Spinal reflex activity that remains after insult to the spinal cord brings with it significant functional impairment. Our patient had suffered from general spasticity and hyperreflexic neurogenic bladder caused by sixth cervical cord injury. Unfortunately, the use of oral medication (baclofen) was limited by an inadequate effect. So we performed two times of subarachnoid block with 0.5% heavy bupivacaine, the patient experienced improvement in bladder and sphincter function. We concluded that subarachnoid block with 0.5% heavy bupivacaine is an effective and safe modality for spasticity control in patients who are refractory to oral medication before neurolytic block.
Bupivacaine ; Humans ; Muscle Spasticity ; Reflex ; Spinal Cord ; Urinary Bladder ; Urinary Bladder, Neurogenic*

BACKGROUND: Propofol has gained widespread popularity but it should at least be questioned in the presence of heart rate lowering medications such as beta-blockers. Esmolol, due to its ultrashort action and cardioselective properties, has been shown to be safe and effective for use in intraoprative tachycardia and hypertension. The purpose of this study is to evaluate the hemodynamic effects of esmolol and propofol under isoflurane anesthesia in dogs. METHODS: Six-mongrel dogs were induced with thiopental, intubated and ventilated with a mixture of isoflurane (1-1.5 vol%) and oxygen. A pulmonary artery catheter was placed via femoral vein and the femoral artery was cannulated. After stabilization, baseline hemodynamic measurements (HR, MAP, CO, SVR) were obtained. Measurements were repeated 5 and 15 minutes after injection of propofol (2 mg/kg), esmolol (1 mg/kg), and additional esmolol (1 mg/kg) for 30 seconds. Data was analyzed by repeated measurement of ANOVA. P < 0.05 was considered significant. RESULTS: Propofol produced no change in heart rate, MAP, CO and SVR. Heart rate decreased significantly during esmolol administration and remained decreased up to 15 minutes after the injection whereas the MAP, CO and SVR showed no significant changes. CONCLUSIONS: We have demonstrated that the decrease in heart rate continued up to 15 minutes after esmolol administration. These findings suggest that concomittent administration of propofol and esmolol requires monitoring of the heart rate after a bolus intravenous injection of esmolol.
Anesthesia* ; Animals ; Catheters ; Dogs* ; Femoral Artery ; Femoral Vein ; Heart Rate ; Hemodynamics* ; Hypertension ; Injections, Intravenous ; Isoflurane* ; Oxygen ; Propofol* ; Pulmonary Artery ; Tachycardia ; Thiopental

BACKGROUND: There are few preoperative assessments focused on elderly surgical patients in Korea. Current study suggest that preoperative tests should be ordered only when the history or finding on physical examination have indicated for test. We performed a study to evaluate the preoperative assessment and to determine the need for routine preoperative laboratory test in elderly patients. METHODS: Three hundred forty-five patients aged 65 yrs or older presenting for elective surgery requiring general or regional anesthesia were divided into three groups according to age. Data was obtained from chart review and anesthesia preoperative records. Demographic information included age, sex, body mass index, coexisting disease, type of surgery and ASA classification. Clinically obtained preoperative laboratory test results (hemoglobin, platelet, chest X-ray, ECG, BUN, creatinine, ALT, AST, arterial blood gas analysis, pulmonary function test, PT, PTT, echocardiography) were measured. RESULTS: Fifty-seven percent were women. The most frequently performed procedures were general surgery followed by orthopedic surgery. In 345 patients, 47.5% of the patients had a coexisting disease. The most frequently coexisting disease was hypertension. 78.6% of the patients were classified as ASA class 2 and 3. The abnormal findings on ECG, pulmonary function test, and chest X-ray were 46.4%, 48.3%, and 42.6% respectively. 48 patients without any clinical history and symptoms had abnormalities on the routine laboratory test. CONCLUSIONS: We demonstrated that 47.5% of the patients had a coexisting disease and the majority of the patients were classified as ASA class 2 and 3. Changes in the cardiovascular and respiratory function were greater than other functions. We concluded that routine preoperative laboratory test in elderly is useful as a part of preoperative assessment.
Aged* ; Anesthesia ; Anesthesia, Conduction ; Blood Gas Analysis ; Blood Platelets ; Body Mass Index ; Classification ; Creatinine ; Electrocardiography ; Female ; Humans ; Hypertension ; Korea ; Orthopedics ; Physical Examination ; Respiratory Function Tests ; Thorax

BACKGROUND: The combined induction using two or more agents has a potential benefit that anesthesia could be induced with smaller anesthetic agents with fewer side effects. We studied the effects of co-administration with midazolam and remifentanil on the dose of propofol, the time to loss of consciousness (LOC) and hemodynamics during tracheal intubation. METHODS: Sixty patients were randomly assigned to three groups. Group 1 was induced with target-controlled propofol alone. Group 2 received midazolam (0.05 mg/kg) and target-controlled propofol. Group 3 received midazolam (0.025 mg/kg), remifentanil (2 ng/ml) and target-controlled propofol. The time to LOC, the infused propofol dose and the effect site concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was given and tracheal intubation was performed. The noninvasive blood pressure, heart rate (HR) and bispectral index were recorded. RESULTS: The time and the dose of propofol to LOC were significantly reduced in group 2, 3 than in group 1 (P < 0.05). Compared with pre-induction values, mean blood pressure at immediately after intubation was increased in group 1, 2 with no change in group 3. The HR immediately after intubation was significantly increased in all groups compared to the pre-induction values, but the rate of increase of HR in group 3 were significantly lower than those group 1, 2 (P < 0.05). CONCLUSIONS: The co-administration with midazolam and remifentanil reduces the time to LOC and the dose of propofol. That also attenuates hemodynamics during tracheal intubation under target-controlled infusion of propofol.
Androstanols ; Anesthesia ; Anesthetics ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam ; Piperidines ; Propofol ; Unconsciousness

BACKGROUND: Laryngoscopic and tracheal intubation often causes an increase in blood pressure and heart rate. The purpose of this study was to evaluate the influence of the duration of laryngoscopy and tracheal intubation on hemodynamic response. METHODS: We studied 110 patients undergoing elective surgery. Anesthesia was induced with fentanyl 1microgram/kg and thiopental 5 mg/kg, and rocuronium 0.6 mg/kg was administrated prior to intubation. The duration of laryngoscopy and tracheal intubation was defined as the interval between the insertion of a laryngoscope into a patient's mouth and its removal after successful tracheal intubation. Patients were divided into three groups according to the duration of intubation: Group 1 (duration < or = 15 seconds); Group 2 (15 < duration < or = 30 seconds); Group 3 (duration > 30 seconds). Systolic blood pressure, diastolic blood pressure and heart rate were measured before intubation, after induction, immediately after intubation, and 1 min and 3 min after intubation. RESULTS: Systolic blood pressure at 1 min after intubation was significantly higher in Group 3 than in Group 1, but no significant differences were observed in diastolic blood pressure or heart rate. Regarding the correlation between systolic blood pressure and the duration of laryngoscopy and tracheal intubation, the linear regression r2 value was 0.03. CONCLUSION: This study suggests that the duration of laryngoscopy and tracheal intubation is not significantly correlated with blood pressure. However, it also shows that when the time to intubation exceeds 30 seconds, that the systolic blood pressure is significantly increased. Thus, when the duration of tracheal intubation is anticipated to be prolonged, attempts to attenuate hemodynamic response to tracheal intubation are necessary.
Anesthesia ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Laryngoscopes ; Laryngoscopy ; Linear Models ; Mouth ; Thiopental*

BACKGROUND: The aim of this study is to evaluate the effects of local anesthetic distribution on symptoms using ultrasound image after C6 stellate ganglion block (SGB). METHODS: Twenty-six patients underwent SGB via an anterior paratracheal approach at the sixth cervical level using 6 ml of 1% mepivacaine. We divided the patients into two groups by local anesthetic distribution using ultrasound image after SGB. In the group 'sub', injected local anesthetic was beneath the prevertebral fascia. In the group 'supra', some of injected local anesthetic was above the prevertebral fascia. The occurrence of Horner's syndrome, warm sensation on the face and hand, brachial plexus block, hoarseness, and foreign body sensation in the throat were evaluated. The skin temperature of the bilateral thumbs was measured pre and post SGB. RESULTS: The occurrence of hoarseness and the foreign body sensation in the throat was significantly reduced in the group 'sub' than the group 'supra' (P<0.05). The skin temperature of the ipsilateral thumb significantly increased in both groups compared to the pre SGB values, and the change of the skin temperature significantly increased in the group 'sub' than the group 'supra' (P<0.05). CONCLUSIONS: Subfascial distribution of local anesthetic under ultrasound image after SGB reduces the typical complications. It is more effective in the sympathetic block than suprafascial distribution.
Brachial Plexus ; Fascia ; Foreign Bodies ; Hand ; Hoarseness ; Horner Syndrome ; Humans ; Mepivacaine ; Pharynx ; Sensation ; Skin Temperature ; Stellate Ganglion ; Thumb

BACKGROUND: Sevoflurane is characterized by the lack of an unpleasant odor, airway irritation and its low blood/gas partition coefficient (0.68), which provides rapid and smooth induction. Inhaled induction with sevoflurane is commonly used in pediatric patients, but not in adult patients. This study was designed to investigate the time to completion of LMA insertion and end-tidal sevoflurane concentration during induction with sevoflurane 8% and N2O 50%, after midazolam administration, in adults. METHODS: Twenty eight patients, aged 20(-60) years, were administered intravenous midazolam 30 microgram/kg and after one minute, sevoflurane 8% and N2O 50% were inhaled with tidal-volume breathing. One minute after loss of consciousness, jaw thrust and mouth opening were checked and an LMA was inserted. The end-tidal concentration of sevoflurane, and the times to loss of consciousness and completion of insertion were recorded. The mean arterial pressure and heart rate were also recorded. RESULTS: From initiation of sevoflurane and N2O inhalation, it took 48 +/- 14 seconds until loss of consciousness, and 143 +/- 19 seconds until the completion of LMA insertion. The end-tidal sevoflurane concentration was 4.1 +/- 0.6% at loss of consciousness, 5.0 +/- 0.7% at one min after loss of consciousness, and 4.1 +/- 0.5% after LMA insertion. In all patients LMA insertion was successful and satisfactory. After LMA insertion, compared to baseline, the mean arterial pressure was reduced and the heart rate increased. CONCLUSIONS: After small-dose of midazolam, inhaled induction with sevoflurane 8% and N2O 50% allowed successful and satisfactory LMA insertion in adults.
Adult ; Arterial Pressure ; Heart Rate ; Humans ; Inhalation ; Jaw ; Laryngeal Masks ; Midazolam* ; Mouth ; Nitrous Oxide ; Odors ; Respiration ; Unconsciousness