using thrombelastography and standard coagulation testing before and a day after surgery in nine atherosclerotic patients and nine control patients. Heparin 5000 U and dextran 500 ml were administrated in atherosclerotic patients during their operations. RESULTS: Atherosclerotic patients showed higher maximal amplitude compared to the control patients during preoperative thrombelastography. After surgery atherosclerotic patients revealed no significant change, but the control group became more hypercoagulable in status compared to the preoperative period. CONCLUSIONS: Intravenous heparin and dextran prevented postoperative change to a more hypercoagulable state than the preoperative status in atherosclerotic patients undergoing arterial bypass surgery.
Anticoagulants ; Arteriosclerosis Obliterans* ; Arteriosclerosis* ; Atherosclerosis ; Blood Coagulation ; Dextrans* ; Heparin* ; Humans ; Preoperative Period ; Thrombelastography ; Thrombophilia ; Thrombosis ; Transplants

An endotracheal tube (ETT) may be thought of as a mechanical burden to a spontaneously breathing patient because increases in airway resistance might result in increases in the work of breathing,when diameter of airway is decreased in the intubated patient compared with his own tracheal diameter. We hypothesized that air removal from ETT cuff would permit the airflow between ETT and tracheal wall and could make the airway resistance decrease. Postanesthetic patients after abdominal surgery were divided into two groups. ETT cuff was inflated in group 1 (n=25) and deflated in group 2 (n=25), while 5 l/min of oxygen was delivered through the ETT via a simple oxygen supplement device without a gas reservoir. The effects of balloon on gas exchange and respiratory pattern were evaluated at 5 and 30 minutes after admission to the recovery room. Postanesthetic PaO2 was increased compared to preanesthetic value with oxygen supply. PaCO2 values revealed no significant changes in preanesthetic and postanesthetic periods. Postanesthetic respiratory rate was increased significantly but there was no difference between two groups. However, there were three hypoxemic patients whose PaO2 were below 70mmHg in group 1. It was concluded that the use of balloon of ETT in postanesthetic recovery period might contribute to airway resistance and the work of breathing. Although almost of patients could make compensations to overcome the effects of balloon, there is a risk of postoperative hypoxemia if compensated inadequately.
Airway Resistance ; Anoxia ; Humans ; Oil and Gas Fields ; Oxygen ; Recovery Room ; Respiration ; Respiratory Rate ; Work of Breathing

Although the endotracheal intubation using laryngoscope can usually be performed under general anesthesia, it may be very difficult in situations such as head and neck trauma, hemorrage, or deformity. Recently we performed antegrade fiberoptic nasotracheal intubation with a guide wire. A 15-month aged female child with mandibular fracture was scheduled for open reduction and internal fixation under general anesthesia. She was anticipated difficult intubation due to displacement of the fracture site. After induction of anesthesia, we passed an adult fiberoptic bronchoscope (O.D. 3.8 mm, LF-2, Olympus optical co, Japan) to vocal cord via right nostril. Then a guidewire was inserted through the suction port of bronchoscope, and bronchoscope was removed in a state of guidewire in situ. We slid the endotracheal tube over guidewire according to Seldinger's technique. We think that nasotracheal intubation using an adult fiberoptic bronchoscope and a guidewire is good for children under 2 years old who are expected the difficult intubation.
Adult ; Anesthesia ; Anesthesia, General ; Bronchoscopes* ; Child ; Child, Preschool ; Congenital Abnormalities ; Female ; Head ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes ; Mandibular Fractures* ; Neck ; Suction ; Vocal Cords

No abstract available.
Pulmonary Ventilation*

BACKGROUND: Cardiac patients undergoing open heart surgery usually require ventilatory support that involves ICU admission in the postoperative period. We tried to find out determinants of postoperative ventilatory support time. METHODS: We reviewed the medical records of 56 open heart surgery patients retrospectively in terms of their disease, preoperative physical status, age, post-bypass arterial oxygen tension/inspired oxygen fraction (PaO2/FIO2) ratio, number of inotropics used and searched the relationship between each factor and postoperative intubation time. RESULTS: None of the factors except the number of inotropics used had an significant influence on the postoperative intubation time. CONCLUSION: In open heart surgical patients their disease, preoperative physical status, age, postbypass PaO2/FIO2 ratio do not affect postoperative intubation time rather than number of inotropics used does.
Heart* ; Humans ; Intubation* ; Medical Records ; Oxygen ; Postoperative Period ; Retrospective Studies ; Thoracic Surgery*

BACKGROUND: Intermittent positive pressure is required to overcome pulmonary airway resistance during inspiration and to deliver an adequate tidal volume. Previous animal experiments have shown that mechanical ventilation may worsen the lung injury when high airway pressure and large tidal volume are required to achieve adequate ventilation and oxygenation. Many ventilatory strategies have been developed to minimize airway pressure increase for the less compliant lung. Intratracheal pulmonary ventilation (ITPV) was developed to allow a decrease in physiological dead space during mechanical ventilation. METHODS: Pressure controlled ventilation (PC) has been compared with hybrid ventilation (HV) which consists of PC and ITPV in 7 rabbits. A reverse thrust catheter (RTC) was introduced into an endotracheal tube (ETT) through an adapter and positioned just above the carina inside the ETT. Fresh gas flowed continuously along the gap between inner cannula and outer cap in the expiratory direction. Gas was intermittently re-directed into the lung as a tidal volume by a valve on the expiratory circuit with ventilatory mode of PC to make HV. Peak inspiratory pressure (PIP) and dead space (VD) at various respiratory rates (RR) of 20/min, 40/min, 80/min and 120/min were compared between PC and HV while maintaining normal PaCO2. RESULTS: The PIPs of PC were 12.4 +/- 3.4 cmH2O, 9.0 +/- 2.7 cmH2O, 8.8 +/- 2.7 cmH2O, and 7.6 +/- 2.5 cmH2O at RR of 20/min, 40/min, 80/min and 120/min, respectively. The PIPs of HV were 9.2 +/- 3.2 cmH2O, 6.2 +/- 1.7 cmH2O, 5.0 +/- 2.0 cmH2O, and 4.5 +/- 1.8 cmH2O at the same RR of 20/min, 40/min, 80/min and 120/min, respectively. The VDS of HV were lower than those of PC. CONCLUSION: It can be concluded that ITPV can be applied as a HV to minimize airway pressure under the setting of PC.
Airway Resistance ; Animal Experimentation ; Catheters ; Lung ; Lung Injury ; Oxygen ; Pulmonary Ventilation ; Rabbits* ; Respiration, Artificial ; Respiratory Rate ; Tidal Volume ; Ventilation*

A 46 years old woman developed a sudden transcalvarial brain herniation 1 hour after removal of a huge right frontal arteriovenous malformation intraoperatively. In spite of all possible anes- thesiologic resuscitative treatments, the brain swelling was not subsided. Resuscitative resection of the frontal lobe was done. The brain CT taken immediately postoperatively showed a large unsuspected epidural hematoma over the contralateral left temporal and occipital areas. This rare complication should be remembered during brain surgery if unexpected brain swelling occurs without apparent reasons after resection of arteriovenous malformation.
Arteriovenous Malformations ; Brain ; Brain Edema ; Craniotomy ; Female ; Frontal Lobe ; Hematoma* ; Humans ; Intracranial Arteriovenous Malformations* ; Middle Aged

The clinical syndrome of hyperammonemic encephalopathy is often encountered in the context of decompensated liver disease. Although it is rare in patients without hepatic disease, non-hepatic causes cannot be excluded. Anesthesiologists should be careful in choosing the anesthetic agent and perioperative management for hyperammonemic patients in order to avoid acute hyperammonemia and encephalopathy. We report successful general anesthesia during GDC (Guglielmi detachable coil) embolization for a large unruptured aneurysm in the right distal internal carotid artery in a female patient with hyperammonemic encephalopathy that was caused by a portal-systemic shunt.
Anesthesia ; Anesthesia, General ; Aneurysm ; Carotid Artery, Internal ; Female ; Hepatic Encephalopathy* ; Humans ; Hyperammonemia ; Intracranial Aneurysm* ; Liver Diseases