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

BACKGORUND: inhalation anesthetics have been known as bronchodilators, and there are reports that enflurane has some relaxing effects on tracheal smooth muscles. However, there are not so many reports on the ACh release in the postganglion nerve endings. We tried to evaluate the effect of enflurane on the contraction of the tracheal smooth muscle in the postganglion nerve ending in guinea pigs. METHODS:isolated tracheal preparations of guinea pigs were used and contractions were induced by electrical field stimulation (3 Hz & 30 Hz). in the pilocarpine- enflurane group, pilocarpine (10(-5) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the gallamine-enflurane group, gallamine (10(-6) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the enflurane 1 MAC group and 2 MAC group, contractions were induced by electrical field stimulation before and after administration of enflurane. The percentile contraction to the contraction induced by acetylcholine (10(-4) M) were evaluated. RESULTS: The potentiation of the contraction which was induced by electrical field stimulation was observed by enflurane administration and with prior administration of pilocarpine (10(-6) M), with prior administration of gallamine (10(-5) M). There was no potentiation of contractions, but potentiation of the contraction was observed with enflurazne (2 MAC, 30 Hz). CONCLUSiONS:Enflurane potentiates the contraction induced by electrical field stimulation in guinea pig tracheal smooth muscle. These findings seem to be related with prejunctional M2 receptor in the postganglionic nerve endings.
Acetylcholine ; Anesthetics, Inhalation ; Animals ; Bronchodilator Agents ; Enflurane* ; Gallamine Triethiodide ; Guinea Pigs* ; Guinea* ; Muscle, Smooth* ; Nerve Endings ; Pilocarpine ; Receptors, Muscarinic

BACKGROUND: Neostigmine, a cholinesterase inhibitor, is known to reverse the neuromuscular blocking action induced by nondepolarizing muscle relaxants at the end of general anesthesia. Some authors, however, reported that neostigmine has the properties of a neuromuscular block in skeletal muscles while others reported that neostigmine caused the smooth muscles such as the diaphragm to relax rather than to contract. The purpose of this study was to evaluate the effect of neostigmine at different doses on the tracheal smooth muscle in rabbits. METHODS: Isolated tracheal ring preparation in rabbits was used. Groups were divided into 7 groups; acetylcholine group (acetylcholine cumulative administered at doses of 10 8, 10 7, 10 6, 10 5, 10 4 and 10 3 M), neostigmine group (neostigmine cumulative administered at doses of 10 8, 10 7, 10 6, 10 5, 10 4 and 10 3 M), acetylcholine 10 6 M + neostigmine group (acetylcholine 10 6 M prior to neostigmine administered at doses of 10 8, 10 7, 10 6, 10 5, 10 4 and 10 3 M), acetylcholine 10 4 M + neostigmine group (acetylcholine 10 4 M prior to neostigmine administered at doses of 10 8, 10 7, 10 6, 10 5, 10 4 and 10 3 M), neostigmine 10 5, 10 4 and 10 3 M groups (neostigmine administered at doses of 10 5, 10 4 and 10 3 M). Smooth muscle contraction was evaluated in isometric tension per gram of tissue. RESULTS: In the acetylcholine group, the contractions increased as the dosage increased (10 8 10 3 M). In the neostigmine group, the contractions increased as the dosage increased (10 8 10 4 M), but at 10 3 M of neostigmine, contractions suddenly decreased. In addition when acetylcholine 10 6 M was given as a pretreatment, there was a sudden decrease in muscle contractions induced by neostigmine at 10 3 M. Also the contractions induced by 10 3 M neostigmine were less than that of 10 4 and 10 5 M. CONCLUSIONS: We concluded that neostigmine caused smooth muscle contraction at low concentrations by blocking acetylcholine metabolism, but at high concentrations, smooth muscle contractions were decreased and this might be due to direct action at the acetylcholine receptor.
Acetylcholine ; Anesthesia, General ; Cholinesterases ; Diaphragm ; Metabolism ; Muscle Contraction ; Muscle, Skeletal ; Muscle, Smooth* ; Neostigmine* ; Neuromuscular Blockade ; Rabbits*

OBJECTIVE: Cerebral vasospasm still remains a major cause of the morbidity and mortality, despite the developments in treatment of aneurysmal subarachnoid hemorrhage. The authors measured the utility and benefits of external lumbar cerebrospinal fluid (CSF) drainage to prevent the clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage in this randomized study. METHODS: Between January 2004 and March 2006, 280 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Among them, 107 patients met our study criteria. The treatment group consisted of 47 patients who underwent lumbar CSF drainage during vasospasm risk period (about for 14 days after SAH), whereas the control group consisted of 60 patients who received the management according to conventional protocol without lumbar CSF drainage. We created our new modified Fisher grade on the basis of initial brain computed tomography (CT) scan at admission. The authors established five outcome criteria as follows : 1) clinical vasospasm; 2) GOS score at 1-month to 6-month follow-up; 3) shunt procedures for hydrocephalus; 4) the duration of stay in the ICU and total hospital stay; 5) mortality rate. RESULTS: The incidence of clinical vasospasm in the lumbar drain group showed 23.4% compared with 63.3% of individuals in the control group. Moreover, the risk of death in the lumbar drain group showed 2.1% compared with 15% of individuals in the control group. Within individual modified Fisher grade, there were similar favorable results. Also, lumbar drain group had twice more patients than the control group in good GOS score of 5. However, there were no statistical significances in mean hospital stay and shunt procedures between the two groups. IVH was an important factor for delayed hydrocephalus regardless of lumbar drain. CONCLUSION: Lumbar CSF drainage remains to play a prominent role to prevent clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage. Also, this technique shows favorable effects on numerous neurological outcomes and prognosis. The results of this study warrant clinical trials after endovascular treatment in patients with aneurysmal SAH.
Aneurysm ; Brain ; Drainage ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Length of Stay ; Prognosis ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial

Synovial sarcomas are rare soft tissue malignancies arising from tendons, tendon sheaths, and bursal structures. These tumors usually develop in the extremities of adolescents and young adults. Uncommonly, these tumors may arise in the head and neck approximately 9% of all synovial sarcomas. Most common sites of head and neck synovial sarcomas are hypopharynx and surrounding structures of paranasal sinuses. However, frontal bone without involving paranasal sinus is extremely rare. We report a case of biphasic synovial sarcoma of the frontal bone discuss the clinical and pathologic features of this case with the literature review.
Adolescent ; Aged* ; Extremities ; Frontal Bone* ; Head ; Humans ; Hypopharynx ; Neck ; Paranasal Sinuses ; Sarcoma, Synovial* ; Tendons ; Young Adult

Isoflurane, which has only recently been introduced into clinical practice, is a nonflammable halogenated ether used as an inhalation anesthetic. It has pharmacological, physical, and clinical properties similar to those of halothane and enflurane: however, it differs from botn in several important aspecs. The potent neuromuscular blocking action of sioflurane in desirable, because it reduces the requirement for muscle relaxants and allows lower doses of anesthesis. To quantitatively clarify the neuromuscular blocking effect of isoflurane, neuromuscular function was monitored by "Train of Four" stimulus with and without administration of muscle relaxants under halothane and isoflurane anesthesis, respectively, in 60 patients. The patients were divided into 4 groups(halothane anesthesia without muscle relaxants, halothane anesthesis with muscle relaxants, isoflurane anesthesia without muscle relaxants and isoflurane anesthesia with muscle relaxants). Twich responses of thenar muscle were monitored and analysed for the value of maximaum twich depression by halothane and isoflurane anesthesia, respectively, and the onset time, degree of maximal neuromuscular blockade, duration of action and recovery index of pnscuronium bromide under halothane and isoflurane anesthesia, respectively. The results were as follows: 1) Isoflurane exhibited a neuromuscular blocking effect 2,3 times more potent than halothane. 2) Neuromuscular depression by halothane and isoflurane was not accompanied by "fade". 3) The recovery time from nuromuscular blockade by succinylcholine in isoflurane anesthesia was increased significantly compared with halothane anesthesia. 4) The duration of action and the recovery index were increased significantly in isoflurane anesthesia compared with halothane anesthesia.
Anesthesia ; Depression ; Enflurane ; Ether ; Halothane ; Humans ; Inhalation ; Isoflurane* ; Neuromuscular Blockade ; Succinylcholine

Intracaval neoplastic extension of renal cell carcinoma to the right atrium has been reported in 14-39% of the patients with carcinoma involving the vena cava. We report a case of 44-year-old woman hospitalized with intermittent vomiting and presented with evidence of renal cell carcinoma extending into the inferior vena cava and right atrium on CF and MRI. We successfully managed renal cell carcinoma surgically extending into the right atrium using hypothermia and circulatory arrest.
Adult ; Carcinoma, Renal Cell* ; Female ; Heart Atria* ; Humans ; Hypothermia* ; Magnetic Resonance Imaging ; Vena Cava, Inferior* ; Vomiting

BACKGROUND: Robotic radical prostatectomy is performed in elderly patients and requires extreme changes in the patient's position and is often associated with a long surgery time. This study reviewed the pulmonary complications occurring after a robotic radical prostatectomy and analyzed the potential risk factors. METHODS: The medical records of all patients who had undergone robotic radical prostatectomy at our institution were reviewed. Among the 80 total patients, 58 were capable of spontaneous respiration at the end of surgery (Group I), whereas 22 patients required assisted ventilation (Group II). A comparison between the two groups was made in terms of the demographic characteristics, coexisting diseases, anesthesia and operation time, amount of intraoperative blood loss and transfused blood products. RESULTS: The mean age of the patients was 67.2 +/- 7.3 years. The mean operation time was 384.1 +/- 203.4 min (range, 195-1,180 min). The anesthesia and operation time, amount of intraoperative blood loss and number of transfused patients were all significantly higher in Group II. Univariate analysis revealed age, body mass index, intraoperative blood loss and transfusion, anesthesia and operation time to be related to postoperative respiratory insufficiency. Multivariate analysis revealed intraoperative transfusion and operation time to be predictive risk factors. CONCLUSIONS: Prolonged laparoscopic surgery in a steep Trendelenburg position has a high likelihood of postoperative respiratory insufficiency, with the intraoperative transfusion and a longer operation time being possible contributing factors.
Aged ; Anesthesia ; Body Mass Index ; Head-Down Tilt ; Humans ; Laparoscopy ; Medical Records ; Multivariate Analysis ; Prostatectomy ; Respiration ; Respiratory Insufficiency ; Risk Factors ; Ventilation

BACKGROUND: Carbon dioxide is a potent cerebral vasodilator. The change of carbon dioxide partial pressure may influence the intracranial pressure and the patients' neurological outcome. There are few reports about the influence of end-tidal CO2 (ETCO2), arterial CO2 (PaCO2) and its pressure difference P(a-ET)CO2 during a craniotomy on the Glasgow coma scale (GCS) score for evaluation of neurological status. In this study, authors tried to discover the influence of PaCO2, PETCO2, and P(a-ET)CO2 on neurological outcome. METHODS: The data of PaCO2 and PETCO2 and P(a-ET)CO2 during a craniotomy was saved. The correlations between each parameter, the GCS score and rCoBF were analyzed. To prevent a direct effect on carbon dioxide tension, blood pressure and body temperature were maintained within a normal range. At the same time, we inserted a probe of the thermal diffusion flowmetry monitor in the subdural space to monitor the regional cortical cerebral blood flow (rCoBF). All the data was saved simultaneously, at the moment of dura closure. RESULTS: There was a fair correlation between the PaCO2 and PETCO2. A low PaCO2 level correlated well with a good GCS score but, not with PETCO2. The mean P(a-ET)CO2 value was 4.4 +/- 3.1 mmHg. The high P(a-ET)CO2 level correlated well with a poor GCS score. High rCoBF correlated well with a good GCS score. However, the changes of PaCO2 and PETCO2 showed no correlations with the rCoBF. CONCLUSIONS: As a result, if we decrease the PaCO2 level by hyperventilation and increase the rCoBF level through proper management during anesthesia, we can improve the patients' neurological outcome.
Anesthesia ; Blood Pressure ; Body Temperature ; Carbon Dioxide ; Craniotomy* ; Glasgow Coma Scale ; Humans ; Hyperventilation ; Intracranial Pressure ; Partial Pressure ; Prognosis* ; Reference Values ; Rheology ; Subdural Space ; Thermal Diffusion

BACKGROUND: It is well known that anticonvusant drugs such as carbamazepine are effective in the management of various neuropathic pain conditions. Oxcarbazepine, a keto analogue of carbamazepine, might also be expected to have an analgesic effect because it is a derivative of carbamazepine. The aim of this study is to evaluate the analgesic effect of oxcarbazepine in a rat neuropathic pain model. METHODS: Male Sprague-Dawley rats were prepared by tightly ligating the L5 and L6 spinal nerves to reproduce neuropathic pain. Sixty neuropathic rats were randomly assigned into 6 groups for the intraperitoneal administration of drugs. Normal saline, vehicle (polyethylene glycol 400), oxcarbazepine (10 mg/kg, 20 mg/kg, 30 mg/kg and 50 mg/kg) were administered respectively to the individual groups. We examined mechanical and cold allodynia preadministration, and 15, 30, 60, 90, 120, 150 and 180 min after intraperitoneal drug administration. Mechanical allodynia was quantified by measuring the withdrawal frequency to stimuli with two von Frey filaments of 35.6 mN and 115.2 mN. Cold allodynia was quantified by measuring the frequency of foot lift to 100% acetone. Pain behavior may be influenced by the adverse effects of anticonvulsants, which include sedation, motor incoordination. We therefore measured the locomotor function of the neuropathic rats by using the rotarod test. RESULTS: The vehicle group showed no significant differences in the mechanical and cold allodynia versus the saline group. In the oxcarbazepine-treated groups, withdrawal frequencies to mechanical and cold stimuli were significantly reduced versus the pre-administration values and versus the vehicle group. The duration of antiallodynic effects increased dose-dependently, and these were maintained for 150 min at the highest dose. Only at the highest dose (50 mg/kg) did oxcarbazepine reduce the rotarod performance time. CONCLUSIONS: We conclude that oxcarbazepine reduces mechanical and cold allodynia in a rat neuropathic pain model and may be a candidate for the management of neuropathic pain.
Acetone ; Animals ; Anticonvulsants ; Ataxia ; Carbamazepine ; Foot ; Humans ; Hyperalgesia* ; Male ; Models, Animal* ; Neuralgia ; Rats* ; Rats, Sprague-Dawley ; Rotarod Performance Test ; Spinal Nerves