We measured the intraocular pressure changes in forty female patients (aged from 20 to 50) without a history of ocular or cardiovascular disease who were classified physical status 1 and 2, and scheduled for elective surgery. They were divided into 4 groups. Group l (n=10); metocurime 0.03 mg/kg as a priming dose and metocurine 0.27 mg/ kg as a intubating dose. Group 2 (n= 10); vecuronium 0.008 mg/kg as a priming dose and vecuronium 0.072 mg as a intubating dose. Group 3 (n=10); vecuronium 0.008mg/kg as a priming dose and metocurine 0.27 mg/kg as a intubating dose. Group 4 (n=10); metocurine 0.03mg/kg as a priming dose and vecuronium 0.072 mg/kg as a intubating dose. In this study, metocurine and vecuronium were used with the priming principle. We also measured changes in blood pressure, pulse rate and T1% of Train of four stimulation and evaluated the discomfort after the administration of the priming dose and the difficulties of intubation. The results were as follows, 1) Compared with the control value, there was no increse in intraocular pressure following intubation in all four groups and intraocular pressure of 2 and 4 minutes following intubation decreased significantly in all four groups. The greatest decrease was seen in group 3, but it was not significant when compared to the other three groups. 2) While a transient increase in blood pressure was seen in all four groups, the lowest increase was seen in group 3 as compared to the control value. Blood pressure 4 minutes following intubation decreased significantly in grop 3. 3) A significant decrease in the T1% of the Train of four stimuli at one minute after administration of the intubating dose was seen in group 3 compared to the other three groups. 4) Group 3 showed the lowest number of difficult intubation. In conclusion, the combination of vecuronium and metoeurine with the priming principle provide optimal conditions for smooth and rapid intubation with no elevation of intraocular pressure, blood pressure and heart rate changes for ocular surgery.
Blood Pressure ; Cardiovascular Diseases ; Female ; Heart Rate ; Humans ; Intraocular Pressure* ; Intubation ; Iodine* ; Vecuronium Bromide*

Intrathecal clonidine injection induces analgesia without significant respiratory depression, but decreases blood pressure and causes sedation. Injection of spinal cholinesterase inhibitor alone increases blood pressure in animals, and enhances clonidine induced analgesia. To evaluate the effect of pretreated pyridostigmine on the change of blood pressure and heart rate, clonidine was injected intrathecally in cats. We divided fifteen cats into three groups and administered saline(0.5 cc) to group 1, pyridostigmine(0.5 cc, 2.5 mg) to group 2, pyridostigmine(0.5 cc, 2.5 mg) and glycopyrrolate(0.5 cc, 0.1 mg) to group 3 before 20 minute of clonidine injection and measured mean arterial pressure, heart rate, P CO2 and central venous pressure. The results were as follows: 1)After clonidine injection, all mean arterial pressure values were significantly reduced in group 1, but in group 3, 20, 30 and 40 minutes values were significantly reduced, and 10, 40 minutes values after clonidine injection were not reduced significantly in group 2 compared to group 1. 2)After clonidine injection, heart rates were significantly reduced in all groups, but there was no significant difference between group 1, group 2 and group 3. 3)There was no significant difference of central venous pressure in any groups. 4)There was no significant difference for reversal of pyridostigmines effect by glycopyrrolate. Based on these results, these data suggest that pyridostigmine pretreatment counteracts clonidine induced hypotension, but further study of spinal az adrenergic-cholinergic combination for pain therapy is needed before clinical application.
Analgesia ; Animals ; Arterial Pressure ; Blood Pressure* ; Cats* ; Central Venous Pressure ; Cholinesterases ; Clonidine* ; Glycopyrrolate ; Heart Rate* ; Heart* ; Hypotension ; Pyridostigmine Bromide* ; Respiratory Insufficiency

BACKGROUND: Most surgical patients experience preoperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contribute to postoperative pain. Music has been recognized as a way to reduce anxiety and fear. The effect of hymn and sutra-chanting on the preanesthetic patient's anxiety in the operating room were studied. METHODS: 98 patients were divided into two groups according to the religionist or atheism. Group I(n=50, religionist) and Group II(n=48, atheism) listened to hymn or sutra-chanting according to the patient's religion and choice. At ward, hemodynamic variables including systolic and diastolic blood pressure and pulse rate were measured as control values. Hemodynamic variables and measurements of anxiety score with Hamilton anxiety rating scale were made at pre-music and post-music in the operating room. Also, patient's response to the music was measured on the postoperative 5-6th day. RESULTS: There were no difference between ward, pre-music, and post-music in terms of systolic pressure, diastolic pressure and pulse rate except the systolic pressure at pre-music that is grater than that of controls in both groups. Both group, anxiety score at post-music was significantly lower than that of pre-music (10.2+/-3.4 vs 4.4+/-2.9, 11.0+/-3.2 vs 5.7+/-3.1). At post-music, anxiety score in Group I showed significant reduced compaired with Group II (p<0.05). Patients showed relatively good satisfaction with music in both groups. CONCLUSION: The results suggest that music with hymn and Sutra-chanting were effective to reduce preanesthetic anxiety in both religionist group and atheism group.
Anesthesia ; Anesthetics ; Anxiety* ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Music ; Operating Rooms* ; Pain, Postoperative ; Preanesthetic Medication ; Premedication

The need for a short-acting non-depolarizing neuromuscular blocking agent to replace succinylcholine chloride(succinylcholine) is recognized widely and attempts to find such a drug have been numerous. Atracurium besylate(atracurium) is one of the new series of neuromuscular blocking agents with little cardiovascular effect and is not dependent on hepatic and renal function for terminating its action because of its self-destroying mechanism. Because succinylchline may occasionally be contraindieated for intubation in parturients we studied the use of atracurium in 23 patients having cesarean section. All patients received 0. 5 mg/kg atracurium for intubation and neuromuscular relaxation. Hemodynamic changes, the time from the injection of atracurium to maximal twitch suppression, the time between atracurium administration and the return to 10% of control twitch height were recorded and observed the degree of vocal cord relaxation and conditions of intubation and evaluated the Apgar scores. 1) Mean arterial pressure and heart rate increased significantly after intubation compared with that of control and just before intubation but there were no significant changes in 5 minutes after intubation. 2) The 90% twitch suppression following atracurium administration was 75.6+/-20.9 seconds. 3) The return of 10% of control twitch height was 2449.3+/-1114.0 seconds. 4) Intubation conditions were excellent for 19 patients. 5) The Apgar scores of 20 neonates were high. These data suggest that the use of atracurium may be a useful alternative for induction for Cesarean section when succinylcholine is contraindicated.
Arterial Pressure ; Atracurium* ; Cesarean Section* ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Intubation, Intratracheal* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pregnancy ; Relaxation ; Succinylcholine ; Vocal Cords

The dose-response for glycopyrrolate and heart rate in anesthetized children has not heen defined. We determined the dose-response for glyeopyrrolate and heart rate in 50 children, ASA physical status l and 2, anesthetized with halothane and nitrous oxide. Anesthesia was induced with 60-70% nitrous oxide in oxygen and halothane(1.5-2.0 vo1%). After induction of aneethesia, glycopyrrolate in a dose of 4, 6, 8, 12 or 16ug Xkg(-1) was administered by rapid infusion to each subject. The effects of glycopyrrolate on heart rate, heart rhythm and systolic blood pressure were compared among dosage groups, and dose-response curve for peak heart rate was constructed, Glycopyrrolate increased the heart rate in a dose-related manner upto 12 ug X kg(-1) except 16 ugX kg(-1). Fifty percent maximal response corresponded to 6.1 ug X kg(-1), and 95% maximal response corresponded to 11.1 ug X kg(-1) . None of the patients had nonsinus rhythm after glycopyrrolate injection. Except for glycopyrrolate given at 4 ug x kg(-1), the systolic blood pressure increased significantly after all other doses. Glycopyrrolate in doses greater than or equal to 6 ug X kg(-1) increased the heart rate and systolic blood pressure in children anesthetized with halothane and nitrous oxide.
Anesthesia ; Anesthetics ; Blood Pressure ; Child* ; Glycopyrrolate ; Halothane* ; Heart Rate* ; Heart* ; Humans ; Nitrous Oxide* ; Oxygen

BACKGROUND: Compared to inhalation and local anesthetics, little is known about the mechanisms of vascular effects of intravenous anesthetics. So we studied the effects of thiopental sodium, midazolam, propofol and ketamine on the endothelial nitric oxide-cGMP pathway and also on the membrane cyclooxygenase pathway. METHODS: After isolating ring strips of rat thoracic aorta, we measured the relaxation ED50 values of the four intravenous anesthetics from the maximally contracted using phenylephrine 10(-5)M. Then using L-NAME and methylene blue, we studied the effects of the drugs upon the NO-cGMP system. In addition, another pathway of vasodilation through membrane prostaglandin metabolism was examined using the membrane cyclooxygenase inhibitor, indomethacine. RESULTS: The following results were obtained. 1. Thiopental sodium (10(-5)M) did not have any effect on the PE induced contractions of aortic rings but midazolam (10(-6)M), propofol (10(-4)M) and ketamine (10(-3)M) significantly (P < 0.05) inhibited the PE induced contractions of aortic rings. 2. Midazolam 10(-6)M and propofol 10(-4)M induced relaxation of aortic rings were recovered with L-NAME pretreatment but ketamine induced relaxation was not recovered with L-NAME. 3. Midazolam 10(-6)M induced relaxation was not recovered with methylene blue pretreatment, but propofol 10(-4)M induced relaxation was recovered with methylene blue. 4. Indomethacine pretreatment induced further relaxation of midazolam or propofol induced relaxation of aortic rings. CONCLUSIONS: Midazolam, propofol and ketamine, but not thiopental sodium, relax rat thoracic aortic rings, and these relaxation effects of midazolam and propofol are endothelium dependent. Cyclooxygenase inhibition is related at least in part to midazolam or propofol induced relaxation, and guanylate cyclase to propofol induced relaxation.
Anesthetics, Intravenous ; Anesthetics, Local ; Animals ; Aorta, Thoracic ; Endothelium ; Guanylate Cyclase ; Indomethacin ; Inhalation ; Ketamine* ; Membranes ; Metabolism ; Methylene Blue ; Midazolam* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Phenylephrine ; Propofol* ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Relaxation ; Thiopental* ; Vasodilation

PURPOSE: Recent studies show that chorioamnionitis has an important role in the pathogenesis of bronchopulmonary dysplasia(BPD) and it induces thymic involution. The purpose of this study is to test the usefulness of thymic size at birth as a predictor of BPD. METHODS: This study was conducted on 91 very low birth weight infants of <1, 500 g with mean gestational age of 29.3 weeks and mean birth weight of 1, 161 g who were admitted at NICU of Dong Kang General Hospital for past 4 years of whom 21 infants had BPD. Thymic size was measured on routine chest radiographs taken in the first 3 hours after birth and measured as the ratio between the width of the cardiothymic shadow at the level of the carina and that of the thorax at the costophrenic angles (CT/ T). RESULTS: Correlation of thymic size with gestational age was statistically significant (P=0.003). CT/T of BPD group was smaller than that of non-BPD group (0.27+/-0.06, 0.33+/-0.07, respectively, P<0.01). A significant positive correlation between small thymus at birth and BPD was detected (P=0.003, odds ratio, 21.7), but not in other disease groups. CONCLUSIONS: We concluded that a small thymus at birth on the chest radiograph could be used as an early predictive parameter of the BPD.
Birth Weight ; Bronchopulmonary Dysplasia* ; Chorioamnionitis ; Female ; Gestational Age ; Hospitals, General ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Odds Ratio ; Parturition* ; Pregnancy ; Radiography, Thoracic ; Thorax ; Thymus Gland

BACKGROUND: Postoperative pain after a spinal laminectomy has very harmful effects on human physiology, and many people are trying to control it more easily and safely. There are controversies in methods used for controlling postoperative pain after a spinal laminectomy. The purpose of this study was to examine an effective way to control postoperative pain after a spinal laminectomy. METHODS: Ninety patients (ASA I-II, aged 40 to 70) scheduled for a spinal laminectomy were divided into three groups. In group A, we administered fentanyl 1,000 microgram and morphine 5 mg (mixed in 0.9% normal saline) using the continuous epidural infuser; in group B, we administered fentanyl 500 microgram and morphine 5 mg and 0.25% bupivacaine (mixed in 0.9% normal saline) using the continuous epidural infuser; in group C, we administered fentanyl 1,500 microgram and morphine 10 mg (mixed in 0.9% normal saline) using the continuous IV infuser. We compared effects between the continuous epidural infusion and the continuous intravenous infusion by using the visual analogue scale and side effects. RESULTS: There was no significant difference between continuous epidural infusion groups. When the continuous epidural infusion groups and the continuous IV infusion group were compared, there were significant differences in 3 hr, 6 hr, and 12 hr VAS scores (P < 0.01). The incidence of side effects was very low, and there was no significant difference in side effects between the continuous epidural infusion and the continuous IV infusion groups. CONCLUSIONS: It was found that continuous epidural infusion methods were more effective than the continuous IV infusion method, but none of them showed satisfactory postoperative pain control in the early periods.
Bupivacaine ; Fentanyl ; Humans ; Incidence ; Infusions, Intravenous ; Laminectomy* ; Morphine ; Pain, Postoperative ; Physiology

To determine the accuracy of end-tidal PCO2(PetCO2) measurement analysed with Ohmeda 5210 capnometer in the pediatric patients whose jung were ventilated with Ohio infant Circle Absorber and Ohio Ventilatior 7200, we compared PetCO2, measurements sampled from the proximal(PetCO2-p) and distal(PetCO2-d) ends of the tracheal tube to arterial PCO2(PaCO2) in 22 healthy pediatric patients between 6.8 to 18.5kg. The results were as follow: 1) Proximal PetCO2 and distal PetCO2 correlated with PaCO2(r=0.76%, SEE=2.79, r=0.70:SEE=3.01, respectively)(p<0.05). 2)Arterial to end-tidal PCO2 difference(delta(a-et)PCO2) was significantyly greater with distal(3.53+/-4.68 mmhg) than proximal(0.35+/-2.72 mmhg) sampling(p<0.05). 3) In subgroup of patients whose proximal to distal concentration of nitrous oxide difference was more than 2%, the delta(a-et)PCO2 using distal sampling(7.90+/-5.15 mmhg) was also significantly greater then it was using proximal sampling(-1.73+/-2.39 mmhg)(p<0.05).. We conclude that distal estimates of PetCO2-P can not provide accepatbale estimate of PaCO2 in healthy pediatric patients who are intubated with pediatric uncuffed tracheal tube.
Carbon Dioxide* ; Carbon* ; Humans ; Infant ; Nitrous Oxide ; Ohio

The authors experienced a case of myoglobinuria accompanied by generalized myalgia and mild fever that developed 3 hours 30 minutes after general anesthesia. Tracheal intubation was done smoothly 5 minutes after injection of thiopental sodium(275 mg) and pancuronium bromide(6 mg), and anesthesia was maintained with ethrane/N2O/O2(1.5-2%/21/21/min). There was no specific event except tachycardia and fluctuation of blood pressure throughout operation. In this case, we assume that the myoglobinuria is a presentation of the sign of an abortive type of malignant hyperthermia. However, it was not confirmed. We had good patient outeome with the supportive measures of hydration and diuresis. The patient was discharged twenty three days after operation without any complication.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Diuresis ; Fever ; Humans ; Intubation ; Malignant Hyperthermia ; Myalgia ; Myoglobinuria* ; Pancuronium ; Tachycardia ; Thiopental