Severe hyperkalemia can induce life threatening cardiac rhythm disturbances, and usually produce classic electrocardiographic (EKG) manifestations. We report a case of severe hyperkalemia in which the EKG did not reveal the expected alterations. The patient was a 57-year-old man with adenocarcinoma of stomach. There were no significant abnormal findings in laboratory analysis, chest X-ray and EKG. His preoperative medications for hypertension consisted of furosemide, amiloride and enalapril. The tests for serum potassium concentration ([K ]) were performed on 20 and 7 days before the operation and the results were 4.5 and 4.9 mEq/l, respectively. Just after induction of anesthesia, we tried the blood gas and electrolyte analysis and the result revealed high [K ] of 8.5 mEq/l, but EKG did not show typical phenotype of hyperkalemia at that time. His intraoperative and postoperative courses were not eventful.
Adenocarcinoma ; Amiloride ; Anesthesia ; Electrocardiography* ; Enalapril ; Furosemide ; Humans ; Hyperkalemia* ; Hypertension ; Ions ; Middle Aged ; Phenotype ; Potassium ; Stomach ; Thorax

BACKGROUND: Midazolam is distinguished from other benzodiazepines by its water solubility, rapid onset, short duration, and lack of accumulation of active metabolites. These pharmacokinetic cbaracteristics support its use by continuous infusion. We evaluated the continuous infusion dose of midazolain for adequate sedation of ventilated patients with hemodynamic and respiratory monitoring. METHODS: We started continuous infusion of midazolam at a rate of 0.5~1.0 ug/kg/minute after bolus injection of 3.0 to 5.0 mg and adjusted infusion dose monitoring sedation scale in the 15 patients. Blood pressure, heart rate and central venous pressure were monitored before and 30 minute, 1, 2, 3 and 6 hours after midazolam infusion. Arterial blood gases were measured and peak inspiratory pressure was monitored. We evaluated liver and kidney function before start of infusion and after discontinuation of midazolam infusion. RESULTS: The mean loading dose, infusion rate and total dose of midazolam were 4.1+/-0.9 mg, 1.2+/-0.4 ug/kg/minute and 251.9+/-84.0 mg. The mean duration of infusion was 59.0+/-37.0 hours. After infusion, systolic and diastolic blood pressure and heart rate and central venous pressure remained stable when compared with those of the preinfusion state. Arterial blood gas and peak inspiratory pressure remained unchanged. The function of liver and kidney did not deteriorate after infusion. CONCLUSIONS: Continuous infusion of midazolam at a rate of 1.2+/-0.4 ug/kg/minute after 4.1+/-0.9 mg intravenous bolus injection was a safe and effective method for sedation of ventilated patients in intensive care unit without hemodynamic disturbance.
Benzodiazepines ; Blood Pressure ; Central Venous Pressure ; Gases ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Intensive Care Units* ; Critical Care* ; Kidney ; Liver ; Midazolam* ; Solubility ; Ventilation

OBJECTIVE: This study was conducted to compare the effects of low frequency needle transcutaneous electrical nerve stimulation (TENS) and high frequency needle TENS on experimental pain threshold. METHOD: Twenty two healthy adult subjects were assigned randomly to a low-TENS group or to a high-TENS group. Experimental pain threshold at forearm was determined with pain threshold of electrical simulation using surface electrode and needle electrode. RESULTS: Low-TENS group showed that pain relief was developed after 10 minutes and persisted 3 hours after treatment cessation. Low-TENS group showed a significant increase in experimental pain threshold opposing to high TENS group. CONCLUSION: This results suggest that effect of low frequency needle TENS therapy is better and longer than high frequency needle TENS therapy.
Adult* ; Electrodes ; Forearm ; Humans ; Needles* ; Pain Threshold* ; Transcutaneous Electric Nerve Stimulation* ; Withholding Treatment

Objective: This study aimed to improve the accuracy of PMI estimates in veterinary forensic cases by looking into how different humidity levels affect autolysis in different organs of rats. Methods: The study involved 38 male rats, examining histopathological changes in their heart, liver, and pancreas. These organs were subjected to controlled humidity levels (20%, 55%, and 80%) at a constant 22°C. Tissue samples were collected at several intervals (0 h, 12 h, 24 h, 3 days, and 8 days) for comprehensive analysis. Results: Distinct autolytic characteristics in animal organs emerged under varying humidity conditions. The low-humidity environment rapidly activated autolysis more than the high-humidity environment. In addition, it was found that lower humidity caused nuclear pyknosis, cytoplasmic disintegration, and myofiber interruption. The liver, in particular, showed portal triad aggregation and hepatocyte individuation. The pancreas experienced cell fragmentation and an enlarged intracellular space. High humidity also caused the loss of striations in cardiac tissues, and the liver showed vacuolation. Under these conditions, the pancreas changed eosinophilic secretory granules. Conclusions and Relevance: The study successfully established a clear connection between the autolytic process in PMIs and relative humidity. These findings are significant for developing a more accurate and predictable method for PMI estimation in the field of veterinary forensic science.

BACKGROUND: Low values of lung compliance have been reported in patients with increased pulmonary blood flow due to intracardiac left to right(L-R) shunt. The compliance had returned to within normal limits 4 to 6 weeks after surgical correction of the shunt. We investigated whether lung compliance was improved immediately after surgical correction of the shunt. METHODS: Fifty four pediatric patients who were undergoing repair of intracardiac L-R shunt were evaluated. Lung compliance, arterial oxygen tension(PaO2) and arterial to end-tidal carbon dioxide tension difference(Pa-ETCO2) were measured after induction of anesthesia and at the completion of surgery. Left atrial pressure(LAP) was monitored. Lung compliance and end-tidal carbon dioxide tension were measured by monitoring system built in Cato anesthetic ventilator system. RESULTS: Lung compliance was significantly lower after surgery(6.57+/-6.46 ml/mbar) than after induction of anesthesia(7.71+/-7.18 ml/mbar). After surgery, PaO2 was significantly decreased and Pa-ETCO2 significantly increased than after induction of anesthesia. The decrease in lung compliance after surgery significantly correlated with a decrease in PaO2(r=0.43) and an increase in Pa-ETCO2 (r=0.47) but not correlated with LAP. CONCLUSIONS: Although surgical correction of intracardiac L-R shunt reduces pulmonary blood flow, the lung compliance decreases in immediate postoperative period. Therefore a deterioration of postoperative lung compliance may need judicious management for pulmonary and hemodynamic instability.
Anesthesia ; Carbon Dioxide ; Compliance ; Hemodynamics ; Humans ; Lung Compliance* ; Lung* ; Oxygen ; Postoperative Period ; Ventilators, Mechanical

To understand the mechanism of cell injury when exposed to HgCl2, monitoring of cytosolic ionized free Ca2+([Ca2+]i), viability test, measurement of the amount of ATP, and Ca-ATPase activity were evaluated in cultured rabbit renal tubular cells(RTC) exposed to HgCl2. The results were as follows: 1) HgCl2 was cytotoxic to rabbit RTC at all doses except 10 uM and the rate of killing displayed a dose- and time-dependent relationship. 2) The absence of extracellular Ca provided partial protection from irreversible injury induced by HgCl2. 3) The increasing pattem of [Ca2+]i varied according to the concentrations of HgCl2. At the low concentrations of HgCl2 (2.5-10 microM), the level of [Ca2+]i increased slowly over the flat 2-3 min and then achieved plateau-state. In contrast, at the high concentrations of HgCl2 (25-100 microM) the level of [Ca2+]i achieved peak within 1 min and then decreased to a plateau state under normal concentrations. 4) The level of ATP was decreased to 27.5% of that of normal control cells within 3 min by using a treatment of 100 microM HgCl2. 5) HgCl2 did not affect the Ca2+ ATPase activity by enzyme histochemical observation. These findings suggest that the elevation of [Ca2+]i in response to the HgCl2-induced injury is an important event in accelerating injury that ultimately leads to cell death. But other possibilities such as HgCl2 might have direct deleterious effects on the also should be considered.
Rabbits ; Animals

BACKGROUND: Dobutamine and amrinone, phosphodiesterase-III inhibitor, are known to have both inotropic and vasodilatory properties. We evaluated the effects of both drugs on systemic and pulmonary hemodynamics in patients with pulmonary hypertension (PH). METHODS: With Institutional Review Board approval, 45 patients whose mean pulmonary arterial pressure was greater than 30 mmHg were studied. After sternotomy under the steady state of anesthesia and controlled ventilation (30 mmHg < PaCO2 < 40 mmHg), patients recieved one of following drugs for 30minutes (min); dobutamine 5.0ug/kg/min (Group I), low dose amrinone (loading dose 1.0 mg/kg, followed by infusion 7.5 g/kg/min, Group II) or high dose amrinone (loading dose 2.0 mg/kg, followed by infusion 10 g/kg/min, Group III). Hemodynamic variables were measured at 10 min and 30 min after start of infusion. RESULTS: Dobutamine didn't decrease pulmonary arterial pressure (PAP) and cause no hemodynamic change while low and high dose amrinone reduced PAP and especcially decrease of PAP in low dose amrinone group was statistically significnat. High dose amrinone increased cardiac index (CI) and decreased both systemic vascular resistance index (SVRI) and central venous pressure (CVP) more significantly than control value. CONCLUSIONS: In patients with chronic right ventricular failure associated with PH, amrinone may decrease the PAP and improve cardiac performance more effectively than dobutamin does. Increment of dosage of amrinone may not result in significant reduction of PAP.
Amrinone* ; Anesthesia ; Arterial Pressure ; Central Venous Pressure ; Dobutamine* ; Ethics Committees, Research ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Sternotomy ; Vascular Resistance ; Ventilation

BACKGROUND: The addition of bupivacaine to lipid soluble opioids have improved analgesia and can reduce opioid related side effects in the epidural analgesia. The use of the combination of bupivacaine and lipid soluble opioid fentanyl is gaining in popularity after surgery. But recent work has produced conflicting results, and the ideal combination of local anesthetics and opioid for Patient Controlled Epidural Analgesia (PCEA) is unknown. We have compared the efficacy and the safety of 0.1% bupivacaine and 0.2% bupivacaine combined with fentanyl 5 microgram/ml for PCEA. METHODS: Forty women undergoing lower abdominal gynecological surgery under general anesthesia were assigned to receive an epidural initial bolus of 0.1% (0.1% group) or 0.2% bupivacaine (0.2% group) combined with 5 microgram/ml fentanyl mixture 10 ml, followed by a PCEA with 2 ml/hr continuous background infusion and demand-dose of 2 ml in prospective, random, double blind fashion. Resting and coughing visual analogue scale (VAS) for pain, infusion rates of the mixture, and side effects were recorded at 4, 8, 24, 48 hr postoperatively, and satisfaction were noted after 48 hr. RESULTS: No differences in resting and coughing VAS scores, hypotension, nausea, itching sensation, and somnolence were observed between the two groups. The mean infusion rates of mixtures during the first 4 hr were higher in the 0.1% group (3.3 1.3 ml/hr) than the 0.2% group (2.5 0.6 ml/hr) (p<0.05). The incidence and the degree of sensory and motor block were higher in the 0.2% group (p<0.05). CONCLUSIONS: Both groups provided sufficient postoperative analgesia and satisfaction with some side effects. The high incidence and degree of sensory and motor block were resulted in the 0.2% group, which is not optimal for early ambulation. To search for more titrated bupivacaine concentration between 0.1% and 0.2%, loading doses or appropriate epidural puncture level having reduced demand dose and decreased side effects, further studies are expected.
Analgesia ; Analgesia, Epidural* ; Analgesics, Opioid ; Anesthesia, General ; Anesthetics, Local ; Bupivacaine* ; Cough ; Early Ambulation ; Female ; Fentanyl* ; Gynecologic Surgical Procedures ; Humans ; Hypotension ; Incidence ; Nausea ; Prospective Studies ; Pruritus ; Punctures ; Sensation

BACKGROUND: Thoracoscopic sympathicotomy was thought to be a simple and safe method for hyperhidrosis. There is a significant decrease in heart rate during the procedure. Also it has been suggested that the effect of the degree of sympathetic block on cardiac function was affected by the preoperative level of sympathetic activity. Our hypothesis was that the higher heart rate before sympathicotomy the more heart rate change during the procedure because heart rate is one of the indicators of sympathetic activity. METHODS: Sixty two patients with essential hyperhidrosis undergoing thoracoscopic sympathicotomy were studied. During the procedure, we recorded blood pressure at left arm and heart rate after anesthetic induction as baseline values, immediately after left side sympathicotomy, and after right side sympathicotomy. Patients were divided by median value of preoperative heart rate (83 beats/min) into group I (n = 32), preoperative heart rate below 83 beats/min, and group II (n = 30), above 83 beats/min. RESULTS: The preoperative mean heart rates of group I and II were 72 +/- 7.9 beats/min and 100 +/- 12.5 beats/min respectively. After sympathicotomy, the decrease of heart rate compared to the preoperative value in Group I was 6.6%, which was significantly lower than that of Group II, 17.6%. After left sympathicotomy, the number of cases of heart rate decreasing more than 10% was higher in Group II (20/30 cases) than Group I (13/32 cases). CONCLUSIONS: The main result of this study showed that the higher heart rate before sympathicotomy the more heart rate change during procedure.
Arm ; Blood Pressure ; Heart Rate* ; Heart* ; Humans ; Hyperhidrosis

BACKGROUND: It is difficult to choose the appropriate drug when hypotension develops in patients with pulmonary hypertension (PH). There is no known drug to increase the systemic blood pressure (BP) without an increase of pulmonary arterial pressure (PAP). We observed the effects of phenylephrine (PE) and norepinehrine (NE) on systemic and pulmonary hemodynamics when hypotension was treated in patients with PH. METHODS: Patients with PH (mean PAP > or = 25 mmHg, n = 28) were studied. When hypotension occurred (systolic BP < or = 100 mmHg, T1) after the induction of anesthesia, PE or NE was randomly infused to raise the systolic BP above 130 mmHg (T2) and 150 mmHg (T3). Hemodynamic variables were measured at T1, T2 and T3, and the ratio (RBP) of mean PAP to mean BP was calculated. The measurements were performed before skin incision to avoid the effects of surgical stimulation. RESULTS: NE increased BP concomitantly with relatively small increase of PAP, meaning a decrease of RBP (P < 0.05) without any other changes of hemodynamic variables in all patients. However, PE could not raise BP above 130 mmHg in one third of patients, and decreased the cardiac index without a significant decrease of RBP. CONCLUSIONS: NE increased BP and decreased RBP without tachycardia or any other hemodynamic disturbances. NE is considered to be a proper and safe drug to raise BP when hypotension occurs in patients with PH.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Hypotension ; Norepinephrine* ; Phenylephrine* ; Skin ; Tachycardia