No abstract available.

Fentanyl-O2 anesthesia has gained wide popularity as an anesthetic technique for patients undergoing cardiac surgery because of its minimal cardiovascular effects and total amnesia for intraoperative events. But, some authors recently reported intraoperative awareness and the excessive cardiovascular response to surgical stimulation during high dose fentanyl-oxygen anesthesia far cardiac operation and suggested the necessity of supplementary anesthetic agent in addition to fentanyl to prevent the intraoperative awareness and maintain hemodynamic stability during the surgical procedure. A variety of supplementary drugs have been used in combination with the opioids in an effort to reduce the incidence of awareness, to control hypertension, and to attenuate the extent of postoperative respiratory depression. One of supplementary drugs, diazepam has little cardiovascular effects by itself, but causes significant depression of arterial blood pressure and cardiac output when given to patients who have received fentanyl or morphine. We measured the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and rate pressure product (RPP) at induction, tracheal intubation, skin incision, and sternotomy time to evaluate the effects of the diazepam on reduction of the excessive cardiovascular response to anesthetic and surgical stimulation and observed the presence of the intraoperative awareness, under fentantyl-diazepam-O2 anesthesia for open heart surgery on 12 patients with cardiac disease. Anesthesia was induced with fentanyl 20 ug/kg + diazepam 0.1 mg/kg and maintained with continuous infusion of fentanyl (1.5 ug/kg/min. prior to sternotomy and 0.3 ug/kg/min. until the end of cardiopulmonary bypass) and diazepam 0.1 mg/kg was injected just before sternotomy and at the end of cardiopulmonary bypass. The patients required the total dose of fentanyl 76+13.1 ug/kg and diazepam 0.3 mg/kg for the entire operation. These measurements were compared with control data (before induction). The results were as followings: 1)During induction period (infusion of fentanyl 20 ug/kg with diazepam 0.1 mg/kg); HR, SBP, DBP, and MAP slightly decreased compared with control data, but there were not statistically significant. RPP decreased significantly from 15898+/-5099 torr. beatsmin. to 12371+/-2407 torr. beatsmin. and there was statistical significance (p<0.05). 2) During intubation and skin incision; HR, SBP, DBP, MAP and RPP revealed no significant change compared with control data. 3) During sternotomy; HR, SBP, DBP, MAP, and RPP slightly increased, but there were not statistically significant. 4) There was no patient who had the recall or awareness for intraoperative events. 5) Duration of controlled or assisted ventilatory support. postoperatively, was 216+/-36 min. These results suggest that fentanyl-diazepam-O2 anesthesia might be more useful than fentanyl-O2 anesthesia for prevention of intraoperative awareness and attenuation of excessive cardiovascular response during open heart surgery. But, continuous and careful monitoring for hemodynamic changes of patients will be needed necessarily to prevent the significant depression of arterial blood pressure and cardiac output throughout the entire operative procedures.
Amnesia ; Analgesics, Opioid ; Anesthesia* ; Anesthetics ; Arterial Pressure ; Benzodiazepines ; Blood Pressure ; Cardiac Output ; Cardiopulmonary Bypass ; Depression ; Diazepam* ; Fentanyl* ; Heart Diseases ; Heart Rate ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Hypnotics and Sedatives ; Incidence ; Intraoperative Awareness ; Intubation ; Morphine ; Respiratory Insufficiency ; Skin ; Sternotomy ; Surgical Procedures, Operative ; Thoracic Surgery*

OBJECTIVES: To investigate the work-relation of the asthma of a 51-year old aircraft maintenance worker and his working environment METHODS: For 2 weeks, the patient went back into his workplace. The pulmonary function test including FEV1 was performed every other day morning in the hospital and peak expiratory flow rate(PEFR) self-monitoring was done 6 times a day. RESULTS: The patient has been worked as aircraft maintenance worker in line maintenance department since 1968. The pulmonary function test(PFT) with bronchodilator confirmed the asthma of the patient. He showed positive response to 2-weeks workplace challenge test. On 3rd day after stopping challenge exposure, FEV 1.0 was 1.04 L(55 % of baseline measurement). The result of PEFR self-monitoring showed progressively deteriorating pattern, baseline PEFR was 6.02 L/min but PEFR on 3rd day after stopping exposure was 2.43 L/min. CONCLUSIONS: The present case could be occupational asthma based on positive results of PEFR monitoring. Further research will be needed to find the specific agent to cause asthma in aircraft maintenance workers exposed to aviation fuel and jet stream exhausts.
Aircraft ; Asthma* ; Asthma, Occupational ; Aviation ; Formaldehyde ; Humans ; Kerosene ; Middle Aged ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Rivers

The internal morphology of the right and left atria of rabbit, cat, pig, and human, particularly on the luminal structures of the auricle, were observed by stereomicroscope improving corrosion casting method using latex. Structures of the right auricular casts markedly differ from those of the left side, consisting of defined surface sturctures with distinct folds and branching patterns. The main atrial region consists of smooth surfaced single mass of the latex, and the auricular region is characterized by well developed branching patte and delicate small folds. The results of this study indicate that auricula have well organized duct-like luminal structures and many small pouches (out-pocketings) expanding the internal wall of the duct-like structures and small pouches. The endocardial nuclear imprints on the surface of the folds in the auricular region appeared larger and deeper than those on the atrium proper region of the atrial cast. These morphological observation will be aid in understanding structures of auricular lumen, regional differences of the endocardium and their function to the secretory process of atrial natriuretic peptide (ANP) release.
Animals* ; Cats ; Corrosion Casting* ; Corrosion* ; Endocardium ; Humans ; Latex ; Methods* ; Phenobarbital* ; Secretory Pathway

Propofol is limited in clinical use for induction of anesthesia, because of its high incidence of pain on injection. We sought to determine whether different methods could prevent this pain. 150 patients were allocated randomly into five groups. Group 1 was received room-air temperature propofol 2.5 mg/kg. Group 2 was received room-air temperature propofol 2.5 mg/kg mixed with 1 ml of 1%(10 mg) lidocaine. Group 3 was received room-air temperature propofol 2.5 mg/kg just after the injection of l ml of 1%(10 mg) lidocaine. Group 4 was received room-air temperature propofol 2.5 mg/kg mixed with 1 ml of 0.5%(5 mg) lidocaine. Group 5 was received propofol 2.5 mg/kg cooled to 0-4degrees C. The pain was classified as none, mild, moderate, or severe. All patients were questioned the degree of pain in an identical manner both at induction of anesthesia and as recalled in the recovery room. There was a significant reduction in the incidnce and severity of pain in the Groups 2 and 3, which were used 10 mg of lidocaine. But 23.3% of patients in the Group 2 and 30.0% of patients in the Group 3 still suffered unpleasant pain during the induction, and 20.0% and 26.7% of patients, respectively recalled in the recovery room. From the above results, we concluded that the pain from injection of propofol can be prevented by 1 ml of 1%(10 mg) lidocaine mixed with propofol or preinjection before propofol.
Administration, Intravenous* ; Anesthesia ; Humans ; Incidence ; Lidocaine ; Propofol* ; Recovery Room

BACKGROUND: Experience of wakefulness and pain perception during general anesthesia can be distressful to patients. For cesarean section, a light plane of general anesthesia is chosen for fetal safety and rapid recovery; there is an increased incidence of maternal wakefulness. Propofol may be the choice if smooth induction and rapid maternal recovery are desired. We compared propofol with thiopental sodium as an induction agent of anesthesia in cesarean section, noting in particular the patients wakefulness during operation. METHODS: Twenty six patients who underwent cesarean section received either thiopental sodium 4 mg/kg (n=13) or propofol 2.5 mg/kg (n=13) as an induction agent. To assess intraoperative wakefulness, a tourniquet was applied before the administration of succinylcholine for maintaining motor function in one arm. Wakefulness during anesthesia could be assessed by asking the patient to move her hand. RESULTS: Although the changes in blood pressure and heart rate were similar in both groups, the propofol group had a less increasing systolic blood pressure from the period immediately and 1 minute after intubation (P<0.05). The patients administered with propofol showed significantly higher incidences of "followed commands" and "made reaching movements" (P<0.05). The incidence of dreams was higher in the propofol group than thiopental sodium group. CONCLUSIONS: Propofol was similar to thiopental sodium in hemodynamic effects on mother, but incidence of intraoperative wakefulness was significantly increased in the propofol groups.
Anesthesia ; Anesthesia, General ; Anesthetics ; Arm ; Blood Pressure ; Cesarean Section* ; Dreams ; Female ; Hand ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Memory ; Mothers ; Pain Perception ; Pregnancy ; Propofol* ; Succinylcholine ; Thiopental* ; Tourniquets ; Wakefulness*

Combining benzodiazepine with opioid has been used for analgesia and sedation during spinal anesthesia, but many authors have warned that combined administration of these drugs produces potent drug interaction that places patients at high risk for hypoxemia and apnea. This study was undertaken to observe the effect of combined use of diazepam with fentanyl on hemodynamic response and change in SaO in twenty healthy adult patients undergone elective surgery with spinal anesthesia. All of the patients were divided into the control and experimental group, and whom spinal anesthesia with 0.5% tetracaine the 12 mg and epinephrine 0.2 mg, were performed. To the control(Group I) and experimental group(Group 2) the combined dose of diazepam 0. 075 mg/kg with fentanyl 1 ug/kg, and diazepam 0.15 mg/kg with fentanyl 2 ug/kg, were given, respectively, by intravenous injection 1 hour after spinal anesthesia started. Blood pressure, heart rate and SaO2 of the two groups were compared at the time before administration of study drugs and 1 min, 2 min, 2 min, 4 min, 5 min, 10 min, 30 min and 60 min after administration of study drugs. The results were as follows. 1) SaO2 was significantly decreased in group 2 than Group 1 after study drugs were administed intravenously. 2) In both group, decrease in SaO2 was significant at the first 5 minutes after intravenous administration of study drugs. 3) SaO2 fell to 90% of the control value after the administration of study drugs in 6 patients of Group 2(60%). 4) Hemodynamic changes after intravenous administration of study drugs were statistically significant but not so clinically in both group. We concluded that combined intravenous administration of benzodiazepine and opioid under spinal anesthesia requires the careful monitoring of hemodynamic response and ventilatory status continuosly with those monitoring devices already in use and pulse oximeter. Availiability of skilled anesthesiologists for airway management and administration of supplemental oxygen are very important in combined intravenous administration of benzodiazepine and opioid.
Administration, Intravenous ; Adult ; Airway Management ; Analgesia ; Anesthesia, Spinal* ; Anoxia ; Apnea ; Benzodiazepines ; Blood Pressure ; Diazepam* ; Drug Interactions ; Epinephrine ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Injections, Intravenous ; Oxygen ; Tetracaine

As an alphs-2 adrenergic agonist, clonidine, which is an antihypertensive drug, can reduce central sympathetic outflow. By regulation of presynaptic transmitter release, it also lowers blood pressure and amounts of anesthetic drugs used during anesthesia, causes sedation, and attenuates postoperative shivering. The authors studied the effects of transdermal clonidine as a premedicant, which is easy and simple to use and maintains constant plasma level. Sixty patients undergoing elective orthopedic surgery, with preoperative normal blood preesure, were seleeted and randomly divided into 2 groups, 30 subjects each. Placebo patch was placed on the shoulder of patients belonging to the placebo group, and clonidine patch for the clonidine group just 48 hours before operation. Cardiovascular effects such as changes in perioperative blood pressure and heart rate, the degree of sedation before to induction, amounts of anesthetic drugs during anesthesia, postoperative analgesic requirements, ratio of patients who experienced postoperative shivering were observed and compared between the two groups. Patients in the clonidine group showed more stable cardiovascular response perioperatively and amounts of anesthetic drugs required during operation were reduced as compared to the placebo group(p<0.05). Preinduction sedation score of clonidine group was definitely higher than that of placebo group. (p <0.05) All 30 patients in the placebo group required analgesics for 48 hours after operation(100%) and only 19 patients of the clonidine group required analgesics(63%). The amounts of postoperative analgesics were definetely reduced in the clonidine group(p<0.05). Postoperative shivering occurred in 12 patients of the placebo group(40%) and 5 patients of the clonidine group(16.6%). We concluded that transdermal clonidine can be used effectively as a premedicant privided close regulation of anesthetic drugs used during anesthesia is possible.
Adrenergic Agonists ; Analgesics ; Anesthesia ; Anesthetics ; Blood Pressure ; Clonidine* ; Heart Rate ; Humans ; Orthopedics ; Plasma ; Shivering ; Shoulder

BACKGROUND: To collect high concentration of granulocytes for transfusion to neutropenic cancer patients with infections, we investigated the effect of G-CSF or dexamethasone as granulocyte mobilizers and 10% pentastarch (PS) as the sedimentation agent in granulocyte collection by leukapheresis. Subsequently, the therapeutic effect of the granulocyte transfusions was assessed. METHODS: Forty five leukapheresis were performed with CS-3000Plus (Baxter, Deerfield, IL, USA) using 10% pentastarch. The donors were classified into three groups according to their premedication drugs and the interface detector offset; group 1 used dexamethasone with offset 15 (n=16), group 2 used dexamethasone with offset 33 (n=16), and group 3 used G-CSF with offset 33 (n=10). We compared total collected granulocyte counts and granulocyte collection efficiency (GCE). RESULTS: The mean counts of total granulocytes collected and GCE were as follows; 0.9 0.5 x 1010 and 31.6 14.3% in group 1, 1.3 0.6 x 1010 and 39.0 14.2% in group 2, and 1.6 0.9 x 1010 and 63.9 32.2% in group 3, respectively. The counts of granulocytes collected in group 3 was significantly higher than that in group 1 (P<0.05). The GCE of group 3 was significantly higher than that of group 1 and group 2 (P<0.05). Sixteen granulocyte transfusions were performed to 11 patients. We observed successful therapeutic effects in 10 out of 16 transfusions (63%). CONCLUSIONS: G-CSF indicates greater potency than dexamethasone although its high cost is limitation of routine use as mobilizing agents and PS was an excellent red cell sedimenting agent in granulocyte collection. Large volume granulocyte transfusions allow high therapeutic effects in neutropenic patients with marrows of sufficient regenerating capacity.
Bone Marrow ; Dexamethasone ; Granulocyte Colony-Stimulating Factor ; Granulocytes* ; Humans ; Hydroxyethyl Starch Derivatives* ; Leukapheresis* ; Neutropenia ; Premedication ; Tissue Donors

It is well known that the pulmonary capillary endothelium is rich in angiotensin converting enzyme(ACE), which is released in the event of smoking, acute lung injury, or some lung diseases such as Gauchers disease and hypertension. Serum ACE levels may be clinically useful because they are reflections of pulmonary circulation. In order to evaluate the effect of extracorporeal circulation and pulmonary perfusion on serum ACE levels, we measured serum ACE level during prebypass, total bypass(5', 30', 60') and pulmonary perfusion (30', 60', 24 hrs.) in 10 open-heart patients. The results were as follows: 1) The SACE level before the begining of extracorporeal circulation was 10.03+/-1.66u/ml and decreased significantly to 2.79+/-0.63u/ml(p<0.005) 5min. after extracorporeal circulation was initiated. 2) The decreased SACE level seen during extracorporeal circulation returned to a nearly normal (9.33+/-1.8u/ml) 24hrs. after pulmonary perfusion. 3) There were no significant correlations between the SACE level and the variation of age during extracorporeal circulation and pulmonary perfusion. The above results suggest that SACE levels are proportional to the amount of pulmonary blood flow.
Acute Lung Injury ; Angiotensins* ; Cardiopulmonary Bypass ; Endothelium, Vascular ; Extracorporeal Circulation* ; Gaucher Disease ; Humans ; Hypertension ; Lung Diseases ; Peptidyl-Dipeptidase A* ; Perfusion ; Pulmonary Circulation ; Smoke ; Smoking