Mivacurium, a new neuromuscular blocking agent, is known not to rely greatly on the renal function for its elimination, therefore, is recommended for the renal failure patient. In these studies, we investigated neuromuscular blocking action of mivacurium in case of bilateral ligation of renal pedicles to prevent the renal excretion and compared its action to that of pancuronium, which is mainly excreted by the kidney. Rabbits were divided into 4 groups: the mivacurium control group, the mivacurium group, the pancuronium control group, and the pancuronium group. Both renal arteries were ligated in the mivacurium group and the pancuronium group. After intravenous administration of mivacurium or pancuronium, the6neuromuscular blocking actions were observed. The results were as follows: 1.There was no significant difference in onset time between the mivacurium group(77+/-18.6 sec) and the mivacurium control group(100+/-36 sec). No significant difference between the pancuronium group(90+/-42 sec) and the pancuronium control group(101+/-43.8 sec), too. And no significant difference in change of onset time was found between the mivacurium group and the pancuronium group. 2.There was no significant difference in duration of action between the mivacurium group ,(664+/-85.2 sec) snd the mivacurium control group(500+/-134.4 sec). But significant difference was found between the pancuronium group(3453+/-1088.4 sec) and the pancuronium control group(1041+/-304.2 sec)(P<0.05). In the pancurounium group, the prolongation of duration of action was significantly greater than that in the mivacurium group(P<0.05). 3.There was no significant difference in recovery index between the mivacurium group (316+/-99.6 sec) and the mivacurium control group(230+/-66.3 seo). But there was significant difference between the pancuronium group(676+/-162.3 sec) and the pancuronium control group(274+/-92 sec)(P<0.05). The prolognation of recovery index in the pancuronium group was significantly greater than that in the mivacurium group(P<0.05).
Administration, Intravenous ; Humans ; Kidney ; Ligation ; Neuromuscular Blockade ; Pancuronium ; Rabbits* ; Renal Artery ; Renal Insufficiency

The insulinoma is a rare tumor, usually small, solitary and benign with no prediction for any part of the pancreas. It is amendable to surgical cure but approximately 10percent are malignant and the peak incidence is encountered between ages 40~60. Surgery has been established as the treatment of choice. The reason for electing to operate rather than treat symptomatically is prevention of complications, such as increasing obesity, or prolonged and irreversible episodes of hypoglycemic coma with resultant permanent central nervous damage. During the anesthesia for a patient with insulinoam, the important problems are to recognize and treat hypoglycemia. This is a case report of a patient with insulinoma who underwent surgical treatment. Two years age, under the diagnosis of insulinoma, she was underwent distal pancreatectomy with splenectomy. But 3 months ago, hypoglycemic attacks recurred during fasting periods surgical intervention was performed under the diagnosis of recurrent insulinoma. She was anesthetized with thalamonal-nitrous oxide-oxygen, pancuronium, and 10 percent dextrose solution was administered throughout the operation. We monitered the level of blood sugar intermittently by using a rapie sugar analyser(Glucometer, Ames, Japan). No hypoglycemic episode during anesthesia was observed. We report the case of our anesthetic experience withan insulinoma and review the anesthetic choice and the management of the patient.
Anesthesia* ; Blood Glucose ; Coma ; Diagnosis ; Fasting ; Glucose ; Humans ; Hypoglycemia ; Incidence ; Insulinoma* ; Obesity ; Pancreas ; Pancreatectomy ; Pancuronium ; Splenectomy

BACKGROUND: Inhalation anesthetics are known to be bronchodilators. However there are several reports that these effects are not consistant, and depend on the way of experiments. Some reports showed that inhalation anesthetics don't affect broncheal smooth mucle contraction. So, we tried to evaluate the effects of inhalation anesthetics on the histamine induced contraction of broncheal smooth muscles in rabbits. METHODS: Isolated broncheal rings of rabbit were suspended in a Tyrode's solution. Contractions were recorded isometrically using a transducer. Cumulative dose responses of histamine (10(-6), 10(-5) & 10(-4) Mol, histamine group) were observed and also cumulative dose responses of histamine with halothane and enflurane administration (0.5 MAC & 1 MAC) were evaluated. RESULTS: A contraction by histamine was weakened with enflurane administration, but with halothane, the contraction was slightly weakened at 0.5 MAC and no changes were observed at 1.0 MAC compared to a contraction induced by histamine. CONCLUSIONS: At 0.5 MAC of halothane, a contraction induced by histamine was slightly weakened, but at 1 MAC, no changes of contraction occurred. However enflurane weakened the contraction at 0.5 MAC and 1 MAC. It showed that in vitro studies of the direct effect of inhalation anesthetics on smooth muscle contraction are different from the results of in vivo study reports.
Anesthetics, Inhalation ; Bronchodilator Agents ; Enflurane* ; Halothane* ; Histamine* ; Muscle, Smooth* ; Rabbits* ; Transducers

BACKGROUND: Antimuscarinic agents are used to block undesirable muscarinic effects of `anticholinesterase given to reverse the residual neuromuscular blockade produced by muscle relaxants. However, besides antimuscarinic effects, atropine was known to have some positive effects on the recovery from neuromuscular blockade by acting at the presynaptic muscarinic receptor of the neuromuscular junction. But there have been few reports about the neuromuscular effects of glycopyrrolate. So we observed the neuromuscular effects of atropine and glycopyrrolate, and compared two. METHODS: Mivacurium(0.064 mg/kg) was administered intravenously and the experimental groups were divided into 5 groups: the control group (no antimuscarinic agent administered), Al group (0.02 mg/kg atropine administered), A2 group (0.04 m atropine administered), Gl group (0.01 mg/kg glycopyrrolate administered) and G2 group (0.02 mg/kg glycopyrrolate administered). The left cammon peroneal nerve was stimulated by the 0.1 Hz single twitch and 100 Hz tetanic stimuli. We manitored the mechanical activity of the anterior tibialis muscle and observed recovery index, tetanic fade, and post-tetanic potentiation. RESULTS: There were no significant differences in recovery indices and post-tetanic potentiations among the 5 groups. Significant differences were found in tetanic fades between the experimental groups(A1, A2, Gl, G2) and the control group(P<0.05). However no significant differences in tetanic fades were found among the experimental groups. CONCLUSIONS: Atropine and glycopyrrolate hastened the recovery from mivacurium induced neuromuscular blockade. The neuromuscular recovery effects of glycopyrmlate were found to be similar to atropine at equipotent dose.
Atropine* ; Cholinergic Agents ; Glycopyrrolate* ; Muscarinic Antagonists ; Neuromuscular Agents ; Neuromuscular Blockade* ; Neuromuscular Junction ; Parasympathetic Nervous System ; Peroneal Nerve ; Receptors, Muscarinic ; Refractory Period, Electrophysiological

BACKGROUND: Several reports have indicated that heparin has a bronchodilative effect in asthma patients, and that it enhances airway smooth muscle contraction in vitro, protamine is known to inhibit or enhance contraction of tracheal smooth muscle. Thus the effects of protamine and heparin on airway smooth muscle contraction are not consistent. However, no report is available on the effects of enflurane on heparin and protamine tracheal smooth muscle contraction. We performed this study to evaluate the effects of heparin or protamine on the carbachol induced contraction of tracheal smooth muscle in the guinea pig. And we also evaluated the effects of enflurane on heparin or protamine induced tracheal smooth muscle contraction. METHODS: Isolated tracheal rings of the guinea pig were suspended in Krebs solution. Contractions were recorded isometrically using a transducer. Contraction was induced by carbachol (10-6 M) and then cumulative dose responses of heparin or protamine (0.006 mg/ml, 0.02 mg/ml, 0.06 mg/ml, 0.2 mg/ml, 0.4 mg/ml) and in heparin (E) group and protmine (E) group, enflurane (4.34%) was administered for 15 minute after carbachol adminstration. RESULTS: Contraction by carbachol was inhibited by level of heparin or protamine at concentrations of 0.2 mg/ml and 0.4 mg/ml. At an enflurane (4.34%) contraction was inhibited, and no further inhibition of contraction by heparin or protamine was observed. CONCLUSIONS: Heparin or protamine inhibited the tracheal smooth muscle contraction induced by carbachol at 0.2 mg/ml and 0.4 mg/ml, and no further significant inhibition of contraction by heparin or protamine was observed after enflurane administration (4.34%).
Animals ; Asthma ; Carbachol* ; Enflurane ; Guinea Pigs* ; Guinea* ; Heparin* ; Humans ; Muscle, Smooth* ; Transducers

It is a highly risky procedure to perform general anesthesia on a patient with toxemia in whom the function of the vital organs is seriously impaired. The risk is much increased when pulmonary edema is also a complication. Recently, many physicians are increasingly interested in PEEP(positive end-expiratory pressure) as a valuable therapeutic approach for pulmonary edema. There are reports that the PEEP has contributed a great deal of the treatment of the pulmonary edema. This is a case report of a patient with toxemia and pulmonary edema who underwent cesarean section. She was treated with oxygen, diuretics, digitalis, steroids, bronchodilators and PEEP(pr.=10cm.H2O, Vt=700ml., assist mode), The therapeutic result was excellent.
Anesthesia* ; Anesthesia, General ; Bronchodilator Agents ; Cesarean Section ; Digitalis ; Diuretics ; Female ; Humans ; Oxygen ; Pregnancy ; Pulmonary Edema* ; Steroids ; Toxemia*

Ketamine, a phencyclidine derivative, has been used as an anesthetic agent since 1965 and it has received much attention as an anesthetic for minor surgical procedures, in some diagnostic procedures in children or as an induction agent for poor risk patients. A troublesome problem has been psychic disturbance on emergence. There are many reports on ketamine anesthesia but some cases describing the failure of recommended doses of ketamine to produce adequate analgesia have been reported with cerebral cortical disease or massive craniocerebral trauma. In this case, we experienced a failure to produce adequate analgesia with intramuscular ketamine (11 mg/kg). It was not confirmed in this case whether the patient had suffered any cerebral cortcial disease or not.
Analgesia* ; Anesthesia ; Child ; Craniocerebral Trauma ; Humans ; Ketamine* ; Minor Surgical Procedures ; Phencyclidine

The volatile anesthetic agent, halothane and ethrane, are most commonly used in general anesthesia practice and a depolarizing neuromuscular blocker, succinylcholine, is also used for endotracheal intubation, if not contraindicated. There were many reports that the volatile anesthetics affect the neuromuscular transmission in akeletal muscles and potentiate the neuromuscular black induced by depolarizing muscle relaxant in moderate to high concentration. But in halothane, a result was different from those of others. It was well known fact that in pregnant woman, the MAC of the volatile anesthetics is decreased. Therefore, present study was performed to determine whether halothane and ethrane may affect the action of succinylcholine or not, in their low concentration, in 40 healthy pregnant women and we divided them randomly in two groups: halothane administered group(group A), ethrane administered group(group B). Ulnar nerve was stimulated at the wrist through surface electrode, using a peripheral nerve stimulator with supramaximal single twitchimpulse of 0.2 msec duration at a rate of 1.0 Hz. The responses of the adduction of thumb were measured with a force displacement transducer and recorded with a biophysiograph(San Ei, Japan). The single twitch were measured before and after intravenous succinylcholine 1 mg/kg and when full paralysis occurred, 0.5% halothane administered in group A and 1% ethrane administered in group B and observed the effects of halothane and ethrane on the neuromuscular blocking action of succinylcholine. The results were as follows. The time from intravenous succinylcholine onset of paralysis was 15.5+/-3.21 sec in halothane group, and 14.8+/-3.17 sec in ethrane group. The time from onset of paralysis to full paralysis was 42.2+/-5.98 sec in halothane group, and 47.1+/-13.55 sec in ethrane group. Duration of full paralysis was 283.9+/-68.02 aec in halothane group, and 270.8+/-44.49 sec in ethrane group. Recovery index(T26-T76) was 68.4+/-16.11 aec in halothane group, and 75.4+/-21.93 sec in ethrane group. We conclude that there is no significant difference between the effects of halothane and ethrane on the neuromuscular blocking actioa of succinylchpline, in their low concentraction, in healthy pregnant women.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Cesarean Section* ; Electrodes ; Enflurane* ; Female ; Halothane* ; Humans ; Intubation, Intratracheal ; Muscles ; Neuromuscular Blockade ; Paralysis ; Peripheral Nerves ; Pregnancy ; Pregnant Women ; Succinylcholine* ; Thumb ; Transducers ; Ulnar Nerve ; Wrist

Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism. In desperated cases, however, pulmonary embolectomy is recommended despite its high mortality rate. We experienced acute respiraory failure after embolectomy performed under cardiopulmonary bypass in patient with chronic massive pulmonary embolism. The patient recovered sucessfully with postoperative management in the intensive care unit.
Cardiopulmonary Bypass ; Embolectomy* ; Humans ; Intensive Care Units ; Mortality ; Pulmonary Embolism* ; Respiratory Insufficiency* ; Thrombolytic Therapy

BACKGROUND: The effects of local and inhalation anesthesia on the contraction of the tracheal smooth muscle have been reported. However, when inhalation and local anesthesia are administered simultaneously, their effects on the contraction of the airway smooth muscle are not well known. Therefore, this study evaluated the effects of lidocaine, bupivacaine, with or without enflurane, on the histamine induced tracheal smooth muscle contraction in guinea pigs. METHODS: Isolated tracheal rings of guinea pigs were suspended in Krebs solution. The contractions were recorded isometrically using a transducer. A contraction was induced by histamine (10(-5) M). Enflurane (1 MAC) was administered for 15 min after administering the histamine. The cumulative dose responses of the lidocaine and bupivacaine (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M, 10(-4) M, and 10(-3) M), enflurane-lidocaine and enflurane-bupivacaine groups were checked. RESULTS: The contraction by histamine were inhibited by lidocaine (10(-4) M and 10(-3) M) and bupivacaine (10(-5) M, 10(-4) M and 10(-3) M). In addition, the contractions were inhibited more significantly in the bupivacaine group (10(-7) M, 10(-6) M, 10(-5) M, 10(-4) M and 10(-3) M) after administering enflurane. CONCLUSIONS: Lidocaine and bupivacaine inhibited the contractions induced by histamine. The contractions by bupivacaine were further inhibited after administering enflurane.
Anesthesia, Inhalation ; Anesthesia, Local ; Animals ; Bupivacaine* ; Enflurane* ; Guinea Pigs* ; Guinea* ; Histamine ; Inhalation ; Lidocaine* ; Muscle, Smooth* ; Trachea ; Transducers