The incidence of myocardial ischemia and silent myocardial infarction are higer in diabetic than in nondiabetic patients. We had a case of a disbetic, myocardial ischemic female patient, 54years old, who had cardiac arrest during an emergency surgery. The patient was admitted via emergency room with the diagnosis of rupture of basilar artery aneurysm. During the dissection for the exposure of the artery. The aneurysm ruptured. causing massive hemorrhage. At this time, cardiac arrest was revealed at the monitoring EKG, cardiopulmonary resuscitation with DC shock were performed to reverse venticular fibriliation but the EKG monitor showed T wave inversion and sinus tachycardia in several leads. And the blood pressure was hardly audible with systolic of about 50mmHg. So nitroglycerin 0.05mg, intravenous bolus injection was given twice and the systolic went up to 110mmHg with a diastolic of 80mmHg. So the operation proceeded and finished. The patient was sent to the ICU. On the third postoperative day, the patient again had cardiac arrest but this time could not be resuscitated. We experienced the dramatic effect of nitroglycerin on this ischemic patient during cardio pulmonary resuscitation and we would like to share this experience with our colleagues.
Aneurysm ; Arteries ; Blood Pressure ; Cardiopulmonary Resuscitation* ; Diagnosis ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Heart Arrest ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin* ; Rupture ; Shock ; Tachycardia, Sinus

No Abstract available.
Drug Interactions*

No abstract available.
Aged* ; Humans

No abstract available.
Hypertension*

BACKGROUND: A long-term objective is to understand the pathogenesis of neurologic injuries associated with cardiac surgery, cardiopulmonary bypass, and circulatory arrest. Our specific aims are to establish a dose of air which results in moderate to severe neurologic defects in normothermic (37degrees C) rabbits. METHODS: To first establish a dose of air which would cause unequivocal neurologic impairment, anesthetized rabbits received either 0, 50, 100 or 150 microgram l/kg of air into the internal carotid artery(n=5 in each group). One hour later, anesthesia was discontinued and animals were recovered. Animal were neurologically evaluated at 24 hours using a zero(normal) to 97(coma) point scale. RESULTS: There was a clear relationship between the dose of air injected and the severity of neurologic impairment at 24 hours, p=1.1x10(-7). Rabbits receiving 50 micrograml/kg of air were minimally affected and were difficult to distinguish from controls. In contrast, rabbits receiving 150 micrograml/kg of air were uniformly and unequivocally impaired. CONCLUSION: we recommend for future cerebral air embolism studies, 150 microgram l/kg as the optimal dose of air which would reliably produce viable subjects for 24 hours with marked unequivocal, neurologic impairment.
Anesthesia ; Animals ; Brain ; Cardiopulmonary Bypass ; Embolism ; Embolism, Air* ; Rabbits ; Thoracic Surgery

BACKGROUND: The body temperature of a patient changes changes during general anesthesia and cholinesterase inhibitor is usually administered at the end of general anesthesia to reverse the neuromuscular blocker effect. We tried to evaluate the effect of temperature changes on the contraction of tracheal smooth muscle induced by acetylcholine (Ach) exogenously administered and neostigmine, cholinesterase inhibitor. METHODS: Isolated tracheal preparations(3 mm wide) of rabbit were mounted in organ baths filled with Tyrode's solution. Cumulative dose responses(isometric contractin) of Ach (10-6, 10-5, 10-4 & 10-3 M) & neostigmine (10-8, 10-7, 10-6, 10-4) at 37oC, 39oC and 27oC were measured with force displacement transducer and pD2 was calculated. RESULTS: Warming from 37oC to 39oC, contraction by Ach weakened significantly and contraction by neostigmine did not change significantly. Cooling from 37oC to 27oC, contraction by Ach were changed significantly and contraction by neostigmine, at low concentration, was inhibited significantly, but at high concentration, was not potentiated significantly. pD2 of Ach did not change significantly by cooling from 37oC to 27oC and decreased significantly by warming from 37oC to 39oC. pD2 of neostigmine was significantly reduced by cooling from 37oC to 27oC and did not change significantly by warming from 37oC to 39oC. CONCLUSIONS: Warming from 37oC to 39oC, the contraction of tracheal smooth muscle induced by Ach was decreased significantly,and cooling from 37oC to 27oC, contraction induced by neostigmine was decreased significantly at low concentration of neostigmine. But it is not sure wheter these effects can be observed in clinical practice when neostigmine is administered to patients,so further study is necessary.
Acetylcholine* ; Anesthesia, General ; Baths ; Body Temperature ; Cholinesterases ; Humans ; Muscle, Smooth* ; Neostigmine* ; Neuromuscular Blockade ; Transducers

Airway perforation is a rare but potentially fatal complication following laser surgery. A 66 years old man was admitted for surgery of tracheal stenosis. He had undergone 2 prior anesthesia for similar surgery and had diabetes mellitus due to chronic steroid therapy. 2 hours after surgery, tracheal perforation lead to pneumomediastinum, tension pneumothorax and perforation of innominate artery with potential risk to injury, which lies in the close proximity to perforation site of trachea. Arterial wall was so weak and fragile that it was difficult to repair the ruptured site. During the procedure, hemorrhage persisted and cardiac arrest developed. Immediate CPR(cardiopulmonary resuscitation) with internal cardiac massage was done but the patient did not recover. We believe that in patient with history of multiple operations, chronic steroid therapy and diabetes mellitus, the vascular structure of thin and fragile should be approached with greater caution when using CO2 laser during surgery.
Aged ; Anesthesia ; Brachiocephalic Trunk ; Diabetes Mellitus ; Granulation Tissue* ; Heart Arrest ; Heart Massage ; Hemorrhage ; Humans ; Laser Therapy ; Lasers, Gas* ; Mediastinal Emphysema ; Metabolism ; Pneumothorax ; Trachea ; Tracheal Stenosis

BACKGROUND: Rocuronium, a new nondepolarizing muscle relaxant, has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence induction of anesthesia. Therefore we have compared rocuronium with pancuronium and vecuronium about the onset time, intubation time, and tracheal intubating conditions. METHOD: Thirty patients were divided into three groups, who were receiving intravenously pancuronium 0.14 mg/kg, vecuronium 0.1 mg/kg and rocuronium 0.6 mg/kg respectively for tracheal intubation during induction of anesthesia. The onset time(Time from drug administration to zero count of PTC) and intubation time were checked using train of four responses of the adductor pollicis muscle after ulnar nerve stimulation(2 Hz, 40mA) every 10 seconds. The intubation conditions were recorded by a "blinded" assessor as excellent, good, fair or not possible. RESULT: The onset time of pancuronium, vecuronium and rocuronium was, 125.0+/-10.0, 256.0+/-18.4 and 90.0+/-22.1 sec. respectivly. The time of intubation was 94.0+/-12.6, 95.3+/-7.9, and 77.0+/-10.6sec.(pancuronium,vecuronium & rocuronium respectively). The onset time of rocuronium was significantly faster than the other two nondepolarizing muscle relaxants. The tracheal intubation with rocuronium was possible earlier than pancuronium or vecuronium but no statistical significance was observed and the condition of intubation was excellent compare to others in all ten patients. CONCLUSION: Rocuronium may have advantages over existing non-depolarizing neuromuscular blocking agents with faster rate of development of neuromuscular block with excellent intubation condition after administraction of a dose 0.6 mg/kg(ED 95 x 2).
Anesthesia ; Humans ; Intubation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pancuronium ; Ulnar Nerve ; Vecuronium Bromide

BACKGROUND: Rocuronium, a new nondepolarizing muscle relaxant, has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence induction of anesthesia. Therefore we have compared rocuronium with pancuronium and vecuronium about the onset time, intubation time, and tracheal intubating conditions. METHOD: Thirty patients were divided into three groups, who were receiving intravenously pancuronium 0.14 mg/kg, vecuronium 0.1 mg/kg and rocuronium 0.6 mg/kg respectively for tracheal intubation during induction of anesthesia. The onset time(Time from drug administration to zero count of PTC) and intubation time were checked using train of four responses of the adductor pollicis muscle after ulnar nerve stimulation(2 Hz, 40mA) every 10 seconds. The intubation conditions were recorded by a "blinded" assessor as excellent, good, fair or not possible. RESULT: The onset time of pancuronium, vecuronium and rocuronium was, 125.0+/-10.0, 256.0+/-18.4 and 90.0+/-22.1 sec. respectivly. The time of intubation was 94.0+/-12.6, 95.3+/-7.9, and 77.0+/-10.6sec.(pancuronium,vecuronium & rocuronium respectively). The onset time of rocuronium was significantly faster than the other two nondepolarizing muscle relaxants. The tracheal intubation with rocuronium was possible earlier than pancuronium or vecuronium but no statistical significance was observed and the condition of intubation was excellent compare to others in all ten patients. CONCLUSION: Rocuronium may have advantages over existing non-depolarizing neuromuscular blocking agents with faster rate of development of neuromuscular block with excellent intubation condition after administraction of a dose 0.6 mg/kg(ED 95 x 2).
Anesthesia ; Humans ; Intubation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pancuronium ; Ulnar Nerve ; Vecuronium Bromide

Central venous catheterization has been widely used in the anesthetic management. Unfortunately, the use of central venous catheter may be associated with adverse events that are hazardous to patients. We experienced a lethal hemomediastinum following subclavian venous catheterization and we discussed the facts that should be kept in mind to prevent the serious complications.
Catheterization ; Catheters ; Central Venous Catheters ; Humans