The effects of enflurane and isoflurane on the postoperative hepatic function were compared in 39 pediatric patients with preoperative mild abnormal hepatic functions. The pediatric patients were divided randomly into two groups of enflurane(=20) and isoflurane(n=19). Anesthesia was maintained 1 MAC of each anesthetic combined with 50% oxygen and 50% nitrous oxide. Serum glutamic-oxaloacetic transaminase(SGOT), serum glutamate pyruvate transaminase (SGPT), total bilirubin, alkaine phosphatase, eosinophil count, body temperature were measured preoperatively, and on postoperative 1 and 3 day. Authors compared above parameters within the group and between two groups. There were no statistically significant differencies in hepatic function, eosinophil count, and body temperature within the group and between two groups. Thus, this study shows that enflurane and isoflurane would not affect hepatic function in pediatric patients with mild hepatic dysfunction.
Anesthesia ; Anesthetics ; Bilirubin ; Body Temperature ; Child* ; Enflurane* ; Eosinophils ; Glutamic Acid ; Humans ; Isoflurane* ; Liver ; Nitrous Oxide ; Oxygen ; Pyruvic Acid

The administration of nitrous oxide can cause bone marrow depression like that aasociated with vitamin B12 defieiency and hematologic abnormalities. We investigated whether the addition of nitrous oxide for up to 4 hours to isoflurane anesthesia causes injury to 40 healthy laminectomy patients. In each patient, serum vitamin B12, folate and hematologic parameters (RBC, Hb, MCV, MCHC, WBC, platelet, reticulocyte, neutrophil) were measured on preinduction and postoperative 1st, 3rd, 5th, 7th day. Fourty patients divided into two groups randomly. In group 1 (n=20), 100% oxygen plus 1.0-2.0 vol% isoflurane was given; Group 2 (n=20), 50 % nitrous oxide, oxygen plus 1.0-2.0 vol% isoflurane was given. The results were as follows; 1) Comparing with the serum vitamin B12 and folate in both groups, there were no statistical signifieant changes between two groups until postoper- ative 7th day. 2) Nitrous oxide using 4 hours didn't influence on the hematologic parame ters until postoperative 7th day. This study suggests that the administration of nitrous oxide for up to 4 hours didnt influence on serum vitamin B12, folate and hematologic parameters until postoperative 7th day. But further studies may be necessary for more prolonged anesthetic time and methods regarding nitrous oxide.
Anesthesia ; Blood Platelets ; Bone Marrow ; Depression ; Folic Acid* ; Hematopoiesis* ; Humans ; Isoflurane ; Laminectomy ; Nitrous Oxide* ; Oxygen ; Reticulocytes ; Vitamin B 12* ; Vitamins*

A central vacuum scavenger modified by the authors, was used to control the atmospheric contamination of the operating room by anesthetic gases and vapours. Air pollution was monitored by measuring the concentrations of halothane vapour in the air of the operating room with the gas chromatograph. Under endotrachal intubation, the semi-colsed circle absorber system was used for anesthetic administration and maintained with 0.8~1.2% Halothane. Total gas flow rates were 4 liter/min with 50% oxygen in nitrous oxide for daily work. Air sampling was taken early in the morning at 10cm high from the floor before anesthesia. After daily work, they were also done at 10cm, 120cm, and 140cm high from the floor and at the corridor of the operating room. We investigated the differences of halothane concentration according to each sits by the changing central vacuum pressure. Results are followings: The atmospheric halothane concentration of the operating room before anesthesia were 0.27+/-0.12, 0.22+/-0.11 and 0.15+/-0.06 ppm.The atmospheric halothane concentration of the operating room after daily work were 7.94 +/- 1.30 ppm without the active central vacuum pressure.The atmospheric halothane concentration of the operating room after daily work were 1.41 +/-0.48ppm of 20mmHg of central vacuum pressure.The tmospheric halothane concentration of the operating room after daily work were 0.49+/-0.18ppm of 40mmHg of central vacuum pressure. The atmospheric halothane concentrations at the corridor of the operating room after daily work were 1.09+/-0.19, 0.77+/-0.11n and 0.36+/-0.17ppm when each vacuum pressure was 0mmHg, 20mmHg and 40mmHg. A significant reduction (p<0.01) in atmospheric halothane concentration of the operation room was obtained by the use of the central vacuum pressure with the scavenger. The higher the vacuum pressure, the greater reduction of the operating room air pollution was observed.
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid ; Air Pollution* ; Anesthesia ; Anesthetics, Inhalation ; Halothane* ; Intubation ; Nitrous Oxide ; Operating Rooms* ; Oxygen ; Vacuum*

For extremity surgery, tourniquet is placed routinely. With deflation of the tourniquet, the metabolic product is flushed into the systemic circulation and theoretically poses a potential for toxic reactions. In actual fact, these are rare events with this technique. Vigilant monitoring will detect cardiovascular depression at this time. By the tourniquet application, lactic acidemia, abnormal coagulopathy, hypotention, hyperkalemia, increased PaCO2, and production of noxious oxygen free radicals were reported following the release of the tourniquet. But the serial changes of metabolic derangement, degree of lactic acidemia following the use of the tourniquet were not exactly known. To confirm the safety of the pneumatic tourniquet use for two hours, the serial changes of lactic acid levels, acid-base status, potassium concentration, concentration of respiratory gaaes (arterial and end-tidal CO2,) and also hypotension, dysrhythmias and respiratory pattern following release of the tourniquet were studied. Patients were anesthetized with 1% halothane, 50% nitrous oxide and 50% oxygen. Ventilation was maintained by the ventilator to keep the end-tidal CO2, to 4.0% just before the release, and then respiratory parameters (respiratory rate, tidal volume) were constantly maintained through the study. The data were measured from arterial samples or monitors with the following interval; just before tourniquet apply (BTA), before tourniquet release (BTR), at 1, 3, 5, 15 and 30 minutes after the tourniquet release (ATR 1 m, 3m, 5 m, 15 m 30 m). Data measured before the tourniquet apply were used as control values. All data were analyzed by the paired t-test with control. Changes of mean values of each time in one parameter were analyzed by one-way ANOVA. Correlationships between the parameters and duration of ischemia induced by the tourniquet were analyzed by simple regression. The results of this study were as follows; 1) The arterial concentration of lactic acid was maximally increased at 3 minutes after tourniquet release and not returned to control value until 30 minutes after tourniquet release. 2) End-tidal CO, was reached to maximal values of 5.3% at 5 minutes after release of tourniquet. Accompanying theses changes, spontaneous respiration was recovered from the controlled ventilation in 11 patients out of 13 and fought with mechanical ventilator due to asynchronism of respiratory cycles. 3) Mild metabolic acidosis showing the decreased arterial pH and increased PaCO2, in arterial blood gas analysis was maintained in 30 minutes following the release of tourniquet. 4) There were no significant changes of concentrations of potassium. 5) Three episodes of mild hypotension were observed out of 13 patients, but dysrhythmias and other significant clinical changes not observed through the study. The above results showed the possibility of lactic acidemia and changes of respiratory pattern by increased PaCO2, after release of the tourniquet may occur. More intent monitoring is needed to the patients who have had the metabolic derangement in acid-base balance and increased intracranial pressure in application of tourniquet on limbs.
Acid-Base Equilibrium ; Acidosis ; Blood Gas Analysis ; Depression ; Extremities ; Free Radicals ; Gases* ; Halothane ; Humans ; Hydrogen-Ion Concentration ; Hyperkalemia ; Hypotension ; Intracranial Pressure ; Ischemia ; Lactic Acid ; Lower Extremity* ; Nitrous Oxide ; Oxygen ; Potassium ; Respiration ; Tourniquets* ; Ventilation ; Ventilators, Mechanical

Nitrites play multiple characteristic functions in invasion and metastasis of hepatic cancer cells, but the exact mechanism is not yet known. Cancer cells can maintain the malignant characteristics via clearance of excess mitochondria by mitophagy. The purpose of this article was to determine the roles of nitrite, reactive oxygen species (ROS) and hypoxia inducing factor 1 alpha (HIF-1 α) in mitophagy of hepatic cancer cells. After exposure of human hepatocellular carcinoma SMMC-7721 cells to a serial concentrations of sodium nitrite for 24 h under normal oxygen, the maximal cell vitality was increased by 16 mg x (-1) sodium nitrite. In addition, the potentials of migration and invasion for SMMC-7721 cells were increased significantly at the same time. Furthermore, sodium nitrite exposure displayed an increase of stress fibers, lamellipodum and perinuclear mitochondrial distribution by cell staining with Actin-Tracker Green and Mito-Tracker Red, which was reversed by N-acetylcysteine (NAC, a reactive oxygen scavenger). DCFH-DA staining with fluorescent microscopy showed that the intracellular level of ROS concentration was increased by the sodium nitrite treatment. LC3 immunostaining and Western blot results showed that sodium nitrite enhanced cell autophagy flux. Under the transmission electron microscopy (TEM), more autolysosomes formed after sodium nitrite treatment and NAC could prevent autophagosome degradation. RT-PCR results indicated that the expression levels of COX I and COXIV mRNA were decreased significantly after sodium nitrite treatment. Meanwhile, laser scanning confocal microscopy showed that sodium nitrite significantly reduced mitochondrial mass detected by Mito-Tracker Green staining. The expression levels of HIF-1α, Beclin-1 and Bnip3 (mitophagy marker molecular) increased remarkably after sodium nitrite treatment, which were reversed by NAC. Our results demonstrated that sodium nitrite (16 mg x L(-1)) increased the potentials of invasion and migration of hepatic cancer SMMC-7721 cells through induction of ROS and HIF-1α mediated mitophagy.
Acetylcysteine ; pharmacology ; Autophagy ; Carcinoma, Hepatocellular ; pathology ; Cell Line, Tumor ; Cell Movement ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Liver Neoplasms ; pathology ; Mitochondrial Degradation ; Neoplasm Invasiveness ; Nitrites ; metabolism ; Reactive Oxygen Species ; metabolism ; Sodium Nitrite ; pharmacology

PURPOSE: The mechanism of hypoxic damage is mainly intracellular influx of calcium ions through the glutamate ionotropic receptor(NMDA, AMPA/kainate). This study was performed to determine alterations in distribution and expression of AMPA receptor subunits after 1-hour of moderate hypoxia in the newborn piglet brain, in a state of mild to moderate perinatal hypoxic-ischemic encephalopathy. METHODS: Ten newborn piglets were mechanically ventilated with a mixture of 21% oxygen and 79% nitrous oxide at PaO2 over 80mmHg for 30min. Thereafter, control group(n=5) was ventilated with 21% oxygen for 1-hour, and hypoxic group(n=5) was ventilated with 6% oxygen at PaO2 below 25mmHg for 1-hour. Concentrations of protein, adenosine triphosphate(ATP) and phosphocreatine were determined. The proteins were immunostained with anti-rat glutamate receptor 1(GluR1), anti-rat GluR2/3 and anti-rat GluR4 antibody. RESULTS: Hypoxia(PaO2 20+/-1mmHg) and acidosis(pH 7.06+/-0.09) developed significantly in the hypoxic group compared to the control group(PaO2 104+/-4mmHg, pH 7.44+/-0.03, respectively, P<0.01). Concentrations of ATP(2.84+/-1.28micromol/kg brain, P<0.05) and phosphocreatine(0.78+/-1.07micromol/kg brain, P<0.001) were significantly reduced compared to the control group(5.04+/-0.25micromol/kg brain, 4.03+/-0.31micromol/kg brain, respectively). The protein contents of GluR1 and GluR2/3 subunits were ordered; hippocampus > cerebral cortex, thalamus, basal ganglia, hypothalamus > white matter, cerebellum, and the protein contents of GluR4 subunits were observed in the cerebellum only. The distribution of GluR1, GluR2/3, and GluR4 subunits between the hypoxic group and control group were similar. CONCLUSION: GluR1 and GluR2/3 subunits were highly distributed in the hippocampus and cere bral cortex, and GluR4 subunits in the cerebellum. These regions may be the most vulnerable to excitotoxic injury. In addition, AMPA receptor subunits did not change after 1-hour of moderate hypoxia.
Adenosine ; Anoxia ; Basal Ganglia ; Brain* ; Calcium ; Cerebellum ; Cerebral Cortex ; Glutamic Acid ; Hippocampus ; Humans ; Hydrogen-Ion Concentration ; Hypothalamus ; Hypoxia-Ischemia, Brain ; Infant, Newborn* ; Ions ; Nitrous Oxide ; Oxygen ; Phosphocreatine ; Receptors, AMPA ; Receptors, Glutamate ; Thalamus

This study was performed to compare the effect of premedicant with triflupromazine, one of the phenothizine derivatives, and more common drugs such as morphine, hydroxyzine or atropine on flow rate and mean arterial pressure. A total of 54 cases who had open heart surgery for acquired or congenital heart diseases were divided into 3 groups depending on the main premedicants. Group l : 22 cases had triflupromazine, pethidine, hydroxyzine and atropine in divided doses. These cases were induced with a small amount of thiopental, morphine and succinylcholine and maintained with either nitrous oxide(50%), oxygen, gallamine and methoxyflurane in analgesic concentrations or with morphine fractionation. Group ll: 26 cases were given morphine, hydroxyzine and atropine as premedicants. Anesthesia was induced with thiopental, morphine and diazepam and maintained with morphine, nitrous oxide and oxygen. Group lll : 6 cases were premedicated with hydroxyzine and atropine only and maintained with halothane. After induction, surface cooling was begun using a blanket, combined with internal cooling during bypass. In group l and lll rectal temperature was maintained between 28 and 32 degrees C. in group ll, however, temperature was lower than other groups. After the main intracardiac procedures, rewarming was performed with combined surface and internal techniques. In most case a bypass time of longer than 1 hour was required with the longest times in group lll, 129.80+/-21.49 min. in duration. The longest anesthetic time was in the child group of group lll, 430+/-45.82min. in duration. Urine output during bypass in subgroup of methoxyflurane and morphine of group l was 8.95+/-0.33 and 12.15+/-0.36cc/kg/hr. In group ll the subgroup maintained with morphine in the adult and child and halothane, outputs were 11.63+/-0.14, 19.79+/-0.26 and 8.43+/-0.33 cc/kg/hr. respectively. In group lll maintained with halothane, output was 8.64+/-0.22mg/kg/hr. Mean arterial pressure(MAP) during bypass in most cases was maintained between 50 to 100 torr. In group l, the methoxyflurane subgroup, pressures were lower than in any other group, and higher flow rate was required than in any other group. Average MAP during cross clamp on the aorta of group l-methoxyflurane, group ll-morphine adult, group lll were 56.61+/-12.47, 78.79+/-17.33, and 74.06+/-19.09 mmHg respectively. MAP below 50 torr immediately after beginning bypass was more frequent in group ll(94.8%) than in other groups, and MAP above 100 torr after aorta clamping was observed more in group ll(65.2%) and in group lll(50%) than in group l(10.05%). Time to extubation was longer in group ll, the morphine subgroup, than in other groups 19.02+/-1.26 hours in the adult group and 20.05+/-2.69 hours in the child group. Post-op recovery in ICU averaged 4.17+/-0.65 days being longer in group l, the morphine subgroup, than in other groups. With this experience, we may conclude that group l with triflupromazine premedicants, as compared with the other groups, showed less esophageal and rectal temperature gradients during cooling and rewarming states, less acid base imbalance, better urine output, lower requirement of vasopressors or dilators to keep MAP with more flow rate in reasonable range during bypass and shorter time to extubation after surgery.
Acid-Base Imbalance ; Adult ; Anesthesia ; Aorta ; Arterial Pressure ; Atropine ; Cardiopulmonary Bypass* ; Child ; Constriction ; Diazepam ; Gallamine Triethiodide ; Halothane ; Heart Diseases ; Humans ; Hydroxyzine ; Meperidine ; Methoxyflurane ; Morphine ; Nitrous Oxide ; Oxygen ; Rewarming ; Succinylcholine ; Thiopental ; Thoracic Surgery ; Triflupromazine

Malignant hyperthermia (MH) is an inherited skeletal muscle disorder characterized by hypermetabolism, muscle rigidity, rhabdomyolysis, fever, metabolic acidosis and death if untreated. The syndrome is believed to result from abnormal control of intracellular calcium ions in the skeletal muscle: on exposure to certain anesthetics, calcium level is increased, and then it activates contractile processes and biochemical events that support muscle contraction. We experienced a MH of 2 years-old male who had release of sternocleidomastoid muscle due to torticolis under general anesthesia. Anesthesia was induced with thiopental and succinylcholine, maintained with enflurane, nitrous oxide and oxygen (2 volume%: 2 L/min: 2 L/min). After induction of anesthesia, his heart rate, end-tidal CO2 tension and body temperature had been gradually increased and then those were reached to maximal value of heart rate (160~170 BPM), end-tidal CO2 tension (60~70 mmHg) and body temperature (41degrees C) 55 minutes later. He was immediately managed with symptomatic treatment such as hyperventilation with oxygen, cooling, beta-blocker, sodium bicarbonate and diuretics, so he was survived without any sequelae.
Acid-Base Equilibrium ; Acidosis ; Anesthesia ; Anesthesia, General ; Anesthetics ; Body Temperature ; Calcium ; Child, Preschool ; Diuretics ; Enflurane ; Fever ; Heart Rate ; Humans ; Hyperventilation ; Ions ; Male ; Malignant Hyperthermia* ; Muscle Contraction ; Muscle Rigidity ; Muscle, Skeletal ; Nitrous Oxide ; Oxygen ; Rhabdomyolysis ; Sodium Bicarbonate ; Succinylcholine ; Thiopental

BACKGOUND: Arterial blood gas analysis is essential on diagnosis and treatment of hypoxia and acid-base imbalance. It is important to decide the timing of arterial blood sampling as well as sampling method, sample transport, and analysis of the results. So we investigated to the adequate timing of sampling when inspired oxygen fraction is changed from 0.5 to 1.0. METHODS: 20 patients were anesthetized with enflurane-N2O-O2 (FiO2=0.5), and paralyzed with pancuronium 0.07~0.08 mg/kg. Ventilation was controlled with Ohmeda 7000 ventilator (BOC Health Care Inc., Madison, USA), using a constant tidal volume of 10 ml/kg and respiration rate of 12/min. After 1 hour of anesthesia, the nitrous oxide inhalation was stopped and 100% oxygen was inhaled, and then arterial blood gas values were measured at 2 min intervals for 20 min, 5 min intervals for next 30 min, and 10 min later. Blood samlpes were drawn from the radial artery and measured immediately on a blood gas analyzer (Civa-Corning 288 Blood Gas System, Civa-Corning Diagnostic Corp., Medifield, USA). Determining the optimal time of sampling was performed with the rate of variation of PaO2 according to time progression, then the point at which the slope decreased abruptly was regarded as statistically significant timing. RESULTS: After 12 minute, arterial oxygen partial pressure was not any more changed significantly. There were no change of pH, arterial carbon dioxide partial pressure, oxygen saturation, base excess, and bicarbonate. CONCLUSION: The timing of arterial blood gas sampling in change with inspired oxygen fraction from 0.5 to 1.0 is about 12 minute later.
Acid-Base Imbalance ; Anesthesia ; Anoxia ; Blood Gas Analysis ; Carbon Dioxide ; Delivery of Health Care ; Diagnosis ; Humans ; Hydrogen-Ion Concentration ; Inhalation ; Nitrous Oxide* ; Oxygen* ; Pancuronium ; Partial Pressure ; Radial Artery ; Respiratory Rate ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

Compositional differences in flavonoids are varied in the big family of Compositae. By summarizing our previous analytical studies and other scientific evidences, new strategy will be possible to further analyze flavonoids and utilize them for human health. The HPLC analytical method has been established in terms of linearity, sensitivity, accuracy, and precision. Herbs of the family of Compositae have considerable amounts of peroxynitrite (ONOO-)-scavenging effects and their phenolic substances. These effects may contribute to the prevention of disease associated with excess production of ONOO-, depending on the high content of flavonoid substances.
Asteraceae* ; Chromatography, High Pressure Liquid ; Flavonoids ; Humans ; Peroxynitrous Acid ; Phenol