No abstract available.

BACKGROUND: We have previously demonstrated the isoflurane and halothane may be detrimental to in vitro fertilization of mouse oocytes in high concentrations. The aim of this study is to compare the toxic effects of volatile anesthetics on mouse embryos using in vitro growth model of two cell mouse embryos. METHODS: Mouse two-cell embryos exposed to three volatile anesthetics, enflurane(0.5 mM; 1.5 mM), isoflurane(0.26 mM; 0.78 mM) and halothane(0.24 mM; 0.72 mM). Mouse two-cell embryos unexposed to any drugs were included as controls. RESULTS: The percentages of two-cell mouse embryos developed over morula stages on the third day after exposure of high concentrations of isoflurane and halothane decreased significantly compared with controls. The rates of embryos arrested at 2-8 cell stage in these groups were significantly higher than that of controls. There were no significant differences in these rates between enflurane group, isofiurane and halothane group of lower concentrations and controls. The hatching and/or hatched blastocysts development were significantly lower in isoflurane and halothane group than in controls. No significant differences in the hatching rate of blastocyst developed were observed among groups. CONCLUSIONS: Our data show that isoflurane and halothane in high concentrations have harm effects of the in vitro growth of two cell mouse embryos.
Anesthesia* ; Anesthetics ; Animals ; Blastocyst ; Embryonic Development ; Embryonic Structures ; Enflurane ; Female ; Fertilization in Vitro ; Halothane ; Isoflurane ; Mice ; Morula ; Oocytes ; Pregnancy

BACKGROUND: We have previously demonstrated the isoflurane and halothane may be detrimental to in vitro fertilization of mouse oocytes in high concentrations. The aim of this study is to compare the toxic effects of volatile anesthetics on mouse embryos using in vitro growth model of two cell mouse embryos. METHODS: Mouse two-cell embryos exposed to three volatile anesthetics, enflurane(0.5 mM; 1.5 mM), isoflurane(0.26 mM; 0.78 mM) and halothane(0.24 mM; 0.72 mM). Mouse two-cell embryos unexposed to any drugs were included as controls. RESULTS: The percentages of two-cell mouse embryos developed over morula stages on the third day after exposure of high concentrations of isoflurane and halothane decreased significantly compared with controls. The rates of embryos arrested at 2-8 cell stage in these groups were significantly higher than that of controls. There were no significant differences in these rates between enflurane group, isofiurane and halothane group of lower concentrations and controls. The hatching and/or hatched blastocysts development were significantly lower in isoflurane and halothane group than in controls. No significant differences in the hatching rate of blastocyst developed were observed among groups. CONCLUSIONS: Our data show that isoflurane and halothane in high concentrations have harm effects of the in vitro growth of two cell mouse embryos.
Anesthesia* ; Anesthetics ; Animals ; Blastocyst ; Embryonic Development ; Embryonic Structures ; Enflurane ; Female ; Fertilization in Vitro ; Halothane ; Isoflurane ; Mice ; Morula ; Oocytes ; Pregnancy

No abstract available.
Anesthesia, General* ; Humans ; Laryngeal Masks* ; Pierre Robin Syndrome*

BACKGROUND: The conventional laryngeal mask airway (LMA) has been used to facilitate blind tracheal intubation in numerous situations where laryngoscopy and conventional intubation has been difficult, but it has the disadvantage that its airway tube is too long and narrow for intubation. The intubating laryngeal mask airway (ILM) has been specifically designed to increase the success rate of blind intubation. A specially constructed ILM tracheal tube is available for use with the ILM, But this tube is in short supply and expensive. Thus, this study was performed to compare the success rate and time of blind intubation through ILM with reinforced tracheal tube or specially-designed tracheal tube, and to assess the use of reinforced tracheal tube as a substitute for specially-designed tracheal tube. METHODS: After acquiring informed consent, 60 ASA grade 1 or 2 patients undergoing anesthesia for elective surgical procedures who normally required tracheal intubation were randomized into two groups. In group 1 (n = 30), the patients were intubated with a specially-designed tracheal tube through ILM. In group 2 (n = 30), reinforced tracheal tubes were used. The patients were induced and relaxed with an iv injection of thiopental sodium, fentanyl-ketamine-midazolam mixture and vecuronium. When an adequate level of anesthesia was achieved, the ILM was inserted. After adequate ventilation was confirmed, blind tracheal intubation with either of the two types of tracheal tubes through the ILM was attempted. Then we recorded success rate, intubation time and adjusting maneuvers. RESULTS: The ILM was successfully inserted at first attempt in 59/60 (98%) patients, but in 1 patient, adequate ventilation was not acheived. The success rate of tracheal intubation was 27 (93%) in group 1 and 28 (93%) in group 2. In group 1, 21 (72%) patients were successfully intubated on the first attempt, 1 (4%) patient on the second attempt, and 5 (17%) patients on the third attempt. In group 2, 20 (67%) patients were successfully intubated on the first attempt, 2 (6%) patients on the second attempt, and 6 (20%) patients on the third attempt. The mean time taken for intubation was 116.9 sec in group 1 and 122.3 sec in group 2. CONCLUSIONS: The authors conclude that the reinforced tracheal tube can be substitute for a specially- designed tracheal tube.
Anesthesia ; Humans ; Informed Consent ; Intubation* ; Laryngeal Masks* ; Laryngoscopy ; Surgical Procedures, Elective ; Thiopental ; Vecuronium Bromide ; Ventilation

The anesthetic management of patients with pheochromocytoma presents many difficult problems, such as hypertension, cardiac arrhythmias, and hypotension. A 21 year-old male underwent resection of pheochromocytoma under general anesthesia with isoflurane and fentanyl. Hypertensive crisis during induction of anesthesia and surgical manipulation of the tumor were managed with phentolamine and sodium nitroprusside drips. Anesthesia was maintained wtih nitrous oxide : oxygen, 50% : 50%, isoflurane, 0.5-2% and supplemented with fractional doses of fentanyl and vecuronium for muscular relaxation. We also used propranolol for the cardiac arrhythmia. An endotracheal semi-closed circle absorption technique with controlled ventilation was employed. Fentanyl does not release histamine, and has stable hemodynamics. Isoflurane has also advocated on the grounds that arrhythmias are less esaily provocated by circulating catecholamines than with other volatile agents, and has been shown to be a satisfactory agent. Vecuronium does not provoke catecholamine release, does not release histamine, has no autonomic effects at clinical plasma concentrations, and is clearly the neuromuscular blocking agent of choice in this case. Optimal pre-operative preparation, smooth induction of anesthesia, adequate alveolar ventilation, proper cardiovascular control, and good communication between surgeon and anesthesiologist are most important for the anesthetic management of pheochromocytoma.
Absorption ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, General ; Arrhythmias, Cardiac ; Autonomic Agents ; Catecholamines ; Fentanyl ; Hemodynamics ; Hemorrhoidectomy* ; Histamine ; Humans ; Hypertension ; Hypotension ; Isoflurane ; Male ; Neuromuscular Blockade ; Nitroprusside ; Nitrous Oxide ; Oxygen ; Phentolamine ; Pheochromocytoma ; Plasma ; Propranolol ; Relaxation ; Vecuronium Bromide ; Ventilation ; Young Adult

Central Venous Catheters*

In recent year, some thoracic operations were performed by use of videothoracoscopy becauae of its benefits: minimal postoperative pain and complications, small surgical scars and shorter hospital stay. We reyort our experience of the anesthetic management for a patient who underwent thoracic endoscopic sympathectomy for upper limh hyperhidrosia. One lung ventilation with a left-sided double lumen endobroncheal tube was performed to provide adequate surgical access, and a careful monitoring was done for adequate oxygenation and ventilation. The patient developed a hypercarbia and sinus tachycardia after CO2 insufflation into the right pleural cavity. We discusaed the benefits and risks of endoscopic thoracic surgery and aneethetic managements.
Cicatrix ; Humans ; Hyperhidrosis* ; Insufflation ; Length of Stay ; One-Lung Ventilation ; Oxygen ; Pain, Postoperative ; Pleural Cavity ; Risk Assessment ; Sympathectomy* ; Tachycardia, Sinus ; Thoracic Surgery ; Thoracoscopy ; Upper Extremity* ; Ventilation

BACKGROUND: The position for tracheal intubation using direct laryngoscopy is extension of the head with flexion of the neck, the classical 'sniffing position'. If necessary, an extra pillow can be used to keep the neck flexed. By adopting this position the oral, pharyngeal, and laryngeal axes is a almost straight line to facilitate tracheal intubation. Also, this position is ideal for conventional laryngeal mask airway (LMA) insertion. However, insertion of intubating laryngeal mask airway (ILM) and intubation through ILM may be achieved from any position relative to the patient's head. As recommended by the manufacturer, when possible a pillow should be placed under the head to achieve a neutral position. The purpose of this study was therefore to compare the easiness of intubation through ILM without support and with the patient's head supported by a pillow. METHODS: After acquiring informed consent, 80 ASA grade 1 or 2 patients undergoing general anesthesia for elective surgical procedures who normally required tracheal intubation were randomized into two groups. In group 1 (n = 40), insertion of ILM and intubation was conducted with the head supported by a pillow, while there was no support in group 2 (n = 40). The patients were induced and relaxed with an IV injection of thiopental sodium, fentanyl-ketamine-midazolam mixture and vecuronium. When adequate level of anesthesia was achieved, the ILM was inserted. After adequate ventilation was confirmed, a blind tracheal intubation through the ILM was attempted. Then we recorded success rate, insertion time, intubation time and adjusting maneuvers. RESULTS: The ILM was successfully inserted on the first attempt in 79/80 patients, but 1 patient of group 1 failed to be adequately ventilated. The mean time for ILM insertion of group 2 was shorter than that of group 1. The success rate of tracheal intubation was 37(95%) in group 1 and 40 (100%) in group 2. In group 1, 30 (81%) patients were successfully intubated on the first attempt, 1 (3%) patient on the second attempt, and 6(16%) patients on the third attempt; in group 2, 35 (87%) patients on the first attempt, and 5 (13%) patients on the third attempt. There was no significant diffrence of mean time taken for endotracheal intubation through ILM between group 1 (105.1 sec) and group 2 (88.1 sec). CONCLUSIONS: The authors conclude that ILM insertion is significantly easier with the patient's head not supported by a pillow compared with the patient's head supported by a pillow and there is no difference in ease of intubation through ILM by the patient's head position.
Anesthesia ; Anesthesia, General ; Head* ; Humans ; Informed Consent ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks ; Laryngoscopy ; Masks* ; Neck ; Surgical Procedures, Elective ; Thiopental ; Vecuronium Bromide ; Ventilation

A laryngeal mask airway(LMA) was first described by Brain1) in 1983. It has been used worldwide as a preferable airway for outpatient anesthesia as well as an emergency airway to overcome the difficult airway. It can be inserted into the hypopharyngeal area in a blind technique. However, because the tongue is displaced against the posterior pharyngeal wall in a sedated and/or relaxed patients, we occasionally encounter a difficulty in inserting LMA in a blind technique even with a jaw thrust maneuver23), rotational movement4) of LMA. With a forceful insertion against resistance, the LMA tip may damage to the uvula4). So a laryngoscopic aid4,5) may be helpful to facilitate a LMA insertion. However, it is well known that a laryngoscope may demage to the the upper teeth or lip. I devised an introducer to facilitate a LMA placement. The L-shaped introducer is made of the stainless-steel tablespoon which is easily got from a kitchen. It is made by appropriately bending the shaft of the tablespoon, and it has several holes on the distal oval plate of the spoon to drain secretions(Fig. 1). It can ease a LMA insertion by lifting the posteriorly displaced tongue base from the posterior wall and the soft palate(Fig. 2). I compared changes in arterial blood pressure of LMA(Intravent, Pacific Medical, Supplies Pty Lte., Melbourne Australia) insertion with this device to those of the blind insertion technique in 36 female patients (introducer group, n=20; blind technique group, n=16). I observed that there was a significant increase of mean arterial blood pressure 1 minute after LMA placement compared with the immediate placement values in both groups.(P<0.01 by student's t-test). However, there were no statistically significant differences of one-minut mean-arterial blood pressure between the two groups. Thus I concluded that a LMA placement with the introducer had comparable hemodynamic changes to the blind insertion technique, I think the introducer it has several advantages ; easy to get and make, easy to learn how to use, smaller and less heavier than a laryngoscope(easy to handle), no damages to the upper teeth or lip, making more room for LMA insertion in the oral opening than a blind technique. I could easily insert the LMAs with the introducer in five patients who developed the insertion difficulties in a blind technique even with a jaw thrust maneuver2,3) and rotations4) of the LMAs. Thus I recommend the introducer to the readers whenever they encounter difficulty in placing a LMA.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Emergencies ; Equipment and Supplies ; Female ; Hemodynamics ; Humans ; Jaw ; Laryngeal Masks* ; Laryngoscopes ; Lifting ; Lip ; Outpatients ; Tongue ; Tooth