BACKGROUND: The clinical efficacy of electroconvulsive therapy (ECT) primarily depends on the adequacy of the seizure duration, but the intravenous anesthetics which are commonly used for ECT may possess anticonvulsant properties and shorten the seizure duration. The aim of this study was to compare the effects of propofol and etomidate on seizure duration and hemodynamic responses during ECT. METHODS: 30 patients undergoing maintenance ECTs were evaluated and divided into two groups randomly. Hypnosis was induced with a bolus injection of either 1.5 mg/kg of propofol or 0.3 mg/kg of etomidate in each group. Time to unconsciousness, seizure duration, heart rate, mean arterial pressure and recovery time were measured after delivery of electrical stimulus. The dynamic energy (joules) delivered was recorded. Correlation between seizure duration and recovery time was calculated and the rates of seizure induction failure after first electrical stimulus were compared. RESULTS: The seizure duration was shorter in the propofol group (34.0 +/- 3.8 s) than in the etomidate group (50.0 +/- 4.0 s)(P < 0.01). The heart rate was significantly lower in the propofol group (132.1 +/- 3.8, 99.7 +/- 6.2 bpm) than in the etomidate group (146.0 +/- 4.2, 119.8 +/- 7.5 bpm) at the time of ECT and 1 min after ECT respectively (P < 0.05). The mean arterial pressure was significantly lower in the propofol group than in the etomidate group from the time of ECT to 10 min after ECT (P < 0.05). CONCLUSIONS: Propofol showed excellent hemodynamic stability and was a good hypnotic for ECT therapy, but etomidate might be a useful alternative to propofol in patients who have an inadequate seizure duration.
Anesthetics, Intravenous ; Arterial Pressure ; Electroconvulsive Therapy ; Etomidate* ; Heart Rate ; Hemodynamics* ; Humans ; Hypnosis ; Propofol* ; Seizures* ; Unconsciousness

No abstract available.
Critical Illness*

No abstract available.
Diagnosis*

The changes in heart rate, systolic, mean and diastolic arterial blood pressure, and the plasma concentration of epinephrine and norepinephrine were measured before and thmughout the induction periods of anesthesia in 60 elective surgical patients in a randomized, double-blind manner to evaluate the effects of continuous intravenous infusion of esmolol for 1 minute at 500 ug/kg/min as a loading dose and for 4 minutes at 100 ug/kg/min as a maintenance dose. The control group (n=30) was given the continuous infusion of normal saline at the same volume-rate. During the study, anesthesia was maintained with N2O-O2-enflurane-vecuronium and controlled ventilation. In the esmolol group, statisticaUy, the heart rate at 1 minute after the intubation was less increased and systolic and diastolic pressure after 11 minutes were more decreased than the control group. And plasma norepinephrine concentration was elevated more than the control group at 3 minutes after the intubation. We concluded that the used infusion rate of esmolol blunted the hemodynamic changes following the laryngoscopy and endotracheal intubation but it is still needed to find the dosage for complete blocking the adrenergic response.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Epinephrine ; Heart Rate ; Hemodynamics* ; Humans ; Infusions, Intravenous* ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Norepinephrine ; Plasma ; Ventilation

Laryngoscopy and endotracheal intubation are potent stimuli that increase heart rate and blood pressure. These transient stress responses are probably not harmful in healthy individuals. However hypertensive patients are more prone to have significant increase in heart rate and blood pressure whether they have been treated beforehand or not and these responses also can lead to fstal complications. A randomized double-blind study was csrried out on 40 ASA physical status II-III adult elective surgical patients with hypertension to assess the effects of continuous intravenous infusion of esmolol, ultrashortacting cardioselective beta blocker, on hemodynamic responses to laryngoscopy and endotracheal intubation. Patients received a continuous infusion of esmolol(500mcg/kg/min for 1 minute, followed by 200mcg/kg/min for 12minutes) or an equal volume of saline before and throughout the induction periods of anesthesia. Using noninvasive automatic blood pressure monitor, blood pressure( systolic, diastolic and mean arterial pressure) and heart rate were measured at 6 points: 1) as the control value, on arrival to operating room, 2) just after IV loading dose of saline or esmolol, 3) just after IV thiopental, 4) 1 minute after intuhation, 5) 3 minutes after intubation, and 6) 5 minutes after intubation. The rate-pressure product was calculated in each time. During this study, anesthesia was maintained with enflursne-N2O-O2 vecuronium and controlled ventilstion. In patients given esmolol, systolic pressure, diasolic pressure, mean arterial pressure, heart rate, and rate pressure product at 1 minute, 3 minutes, 5 minutes after intubation were less increased than control group. And the heart rste response was more effectively blunted than the blood pressure response. The continuous infusion of esmolol can blunt hemodynamic changes caused by laryngoscopy and endotracheal intubation in hypertensive patients, yet it is needed to find out the optimal dosage of esmolol for complete blocking of the sympathetic response without the adverse effects.
Adult ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Blood Pressure Monitors ; Double-Blind Method ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension* ; Infusions, Intravenous ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Operating Rooms ; Thiopental ; Vecuronium Bromide

Because of various complicatins it's a trend to use non-depolarizing N-M blocker for the intubation, but oneset of action is delayed. So inhalation anesthetics are administered by mask until the onset time of action of N-M blocker which may cause pollution in operating room and it is possible for operating room personnel to bring up serious health problems. So, we used midazolam as adjuvant to induce general anesthesia and compared it with inhalation anesthetics for cardiovascular responses. Group E was given pentothal sodium 5mg/kg and inhaled 2% enflurane, group MP given midazolam O.lmg/kg and pentothal sodium 3mg/kg, and group M given only midazolam 0.3 mg/kg. As a N-M blocker O.lmg/kg of vecuronium bromide was given to all groups for endotracheal intubation. The results were as follows. 1. There was no significant difference in blood pressure and heart rate in each group. 2. Recovery time of consciousness at the end of anesthesia was longer in groups given midazolam. 3. The ratio of the patients who became asleep after the administration of O.lmg/kg of midazolam was 20% and 100% of patients became asleep with 0.3mg/kg of midazolam.
Anesthesia ; Anesthesia, General ; Anesthetics, Inhalation ; Blood Pressure ; Consciousness ; Enflurane ; Heart Rate ; Humans ; Inhalation* ; Intubation* ; Intubation, Intratracheal ; Masks ; Midazolam* ; Operating Rooms ; Sodium ; Thiopental ; Vecuronium Bromide

BACKGROUND: The addition of various opioids to 0.5% hyperbaric bupivacaine intrathecally seems to potentiate analgesic effects of bupivacaine and to prolong the duration of analgesia. We compared the effect of intrathecal meperidine 0.25 mg/kg and 0.5 mg/kg, fentanyl 0.15 microgram/kg, and placebo when administered together with 0.5% hyperbaric bupivacaine 9 mg for cesarean section. METHODS: Forty-four healthy term parturients were randomly allocated (n = 11 per group) to receive the test solution (1 ml) containing preservative-free normal saline (control group), fentanyl 0.15 microgram/kg, meperidine 0.25 mg/kg, or meperidine 0.5 mg/kg intrathecally, immediately followed by the injection of 0.5% hyperbaric bupivacaine 9 mg. We observed the effective postoperative analgesic duration (time to VAS > or = 4), quality of anesthesia and side effects. RESULTS: The effective postoperative analgesic duration significantly increased in the groups receiving opioid compared with the control group (P < 0.05); control group 101.4 +/- 28.6 min; fentanyl group 192.3 +/- 29.2 min; meperidine 0.25 mg/kg group 208.8 +/- 21.7 min; meperidine 0.5 mg/kg group 289.8 53.6 min (data expressed as mean +/- SD). The quality of anesthesia was excellent in 100% of the meperidine group but in 82% of the fentanyl group and 91% of the control group. The incidence of nausea and vomiting were higher in the meperidine 0.5 mg/kg group (73%) than in the remaining groups (P < 0.05). CONCLUSIONS: The addition of fentanyl 0.15 microgram/kg or meperidine 0.25 mg/kg to 0.5% hyperbaric bupivacaine 9 mg for spinal anesthesia improves intraoperative analgesia and provides analgesia into the immediate postoperative period with no adverse effects on mother or neonate.
Analgesia ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Bupivacaine* ; Cesarean Section* ; Female ; Fentanyl* ; Humans ; Incidence ; Infant, Newborn ; Meperidine* ; Mothers ; Nausea ; Postoperative Period ; Pregnancy ; Vomiting

The maternal and neonatal effects of 50% O2 -50% N2O alone and 50r% O2-5O% N2O combined with 0.5% halothane or 1% enflurane were studied in 37 parturients undergoing general anesthesia for cesarean section, All patients received thiopental and succinrlcholine for induction and were intubated and ventilated with a tidal volume of 10m1/kg and a rate of 107 breaths/min. ulltil the delivery. Two of 11(18%) patients given O2-N2O alone had recall; none in those patients receiving a potent inhalation agent had any recall. Blood loss was similar in 7tle two groups. There were no statistically significant differences between groups in induction-7odeliverr and uterine incision-t7-delivery intervals, the frequen-cies of Apgar score<7 at and 5 min., maternal and fetal blood 7as tensions, and acid-base balance. 1t is concluded that analgesic concentrations of halothane and enflurane can be safely added to 50% O2-5O% N2O to prevent maternal awareness during general anesthesia for cesarean section while maintaining normal maternal and neonatal conditions.
Acid-Base Equilibrium ; Anesthesia, General ; Cesarean Section* ; Enflurane* ; Female ; Fetal Blood ; Halothane* ; Humans ; Inhalation ; Pregnancy ; Thiopental ; Tidal Volume

Background: Desflurane, a fluorinated methyl-ethyl ether, has some advantageous properties including low blood solubility, stability in soda lime, and resistance to biodegradation. Desflurane in vivo has demonstrated myocardial depressant property. The purpose of this study was to test the direct effects of desflurane on myocardial contractile function and coronary flow in the isolated heart. Methods: Twelve isolated rat hearts were continuously perfused with modified Krebs solution containing 6, 9 and 12 vol% of desflurane for 10 min at each concentration. Systolic left ventricular pressure and rate of change of ventricular pressure (dp/dt) were measured. Heart rate and coronary flow were also measured. To differentiate direct vasodilatory effect of desflurane from an indirect metabolic effect due to autoregulation of coronary flow, oxygen delivery, myocardial oxygen consumption and percent oxygen extraction were calculated. Results: Heart rate (control 266+/-22 beats/min) decreased to 250+/-23 beats/min at 6 vol%, 236+/-26 beats/min at 9 vol% and 223+/-22 beats/min at 12 vol% of desflurane. Systolic left ventricular pressure and dp/dt decreased in a concentration-dependent manner. In spite of decrement of myocardial oxygen consumption, coronary flow (control 12.0+/-1.2 ml/min) increased to 12.8+/-1.6 ml/min at 6 vol%, 12.9+/-1.6 ml/min at 9 vol% and 13.7+/-1.4 ml/min at 12 vol% of desflurane. Oxygen delivery increased proportionally with coronary flow. Percent oxygen extraction decreased in a concentration-dependent manner. Conclusion: These results suggest that desflurane has a direct myocardial depressing and coronary vasodilating effect in a concentration-dependent manner.
Animals ; Ether ; Heart Rate ; Heart* ; Homeostasis ; Oxygen ; Oxygen Consumption ; Rats* ; Solubility ; Ventricular Pressure

Background: Postoperative sore throat is a complaint after general anesthesia of multifactorial etiology. The laryngeal mask airway (LMA) reduces sore throat and discomfort during maintenance of the airway and make patients more comfortable. The purpose of this study was to compare effect of patient's position during operation on postoperative sore throat after the use of LMA. Methods: The fifty three patients were randomly divided into two groups. Group 1 (n=30) was underwent general anesthesia with supine position and group 2 (n=23) with prone position. After the LMA was positioned in the hypopharynx and the cuff inflated, fiberoptic laryngoscope was immediately passed down through the LMA. Number of attempts, degree of postoperative sore throat and other complications were also noted. Results: The incidence of postoperative sore throat after the use of LMA was 10% in supine position and 4% in prone position. But the difference between the groups was not statistically significant. All of the reported sore throats were rated as mild. Conclusions: Postoperative sore throat after the use of LMA is mild and the incidence is not affected by the prone position during the operation.
Anesthesia, General ; Humans ; Hypopharynx ; Incidence ; Laryngeal Masks* ; Laryngoscopes ; Pharyngitis* ; Prone Position* ; Supine Position