No abstract available.
Classification* ; Ventilators, Mechanical*

BACKGROUND: It has been known that arterial carbon dioxide tension is 4~5 mmHg higher than end-tidal carbon dioxide tension in healthy adults during general anesthesia. But negative arterial to end-tidal PCO2 difference was reported in pregnant patients undergoing cesarean section. The purpose of this study was to elucidate the difference between arterial and end-tidal PCO2 in anesthetized patients with reduced functional residual capacity. METHODS: 90 patients were divided into 3 groups i.e. control group (n=30), obese group (n=20, body weight more than 20% greater than ideal weight), pregnant group (n=40). All patients had no cardiac or respiratory abnormalities and never smoked. Arterial blood gas analysis and measurement of end-tidal PCO2 were done 20 minutes after induction of anesthesia in control and obese group and just before uterine incision and 20 minutes after fetal delivery in pregnant group. RESULTS: There were significant correlations between arterial and end-tidal PCO2 in all groups. The incidences of negative arterial to end-tidal PCO2 difference were 10% in control group, 40% in obese group, 42.5% in pregnant group (p<0.05). CONCLUSION: From this study, it is concluded that patients with reduced functional residual capacity have more incidences of negativity than normal patients in the values of arterial to end-tidal PCO2 difference during general anesthesia. So when the tight control of PaCO2 is required in patients with reduced FRC, we recommend to measure PaCO2 for better anesthetic management.
Adult ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Body Weight ; Carbon Dioxide* ; Carbon* ; Cesarean Section ; Female ; Functional Residual Capacity* ; Humans ; Incidence ; Pregnancy ; Smoke

During a six month period in 1985, we evaluated the changing patterns of plasma calcium and magnessium level in 14 patients undergoing open heart operation for correction of congenital heart disease. Magnesium and phosporus were measured with spectrophotometer and total calcium with Gilfor 203-S autonalyzet. Ionized calcium was calculated by equation of (6 X Ca + (P/3))/(P+6). Total calcium and ionized calcium values were 8.47+/-0.75 mg%, 4.77+/-0.90mg% at control. They decreased significantly during bypass period and then rose progressively to reach control level at postbypass period. Magnesium levels were 2.2+/-0.39mg% at control, 2.0+/-0.40mg% at prebypass period. 2.80+/-0.98mg% bypass and 2.1+/-0.55 mg% at postbypass period respectively. It was maintained at higher level during bypass and reached to control value during postbypass period.
Calcium* ; Heart Defects, Congenital ; Heart* ; Humans ; Magnesium* ; Plasma* ; Thoracic Surgery*

Prostaglandin E1(PGE1) is a potent vasodillator of the systemic and coronary circulatory system, and when used in adult respiratory distress syndrome, PGE1 produces a decrease in pulmonary arterial pressure(PAP) and pulmonary vascular resistance(PVR), and increases cardiac output(CO) and arterial oxygen tension(PaO2). Another vasodilator hydralazine in patients with pulmonary hyertension and heart failure produces a decrease in PVR, and an increase in CO and inspite of an increase in CO, hydralazine maintains or increases the PaO2. The authors made a comparative studies on the effects of PGE1 and hydralarine on hemodynamics and gas exchange in experimentally induced acute lung injury. Oleic acid was infused in 8 dogs in order to induce acute lung injury and the effects on hemodynamics and gas exchange were measured every 30 minutes for 2hrs. After measuring Pre-PGE1 and Pre-hydralazine values, PGE1 and hydralazine were administered intravenously in order to evaluate and compare their effects. Doses for PGE1 and hydralazine were titrated until CO increased by 25%, heart rate(HR) increased by 15%, or mean arterial pressure(MAP) decreased by more than 20% from Pre-PGE1 and prehydralazine values. In PGE1 group, CO increased by 21%(p<0.01). MAP decreased by 14%(p<0.01). PVR decreased by 19%(p<0.01) and systemic vascular resistance(SVR) decreased by 29%(p<0.01). As CO increased with PGE1, intrapulmonary shunt(Qs/Qt) increased from 37% to 49%(p<0.01) and PaO2 fell from 109mmHg to 88mmHg(p<0.01). In hydralazine group, MAP, PVR, SVR and pulmonary capillary wedge pressure(PCWP) all decreased by 9%(p<0.01), 10%(p<0.05), 30%(p<0.0), 28%(p<0.01), respectively. CO increased by 41%(p<0.01) but the increase in Qs/Qt was only 5% inspite of a remarkable increase in CO, consequently PaO2 increased by 10% rising from 86mmHg to 94mmHg(p<0.01). Comparing the two groups, hydralazine resulted in a minor increase in Qs/Qt while there was a remarkable increase in CO. Moreover, it caused an increase in PaO2 and decrease in PCWP. The above results suggest that the effects of hydralazine are superior to those of PGE1 on the effects of hemodynamics and gas exchange in acute lung injury in dogs.
Acute Lung Injury* ; Alprostadil* ; Animals ; Capillaries ; Dogs ; Heart ; Heart Failure ; Hemodynamics* ; Humans ; Hydralazine* ; Lung Injury ; Oleic Acid* ; Oxygen ; Respiratory Distress Syndrome, Adult

We experidced recently a case which showed intravascular homolysis and acute renal insufficiency during open heart surgery. After various studies including immunohematologic study, urinalysis, CBC, transfusion reaction study, coombs test, we detected antibody against thiopental in the patient's serum. The end-point titer was 1:4. We concluded that it was thiopental-induced immune hemolysis so report this case along with references.
Acute Kidney Injury ; Blood Group Incompatibility ; Coombs Test ; Hemolysis* ; Thiopental ; Thoracic Surgery ; Urinalysis

During a 3 month period in 1984, 12 patients undergoing scheduled valvular replacement were Studied by CK and CK-MB isoenzyme to evaluate the myocardial damage during open heart operation. Total creatine kinase value was 58.3+/-25.6 u/L at control, 59.8+/-23.5 u/L at prebypass period, 85.5+/-49.6 U/L at during bypass period, 20.2+/-87.6 at postbypass period respectively. It began to rise in prebypass period and showed higtest level in postbypass period. CK-MB value was low in most cases below 20 U/L but in 2 patients postbypass period showed high level which above 40U/L. Initial isoenzyme activity was detected in 2 patients prior to anesthesia, in 2patients prior to bypass, in 5 patients during bypass, and in all others after termination of bypass. Considering above data we concluded that anesthetic management during prebypass period and myocardial preservation during bypass period required more proper and aggressive management despite of good operation results.
Anesthesia ; Creatine Kinase* ; Creatine* ; Heart ; Heart Valve Diseases* ; Humans

Succinylcholine induced hyperkalemia has been reported in many neurologic disorders including subarachnoid hemorrhage. The purpose of this study was to evaluate suceinylcholine induced-hyperkalemia in twenty ruptured cerebral aneuryam patients undergoing general anesthesia for repair of the cerebral aneurysm. Serum potassium levels were measured after induction of anesthesia, but before succinylcholine, and 1, 5 and 10 min after administration of succinylcholine. Serum potassium levels were continuously increased until 10 min after euccinylcholine administration. The increments of serum potassium above 1.0mEq/L were observed in 5 of 9 patients with loss of consciousnesa A relationship between the loss of consciousness and hyperkalemic response after succinylcholine was suggested.
Anesthesia ; Anesthesia, General ; Humans ; Hyperkalemia ; Intracranial Aneurysm* ; Nervous System Diseases ; Potassium* ; Subarachnoid Hemorrhage ; Succinylcholine* ; Unconsciousness

In vivo 31P magnetic resonance spectroscopy (MRS) was used to evaluate the effect of nimodipine on changes of [H] (pH) and the ratio of [PCr]/[Pi] in cats subjected to an incomplete global cerebral ischemia-reperfusion under the pretreated condition of hyperglycemia. Animals were subjected to a transient (18 minutes) incomplete global cerebral ischemia; the systemic arterial hypotension was induced, and immediately followed by the bilateral carotid artery ligation. Twenty cats were divided into 3 groups; for group 1 (control), 7 cats were employed for a control group; for group 2 (hyperglycemia), 7 cats were a hyperglycemia group with infusion of 50% glucose prior to ischemia; for group 3 (Nimodipine), 6 cats were infused with 50% glucose prior to ischemia, and nimodipine after ischemia. The time course of changes in pH and [PCr]/ [Pi] was monitored before, during and after ischemia. The pH decreased immediately after ischemia in all three groups. After the reperfusion was made, the values of the pH did not retum to the baseline value for the group 2 (hyperglycemia) and 3 (nimodipine), in contrary to the group 1 (control). The ratio of [PCr]/[Pi] was dropped to 20% of the baseline value after ischemia in all three groups. The value was recovered progres- sively during reperfusion period for group 1 (control), whereas for group 2 (hyperglycemia) and group 3 (Nimodipine) the values were remained depressed. The results suggest that the condition of hyperglycemia induced by the infusion of 50% glucose prior to the incomplete global cerebral ischemia-reperfusion, may deteriorate the cerebral ischemia and the infusion of nimodipine during ischemia-reperfusion has no beneficial effects to improve the cerebral acidosis and the metabolic recovery.
Acidosis ; Animals ; Brain Ischemia ; Carotid Arteries ; Cats* ; Glucose ; Hydrogen-Ion Concentration ; Hyperglycemia* ; Hypotension ; Ischemia ; Ligation ; Magnetic Resonance Spectroscopy ; Nimodipine* ; Reperfusion

In vivo 31P magnetic resonance spectroscopy (MRS) was used to evaluate the effect of nimodipine on changes of [H] (pH) and the ratio of [PCr]/[Pi] in cats subjected to an incomplete global cerebral ischemia-reperfusion under the pretreated condition of hyperglycemia. Animals were subjected to a transient (18 minutes) incomplete global cerebral ischemia; the systemic arterial hypotension was induced, and immediately followed by the bilateral carotid artery ligation. Twenty cats were divided into 3 groups; for group 1 (control), 7 cats were employed for a control group; for group 2 (hyperglycemia), 7 cats were a hyperglycemia group with infusion of 50% glucose prior to ischemia; for group 3 (Nimodipine), 6 cats were infused with 50% glucose prior to ischemia, and nimodipine after ischemia. The time course of changes in pH and [PCr]/ [Pi] was monitored before, during and after ischemia. The pH decreased immediately after ischemia in all three groups. After the reperfusion was made, the values of the pH did not retum to the baseline value for the group 2 (hyperglycemia) and 3 (nimodipine), in contrary to the group 1 (control). The ratio of [PCr]/[Pi] was dropped to 20% of the baseline value after ischemia in all three groups. The value was recovered progres- sively during reperfusion period for group 1 (control), whereas for group 2 (hyperglycemia) and group 3 (Nimodipine) the values were remained depressed. The results suggest that the condition of hyperglycemia induced by the infusion of 50% glucose prior to the incomplete global cerebral ischemia-reperfusion, may deteriorate the cerebral ischemia and the infusion of nimodipine during ischemia-reperfusion has no beneficial effects to improve the cerebral acidosis and the metabolic recovery.
Acidosis ; Animals ; Brain Ischemia ; Carotid Arteries ; Cats* ; Glucose ; Hydrogen-Ion Concentration ; Hyperglycemia* ; Hypotension ; Ischemia ; Ligation ; Magnetic Resonance Spectroscopy ; Nimodipine* ; Reperfusion

This report concerned to our clinical expenence of 22 cases of open heart anesthesia at the Department of Anesthesiology, Capital Armed Forces General hospital during the period between May, 1982 and February, 1984. Among 22 cases male were 20, female were 2 cases. Age was varied from 21 years to 50 years and mean was 25.8 years. Morphine & demerol were used as premedicants in most cases in conjunction with valium or alone, and thiopental in 2.5~6mg/kg dosage as in duction agent for 20 cases. We used halothane for 21 cases, enflurane for 1 case in concentration of 0.3~1%, 0.7~1.5% respectively. Intravenous anesthetic agents, morphine and thalamonal, were used as supplementary to reduce the required dosage of inhalation agents, halothane and enflurane, to maintain the anesthesia. Succinylcholine for intubation of trachea and pancuronium for maintenance of muscle relaxation were used in dosage of 1~1.6mg/kg, 0.1~0.3mg/kg respectively.
Anesthesia* ; Anesthesiology ; Anesthetics ; Arm ; Diazepam ; Enflurane ; Female ; Halothane ; Heart* ; Hospitals, General ; Humans ; Inhalation ; Intubation ; Male ; Meperidine ; Morphine ; Muscle Relaxation ; Pancuronium ; Succinylcholine ; Thiopental ; Trachea