BACKGROUND: It is a routine practice that High Frequency Jet Ventilation (HFJV) is applied through a 14~16 gauge (about 12 French (Fr.)) angiocath. The 14 Fr. suction catheter which is similar to angiocath in its internal diameter is commonly available in the operating room. We evaluated the suction catheter as a carrier of HFJV in point of ventilation, oxygenation and operating field during HFJV at microlaryngeal endoscopic surgery (MES). METHODS: Fifteen adult patients undergoing HFJV via 14 Fr. suction catheter during MES were studied. Time-based arterial blood gas analyses were done before and after HFJV. The movement of operating field was examined using laryngoscopic examination by surgeon and anesthesiologist. We also evaluated complications such as abdominal distension, barotrauma and so on. RESULTS: The mean arterial oxygen tension was maintained above 250 mmHg all the time during HFJV. The mean carbon dioxide tension was less than 51 mmHg. There were no remarkable catheter movement and complications. CONCLUSION: The 14 Fr. suction catheter is a good replacement of angiocath. It provided good operating field, ventilation and oxygenation without complications.
Adult ; Barotrauma ; Blood Gas Analysis ; Carbon Dioxide ; Catheters* ; High-Frequency Jet Ventilation* ; Humans ; Operating Rooms ; Oxygen ; Suction* ; Ventilation

BACKGROUND: Shivering is a common postanesthetic complication. Because all shivering patients feel uncomfortable and increase oxygen consumption, various attempts have been made to prevent its occurrence or to control it. Among the pharmacological methods of treating shivering, meperidine has been known to be the most effective. This study was designed to evaluate whether there was any difference among meperidine, fentanyl, doxapram and normal saline in the treatment of post-anesthetic shivering. METHODS: Forty patients (ASA class I or II) who showed postoperative shivering were randomly assigned into four groups (n=10): Normal saline group: normal saline 5 ml, Doxapram group: doxapram 1.5 mg/kg, Meperidine group: meperidine 25 mg, Fentanyl group: fentanyl 25 microgram. And all patients received routine care: oxygen by T-piece and heat-reflective blanketrol (cincinati Subzero, U.S.A.). Evaluation of the state of shivering was done every 5 minutes from the beginning of the treatment by the same investigator who had injected the drugs intravenously for treatment of shivering. The age, sex, weight and duration of surgery were recorded. RESULTS: There were no significant statistical differences in age, sex, weight and duration of surgery among the four groups. By 5 minutes, 90% of doxapram group and 30% of meperidine group had stopped shivering. By 10 minutes, 90% of doxapram group and 70% of meperidine group had stopped shivering. But in fentanyl and normal saline group, only 20% had stoppd shivering by 10 minutes. CONCLUSIONS: We conclude that both meperidine and doxapram are effective on post-anesthetic shivering. In cases of patient with respiratory depression, doxapram is especially effective because it stimulates the respiratory center.
Doxapram* ; Fentanyl* ; Humans ; Meperidine* ; Oxygen ; Oxygen Consumption ; Research Personnel ; Respiratory Center ; Respiratory Insufficiency ; Shivering*

BACKGROUND: Lidocaine is a useful local anesthetic and antiarrhythmic agent perioperatively. It may augment a neuromuscular block from both nondepolarizing and depolarizing muscle relaxants. Cisatracurium of benzylisoquinoline derivatives and rocuronium of aminosteroid derivatives are new nondepolarizing muscle ralaxants. We investigated interactions of cisatracurium or rocuronium with lidocaine in vitro. METHODS: Institutional approvement was obtained. Eighty male Sprague Dawley rats (150 - 200 g) were divided into 8 groups (control, lidocaine 1, 10 and 100microgram of both cisatracurium and rocuronium groups). The animals were anesthetized with phentobarbital 40 mg/kg I.P.. The hemidiaphragm with the phrenic nerve was dissected and mounted within 5 minutes in a bath containing 100 ml Kreb's solution at room temperature. The phrenic nerve was stimulated at supramaximal intensity by a Grass S88 stimulator through an SIU5 isolation unit. A twitch height was measured by a precalibrated Grass FT88 force displacement transducer and recorded with a Grass 79 polygraph. After stabilization of the twitch response, cisatracurium (50microgram), and rocuronium (100microgram) were added to the Kreb's solutions. After 10 minutes, we measured twitch height, and saline 1 ml or lidocaine 1, 10 or 100microgram was added to the Kreb's solution. After 10 minutes, we again measured twitch responses. The data was analyzed by repeated measures of ANOVA. RESULTS: There were significant depressions in the twitch response of cisatracurium in lidocaine 10microgram and 100microgram groups compared with the control group and lidocaine 1microgram group. In addition, the lidocaine 100microgram group was significantly depressed compared with the lidocaine 10microgram group. There were no significant depressions of the twitch response of rocuronium in lidocaine 1microgram, 10microgram, and 100microgram groups compared with the control group. CONCLUSIONS: We concluded that lidocaine will increase the sensitivity to cisatracurium in the hemdiaphragm preparation of rats. Lidocaine will be able to cause recurarization. There was not a statistically significant change in the rocuronium group but it was clinically significant.
Animals ; Baths ; Depression ; Humans ; Lidocaine* ; Male ; Neuromuscular Blockade* ; Neuromuscular Depolarizing Agents ; Phrenic Nerve ; Poaceae ; Rats ; Rats, Sprague-Dawley ; Transducers

Resection of large sacrococcygeal teratomas (SCTs) in premature neonates has been associated with significant perinatal mortality, making this a high risk procedure requiring careful anesthetic management. Most deaths during resection of SCTs are due to cardiac arrest caused by electrolyte imbalances, such as hyperkalemia, and massive bleeding during surgery. We describe two premature neonates who experienced cardiac arrest, one due to hyperkalemia and the other not due to hyperkalemia, during excision of large, prenatally diagnosed SCTs. We present here the considerations for anesthesia in premature neonates with huge SCTs.
Anesthesia ; Heart Arrest ; Hemorrhage ; Humans ; Hyperkalemia ; Infant, Newborn ; Perinatal Mortality ; Teratoma

It was reported that pentoxifylline(PTX) improved tissue oxygenation and increased survival rate in animal models of hemorrhagic shock. The authors investigated the salutary effects of PTX on hemodynamics, oxygen transport and tissue metabolism in animal models of hemorrhagic shock. 18 anesthetized cats were subjected to hemorrhage to MABP of 40-45 mmHg and this pressure was maintained for 120 minutes. After this period, normal saline was administered in a volume double the original shed blood volume over 30 minutes. Thereafter the cats were observed for 120 minutes. Drug-treated cats received at 25 mg/kg i.v. bolus of PTX at the beginning of hemorrhage, followed by a continuous infusion of 25 mg/kg/hr throughout the experiment. PTX had no effect on MABP, pH(a-cv), P(cv-a) CO2 and lactic acid value but, PTX group had more rapid HR and higher PcvO, than placebo group(P<0.05). In addition, we found that pH(a-cv) and P(cv-a) CO2 changes occurred more rapidly than lactic acid changes(P<0.05) after hemorrhagic shock. So, pH(a-cv) and P(cv-a) CO2 changes might be considered as useful parameters for early detection of derangement of tissue oxygenation in shock states. It was concluded that PTX had no effects on indices of representing tissue oxygenation except improvement of central venous oxygen tension in this feline hemorrhagic shock model. Further studies are needed.
Animals ; Blood Volume ; Cats* ; Hemodynamics ; Hemorrhage ; Lactic Acid ; Metabolism ; Models, Animal ; Oxygen ; Pentoxifylline* ; Shock ; Shock, Hemorrhagic* ; Survival Rate

BACKGROUND: Poly (ADP-ribose) polymerase (PARP) has been described as an important candidate for mediation of neurotoxicity after brain ischemia. This study was purposed to evaluate the effects of a PARP inhibitor on hypoxic-ischemic injury in the neonatal rat brain. In this study, a highly potent inhibitor of PARP, 3, 4-Dihydro-5-[4-(1-piperidinyl) butoxy]-1 (2H)-isoquinolinone (DPQ) was investigated. METHODS: Seven-day old Sprague-Dawley rat pups were used. The right common carotid artery was ligated under halothane anesthesia. After a recovery period of 3 hours, they were exposed to 8% oxygen at 37degreesC for about 120 minutes. The animals were divided into four groups: the pre-treatment group (n = 13) and post-treatment group (n = 21) were given DPQ 10 mg/kg and the pre-control group (n = 7) and post-control group (n = 14) were given a vehicle for controls. Pre-treatment and pre-control groups were injected 30 minutes prior to the hypoxic injury while post-treatment and post-control groups were injected 30 minutes after the hypoxic period intraperitoneally. The right cerebral hemisphere of the rats were examined with localized (1)H magnetic resonance spectroscopy on day 1 and 7 after the hypoxic insult. Lipid/N-acetyl aspartate (Lip/NAA) and lipid/creatine (Lip/Cr) ratios were used as apoptotic markers. On day 14, the degree of brain injury was scored by morphological changes. RESULTS: In the DPQ treated groups, the Lip/NAA and Lip/Cr ratios were lower than those of the control groups on day 1 after the hypoxic-ischemic injury (P < 0.05). However on day 7, only the ratios of the pre-treatment group were lower than those of the control group (P < 0.05). The degree of morphological changes of the brain injury on day 14 were lower in the DPQ treated groups (P < 0.05). CONCLUSIONS: These results suggest that DPQ exerts a neuroprotective effect in cerebral hypoxic-ischemic injury probably by inhibiting apoptosis especially in the early stage after an insult. Acute inhibition of PARP can have a therapeutic value in preventing ischemic brain injury.
Anesthesia ; Animals ; Apoptosis ; Aspartic Acid ; Brain Injuries ; Brain Ischemia ; Brain* ; Carotid Artery, Common ; Cerebrum ; Halothane ; Magnetic Resonance Spectroscopy ; Negotiating ; Neuroprotective Agents ; Oxygen ; Rats* ; Rats, Sprague-Dawley

Acute aortic dissection can occur in pregnancy in association with severe hypertension due to preeclampsia, coarctation of the aorta, or connective tissue diseases such as Marfan syndrome. The aims of anesthesia are to minimize fetal exposure to cardiopulmonary depressant drugs prior to delivery while ensuring a well-controlled hemodynamic environment for the mother. We encountered a case of a 31-year-old pregnant woman (gestational age 38 weeks) with preeclampsia, gestational DM, and acute aortic dissection (Stanford type A, DeBakey type II). The patient successfully underwent an emergency cesarean section and the subsequent repair of the aortic dissection under general anesthesia. We report this experience with a brief review of the relevant literature.
Adult ; Anesthesia ; Anesthesia, General* ; Aortic Coarctation ; Cesarean Section* ; Connective Tissue Diseases ; Emergencies* ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced* ; Marfan Syndrome ; Mothers ; Pre-Eclampsia ; Pregnancy ; Pregnant Women

BACKGROUND: Core temperature changes during tourniquet inflation and deflation have been reported. The aim of this study is to investigate the extent of core temperature changes during inflation and deflation, depending on tourniquet time. METHODS: Esophageal temperature in sixty patients who undergoing knee arthroscopy with tourniquet longer than 1 h (group L, n = 30) and less than 1 h (group S, n = 30) were measured before inflation, 30 and 60 min after inflation, just before deflation, and 1 min interval for 10 min after deflation. RESULTS: Tourniquet time in L and S group was 109 +/- 20 min and 46 +/- 10.7 min, respectively. Compared to baseline value of 35.7 +/- 0.07 degrees C, significant increase of 0.14 +/- 0.02 degrees C, 0.25 +/- 0.03 degrees C, 0.4 +/- 0.05 degrees C were observed at 30, 60 min after inflation, and just before deflation, respectively in group L, and the increase of 0.11 +/- 0.03 degrees C and 0.18 +/- 0.03 degrees C at 30 min after inflation and just before deflation, respectively in group S. Temperatures from 2 to 10 min after deflation were significantly lower than value of just before deflation in each group (P < 0.05). At 10 min after deflation, 0.76 +/- 0.13 degrees C in group L and 0.4 +/- 0.04 degrees C in group S were lower than values of just before deflation in each group (P < 0.05). Temperature at 10 min after deflation was significantly different between the groups (P < 0.05). CONCLUSIONS: Extent of core temperature decrease after tourniquet deflation was dependent on the duration of tourniquet application.
Arthroscopy ; Humans ; Inflation, Economic ; Knee ; Tourniquets*

BACKGROUND: Most recently, the antiemetic effects of high inspired oxygen have been discussed and various results have been reported according to the types of surgeries and the groups of patients. In ophthalmic surgical patients, surgical procedures involving intraoperative manipulation of the eye and giving rise to residual eye discomfort were associated with the increased incidences of postoperative nausea and vomiting (PONV). The antiemetic effect of 80% inspired oxygen for the patients undergoing vitreoretinal surgery is unknown. Therefore, we examined the efficacy of 80% inspired oxygen in the decrease of the PONV incidences after vitreoretinal surgery under general anesthesia. METHODS: 170 adults under 70 years of age have received standardized sevoflurane anesthesia. After tracheal intubation, they were randomly assigned to two groups: 30% inspired oxygen in air (Group 30), and 80% inspired oxygen in air (Group 80). Postoperative nausea and vomiting were evaluated at the 2, 6, and 24 h postoperatively by an investigator unaware of patients' allocation. RESULTS: There was a significantly lower incidence of PONV during the first 2 h postoperatively in the Group 80 (22%) compared with the Group 30 (40%) (P = 0.024). The Group 80 (33.8%) showed the decreased incidence of PONV during the first 24 h postoperatively compared with the Group 30 (48.8%), but these differences were not statistically significant (P = 0.081). CONCLUSIONS: The use of 80% inspired oxygen during vitreoretinal surgery reduced the incidence of PONV during the first 2 h postoperatively.
Adult ; Anesthesia ; Anesthesia, General ; Antiemetics ; Humans ; Incidence ; Intubation ; Oxygen* ; Postoperative Nausea and Vomiting* ; Research Personnel ; Vitreoretinal Surgery*

We report two cases of high-risked patients with cardiac dysfunction undergoing femoro-popliteal or tibial arterial bypass surgery anesthetized by ultrasound guided peripheral nerve blocks; femoral nerve, femoral branch of genitofemoral nerve and sciatic nerve block. We used an anesthetic solution consisting of 0.375% ropivacaine with epinephrine. We provided sufficient surgical anesthesia. These nerve blockades provided stable intraoperative and postoperative hemodynamic status, which is valuable knowledge from the perspective of postoperative pain control as well as satisfaction of both patients and surgeons. We believe that femorosciatic nerve block with concurrent femoral branch block of genitofemoral nerve could be an excellent anesthetic choice for patients receiving femoro-popliteal or tibial arterial bypass surgery, especially in patients with cardiac dysfunction.
Amides ; Anesthesia ; Anesthesia, Conduction ; Epinephrine ; Femoral Nerve* ; Hemodynamics ; Humans ; Nerve Block ; Pain, Postoperative ; Peripheral Nerves ; Peripheral Vascular Diseases ; Sciatic Nerve* ; Ultrasonography