No abstract available.
Anesthesia, General ; Oxygen

OBJECTIVE: Excitatory amino acids play important roles in the development of secondary pathology following spinal cord injury (SCI). This study was designed to evaluate morphological changes in the dorsal horn of the spinal cord and assess profiles of pain behaviors following intraspinal injection of N-methyl-D-aspartate (NMDA) or quisqualate (QUIS) in rats. METHODS: Forty male Sprague-Dawley rats were randomized into three groups : a sham, and two experimental groups receiving injections of 125 mM NMDA or QUIS into their spinal dorsal horn. Following injection, hypersensitivity to cold and mechanical stimuli, and excessive grooming behaviors were assessed serially for four weeks. At the end of survival periods, morphological changes in the spinal cord were evaluated. RESULTS: Cold allodynia was developed in both the NMDA and QUIS groups, which was significantly higher in the QUIS group than in the NMDA group. The mechanical threshold for the ipsilateral hind paw in both QUIS and NMDA groups was significantly lower than that in the control group. The number of groomers was significantly higher in the NMDA group than in the QUIS group. The size of the neck region of the spinal dorsal horn, but not the superficial layer, was significantly smaller in the NMDA and QUIS groups than in the control group. CONCLUSION: Intraspinal injection of NMDA or QUIS can be used as an excitotoxic model of SCI for further research on spinal neuropathic pain.
Animals ; Cold Temperature ; Excitatory Amino Acids ; Grooming ; Horns ; Humans ; Hyperalgesia ; Hypersensitivity ; Injections, Spinal ; Male ; N-Methylaspartate ; Neck ; Neuralgia ; Quisqualic Acid ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Spinal Cord ; Spinal Cord Injuries

BACKGROUND: Alpha-2 adrenergic agonists decrease the sympathetic tones of hemodynamic and endocrine responses to surgical stimuli. The goal of this study was to evaluate the hemodynamic and endocrinologic effects of intraoperatively administered dexmedetomidine, a highly selective alpha-2 adrenergic agonist, in patients undergoing coronary artery bypass graft surgery. METHODS: Fifty coronary artery bypass graft patients, in a double-blind, randomized manner, received a continuous infusion of normal saline placebo or dexmedetomidine, 10 ng/kg/min for 1 hr from 5 minutes after sternotomy. All patients received standardized anesthesia. Plasma catecholamine was measured at 5 minutes after sternotomy (T1), 30 minutes after drug infusion (T2), and 30 minutes after drug cessation (T3). Heart rate, blood pressure, pulmonary artery pressure and cardiac output were monitored. RESULTS: Compared with the placebo group, plasma norepinephrine concentrations decreased in the dexmedetomidine group Dexmedetomidine attenuated increased blood pressure on surgical stimuli and induced more hypotension. CONCLUSIONS: The intraoperative infusion of dexmedetomidine to patients undergoing coronary artery bypass graft surgery reduced sympathetic tone and attenuated hemodynamic responses to surgical stimuli.
Adrenergic Agonists ; Anesthesia ; Blood Pressure ; Cardiac Output ; Coronary Artery Bypass* ; Coronary Vessels* ; Dexmedetomidine* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Norepinephrine ; Plasma* ; Pulmonary Artery ; Sternotomy ; Transplants

Renal cell carcinoma (RCC) rarely extends to the cardiac chambers, and the presence of an extension of tumor thrombus to the inferior vena cava or the right atrium has not been shown to determine the survival of patients with RCC.Although an aggressive surgical approach remains the primary treatment for RCC, the anesthetic management remains a difficult intraoperative challenge.We report here on a case of performing cavoatrial tumor thrombectomy and radical nephrectomy in a patient with RCC with an intracardiac extension, and we used cardiopulmonary bypass and intraoperative trans-esophageal echocardiography to assess and treat this tumor.
Carcinoma, Renal Cell ; Cardiopulmonary Bypass ; Echocardiography ; Heart Atria ; Humans ; Nephrectomy ; Thrombectomy ; Thrombosis ; Vena Cava, Inferior

BACKGROUND: Hypoperfusion during manipulation of the heart in off-pump coronary artery bypass (OPCAB) surgery may lead to postoperative neurological complications. Therefore, it will be necessary to monitor cerebral function during OPCAB surgery. In this study, we compared regional cerebral oxygenation (rSO2) by near-infrared spectroscopy (NIRS) with jugular bulb venous oxygen saturation (SjvO2) and assessed whether rSO2 measured by NIRS could be an alternative method of SjvO2 during OPCAB surgery. METHODS: A total of 20 patients who underwent OPCAB surgery were studied. A fiberoptic catheter was placed in the right jugular bulb to measure SjvO2 while a cerebral oximeter based on NIRS, INVOS 5100B was used to monitor rSO2. Radial arterial and jugular bulb blood samples were drawn simultaneously from baseline every hour during operation. The values of rSO2 were compared with SjvO2 values. RESULTS: For all data points (n = 78) for all patients combined, rSO2 values were significantly correlated with SjvO2 values (r = 0.513, P < 0.0001). There were significant correlations between arterial carbon dioxide and values of SjvO2 (r = 0.393, P = 0.0002) and rSO2 (r = 0.432, P < 0.0001). CONCLUSIONS: We concluded that NIRS correlates with SjvO2 in this patient population. These findings suggest that near-infrared spectroscopy may be useful in assessing cerebral oxygenation during OPCAB surgery.
Carbon Dioxide ; Catheters ; Coronary Artery Bypass, Off-Pump ; Heart ; Humans ; Organothiophosphorus Compounds ; Oxygen ; Spectroscopy, Near-Infrared

BACKGROUND: Remifentanil may be advantageous during induction of anesthesia in patient with heart disease because of rapid onset and hemodynamic stability. Some study reported that remifentanil showed complications such as profound bradycardia, severe hypotension and rigidity. The purpose of this study is to investigate the hemodynamic changes and side effects of remifentanil by using the methods of bolus administration during induction of anesthesia in cardiac surgery. METHODS: Fifty eight patients of ASA physical status 2~3 undergoing cardiac surgery were enrolled into 3 groups. We administered no remifentanil in Group A, 5microg/kg of remifentanil in Group B and 10microg/kg of remifentanil in Group C. After bolus administration of remifentanil over 30 sec, we infused 0.2microg/kg/min of remifentanil continuously. All group received continuous infusion of 100microg/ kg/min of propofol. After loss of consciousness, 0.15 mg/kg of vecuronium was administered. After the Bispectral index (BIS) value became lower than 60, intubation was done. Mean arterial pressure, heart rate, the incidence of cough, jaw and chest wall rigidity, and BIS value were measured initially and 1, 2, 3, 4, 5 minutes before intubation and 1, 2, 3, 4, 5 minutes after intubation. RESULTS: Mean arterial pressures of group B and C were significantly lower than those of group A (P < 0.05). Heart rate was similar among the groups. Group C showed a greater incidence of jaw rigidity (77%) compared with group A (35%) and group B (35%) (P < 0.05). The incidence of chest wall rigidity (66%) in group C was greater than group A (5%) and group B (15%) (P < 0.05). CONCLUSIONS: Remifentanil used as an induction agent (5microg/kg or 10microg/kg) may cause hypotension and jaw, chest wall rigidity with improper ventilation.
Anesthesia ; Arterial Pressure ; Bradycardia ; Cough ; Heart Diseases ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Incidence ; Intubation ; Jaw ; Propofol ; Thoracic Surgery* ; Thoracic Wall ; Unconsciousness ; Vecuronium Bromide ; Ventilation

Spinal cord stimulation has been applied for some patients with failed back surgery syndrome or neuropathic pain. Tests for the spinal cord stimulation can be performed under local or general anesthesia. However, if this is done during an operation with the patient under general anesthesia, it would be impossible to recognize whether an electrode induces paresthesia in the concordant painful area by the patient's self report. A 79-year-old female patient with failed back surgery syndrome had a spinal cord stimulator implanted under spinal anesthesia and the stimulation led to paresthesia on the most painful area of the patient. We report here on a case that surgical implantation of a spinal cord stimulator was successfully performed under spinal anesthesia.
Aged ; Anesthesia, General ; Anesthesia, Spinal ; Electrodes ; Failed Back Surgery Syndrome ; Female ; Humans ; Laminectomy ; Neuralgia ; Paresthesia ; Self Report ; Spinal Cord ; Spinal Cord Stimulation

Cerebral complication after cardiac surgery with cardiopulmonary bypass varies widely focal neurologic deficit, stupor, coma, dementia, memory deficit, or seizures. The incidence of visual loss from ischemic optic neuropathy is from 0.06% to 0.113%. Visual loss is a rare but devastating complication of cardiac surgery. This report describes a patient who had reversible visual loss in postoperative period. She had undergone the decrease of bispectral index, cerebral oxygen saturation and the increase of suppression ratio during mitral valvuloplasty.
Cardiopulmonary Bypass ; Coma ; Delirium ; Dementia ; Humans ; Hypertensive Encephalopathy ; Incidence ; Memory Disorders ; Neurologic Manifestations ; Optic Neuropathy, Ischemic ; Oxygen* ; Postoperative Period* ; Seizures ; Stupor ; Thoracic Surgery

BACKGROUND: The effect of a muscle relaxant may differ in the elderly for pharmacokinetic and pharmacodynamic reasons. Rocuronium, a derivative of vecuronium is a non depolarizing neuromuscular blocker with a rapid onset and intermediate duration. The purpose of this study was to compare differences in the onset and duration of rocuronium in young adults and the elderly. METHODS: The study was approved by our instituitional review board, and informed consent was obtained from all patients. Twenty two young adults (15 59 yr) and 21 elderly (65 80 yr) patients, ASA physical status 1 2 underwent elective orthopedic surgery under general anesthesia. All were anesthetized with pentothal sodium, nitrous oxide, and isoflurane. Rocuronium (0.6 mg/kg) was given and then intubation was performed after TOF response had totally disappeared. Neuromuscular relaxation was measured by TOF response at the adductor pollicis muscle after a supramaximal stimulation of Train-of-four (TOF, 2 Hz every 12 sec) at the ulnar nerve. Onset (disappearance of T1) and the recovery times of T1, T2, T3 and T4 were recorded. RESULTS: The onset of neuromuscular block was slower in the elderly than the young adults (P < 0.05), and recovery times of T1, T2, T3, and T4 were prolonged in the elderly (P < 0.05). CONCLUSIONS: Rocuronium has a slower onset time and a delayed recovery in the elderly.
Aged* ; Anesthesia, General ; Geriatrics ; Humans ; Informed Consent ; Intubation ; Isoflurane ; Neuromuscular Blockade ; Nitrous Oxide ; Orthopedics ; Relaxation ; Sodium ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide ; Young Adult

The bispectral index (BIS) has been developed as a measure for monitoring the hypnotic drug effect. EEG processing results in a BIS scale from 0 to 100, where 100 represents an awake and responsive patient, and the scale decreases when hypnotics are administered. Here we describe two patients in whom the BIS decreased to nearly 0 during cardiac surgery. Postoperatively both patients showed hypoxic brain injury. There are several possible causes for a decrease in the BIS during surgery, including deep anesthesia, hypothermia and cerebral ischemia. In the present cases, cerebral hypoperfusion was the likely cause. During cardiac surgery, hemodynamic changes such as acute hypotension and cardiac arrest can cause cerebral ischemia. Cerebral ischemia develops most commonly during cardiopulmonary bypass (CPB). Therefore, the BIS may be useful for detecting severe cerebral ischemia during CPB, although it has some limitations as a cerebral monitor.
Anesthesia ; Brain Injuries ; Brain Ischemia* ; Cardiopulmonary Bypass* ; Electroencephalography ; Heart Arrest ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Hypotension ; Hypothermia ; Thoracic Surgery