No abstract available.

No abstract available.
Anaphylaxis* ; Histamine Release* ; Histamine* ; Mast Cells*

Rapid induction,complete loss of conciousness,and stability of cardiovascular system are the variables that should be considered in choosing anesthetics and method of induction for patients with cardiovascular diseases. The great attention should be given because elevation of blood pressure and tachycardia during induction of anesthesia can deteriorate patients cardiovascular system. High-dose of fentanyl was used for the induction of open heart surgery since 1978 and showed effectiveness in stabilizing cardiovascular changes. Many authors argued that fentanyl may not induce unconciousness. As endeavor to shorten the oneset time of unconsciousness, commonly used intravenous anesthetics with fentanyl were tried. Among patients scheduled for open heart surgery, 30 patients with ejection fraction higher than 0.5 were randomly selected and divided into three groups. For the induction of anesthesia, group 1 was given fentanyl alone; group 2 fentanyl with diazepam(0.1mg/kg); and group 3 fentanyl with thiopental sodium (0.2mg/kg). Loss of conciousness (oneset time of unconciousness and dosage of fentanyl) and cardiovascular responses(systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and rate pressure product) just before induction,before intubation, and immediately after intubation were compared and results were as followes. l. It took 322 seconds to induce unconciousness in group 1, 213 seconds in group 2,and 87 seconds in group 3. It was shortened significantly in group 2 and group 3 as compared to group 1 and in group 3 as compared to group 2(p<0.05). 2. Dosage of fentanyl was 30 mcg/kg in group 1, 20 mcg/kg in group 2, and 8 mcg/kg in group 3. As compared to group 1 and group 2, it was significantly decreased in group 3 (p<0.05). 3. Systolic blood pressures before tracheal intubation in gmup 2 and group 3 significantly decreased as compared to the level of preinduction(p<0.05), 4. Diastolic blood pressure before tracheal intubation in group 3 significantly decreased as compared to the level of preinduction(p<0.05). 5. Mean arterial blood pressure before tracheal intubation in group 2 and group 3 significantly decreased as compared to the level of preinduction(p<0.05). 6. There was no significant change in heart rate. 7. Rate pressure product before tracheal intubation in group 3 significantly decreased as compared to the level of preinduction and rate pressure product after tracheal intubation in group 1 significantly increased as compared to the level of preinduction(p<0.05). Considering above results, it is difficult to choose specific anesthetics and methods for the induction of open heart surgery. It depend on the patients cardiovascular function and physicians experience and their preference. Meticulous observation and continuous monitoring of cardiovascular response are very important when intravenous anesthetics are used with fentanyl.
Anesthesia ; Anesthetics ; Anesthetics, Intravenous ; Arterial Pressure ; Blood Pressure ; Cardiovascular Diseases ; Cardiovascular System ; Fentanyl ; Heart Rate ; Heart* ; Humans ; Intubation ; Tachycardia ; Thiopental ; Thoracic Surgery* ; Unconsciousness*

Combining benzodiazepine with opioid has been used for analgesia and sedation during spinal anesthesia, but many authors have warned that combined administration of these drugs produces potent drug interaction that places patients at high risk for hypoxemia and apnea. This study was undertaken to observe the effect of combined use of diazepam with fentanyl on hemodynamic response and change in SaO in twenty healthy adult patients undergone elective surgery with spinal anesthesia. All of the patients were divided into the control and experimental group, and whom spinal anesthesia with 0.5% tetracaine the 12 mg and epinephrine 0.2 mg, were performed. To the control(Group I) and experimental group(Group 2) the combined dose of diazepam 0. 075 mg/kg with fentanyl 1 ug/kg, and diazepam 0.15 mg/kg with fentanyl 2 ug/kg, were given, respectively, by intravenous injection 1 hour after spinal anesthesia started. Blood pressure, heart rate and SaO2 of the two groups were compared at the time before administration of study drugs and 1 min, 2 min, 2 min, 4 min, 5 min, 10 min, 30 min and 60 min after administration of study drugs. The results were as follows. 1) SaO2 was significantly decreased in group 2 than Group 1 after study drugs were administed intravenously. 2) In both group, decrease in SaO2 was significant at the first 5 minutes after intravenous administration of study drugs. 3) SaO2 fell to 90% of the control value after the administration of study drugs in 6 patients of Group 2(60%). 4) Hemodynamic changes after intravenous administration of study drugs were statistically significant but not so clinically in both group. We concluded that combined intravenous administration of benzodiazepine and opioid under spinal anesthesia requires the careful monitoring of hemodynamic response and ventilatory status continuosly with those monitoring devices already in use and pulse oximeter. Availiability of skilled anesthesiologists for airway management and administration of supplemental oxygen are very important in combined intravenous administration of benzodiazepine and opioid.
Administration, Intravenous ; Adult ; Airway Management ; Analgesia ; Anesthesia, Spinal* ; Anoxia ; Apnea ; Benzodiazepines ; Blood Pressure ; Diazepam* ; Drug Interactions ; Epinephrine ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Injections, Intravenous ; Oxygen ; Tetracaine

BACKGROUND: Electroconvulsive(ECT) or electroshock therapy(EST) remains controversial and its indications are still the subject of discussion. Despite both medical and legal opposition, it is still widely practiced. The aim of ECT is to produce a grand mal seizure rather than the electrical stimulus which is responsible for the therapeutic effect. This causes widespread physiological changes, particularly affecting the cardiovascular and nervous system. The anesthetic agents for ECT should provide a smoooth rapid induction, a rapid recovery and attenuation of the physiologic effect of ECT. METHODS: Propofol(1 mg/kg) and thiopental sodium(2 mg/kg) were compared as anesthetic agents for ECT in 20 patients on four occasions in a repeated measure crossover study. In each patients receiving propofol or thiopental sodium on different occasions, arterial pressure, heart rate, seizure duration and recovery time were recorded. RESULTS: The incidence of discomfort on injection was significantly higher with propofol (47.5%) compared to thiopental sodium (2.5%). The duration of seizure with propofol was 37+/-11.3 sec and thiopental sodium was 41.2+/-11.6 sec but it was not significant(P=0.11). The increase in systolic and diastolic arterial pressure and heart rate were higher with thiopental sodium. Recovery time was significantly shorter with thiopental sodium (476.5+/-47.7 sec) compares to propofol (506.6+/-62.2 sec) (P<0.05). CONCLUSIONS: Propofol is more effective than thiopental sodium at obtunding the hypertensive to ECT without causing significant hypotention.
Anesthetics ; Arterial Pressure ; Cross-Over Studies ; Electroconvulsive Therapy* ; Electroshock ; Heart Rate ; Humans ; Incidence ; Nervous System ; Propofol* ; Seizures ; Thiopental*

It is well known that the pulmonary capillary endothelium is rich in angiotensin converting enzyme(ACE), which is released in the event of smoking, acute lung injury, or some lung diseases such as Gauchers disease and hypertension. Serum ACE levels may be clinically useful because they are reflections of pulmonary circulation. In order to evaluate the effect of extracorporeal circulation and pulmonary perfusion on serum ACE levels, we measured serum ACE level during prebypass, total bypass(5', 30', 60') and pulmonary perfusion (30', 60', 24 hrs.) in 10 open-heart patients. The results were as follows: 1) The SACE level before the begining of extracorporeal circulation was 10.03+/-1.66u/ml and decreased significantly to 2.79+/-0.63u/ml(p<0.005) 5min. after extracorporeal circulation was initiated. 2) The decreased SACE level seen during extracorporeal circulation returned to a nearly normal (9.33+/-1.8u/ml) 24hrs. after pulmonary perfusion. 3) There were no significant correlations between the SACE level and the variation of age during extracorporeal circulation and pulmonary perfusion. The above results suggest that SACE levels are proportional to the amount of pulmonary blood flow.
Acute Lung Injury ; Angiotensins* ; Cardiopulmonary Bypass ; Endothelium, Vascular ; Extracorporeal Circulation* ; Gaucher Disease ; Humans ; Hypertension ; Lung Diseases ; Peptidyl-Dipeptidase A* ; Perfusion ; Pulmonary Circulation ; Smoke ; Smoking

Ketamine may increase blood pressure and heart rate and should be avoided in hypertensive patients. However, in hypovolemic and asthmatic patients, ketamine is used as an induction agent because of its cardiovascular stimulating effect and bronchodilating effect. This study aims to assess the effects of clonidine and lidocaine on the cardiovascular response of intravenous ketamine administration during induction of anesthesia. sixty patients were divided into 3 groups as followed: group I: control ( received no lidocaine or no clonidine) group II: received lidocaine (1.5 mg/kg IV) 3 minutes before intubation group IIl: received clonidine (0.3 mg PO) 90 minutes before induction of anesthesia The changes of blood pressure, heart rate and rate pressure product following intubation were measured at different time interval (before induction,before intubation just after intubation, postintubation 1, 3, 5, 10 min) and compared with the value of control (2 hours before induction of anesthesia). The results are as follows 1) Group I and Group II: The systolic and diastolic blood pressure increased significantly compared to the control value from preinduction to 5 minutes after intubation(p<0.05). It recovered to the control value in 10 minutes, but heart rate and rate-pressure product increased significantly for 10 minutes after intubation(p<0.05) 2) Group III: The systolic and diastolic blood pressure, heart rate and rate-pressure product of preinduction and preintubation values decreased significantly compared to control values but 1 minute after intubation,all values increased significantly(p<0.05). The systolic and diastolic blood pressure and rate-pressure product values recovered to control value in 3 minutes after intubation and heart rate recovered in 5 minutes. Comparing group III with group I and II, it showed significant changes(p<0.05). From the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia. the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia.
Anesthesia* ; Blood Pressure ; Clonidine* ; Heart Rate ; Humans ; Hypovolemia ; Intubation ; Ketamine* ; Lidocaine* ; Premedication*

In obsterics and gynecology laparoscopic surgery is increasing in numbers and gaining wide popularity replacing classical laparotomy and is becoming new trend in surgical fields. Laparoscopic surgery is favoured over the classical laparotomy because of numerous advantages but it can cause complications by insuffulatory CO2 to induce artificial pneumoperitoneum. Therefore, wide knowledges and thorough understandings of anesthesiologist on the prevention of complications and their treatments are essential. Authors present one case that the patient developed subcutaneous emphysema and ateleciasis on right upper lobe, pulmonary edema in left side lung resulting from inadvertent one lung ventilation during laparoscopic hysterectomy under general anesthesia and on trendelenberg position.
Anesthesia, General* ; Gynecology ; Humans ; Hysterectomy* ; Laparoscopy ; Laparotomy ; Lung ; One-Lung Ventilation* ; Pneumoperitoneum, Artificial ; Pulmonary Edema ; Subcutaneous Emphysema*

BACKGOUND: Disruption of the blood-brain barrier (BBB) can alter the internal milieu and may increase the release of excitatory amino acid neurotransmitters or catecholamines, which may affect metabolic rate or coupling. This study was performed to evaluate whether disruption of BBB by unilateral intracarotid injection of hyperosmolar mannitol would alter oxygen supply/consumption balance in the ipsilateral cortex. METHODS: Rats were anesthetized with 1.4% isoflurane using mechanical ventilation via tracheostomy. 25% mannitol was administered at a rate of 0.25 mlxkg-1s-1 for 30 s through unilateral internal carotid artery. The BBB transfer coefficient (Ki) of 14C-alpha-aminoisobutyric acid was measured in one group (N=7) after administering mannitol. Regional cerebral blood flow (rCBF), regional arterial and venous O2 saturation and O2 consumption were measured in another group using a 14C-iodoantipyrine and microspectrophotometry (N=7). RESULTS: Vital signs were similar before and after administering mannitol. Ki was significantly higher in the ipsilateral cortex (IC) than in the contralateral cortex (CC), (22.3+/-8.4 vs 4.4+/-1.1 microliterxg-1min-1). rCBF was similar between IC (105+/-21 mlxg-1min-1) and the CC (93+/-20). Venous O2 saturation was lower in the IC (43+/-7%) than in the CC (55+/-4). O2 consumption was higher in the IC (9.6+/-3.0 mlx100 g-1min-1) than in the CC (6.7+/-1.5). CONCLUSIONS: Our data suggested that increasing permeability of the BBB increased cerebral O2 consumption and deteriorated cerebral oxygen balance.
Animals ; Blood-Brain Barrier* ; Brain ; Carotid Artery, Internal ; Catecholamines ; Excitatory Amino Acids ; Isoflurane ; Mannitol ; Microspectrophotometry ; Neurotransmitter Agents ; Oxygen* ; Permeability ; Rats ; Respiration, Artificial ; Tracheostomy ; Vital Signs

Background and Objectives: Several studies have assessed the impact of laryngopharyngeal reflux disease (LPRD) on the health-related quality of life (HR-QoL), showing significant impairment of HR-QoL. This study aims to assess the impact of proton pump inhibitor (PPI) treatment of LPRDs to enhance HR-QoL.Subjects and Method We prospectively collected data from LPRD patients from April 2017 to July 2019. Patients who have reflux symptom index (RSI) of ≥13 or reflux finding score (RFS) of ≥7 were enrolled in this study. We assessed HR-QoL using a questionnaire with EORTC QLQ-H&N35, -C30 on the first visit. Patients were treated with PPI (Ilaprazole 20 mg/day) on their visits at 4, 8, and 12 weeks. RSI and RFS were measured at each visit and HR-QoL was reevaluated on the last visit. Results: Ninety-five patients completed the 3-months follow-up and were enrolled in this study. Female : male ratio was 71:24 and the mean age was 57.0±11.9 (27-80). The initial RSI and RFS were 16.3±8.8 and 12.6±2.9, respectively, but were changed to 11.1±9.7 and 9.7±2.6 (p<0.001 in both) at 12 weeks after the treatment. Global health status/QoL, speech problem, dry mouth, and coughing were significantly improved. Conclusion PPI administration is effective in treating LPRD, where effects begin to appear at 4 weeks after treatment. HR-QoL was also improved in patients who have RSI improvement.