An induced hypotension is employed as a useful technique for operations on intracranial aneurysms, brain tumors and other intracranial lesions to diminish operative bleeding and to decrease brain tension. In aneurysm surgery under induced hypotension, the sac becomes softer and thus diminishes the risk of rupture when clips are applid. In 1946 Gardner used arteriotomy to lower blood pressure by decreasing the blood volume during brain tumor surgery, then gradually improved. Pharmacologically-induced hypotension soon became the cominant method of producing hypotension. Halothane and trimethaphan are the most popular drugs for this purpose. On the other hand, the risks of hypotension are obvious. These include decreased cardiac output, decreased cerebral blood flow, and low perfusion pressure exposing brain tissue to the risk of hypoxia thereby aggravating the effects of the circulatory disturbance present in the brain lesion. In this situation the blood oxygen tension in jugular-bulb and lactate content in brain tissue have been found to be reliable indices of degrees of cerebral oxygenation. Consequently, several investigators have studied the critical level of arterial blood pressure during hypotensive anesthesia and have accepted 60 mmHg of systolic pressure(40~50 mmHg of mean arterial pressure) as a clinically applicable level free from the danger of cerebral hypoxia. Furthermore, Griffiths and Gillies(1948) postulated that systolic pressure over 30 mmHg would provide adequate tissue oxygenation. However, there are only a few reports concerning the adequacy of cerebral oxygenation under such low levels of arterial blood pressure. The purpose of this study is to investigate cereral hemodynamics and metabolism during halothane-induced hypotensive anesthesia and to find any evidence of cerebral hypoxia at the levels of 60 mmHg and 30 mmHg, of systolic blood pressure. 15 adult mongrel dogs, weighing 10~13kg, were anesthetized with intravenous pentobarbital sodium. Endotracheal intubation was performed. One femoral artery was cannulated with a polyethylene tube for arterial blood sampling. The tube was connected to a Statham pressure transducer for continuous arterial blood pressure recording. The common carotid artery was exposed and a probe of square-wave electromagnetic flowmeter was placed on the vessel to record the carotid blood flow. An electrocardiogram and above two parameters were recorded simultaneously on a 4-channel polygraph. The internal jugular vein was cannulated and a catheter threaded up to the jugular-bulb for sampling of venous blood draining from the brain. The cisterna magna was punctured with an 18 gauge spinal needle to sample the cerebrospinal fluid. The experiments were divided into control phase, induction phase, hypotensive phase I, hypotensive phase II, and recovery phase. Each phase was maintained for 30 minutes. Cerebrospinal fluid, arterial venous blood were sampled at the end of each phase for analysis of gas tension and lactate content. 100% oxygen was inhaled during the induction phase. During the hypotensive phases, halothane/O2 was administered to lower the arterial blood pressure. In the hypotensive phase I and hypotensive phase II systolic pressure was maintained at 60 mmHg and 30 mmHg, respectively. In the recovery phase, halothane was discontinued and 100% oxygen only was inhaled. The results obtained are summarized as follows; 1. The carotid artery blood flow, which represents the cerebral blood flow, decreased linearly during the decline of the arterial blood pressure. At the end of each phase there was no difference in the carotid blood flow between hypotensive phase I and phase II. Cerebral vascular resistance was markedly reduced in the hypotensive phase II, which suggests cereral vasodilation. 2. Cerebral venous pO2 decreased significantly in the hypotensive phases, but the values till remained within normal limits. A marked reduction of arterial pCO2 was noted in the hypotensive phases. The values approach the lower limits of safety. 3. The most outstanding difference between hypotensive phase I and II is in the lactate content of cerebral venous blood and cerebrospinal fluid. There was a moderate increase of lactate content, and a slight reduction of cereral venous pH in hypotensive phase II, however, a significant degree of cerebral hypoxia and metabolic acidosis could be excluded. 4. Most of the changes in the cerebral metabolism and hemodynamics including arterial blood pressure, tent to return to return to normal at the end of the recovery phase. From the result of this study, it is concluded; Halothane-induced hypotensive anesthesia at 60 mmHg of systolic blood pressure(45 mmHg of possibility of mild metabolic acidosis 30 mmHg of systolic blood pressure(23 mmHg of mean arterial pressure), adequate cerebral oxygenation is maintained without difficulty.
Acidosis ; Adult ; Anesthesia* ; Aneurysm ; Animals ; Anoxia ; Arterial Pressure ; Blood Pressure ; Blood Volume ; Brain ; Brain Neoplasms ; Cardiac Output ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Cerebrospinal Fluid ; Cisterna Magna ; Dogs ; Electrocardiography ; Femoral Artery ; Flowmeters ; Halothane ; Hand ; Hemodynamics ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Hypoxia, Brain ; Intracranial Aneurysm ; Intubation, Intratracheal ; Jugular Veins ; Lactic Acid ; Magnets ; Metabolism ; Needles ; Oxygen ; Pentobarbital ; Perfusion ; Polyethylene ; Research Personnel ; Rupture ; Transducers, Pressure ; Trimethaphan ; Vascular Resistance ; Vasodilation

Tachycardia and hypertension are well documented complications of laryngoscopy and tracheal intubation in normal patients(Reid and Brace, 1940; Burstein et al, 1950; King et al 1951; Takeshima et al, 1964; Forbes and Dally, 1970). This phenomenon has been studied in detail in cats by Tomori and Widdicombe(1969), who found it to be associated with an increased impulse traffic in the cervical sympathetic efferent fibers. This nervous activity was especially increased by stimulation of the epipharyngeal and laryngopharyngeal regions, and was accompanied by the largest hypertensive response(Takki et al, 1972). Also various arrhythmias were elicited by vagal stimulation during endotracheal intubation(Burstein et al, 1950: King et al, 1951; Forbes et al, 1970), and it has been known that cardiac arrest could be observed in severe cases(Burstein et al, 1950; Dwyer, 1953; Raffan, 1954; Lander and Mayer, 1965). That hypertension during induction of anesthesia in critically ill patients may be harmful is substantiated by reports of cerebral hemorrhage, left ventricular failure and life threatening cardiac arrhythmia(Forbes and Dally, 1970; Dingle, 1966; Masson, 1964; Katz and Bigger, 1970). Pharmacologic attempts to attenuate these blood pressure and heart rate elevations and appearances of arrhythmia have been tried but theese approaches have been only partially successful. We selected at random 60 adult patients who had received operation under the general anesthesia with intubation at Severance Hospital from August to September, 1979. They were divided into 4 groups. Group l was normotensive without trimethaphan(n=20), Group ll was normotensive with trimethaphan(n=20), Group ll was hypertensive without trimethaphsn(n=10) and Group lV was hypertensive with trimethaphan(n=10). The changes of arterial blood pressure and pulse rate, and appearance of arrnythmia were analyzed and data were compared between groups. The results were as follows; 1. In the trimethaphan injected group, during induction attenuation of increase in blood pressure was not significant in the normotensive group but was statistically significant in the hypertensive group. 2, The effects of trimethaphan on changes of pulse rate were not significant during laryngoscopic insertion under general anesthesia. 3, On EKG of hypertensive patients the trimethaphan injected group revealed fewer abnormal EKG findings than the control group. It is suggested from the above results that intravenous injection of a small amount(0.1 mg/kg) of trimethaphan in a hypertensive patient just before endotracheal intubation can be used as one method to prevent a dangerous hypertensive crisis.
Adult ; Anesthesia ; Anesthesia, General ; Animals ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Pressure ; Braces ; Cardiovascular System* ; Cats ; Cerebral Hemorrhage ; Critical Illness ; Electrocardiography ; Heart Arrest ; Heart Rate ; Humans ; Hypertension ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Methods ; Tachycardia ; Trimethaphan*

For lesions like intracranial aneurysms which are located near highly vascularized regions, adequate dissection becomes almost impossible unless local blood flow can be reduced. Deliberate hypotension, purposefully lowering the arterial pressure to a level at which bleeding is no longer a problem, facilitates surgery, allows performance of a better dissection, and shortens the length of the procedure. Currently, the most useful method for induced hypotensive anesthesia is the use of chemical drugs, such as trimethaphan, nitroprusside and halothane. Induced hypotension with halothane has been reported to be a relatively safe and useful method by Murtagh (1960) and Schettini, et al (1967). Halothane has the effect of depression of myocardial contractility, central autonomic inhibition, ganglionic blocking action and suppression of the peripheral actions of norepinephrine and direct vasodilation on the vessel wall. The advantage of halothane is the reduction of mean arterial pressure slowly (1-3 mm Hg/min) and it has a transient effect on EKG, little effect on brain cortical function and appropriate oxygen supply to brain tissue. The halothane induced hypotension in 100 cases of intracranial aneurysm surgery, which were performed at Severance Hospital of the Yonsei University College of Medicine from .1972 to 1977, was investigated clinically. The results of our study were as follows: 1) The locations of intracranial aneurysm in order were the anterior cerebral artery (37 cases), internal carotid artery (35 cases), middle cerebral artery (23 cases) and posterior cerebral artey (2 cases). Three cases of multiple cerebral aneurysm were found in our study. 2) In the hypotensive phase, the mean systolic and diastolic pressures were 73. 45 mmHg+/- 0. 86, 54. 95 mmHg+/- 0. 86 and the mean duration was 34. 74 min+/- l. 60. 3) The blood pressure control by halothane was comparatively easy and there was no cliaical evidence of direct injury to the brain, heart, kidney and liver due to halothane induced hypotension. 4) The mortality rate in the 100 cases of the intracranial aneurysm was 16 percent. From the above observation it may be concluded that the technique of deliberate hypotension induced by halothane anesthesia is a useful method in the surgery of intracranial aneurysm.
Anesthesia ; Anterior Cerebral Artery ; Arterial Pressure ; Blood Pressure ; Brain ; Carotid Artery, Internal ; Depression ; Electrocardiography ; Ganglion Cysts ; Halothane* ; Heart ; Hemorrhage ; Hypotension* ; Intracranial Aneurysm* ; Kidney ; Liver ; Middle Cerebral Artery ; Mortality ; Nitroprusside ; Norepinephrine ; Oxygen ; Trimethaphan ; Vasodilation

No abstract available.

No abstract available.
Female ; Humans ; Karyotyping* ; Pregnancy ; Pregnancy Trimester, Third*

The objective of this study were to evaluate a correlation between airborne benzene concentrations and urinary muconic acid and to evaluate that between airborne benzene concentrations and urinary phenol concentrations. The high performance chromatographic method was used to measure the muconic acid concentrations in urine samples collected from 69 workers exposed to benzene and 155 non-exposed workers. The time weighted average benzene concentrations in breathing zone of workers were also determined. The physical examination and blood counts (hemoglobin, hematocrit, red blood cell, and white blood cell) were made for both workers exposed to benzene and control group. The results are as follows; 1. The geometric mean of airborne benzene concentrations for all workers was 2.0ppm (0.1-56.9ppm). The mean airborne benzene concentration of workers in adhesive tape manufacturing industry was 12.2ppm (8.3-56.9ppm), which was the highest by type of industry. 2. The geometric mean concentration of muconic acid in urine from male workers exposed to benzene was 3.9 mg/l (0.8-40.8 mg/l), which was significantly higher than that of non-exposed workers. The highest muconic acid concentration was indicated in the workers at the adhesive tape manufacturing industry. 3. There was a significant difference between the mean concentration of muconic acid of workers exposed to airborne benzene concentration of 5-10 pm and that of workers exposed to concentrations below 5 ppm. The urinary muconic acid concentration were correlated with airborne benzene concentration for workers (r=0.85). However there was no significant correlation between urinary phenol concentrations and airborne benzene concentrations. 4. The correlation coefficients between the urinary muconic acid concentration and airborne benzene concentration, urinary phenol concentration, exposure dose(airborne benzene concentration x work duration) and white blood cell were 0.85, 0.74, 0.63 and -0.33, respectively.
Adhesives ; Benzene* ; Environmental Monitoring* ; Erythrocytes ; Hematocrit ; Humans ; Leukocytes ; Male ; Phenol ; Physical Examination ; Respiration

Tracheal stenosis is now a well-recognized, and very serious complication following increased use endotracheal tubes of tracheostomies with air inflated cuffed tubes and assisted ventilation. Up to 10% of patients surviving treatment have been reported to develop stenosis following closure of tracheostomy and some prospective studies predict a 16~20% incidence of stricture following prolonged cuffed tube ventilation. The most important principle is prevention. Once stenosis is established, the logical approach is resection of the stenotic segment and reestablishment of an adequate airway by primary anastomosis or the insertion of a tracheal substitute. In this regard, Pearsor, Grillo, Naef and Binet have made major contributions to the technique of reconstruction of the tracheo-bornchial tree after extensive resection. Strictures are described both in the region of the stoma and at the level of the inflatable cuff. Anesthetic management of these patients should focus on maintenance of the airway and adequate ventilation. If not, hypoxia or cardiac arrest can occur during a prolonged operation due to alvsolar hypoventilation. Extracorporeal circulation for tracheal stenosis reconstruction was first used by Woods for prevention of hypercarbia and hypoxia. The Department of Anesthesiology of Yonsei University has had experience in the anesthetic management of two cases of tracheal stenosis reconstruction using extracorporeal circulation during surgery, these cases are reported along hear with references from the literature.
Anesthesiology ; Anoxia ; Constriction, Pathologic ; Extracorporeal Circulation ; Heart Arrest ; Humans ; Hypoventilation ; Incidence ; Logic ; Tracheal Stenosis* ; Tracheostomy ; Ventilation ; Wood

BACKGROUND: Transcriptional factors of the CREB(cAMP Response Element Binding Protein) are involved in the regulation of gene expression in response to a variety of signaling pathways. Proteins produced by the CREB genes play key roles in many physiological processes, including memory and long term potentiation. The retinoic acid receptor (RAR) axis mediates epithelial cell differentiation and proliferation in many tissues including the lung. MATERIAL AND METHOD: The RAR and CREB expression levels were examined in 60 adenocarcinomas and 60 squamous cell carcinomas of the lung using immunohistochemical staining. RESULTS: 1)RAR protein expression was found in 58.3%(35/60) of adenocarcinomas and 36.7%(22/60) of squamous cell carcinomas(P<0.05). 2)RAR protein expression was found in 80%(16/20) of well differentiated adenocarcinomas, 60%(12/20) of moderately differentiated adenocarcinomas, and 35%(7/20) of poorly differentiated adenocarcinomas (P<0.01). 3)RAR protein expression was found in 45%(9/20) of well differentiated squamous cell carcinomas, 35%(7/20) of moderately differentiated squamous cell carcinomas, and 30%(6/20) of poorly differentiated squamous cell carcinomas (P>0.05). 4)CREB expression was found in 61.7%(37/60) of adenocarcinomas and 40%(24/60) of squamous cell carcinomas(P<0.05). 5)CREB expression was found in 85%(17/20) of well differentiated adenocarcinomas, 60%(12/20) of moderately differentiated adenocarcinomas, and 40%(8/20) of poorly differentiated adenocarcinomas (P<0.01). 6)CREB expression was found in 45%(9/20) of well differentiated squamous cell carcinomas, 35%(7/20) of moderately differentiated squamous cell carcinomas, and 35%(8/20) of poorly differentiated squamous cell carcinomas(P>0.05). 7)RAR and CREB expression was found in 68.5% of lung cancers, and there was a significant correlation between them(P<0.05). CONCLUSION: RAR and CREB expression can be used to indirectly determine the malignant potentiality of a cell.
Adenocarcinoma ; Axis, Cervical Vertebra ; Carcinoma, Squamous Cell ; Epithelial Cells ; Gene Expression Regulation ; Long-Term Potentiation ; Lung Neoplasms* ; Lung* ; Memory ; Physiological Processes ; Receptors, Retinoic Acid ; Response Elements*

The neuroendocrine responses to surgical stress in man include release of ACTH, GH and prolactin in the serum(Cooper and NElson, 1962: Ney et al., 1963: Ross et al., 1966: Schlach, 1967: Gordon et al., 1972: Jeffrey et al., 1977). Data on serum LH and FSH during operation under general anesthesia have been conflictiong. Evidence has also been accumulated that serum LH levels are increased significantly in male patients during operation under general anesthesia in comparison of serum LH in males might be different from that in postmenopausal females with a very high basal level of LH and from menstrating females. Effects of surgical stress under general anesthesia with halothane-N2O on serum LH and FSH levels were studied in 12 menstruating female patients, 8 postmenopausal female patients, and in 8 male patients with no endocrine disorders, liver or kidney function impairment as judged by routine tests. Control serum samples were taken immediately before anesthesia and subsequent samples were obtained from the patients 30 minutes, 1hour and 5~6hours after the onset of anesthesia and on the second and seventh postoperative day. The concentrations of serum LH and FSH were measured by a specific and sensitive radioimmunoassay method. The results are as follows; 1) Preanesthetic levels of serum LH and FSH served as controls and were within range of normal values for male and female subjects in our laboratory. 2) In male patients, serum LH levels 1 hour after onset of anesthesia increased significantly over those of preanesthesia, while no significant intraoperative increase in LH levels was found in female patinets. 3) No significant change in serum LH levels was demonstrated on the second and seventh postoperative day except female patients, who showed significant decrease in the serum LH level on the second postoperative day. 4) No significant intracperative and postoperative changes in serum FSH levels were observed in male or female patients. From the above results, it may be concluded that significant intraopertive increase in serum LH levels occurs in male patients but not in female patients.
Adrenocorticotropic Hormone ; Anesthesia ; Anesthesia, General* ; Female* ; Gonadotropins* ; Humans ; Kidney ; Liver ; Male* ; Prolactin ; Radioimmunoassay ; Reference Values

BACKGROUND: Falling in elderly persons can lead to disability, hospitalizations, and premature death. It may also result in a psychological trauma termed fear of falling. Although it has been reported in developed countries that such fear may lead to staying home or other self-restriction of activities with debilitating physical consequenoes, it has not been studied yet in Korea. So we conducted this study to examine relative frequency of fear of falling and its association with measures of falling, activities of daily living, depression, frailty in elderly persons living in a home for the aged. METHODS: We conducted a cross-sectional study of a sample of 152 subjects among 163 elders living in a home for the aged in Seoul Data on demographic and medical characteristics, and cognitive(MMSEK), functional(ADL, Instrumental ADL), and psychological(GDS-K) functioning, and measures of fall and frailty were obtained during assessments. We asked the subjects whether they had fear of falling in a dichotomous manner. RESULTS: The incidence of falls in the prior year was 29.6%, and the relative frequency of fear of falling was 57.2%. The variables associated with fear of falling with a statistical significance were as follows; old age(>or=80years), no education, no alcohol drinking, no smoking, use of assistive device, experience with falls and fall with injury in the prior 12 months, any disability in ADL, 3 or more disability in IADL In a stepwise logistic regression analysis, experience with falls(OR 2.80, 95% CI 1.12-6.97), 3 or more disability in IADL(OR 2.99, 95% CI 1.33-8.78), and no alcohol drinking(OR 3.23, 95% CI 1.36-7.95) were still associated independently with fear of falling. CONCLUSIONS: Fear of falling is common in the institutionalized elderly persons in Korea, and is associ- ated with decreased instrumental activities, recent experience with falls, and no alcohol drinking. There fore it represents the need for effective intervention to prevent and limit the consequences of falls and fear of falling in elderly persons.
Activities of Daily Living ; Aged* ; Alcohol Drinking ; Cross-Sectional Studies ; Depression ; Developed Countries ; Education ; Hospitalization ; Humans ; Incidence ; Korea ; Logistic Models ; Mortality, Premature ; Self-Help Devices ; Seoul ; Smoke ; Smoking