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*

No abstract available.

Nausea and vomiting are common problems after strabismus surgery in pediatric patients. We compared the effects of droperidol and ephedrine with conventional regimen consisting of halothane-N2O to the effects of conventional regimen itself, 69 children. ASA physical status l, ages 1-12yrs, were studied. Each child was randomly assigned to receive droperidol 0.04mg/kg., ephedrine 0.5mg/kg or normal saline 2ml intramuscularly, 10 minutes before the end of surgery. The incidence of postanesthetic nausea and vomiting was 17% in the droperidol group(p<0.05)., 13% in the ephedrine group(p<0.05), which were significantly less than the control group(43%). But there was no significant difference between droperidol group and ephedrine group. We concluded that droperidol and ephedrine have significant postoperative antiemetic effect in patients undergoing strabismus surgery.
Antiemetics ; Child* ; Droperidol ; Ephedrine ; Humans ; Incidence ; Nausea ; Postoperative Nausea and Vomiting* ; Strabismus* ; Vomiting

We report a case of pituitary apoplexy resulting in right internal carotid artery occlusion accompanied by hemiplegia and lethargy. A 43-yr-old man presented with a sudden onset of severe headache, visual disturbance and left hemiplegia. Investigations revealed a nodular mass, located in the sella and suprasellar portion and accompanied by compression of the optic chiasm. The mass compressed the bilateral cavernous sinuses, resulting in the obliteration of the cavernous portion of the right internal carotid artery. A border zone infarct in the right fronto-parietal region was found. Transsphenoidal tumor decompression following conservative therapy with fluid replacement and steroids was performed. Pathological examination revealed an almost completely infarcted pituitary adenoma. The patient's vision improved immediately after the decompression, and the motor weakness improved to grade IV+ within six months after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. However, clinicians should be aware of the possibility and the appropriate management of such an occurrence.
Adult ; Carotid Artery Diseases/*diagnosis/etiology/therapy ; *Carotid Artery, Internal/pathology/surgery ; Diagnosis, Differential ; Embolization, Therapeutic ; Humans ; Magnetic Resonance Angiography ; Male ; Pituitary Apoplexy/complications/*diagnosis ; Tomography, X-Ray Computed

GTP-Binding Proteins ; Receptors, Thyrotropin-Releasing Hormone ; Thyrotropin-Releasing Hormone*

It is well known that hypertension is associated with left ventricular diastolic dysfunction which frequently precede systolic dysfunction. To determine whether nifedipine could improve left ventricular diastolic function in hypertensive patients, we studied 15 hypertensive patients and 15 normotensive subjects matched for sex, age with Doppler echocardiography. After oral administration of 10mg of nifedipine, there were no significant changes in Doppler-derived transmitral diastolic filling indexes of normotensive subjects. On the other hand, although peak flow velocity in atrial systole(PFVA), time velocity integral in atrial systole(TVIA) did not change significantly after nifedipine, nifedipine significantly increased peak flow velocity in early diastole(PFVE) from 40.2+/-6.4cm/sec to 46.5+/-10.9cm/sec(p<0.005), time velocity integral in early diastole(TVIE) from 5.24+/-1.2cm to 5.97+/-1.43cm(p<0.001), the ratio of PFVE/PFVA from 0.69+/-0.11 to 0.76+/-0.12(p<0.05), the ratio of TVIE/TVIA from 1.18+/-0.21 to 1.29+/-0.24(p<0.05), deceleration slope(DS) from 244.9+/-51.9cm/sec2 to 289.9+/-49.1cm/sec2 (p<0.001) and decreased isovolumic relaxation time(IVRT) from 132.3+/-10.3msec to 117.2+/-13.5msec(p<0.001), deceleration time(DT) from 168.8+/-30.3msec to 154.9+/-29.8msec(p<0.05) in hypertensive patients. These fimdings indicated that nifedipine improves Doppler-derived early diastolic filling indexes in hypertensive patients and may be related to improvement of active relaxation of left ventricle in early diastole.
Administration, Oral ; Deceleration ; Diastole ; Echocardiography, Doppler* ; Hand ; Heart Ventricles ; Humans ; Hypertension ; Nifedipine* ; Relaxation

BACKGROUND: Induction of anesthesia with propofol caused a decrease in arterial blood pressure and systemic vascular resistance. This effects of propofol on the circulation can be more clarified by studying cardiovascular control mechanism such as baroreflex sensitivity during variable rate infusion of propofol. METHODS: The effects of three infusion rates of propofol (3, 6, 12 mg/kg/hr) to supplement 66% nitrous oxide in oxygen anesthesia on baroreflex sensitivity were studied and compared with awake value in 80 ASA I or II patients (20-55 years old, n=20 in each group). Baroreflex control of heat rate was studied by pertubing the patients' arterial pressure with 100 microgram of phenylephrine in each three infusion rates of propofol which was maintained at least 30 min without any surgical stimulation. RESULTS: Baroreflex slope representing baroreflex sensitivity among three infusion rates of propofol did not show any significant differences. The slope of each infusion rate was 8.4+/-0.7 at awake, 8.9+/- 1.7 at 3 mg/kg/hr, 8.0+/-1.3 at 6 mg/kg/hr, 7.2+/-1.0 at 12 mg/kg/hr, respectively. But, resetting of the reflex occured at low heart rates. CONCLUSIONS: Usual propofol-nitrous oxide-oxygen anesthesia was not associated with impairment of baroreflex sensitivity, but showed reflex resetting at low heart rates.
Anesthesia ; Arterial Pressure ; Baroreflex* ; Heart Rate ; Hot Temperature ; Humans ; Nitrous Oxide ; Oxygen ; Phenylephrine ; Propofol* ; Reflex ; Vascular Resistance

Intracranial cavernous angiomas are benign vascular malformations and can be divided into intra-axial and extra-axial lesions. Extra-axial cavernous angiomas are relatively rare and usually arise in relation to the dura mater and mimick meningiomas. We report a case of cavernous angioma that occured in the falx cerebri of a 22-yr-old female patient with the special focus on neuroradiologic findings. This is the fourth case of cavernous angioma in the falx cerebri reported in the literature to our knowledge.
Tomography, X-Ray Computed ; Meningeal Neoplasms/pathology/*radiography/surgery ; Magnetic Resonance Imaging ; Humans ; Hemangioma, Cavernous/pathology/*radiography/surgery ; Female ; Dura Mater/*pathology ; Adult

No abstract available.
Lipomatosis, Multiple Symmetrical*

OBJECTIVE: Temozolomide is a novel oral alkylating agent, which has been reported to be effective in treating patients with recurrent malignant gliomas. This study report an analysis of the activity and toxicity of temozolomide as second-line therapy for patients with recurrent and progressive malignant gliomas after surgery and standard radiation therapy with or without chemotherapy. METHODS: Twenty patients with malignant gliomas of which thirteen(65%) had glioblastoma multiforme(GBM), five(25%) with anaplastic astrocytoma(AA), and two(10%) with anaplastic oligodendroglioma(AO) were enrolled in this study. They had been treated in our institution since July, 2000 and had been previously irradiated with or without chemotherapy. For the patients with recurrent and progressive disease, temozolomide(150-200mg/m2/d x5 days) was administered every 28 days until the progression of the tumor or toxicity developed. RESULTS: The median number of treatment cycles was 3(total 86). Of the 20 patients, 2(10%) achieved a complete response(CR), 5(25%) achieved a partial response(PR), 5(25%) had stable disease(SD), and 8(40%) had progressive disease(PD). One patient achieved a CR, 3 patients achieved a PR, 2 patients had SD and 7 patients had PD in GBM, and 1 patient achieved a CR, 2 patients achieved a PR, 3 patients had SD, 1 patient had PD in the non-GBM patients. Median progression free survival(PFS) was 8 weeks in GBM and 22 weeks in the non-GBM patients. No hematological toxicity greater than grade 2 was observed, and hepatotoxicity of grade 2 was encountered in 1(5%) patient. CONCLUSION: Temozolomide demonstrate moderate activity in recurrent and progressive malignant brain tumors, and the response rate and PFS were better in the non-GBM tumors than in the GBM tumors. The treatment is well tolerated without any serious toxicity.
Brain Neoplasms ; Drug Therapy* ; Glioblastoma ; Glioma* ; Humans