BACKGROUND: Induction of general anesthesia with tracheal intubation and skin incision are potent stimuli that can induce increased sympathetic activity, heart rate and blood pressure. We compared the hemodynamic response and catecholamine concentration during general anesthesia with intravenous clonidine pretreatment, a centrally acting -2 adrenoceptor agonist, and without pretreatment. METHODS: Forty ASA I or II patients aged from 20 to 60 years undergoing elective surgery were randomly allocated to two groups. In group I, 5 ml of 0.9% normal saline as control administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O (2.5L/min)-O2 (2.5L/min)-enflurane (1.3~1.8 vol%). In group II, 4 g/kg clonidine diluted in 5ml of normal saline administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O-O2-enflurane (0.5~1.0vol%) and 2 g/kg/hr clonidine was continuously infused. We measured blood pressure, heart rate and plasma catecholamine at preinduction, 1 minute after intubation (T1), 1 (T2) and 30 minutes after skin incision (T3) and compared with group I. RESULTS: There was statistical significance in systolic and diastolic pressure at T1 between two groups. There was statistical significance in heart rate, epinephrine and norepinephrine at T1, T2 and T3 between two groups. CONCLUSION: The elevation of blood pressure, heart rate and plasma catecholamine accompanying tracheal intubation and skin incision may be prevented by administration of intravenous clonidine.
Adult ; Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Brain ; Clonidine* ; Epinephrine ; Heart Rate* ; Heart* ; Hemodynamics ; Hemorrhage ; Hope ; Humans ; Incidence ; Intubation* ; Larynx ; Male ; Norepinephrine ; Plasma* ; Skin ; Spondylitis, Ankylosing ; Succinylcholine ; Thiopental

Herpes zoster represents the reactivation of latent varicella-zoster virus located in the dorsal root ganglion. The virus multiplies and migrates to the skin surface producing a characteristic, usually painful, pustular eruption. Severe pain during the acute phase of herpes zoster has been associated with a higher risk of developing postherpetic neuralgia. Sympathetic ganglion blocks have been used for patients in the acute phase of herpes zoster to alleviate pain and prevent postherpetic neuralgia. We experienced 2 cases of patients with acute herpes zoster in which one of them presented with pain localized to the dermatomal distribution of L2-3, the other T3. The authors report the results achieved in treatment of the herpes zoster patients, using radiofrequency thermocoagulation of the sympathetic ganglion.
Electrocoagulation* ; Ganglia, Spinal ; Ganglia, Sympathetic ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Neuralgia, Postherpetic ; Skin ; Sympathectomy*

No abstract available.
Carrier State*

A stellate ganglion block (SGB) is a widely used procedure in the treatment of chronic pain syndromes in the facial and cervicobrachial regions as well as in nonpainful conditions. The complications of a stellate ganglion block include intra-arterial or intracranial injection of local anesthetic, Horner's syndrome, phrenic nerve block, recurrent laryngeal nerve paralysis, brachial plexus block, and pneumothorax. Horner's syndrome after the performance of a stellate ganglion block is a valuable sign of a successful block, but contralateral or bilateral Horner's syndrome remains an unusual and poorly explained phenomenon. We experienced a case of a 56 year-old female patient who had developed ipsilateral and contralateral Horner's syndrome after a stellate ganglion block. The ipsilateral Horner's syndrome was resolved after several hours but the contralateral side lasted for a week.
Brachial Plexus ; Chronic Pain ; Female ; Horner Syndrome* ; Humans ; Middle Aged ; Paralysis ; Phrenic Nerve ; Pneumothorax ; Recurrent Laryngeal Nerve ; Stellate Ganglion*

Moyamoya disease is a rare, progressive, occlusive cerebrovascular disorder characterized by bilateral stenosis of the intracranial portion of the internal carotid artery. Symptoms including transient ischemic attacks, seizures, intracranial hemorrhage and cerebral infarction, are variable. There are few case reports of moyamoya disease in pregnancy. Since hyperventilation-induced cerebral ischemia and hypertension are provoked by active labor, cesarean section has been recommended to avoid neurologic complications for pregnant women with moyamoya disease. The optimal anesthetic management for cesarean section in these patients has not been discussed. We report a case of moyamoya disease in a patient presenting for cesarean section at 40 weeks' gestation. Epidural anesthesia was administered using 0.5% bupivacaine and fentanyl. Intraoperative hemodynamic state was stable. The patient has no significant postoperative complications.
Anesthesia* ; Anesthesia, Epidural ; Brain Ischemia ; Bupivacaine ; Carotid Artery, Internal ; Cerebral Infarction ; Cerebrovascular Disorders ; Cesarean Section* ; Constriction, Pathologic ; Emergencies* ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypertension ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Moyamoya Disease* ; Postoperative Complications ; Pregnancy ; Pregnant Women ; Seizures

BACKGROUND: The efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Clonidine, an alpha2 adrenergic agonist, has nonopiate antinociceptive properties which might be an alternative for postoperative analgesia free of undesirable effects from opioids. The aim of this study was to evaluate the postoperative analgesic effects of an epidural administration with a combination of tramadol and clonidine. METHODS: Sixty patients undergoing lower abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1, 10 ml of bupivacaine 0.125%; group 2, 10 ml of bupivacaine 0.125% with tramadol 50 mg; group 3, 10 ml bupivacaine 0.125% with tramadol 50 mg and clonidine 100 microgram. In the recovery room, postoperative analgesia was assessed by the visual analogue scale (VAS) at 30 min, 1, 2, 3, 4, 5 and 6 hour. Vital signs, sedation score and side effects were also checked. RESULTS: VAS scores were significantly lower in group 3 than group 1. In addition, VAS scores were significantly lower in group 3 than group 2 at 4 and 5 hours. Blood pressure, heart rate and sedation scores were not significantly different among the three groups. CONCLUSIONS: The combination of epidural 0.125 % bupivacaine, tramadol 50 mg and clonidine 100 microgram produces more profound and longer postoperative analgesic effects than 0.125% bupivacaine and tramadol 50 mg or only 0.125% bupivacaine for the lower abdominal surgery.
Adrenergic Agonists ; Analgesia* ; Analgesics, Opioid ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Humans ; Pain, Postoperative ; Recovery Room ; Tramadol* ; Vital Signs

BACKGROUND: This study was designed to evaluate the effect of continuous intravenous infusion of esmolol on the heart rate and blood pressure, after ketamine induction and endotracheal intubation. METHODS: With informed consent, forty patients with ASA physical status 1 were randomly divided into two groups. Esmolol group received the continuous intravenous infusion of esmolol (at 500 microgram/kg/min for 1 minute as a loading dose and at 300 microgram/kg/min until 7 minutes after endotracheal intubation as a maintenance dose) and saline group received normal saline at the same volume-rate. 2 mg/kg of ketamine and 0.15 mg/kg of vecuronium were given at 4 minutes after the test drugs. Intubation was performed at 3 minutes after the induction. The changes of blood pressure, heart rate and rate pressure product were measured at different time intervals (preinduction, preintubation, immediately after intubation and postintubation 1, 3, 5 and 7minutes). RESULTS: In the esmolol group, the changes of systolic blood pressure, diastolic blood pressure, heart rate and rate pressure product were significantly attenuated when compared with the saline group. The changes in heart rate at preintubation and intubation were not statistically significant when compared with the baseline value within the esmolol group. CONCLUSIONS: It is concluded that the infusion of esmolol attenuated the hemodynamic changes following ketamine induction and endotracheal intubation, but it is still needed to find the dosage of esmolol.
Anesthetics ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Informed Consent ; Infusions, Intravenous* ; Intubation ; Intubation, Intratracheal* ; Ketamine* ; Sympathetic Nervous System ; Vecuronium Bromide

No abstract available.
Amputation* ; Replantation*

OBJECTIVES: For the understanding and effective treatment of depressive symptoms in chronic schizophrenia, this study investigated the frequency of depressive symptoms and examined associations between depressive symptoms and positive symptoms, negative symptoms, general psychopathology in chronic schizophrenia. METHOD: The authors assessed the frequency of depressed schizophrenia with 30 or higher scores of HRSD in 135 DSM-IV chronic schizophrenia. We measured PANSS, BPRS in depressed(n=37) and non-depressed schizophrenia(n=37) who were matched in sex, age and dose of antipsychotics to compare positive, negative symptoms and other psychopathology. Also, we evaluated correlation between depressive symptoms and positive symptoms, negative symptoms, other psychopathology in depressed schizophrenic patients. RESULTS: 1) The depressive symptoms were present in 27.4% of chronic schizophrenia. 2) The positive scale of PANSS were significantly higher in depressed than in non-depressed schizophrenia(p<.01), and the negative scale of PANSS were higher in depressed schizophrenia but there were no statisical significance. Thinking disturbance and depressive-anxiety factors of BPRS were significantly higher in depressed than in non-depressed schizophrenia(p<.01, p<.01). 3) The positive and negative scale of PANSS correlated with HRSD in depressed schizophrenia(p<.01, p<.05), and thinking disturbance and depressive-anxiety factors correlated with HRSD in depressed schizophrenia(p<.01, p<.01). CONCLUSION: The depressive symptoms are relatively commom and important part of schizophrenic symptomatology, and they are more related to positive symptoms than negative symptoms of schizophrenia. Thus this study suggest that appropriate assessment and therapeutic intervention for depressive symptoms is especially necessary to the schizophrenic patients with severe positive symptoms.
Antipsychotic Agents ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Psychopathology ; Schizophrenia* ; Thinking

No abstract available.
Cartilage*