Although the mechanism of the development of hypertension has not been fully elucidated, abnormal ion transport across the cardiovascular musle membrance may play some role in this mechanism. The elevation of intraceular sodium by inhibition of the Na(+), K(+)-ATPase diminshes the sodium gradient for calcium extrusion and/or increase Na(+)/Ca(++) exchange across the cell membrance. In any event, contractility and vascular tone of cardiovascular system can be incresed as reslut of an increase of intracellular calcium. Recently it is reported that the defects of Na(+), K(+)-ATPase occur in spontaneously hypertensive rat(SHR) hearts, compared to control normotensive Spargue Dawley(SD) rat hearts. However, one missing, unresolved question arose in the previous reports in whether the reduced Na(+)-pump activity in the heart of SHR is associated with the development of hypertension itself in these animals or is a consequence of inhertied pathological features that later reslut in a reduced pump activity. In order to clearify this question it is attempted to measured to measure the change of the Na(+), K(+)-ATPase activities in cardiac sarcolemma purified from both the normotensive SD rats and SHR rats during growth ; Simultaneously the charge of cation concentration in both intracellular space(RBC) and extracelluar space(ECF) are measured to the erythrocyte test(Garay and Meyer) applied to the clinical investiation of hypertension. The results obtained are summarized as follows ; 1) The systolic blood pressure of 7 week old SHR was 120-130mmHg, which was not significantly different from that of the age-matched SD rats. However, the blood pressure was elevated to 160-170mmHg in 13-15 week old SHR, even elevated to 190mmHg in one of 19 week old SHR. On the other hand, SHR, in which hypertension was well established had pronounced cardiac hypertrophy. 2) The Na(+), K(+)-ATPase activities in cardiac sarcolemma of the SHR rats were decreased gradually as hypertension established.The decrease of Na(+), K(+)-ATPase was well associated with the increase of intracellular potassium concentration.By contrast, thr Na(+), K(+)-ATPase activities and cation transports og the normotensive SD rats were not significanlty chaged during growth. 3) The charges of Na(+), K(+)-ATPase activities in SHR were specific because the activities of Ca(++)-ATPase which is one of the membrance bound enzyme were not changed during growth appeared to be a major fator which generated hypertension in SHR rats. However, question on how the Na(+), K(+)-ATPase activities are decreased and which event is initiative between reduction of Na(+), K(+)-ATPase and development of hypertension are still remained unclear. Recent literature suggests the there might be a genetic factor, so-called Na(+)-pump inhibitor, involved in the meachanism.
Animals ; Blood Pressure ; Calcium ; Cardiomegaly ; Cardiovascular System ; Erythrocytes ; Hand ; Heart ; Hypertension ; Ion Transport ; Potassium ; Rats ; Rats, Inbred SHR* ; Sarcolemma ; Sodium

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

No abstract available.
Angiofibroma ; Carbon ; Carbon Dioxide ; Lasers, Gas

BACKGROUND: Ropivacaine is a new local anesthetic approved for epidural analgesia. The addition of fentanyl improves analgesia from epidural ropivacaine. We studied the effects of two solutions of ropivacaine/fentanyl for postoperative pain after a total abdominal hysterectomy. METHODS: Twenty five female patients scheduled for an elective total abdominal hysterectomy were prospectively randomized to receive one of two solutions. Group 1 (n = 13) received 0.2% ropivacaine and 5 microgram/ml of fentanyl at a rate of 2 ml/hour (bolus: 10 ml). Group 2 (n = 12) received 0.08% ropivacaine and 2 microgram/ml fentanyl at a rate of 5 ml/h (bolus: 25 ml) postoperative for two days. After an epidural bolus injection, we assessed the blood pressure, pulse rate, respiratory rate, visual analog scale (VAS), level of sensory block, motor block and sedation score among the two groups. Additional analgesic requirements and side effects such as nausea, itching and urinary retention were assessed for 48 hours post operation. RESULTS: There were no significant differences in the blood pressure, pulse rate and respiratory rate between the two groups. The sum of VAS for 48 hours, the level of sensory block after an epidural bolus injection, additional analgesics, and the number of patients showing motor blockade were similar. Although statistically insignificant, the incidence of nausea, and urinary retention in group 2 was higher than group 1. CONCLSIONS: Both the continuous epidural infusion of 0.2% ropivacaine with fentanyl (2 ml/hour) and 0.08% ropivacaine with fentanyl (5 ml/h) showed similar quality of analgesia on postoperative pain. To reduce the side effect of fentanyl, the volume of ropivacaine/fentanyl solution is important.
Analgesia ; Analgesia, Epidural* ; Analgesics ; Blood Pressure ; Female ; Fentanyl ; Heart Rate ; Humans ; Hysterectomy ; Incidence ; Nausea ; Pain, Postoperative ; Prospective Studies ; Pruritus ; Respiratory Rate ; Urinary Retention ; Visual Analog Scale

BACKGROUND: Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanisms. We evaluated the additive effects of ketamine (30 mg) on 0.5%, and 0.75% ropivacaine (total 30 ml) for an interscalene brachial plexus blockade (IBPB). METHODS: Thirty five adult patients scheduled for major forearm or hand surgery were prospectively randomized to receive one of the following solutions. Group 1 received 0.75% ropivacaine 28 ml with normal saline 2 ml, group 2 received 0.75% ropivacaine 28 ml with 5% ketamine 0.6 ml and normal saline 1.4 ml, group 3 received 0.75% ropivacaine 20 ml with normal saline 10 ml, and group 4 received 0.75% ropivacaine 20 ml with 5% ketamine 0.6 ml and normal saline 9.4 ml. At 1 minute intervals after IBPB, patients were assessed to determine loss of shoulder abduction, elbow flexion, wrist flexion and loss of pinprick in the deltoid, radial, median, and ulnar dermatomes. At 5 minute intervals after IBPB, pulse rate, blood pressure, sedation score and level of discomfort were assessed. Before discharge, patients were asked to document when incisional discomfort began and when full sensation and motor control returned to the arm. RESULTS: The onset time of loss of pinprick and motor blockade were similar. Duration of sensory and motor blockade were similar in all groups. Hemodynamic changes and sedation scores were not significantly different in all groups. CONCLUSIONS: We demonstrated that 30 mg of ketamine didn't enhance the onset and duration of sensory or motor blockade of ropivacaine during the 0.75% or 0.5% ropivacaine IBPB.
Adult ; Arm ; Blood Pressure ; Brachial Plexus* ; Bupivacaine ; Elbow ; Forearm ; Hand ; Heart Rate ; Hemodynamics ; Humans ; Ketamine* ; Prospective Studies ; Sensation ; Shoulder ; Wrist

BACKGROUND: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of central sensitization, which amplifies the postoperative pain. In this study, we investigated the preemptive effect of local infiltration of bupivacaine on postoperative pain after inguinal herniorrhaphy. METHODS: Thirty adult patients scheduled for inguinal herniorrhaphy were randomly assigned to one of two groups. 0.25% bupivacaine 20 ml was infiltrated in the surgical wound site either 15 min before skin incision or immediately after skin closure. Postoperatively, visual analogue scale (VAS) at rest and movement were assessed. Also the time to the first request for postoperative analgesic and the total dose of postoperative analgesics were assessed. In addition, the number of patients who didn't require any analgesics during the postoperative period were assessed. RESULTS: The VAS at rest and movement was not significantly different between the two groups. The time to the first request for postoperative analgesic, the total dose of supplemental analgesics and the number of patients who didn't require any analgesics were not significantly different. CONCLUSIONS: In pain after inguinal herniorrhaphy, we could not demonstrate the pre-emptive analgesic effect of preincisional bupivacaine infiltration. Traction pain after inguinal herniorrhaphy was sustained during the study period and this kind of pain was not inhibited (or prevented) by local infiltration of bupivacaine.
Adult ; Analgesia ; Analgesics ; Bupivacaine* ; Central Nervous System Sensitization ; Herniorrhaphy* ; Humans ; Pain, Postoperative* ; Postoperative Period ; Skin ; Traction ; Wounds and Injuries

Iatrogenic aortic dissection (IAD) is a life-threatening complication that can occur during open heart surgery, therefore IAD requires early diagnosis and prompt management. We describe here a case of IAD that occurred during mitral valve replacement. The transesophageal echocardiography (TEE) evaluation revealed features indicative of acute aortic dissection and the tear was successfully repaired by interposition of a graft.
Early Diagnosis ; Echocardiography, Transesophageal ; Mitral Valve* ; Thoracic Surgery ; Transplants

Postoperative acute renal failure is a major problem in surgical patients and may result from varieties of prerenal, renal, and postrenal causes. Mortality of this disorder was distressingly high despite improvement in dialysis and intensive general care. Clinical data from 31 patients with postoperative acute renal failure treated between 1989 and 1993 were reviwed. The results were summerized as follows: 1) There were 16 men and 15 women with a median age of 49 years. Twenty one(6896) of 31 patients were over 50 years old. 2) General surgery 14 cases(45%), cardiac surgery 11 cases(35%), neurologic surgery 3 cases, orthopedic surgery 2 cases and gynecologic surgery 1 case were performed. 3) Preoperative clinical characteristics were over 50 years old in 21 cases(68%), antibiotics in 9 cases(29%), infections in 6 cases, hypertention in 5 cases, diabetes mellitus in 4 cases, radiocontrast agent in 3 cases, jaundice in 3 cases, cardiovascular disease in 3 cases, emergeney operation in 10 cases(32%), and trauma in 4 cases. 4) Perioperative hypotension was 9 cases(29%) and massive blood transfusion was 20 cases(65%). Fourteen of the 31 patients(45%) received intraoperative diuretics, and twenty of 31 patients(66%) received diuretics within 24 hours after operation. 5) Enflurane(66%) was the most commonly used anesthetic, followed by intravenous anesthetics(16%), isoflurane(10%), and halothane(10%). 6) When acute renal failure was diagnosed, urinalysis showed gross or microhematuria in 27 cases (87%), pyuria in 10 cases(32%), and proteinuria in 21 cases(68%). Urine specific gravity in 7 patients(23%) were below 1.010. Routine CBC showed anemia less than 10 g/dl in 16 cases(52%), and thrombocytopenia less than 50,000/mm in 10 cases(32%). During postoperative period blood chemistry showed elevated BUN in most of the cases. BUN levels in 20 cases(65%) were above 60 mg/dl and serum creatinine levels in 26 cases(84%) were above 3mg/dl. Serum sodium levels in 4 cases were below 125 mEq/L and serum potassium levels in 11 cases(35%) were above 6 mEq/L. 7) Nineteen(61%) of 31 patients were nonoliguric type, nine(29%) were oliguric type and three(10%) were anuric type. Fourteen(45%) of 31 patients underwent hemodialysis. 8) Postoperative complications were developed in 25 cases(81%) and pulmonary complications were most common. 9) Median time interval between onset of acute renal failure and death was 18 days(rang to 45 days) and. median time to recovery was 24 days(range, 3 to 72 days). 10) Twenty(6496) of 31 patients were died. Main causes of death were respiratary failure, cardiac failure and sepsis. The high mortality rate was seen in patients with abdceninal operation(79%), postoperative complications(80%), over 50 years old(71%) and oliguric(78%) or anuric(100%) renal failure.
Acute Kidney Injury* ; Anemia ; Anti-Bacterial Agents ; Blood Transfusion ; Cardiovascular Diseases ; Cause of Death ; Chemistry ; Contrast Media ; Creatinine ; Diabetes Mellitus ; Dialysis ; Diuretics ; Female ; Gynecologic Surgical Procedures ; Heart Failure ; Humans ; Hypotension ; Jaundice ; Male ; Middle Aged ; Mortality ; Orthopedics ; Postoperative Complications ; Postoperative Period ; Potassium ; Proteinuria ; Pyuria ; Renal Dialysis ; Renal Insufficiency ; Sepsis ; Sodium ; Specific Gravity ; Thoracic Surgery ; Thrombocytopenia ; Urinalysis

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.
Dextrans* ; Heart Arrest ; Hip ; Humans ; Microcirculation ; Molecular Weight ; Plasma Volume

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.
Dextrans* ; Heart Arrest ; Hip ; Humans ; Microcirculation ; Molecular Weight ; Plasma Volume