Anesthesia, Local* ; Oximetry ; Oxygen* ; Tonsillectomy*

The micelle solution of Triton X-100 has been used as one of the experimental analogues of biological membrane in the study of the mechanism of anesthesia. It is well known that the cloud point(Tc) of micelle solution is increased by the unionized species of local anesthetics which can penetrate and move into the micelle, and decreased by the ionized form of local anes- thetics which can not penetrate the membrane. Barbiturates(HA) ionize to H+ and A- . The degree of ionization of any drug depends on its own pKa and pH of the solution. The effect of thiobarbiturates on the Tc of micelle solution was studied to see if an unionized form is necessary for the drug to penetrate cell membrane as in local anesthetics. Thiobarbiturates decreased the Tc at low pH and increased at high pH. From the data obtained at pH around 4, the decrease in Tc(dT1) was regarded to be proportional to the concentration of [HA] in micelle, and the data obtained at pH around 10, the increase in Tc(dT2) was regarded to be proportional to the concen- tration of [A-] in aqueous phase. Assuming that the observed changes in Tc(dTc) at pH ranging from 4 to 10 were the summation of dT1 and dT, dTc was expressed as theoretical equation. The experimental data showed a perfect fit to the curve derived from the equation. This confirmed that thiobarbiturates, as local anesthetics, penetrate the micelle(membrane) in an unionized form.
Anesthesia ; Anesthetics, Local ; Cell Membrane ; Hydrogen-Ion Concentration ; Membranes ; Octoxynol ; Thiobarbiturates*

Anesthesia for thoracic surgery is most commonly performed with the patient in the lateral decubitus position, with nondependent hemithorax comprising the operation field. When one-lung ventilation is employed, the nondependent lung is nonventilated and collapsed, while the dependent lung is ventilated. Consequently one-lung ventilation creates an obligatory right to left transpulmonary shunt through the nondependent nonventilated lung. Therefore one-lung ventilation results in a much larger alveolar-arterial oxygen tension-difference P(A-a)O2 and lower PaO2 than does two-lung ventilation. The present study was to evaluate oxygenation effect of selective CPAP to nondependent lung in the 17 thoracic surgical patients. Arterial blood gases were analysed, systolic blood pressures and heart rates were measured at following stages. Stage I; lateral decubitus position before chest opening Stage II; 15 min after chest opening and one lung ventilation stage III; 15 min after application of selective CPAP 5 cmHO to the nondependent lung stage IV; 40 min after application of selective CPAP 5 cmHO to the nondependent lung The results were as follows: 1) In stage II, the value of PaO2 was significantly lower as compared to that in stage I(224.9+/-78.0 vs 418.2+/-63.1 mmHg, P<0.01). 2) In stage III and IV, the values of PaC4 were significantly higher.as compared to that in stage II(333.8+/-97.1, 364.5+/-88.6 vs 224,9+/-78.0 mmHg, P<0.01). 3) In stage III, the value of PaCO2 was significantly lower as compared to that in stage II(37.1+/-2.9 vs 38.2+/-2.7 mmHg, P<0.05). 4) In stage IV, the value of pH was significantly lower as compared to that in stage III(7.37+/-0.05 vs 7.38+/-0.05 P<0.05). 5) Systolic blood pressures and heart rates remained unchanged at all times. We concluded that application of 5 cmHO CPAP to the nondependent lung during one-lung ventilation is one of most efficacious maneuvers to increase PaO2, accompanying less surgical interference.
Anesthesia* ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Lung ; One-Lung Ventilation ; Outpatients* ; Oxygen ; Thoracic Surgery ; Thorax ; Ventilation

The effect of anesthetic volume on the spread of hypobaric tetracaine were sutdied after intrathecal injection in thirty patients with prone jackknife and 15 degree Trendelenburg position for perinal surgery. The patients were assigned randomly into the one of three groups divided by the 3, 4, or 5 ml of volume of anesthetic solution. The results show that the volume of tetracaine in distilled water with hypobaric spinal anesthesia in prone jackknife and l5 degree Trendelenburg position had a important effect on the anesthetic dermatomal levels in spite of slightly rapid onset with large. volume. Therefore, we concluded that for the perianal surgery in prone jackknife position, as the volume of the anes- thetic solution with hypobaric spinal anesthesia, 3 or 4 ml of the volume are sufficient to get the adequate anesthetic levels.
Anesthesia, Spinal* ; Head-Down Tilt ; Humans ; Injections, Spinal ; Tetracaine ; Water

Meta-analysis is the statistieal analysis of a collection of analytic result for the purpose of integrating the findings across studies. Such a systematic quantitative procedure through combination of statistic offers accumulation of evidence in terms of the effect size. Furthermore, the combination of data from several studies increases generalibility and statistical power with some criticisms. Schmidt-Hunter procedure is appropriate method for measuring d(the difference between the group mean divided by the standard deviation) statistics. In this paper we present the cumulation formulas for effect sizes and analyzed mean d statistics. Twenty-five research reports of clinical trials for prevention of hemodynamie changes after tracheal intubation were gathered. Three drugs(lidocaine, fentanyl, esmolol) were reported in detail sufficient to get for analyzing variables(systolic, diastolic and heart rate). Means of each variable were summarized and calculated by each drug between control and treatment group. Nine meta-analysis were performed. Lidocaine, fentanyl and esmolol all effectively decreased hemodynamic changes compared to control group(placebo group). Fentanyl provided reliable protection in systolic blood pressure as esmolol in heart rate. Range variation.of mean effect size was smallest and consistent in esmolol group. Variance of the effect size corrected for sampling error was large in all drugs and there should be a search for moderator variables(covariate) with need for stratification.
Blood Pressure ; Fentanyl ; Heart ; Heart Rate ; Hemodynamics* ; Intubation* ; Lidocaine ; Research Report ; Selection Bias

Anesthesia for thoracic surgery is most commonly performed with the patient in the lateral decubitus position, with nondependent hemithorax comprising the operation field. When one-lung ventilation is employed, the nondependent lung is nonventilated and collapsed, while the dependent lung is ventilated. Consequently one-lung ventilation creates an obligatory right to left transpulmonary shunt through the nondependent nonventilated lung. Therefore one-lung ventilation results in a much larger alveolar-arterial oxygen tension-difference P(A-a)O2 and lower PaO2 than does two-lung ventilation. The present study was to evaluate oxygenation effect of selective CPAP to nondependent lung in the 17 thoracic surgical patients. Arterial blood gases were analysed, systolic blood pressures and heart rates were measured at following stages. Stage I; lateral decubitus position before chest opening Stage II; 15 min after chest opening and one lung ventilation stage III; 15 min after application of selective CPAP 5 cmHO to the nondependent lung stage IV; 40 min after application of selective CPAP 5 cmHO to the nondependent lung The results were as follows: 1) In stage II, the value of PaO2 was significantly lower as compared to that in stage I(224.9+/-78.0 vs 418.2+/-63.1 mmHg, P<0.01). 2) In stage III and IV, the values of PaC4 were significantly higher.as compared to that in stage II(333.8+/-97.1, 364.5+/-88.6 vs 224,9+/-78.0 mmHg, P<0.01). 3) In stage III, the value of PaCO2 was significantly lower as compared to that in stage II(37.1+/-2.9 vs 38.2+/-2.7 mmHg, P<0.05). 4) In stage IV, the value of pH was significantly lower as compared to that in stage III(7.37+/-0.05 vs 7.38+/-0.05 P<0.05). 5) Systolic blood pressures and heart rates remained unchanged at all times. We concluded that application of 5 cmHO CPAP to the nondependent lung during one-lung ventilation is one of most efficacious maneuvers to increase PaO2, accompanying less surgical interference.
Anesthesia ; Continuous Positive Airway Pressure* ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Lung* ; One-Lung Ventilation ; Oxygen* ; Thoracic Surgery ; Thorax ; Ventilation*

Authors selected 54 patients in ASA class I, II, aged from 20 to 60 years old undergoiag operations of lower limbs and lower abdomen. In the different dosage of 0.25% hyperbaric bupivacaine, these were divided into 3 groups ; group A(22 patients) using l0 mg(4 ml), group B(17 patients) using 15 mg(6 ml), group C(15 patients) using 20 mg(8ml), which were injected into subarachnoid space. The following results were obtained. I) Maimum level of sensory loss was significantly increased with increase dosage, and the time of onset was significantly faster with decrease dosage. 2) Duratioan of sensory loss was significantly longer with increase dosage. 3) Onset time of motor block was signficantly faster in the group C of Bromages scale degree l, Duration of motor block was signficantly longer with increase dosage. 4) Systolic and diastolic blood pressure were little decreased with increase dosage. No signficant changes were noted in the pulse rate. 5) Post spinal headache developed in 5 patients out of 54 patients(9.3%). In the study of the group C, urinary retention developed in 4 patients out of 15 patients. From above results, we conclude that 0.25% hyperbaric bupivacaine can be used for operations lasting than 1~2 hours of lower limbs and lower abdomen because cardiovascular system is little affected with increase dosage.
Abdomen ; Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine* ; Cardiovascular System ; Headache ; Heart Rate ; Humans ; Lower Extremity ; Middle Aged ; Subarachnoid Space ; Urinary Retention

The retrograde microorganismal colonization in the pharynx from stomach may cause the nosocomial pneumonia and that may be more likely when the gastric pH is relatively high. We tried to find out the relationships between the gastric pH and the incidence of nosocomial pneumonia with twenty patients intubated for longer than 48 hours at ICU. We achieved following results: 1) The incidence of the nosocomial pneumonia was twenty percent. 2) All the patients developed nosocomial pneumonia showed the gastric pH above 4.0. 3) In the patients intubated for longer than 5 days, the incidence of nosocomial pneumonia was 33.3% in contrast to 9.0% for less than 5 days. 4) With the sputum culture, the incidence of colonization was higher in the patients with gastric pH above 4.0 than that in the patients with gastric pH below 4.0(84.6% vs 58.1%). 5) With regard to the duration of intubation, the incidence of colonization was higher in the patients intubated for longer than 4 days than that in the patients intubated for less than 4 days(90% vs 50%). 6) The most common pathognomic organisms were astreptoccus and Pseudomonas aeroginosa. It is conculded that the nosocmial pneumonia might develop more frequently in the patients with gastric pH above 4.0 than in the patients with gastric pH below establishment of the relationship between the treatment of the stress ulcer and the nosocomial pneumonia.
Colon ; Humans ; Hydrogen-Ion Concentration* ; Incidence ; Intubation ; Pharynx ; Pneumonia* ; Pseudomonas ; Sputum ; Stomach ; Ulcer

The purpose of this study was to compare the cardiovascular changes with various administration method of lidocaine. This study was performed 40 patients scheduled for elective surgery at chosun university hospitaL Patients were randomly assigned to recieve lidocaine by intravenous, larynogotracheal spray, transtracheal injection before tracheal intubation. Systolic blood pressure(SBP), diastolic blood pressure(DBP) mean arterial pressure(MAP) and Heart rate(HR) were measured at preinduction and 1, 2, 3, & 5 minutes after intubation. The results were as follows; 1) Control group; not administered lidocaine; SBP, DBP, MAP % HR were significantly increased at 1, 2 minutes after intubation(P<0.05, P<0.01). 2) Group 1; intravenous lidocaine administration(2 mg/kg);, SBP, DBP, MAP were increased but not statistically significant. Heart rate was significantly increased at 1, 2, 3 minutes after intubation(P<0.05, P<0.01). Compared with control group, SBP, DBP & MAP were statistically significant (P<0.05). 3) Group 2; laryngotracheal spray(2 mg/kg); Similar to group 1 but DBP was increased at 1 minute after intubation(P<0.05). and SBP, DBP, MAP & HR were maintained higher level than group I at every time. 4) Group 3; Transtracheal injection of l% lidocaine 2~3 ml; SBP, DBP & MAP were not exceed baseline level at 1 minute but HR was significantly increased at l, 2 minutes after intuhation(P<0.05). Compared with control group, SBP, DBP, and MAP were statistically singnificant (P<0.05). This study suggest that administration of lidocaine attenuate sympathetic stimulation follwing tracheal intubation. Intravenous injection of lidocaine is recommendable method to prevent the sympathetic stimulation following tracheal intubation.
Heart ; Heart Rate ; Humans ; Injections, Intravenous ; Intubation* ; Lidocaine*

Isoflurane causes little myocardial depression, rapid onset and recovery during controlled hypotensive anesthesia. Nitroglycerin, vasodilating agent, has short plasma half-life and myocardial protective effect, is easy to cantrol, and has no direct toxic effect. Doxapram hydrochloride(doxapram Hcl), respiratory stimulant, has been found to be safe and significantly potent, but also has significant pressor effect when larger doses are administered. The purpose of this study was to evaluate the effects of doxapram on the hemodynamics after isoflurane and nitroglycerin-induced hypotensive anesthesia in dogs. Hemodynamic measurement including the value of left ventricular pressure, aortic pressure, pulmonary eapillary wedge pressure, pulmonary artery pressure, heart rate, cardiac output, maximal and minimal dP/dT were determined in 8 dogs before doxapram Hcl administration, Smin, 15min and 30min after doxapram Hcl administration. 1) Left ventricular pressure and aortic pressure increased at 5min and 15min after doxapram Hcl administration but did not change significantly at 30min compared to the preadministration values. 2) Pulmonary capillary wedge pressure and pulmonary artery pressure increased significantly at Smin and 15min, but did not change significantly 30min compared to the preadministration values. 3) Heart rate increased significantly at Smin, but did not change significantly at 15min and 30min compared to the preadministration value. 4) Cardiac output and body temperature did not change significantly at 5min, 15min compared to the preadministation values. 5) Maximal dP/dT increased signifieantly at Smin and 15min, but did not change at 30min compared to the preadministration value, minimal dP/dT increased significantly at 5min, but did not change at 15min and 30min compared to the preadministration value.
Anesthesia* ; Animals ; Arterial Pressure ; Arteries ; Body Temperature ; Cardiac Output ; Depression ; Dogs* ; Doxapram* ; Half-Life ; Heart Rate ; Hemodynamics* ; Isoflurane* ; Nitroglycerin* ; Plasma ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Ventricular Pressure