Usually FEV1 lower than 1 liter is considered as a contraindication to pneumonectomy. Therefore sometimes, the curative operations of the resectable lung cancer can not be performed in case of poor pulmonary functions. The usual criteria on the performance of pneumonectomy on high risk patients based on the preoperative assessment of pulmonary function may not predict the operative outcome with accuracy in the postoperative period. Nowadays, there are some arguing points about applying the values of preoperative PFTs to pulmonary resection surgery. We performed a right pneumonectomy for stage IIIb lung cancer in a patient with poor lung function test; FVC 2.17 L, FEV1 0.97 L, FEV1/FVC 44%, FEF 25~75% 0.42 L/sec, MVV 28 L/min, TLC 5.18 L, RV 2.99, DLCO 13.46. After the temporary ligation of right main pulmonary artery during 30 minutes, arterial blood gas and percutaneous oxygen saturation with the controlled ventilation with room air (FiO2=0.21) confirmed the hemodynamic and oxygenation stabilities, twice. After successful surgery, the patient was tolerated for 4 months. And the follow up PFTs at postoperative 3 months and 18 days showed as follows; FVC 1.20 L, FEV1 0.63 L, FEV1/FVC 53%, FEF 25~75% 0.31 L/sec, MVV 25 L/min, TLC 3.80 L, RV 2.33 L, DLCO 8.04. Through the intraoperative re-evaluation of pulmonary function in a patient with poor preoperative PFTs,had been conventionally considered as a contraindication to pneumonectomy, we report a successful surgery and anesthetic management with the literatures reviewed.
Anesthesia ; Follow-Up Studies ; Hemodynamics ; Humans ; Ligation ; Lung Neoplasms* ; Lung* ; Oxygen ; Pneumonectomy* ; Postoperative Period ; Pulmonary Artery ; Respiratory Function Tests* ; Ventilation

BACKGROUND: The effects of the levering laryngoscope (McCoy laryngoscope) on the laryngoscopic view classified by the Cormack and Lehane were investigated in this study. METHODS: The laryngoscopic view with the levering laryngoscope blade in neutral and best position were recorded respectively and analysed statistically. RESULTS: 109 laryngoscopic views were grade 1 or 2 and 12 were grade 3 or 4 in the neutral position with the McCoy blade. Only three patients were grade 3 or 4 in its best position and the others grade 1 or 2. The reduction in the incidence of difficult laryngoscopic view (grade 3 or 4) using the levering laryngoscope in its best position was statistically significant (p<0.01). CONCLUSIONS: Levering laryngoscope improves laryngoscopic view and also reduces the incidence of difficult intubation. So, we suggest that it is an useful instrument for the anesthesiologists in the difficult tracheal intubation.
Humans ; Incidence ; Intubation ; Laryngoscopes*

Non-depolarizing muscle relaxant; d-tubocurarine was introduced clinically in 1942. Thereafter depolarizing muscle relaxant; succinylcholine was introduced in 1951. Those muscle relaxants were highly contributed in modern anesthesia practice today. But, since many years ago complications of succinylcholine were reported clearly so many anesthesia practice. Complications were such as ventricular arrythmia(cardiac arrest), fasciculation, hyperkalemia, muscle pain, elevation of intragastric, intraocular & intracranial pressure, prolonged apnea, generalized muscle clonus, masseter muscle rigidity and malignant hyperthermia etc. Succinylcholine was still used in clinical practice despite of many complications reported as long as more than 45 years. Finally, FDA(USA) decleared the routine use of succinylcholine was contraindicated in children and adolescents. Many textbooks of anesthesiology shows that use of succinylcholine was contraindicated in children and adolescents those were published recently since 1994. What is the current status of succinylcholine in despite of changing current concept of succinylcholine use in Korea? Succinylcholine is still inadvertently used in Korea over 79% of resident training hospital. Intravenous dantrolene reserve was only one hospital(1.4%). Undoubtedly, amazing things were going on in Korea. Seventeen cases of malignant hyperthermia had been reported from 1971 to 1996 on Korean medical journals. It's mortality was 70.6%. Not only the reported malignant hyperthermia, there are many cardiac arrest during anesthesia reported on Korean medical journals. Etiological analysis of cardiac arrest was reviewed some of them, there are certain numbers of cardiac arrest cases confirmed by succinylcholine was guilty. What is the counterplan? Change the current concept of succinylcholine is important. Conclusions ; 1. Non-depolarizing mucle relaxant should be used for intubation &/or muscle relaxation. 2. Hot line for malignant hyperthermia should be established.. 3. Intravenous dantrolene reserve is necessary. 4. Routine monitoring during anesthesia should be blood pressure, ECG, SPO2, ETCO2, body temperature and peripheral nerve stimulator.
Adolescent ; Anesthesia ; Anesthesiology ; Apnea ; Blood Pressure ; Body Temperature ; Child ; Cognition* ; Dantrolene ; Electrocardiography ; Fasciculation ; Heart Arrest ; Humans ; Hyperkalemia ; Intracranial Pressure ; Intubation ; Korea ; Malignant Hyperthermia ; Masseter Muscle ; Mortality ; Muscle Relaxation ; Myalgia ; Peripheral Nerves ; Succinylcholine* ; Tubocurarine

No abstract available.
Larynx* ; Pharmacology ; Succinylcholine* ; Vecuronium Bromide*

BACKGROUND: A question was whether it was preferable to give the reversal agent when profound block was present or wait for some spontaneous recovery before antagonizing the block. This study has been conducted to evaluate the reversal effects of neostigmine with divided doses in the rabbits after pancuronium when profound relaxation(PTC=O) or the first twitch of TOF stimulation was appeared (TOF,T1) was confirmed. METHODS: Rabbits(n=60) were randomly allocated to 5 groups. After pancuronium 0.2 mg/kg intravenously, spontaneous recovery was evaluated in group 1. When the profound relaxation(PTC=O) was confirmed at 5 min. after pancuronium, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 2. At that time, neostigmine 10 ug/kg with atropine 4 ug/kg were injected and after 3 min. neostigmine 40 ug/kg with atropine 16 ug/kg were injected in group 3. When TOF, Tl was confirmed, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 4. At that time, neostigmine and atropine were injected in group 5 as the same way of group 3. RESULTS: The mean time from injection of pancuronium to 95% recovery was 98.9 min. in group 1, 60.3 min. in group 2, 50.9 min. in group 3, 71.0 min. in group 4 and 67.1 min. in group 5. The recovery index was significantly reduced when neostigmine was injected at TOF,T1(p<0.05). The recovery time after neostigmine with divided doses was reduced, but there was no significant difference. CONCLUSIONS: The results of present study suggested that total recovery time was reduced when neostigmine was injected earlier with divided doses than single dose unrelated to profound relaxation.
Atropine ; Muscle Relaxation* ; Neostigmine* ; Pancuronium ; Rabbits* ; Relaxation

BACKGROUND: Propofol(2,6 diisopropylphenol) is a potent hypnotic currently formulated as an oil-in-water emulsion. Although previous studies reported decreases in arterial pressures and heart rate, no detailed studies of hemodynamic effects of propofol administration alone are available in Korea. This study is to determine the hemodynamic changes induced by doses of propofol. METHODS: Sixty patients(ASA physical status 1 or 2) were divided randomly into three groups as follows: group I, pmpofol 1.5 mg/kg; group 2, propofol 2.0 mg/kg; group 3, propofol 2.5 mg/kg. Heart rate and mean arterial pressure were measured by Datascope 2200I, and cardiac index(CI) and systemic vascular resistance index(SVRI) were obtained by doppler cardiac output monitor(Datascope Accucom 2) at the suprasternal notch before and after induction of propofol. RESULTS: Statistically significant decreases in mean arterial pressure were observed since 2 min after induction. CI was decreased from 2.94+/-0.51 to 2.35+/-0.57 L/min/m(2) at 6 min after induction of propofol 2.5 mg/kg, and no differences among groups. CI was also decreased in group 1 and 2 but without any significance. SVRI was decreased in all groups but there were no significance, and no differences among groups. CONCLUSIONS: The data suggest that the usual doses of propofol do not significantly cause hemodynamic changes, and a decrease in mean arterial pressure is a result of decreased CI and reduced SVRI.
Anesthetics ; Arterial Pressure ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Korea ; Propofol* ; Vascular Resistance

The characteristics of an ideal intravenous anesthetic agent include stability in solution, rapid onset of action, minimal effect on the cardiovascular and respiratory systems, short elimination half life, and minimal side effects. Using this criteria, the ultra-short acting barbiturate, thiopental has long been considered the gold standard of intravenous agents used for induction of anesthesia. In normovolemic subjects, thiopental produces a transient decrease in blood pressure, and increase in heart rate. In practice, thiopental is administered high dose(30 mg/kg IV) for brain protection, rarely. We tried to confirm the direct vascular effects of thiopental and its mechanism on the rabbit abdominal aorta in vitro. The rabbit abdominal aorta were precontracted with norepinephrine(10(-7) M) in 5 ml tissue bath and 10(-5), 10(-4), and 10(-3) M thiopental was administrated in cumulative manner. Ten minutes later, changes of the vascular tones were obtained. For confirming the relaxing mechanism induced by thiopental, experiment was performed by indomethacin, methylene blue and LNAME pretreatment, and endothelium removed, respectively. The results were as follows 1) Thiopental at 10(-5), and 10(-4) M produced no signifcant changes, and at 10(-3) M produced signifcant relaxation. 2) There were no significalnt difference in their vascular tones between intact and denuded endothelium group. 3) The vascular tones were not affected by LNAME, methylene blue, and indomethacin pretreatment. These results suggest that thiopental induce vasorelaxation in rabbit abdominal aorta at high concentration(10(-3) M). The vasorelaxation mechanism is not correlated with NO, cyclic GMP, prostacyclin and endothelium.
Anesthesia ; Aorta, Abdominal* ; Baths ; Blood Pressure ; Brain ; Cyclic GMP ; Endothelium ; Epoprostenol ; Half-Life ; Heart Rate ; Indomethacin ; Methylene Blue ; Relaxation ; Respiratory System ; Thiopental* ; Vasodilation

Why anesthesiologists use the muscle relaxants? Because muscle relaxants are an adjunct to modem anesthesia practice today. What should be pepared whenever using a muscle relaxant? Of course, its necessary for artificial respiration. Why should be anesthesiologists monitor the neuromuscular blockade? There are so many factors affecting neuromuscular blockade. Factors are ; individual difference, age, sex, bady fluid, drug interactions including muscle relaxants themself and more than 250 drugs including anesthetics and antibiotics, disease states, hypothermia etc. That why anesthesiologists should know the degree of neuromuscular blockade. Whenever assurance on the degree of neuromuscular blockade is essential to the modern anesthetic practice. Observation of the motor response to peripheral nerve stimulation is helpful. Use of the peripheral nerve stimulator for monitoring of the neuromuscular blockade must be made mandatory whenever muscle relaxants are used. This study was performed 50 healthy patients. Ulnar nerve-adductor pollicis was stimulated simultaneously both hand by TOF and DBS3,3 each, during intubation dose of vecuronium 0.1 mg/kg and same stimulation was given both hand during anesthetic maintenance by intermittent bolus of vecuronium 1-2 mg during surgery. Number of twitch was counted by each TOF and DBS3,3 in the same time and onset time (TOF, TO) and time for reappearance of TOF, Tl was measured. Results were as follows ; 1) Simple, by use of peripheral nerve stimulator. 2) During onset time ; TOF twitch was disapperared earlier than DBS3,3. 3) During recovery phase ; DBS3,3 twitch was appeared earlier than TOF. 4) Onset time was 215.4+/-54.04 sec. and TOF, Tl reappearance was 1,793.4+/-487.61 sec. 5) Clinical evaluation of neuromuscular function was more reliable by number of twitch count with ulnar nerve-adductor pollicis on TOF than DBS3,3.
Anesthesia ; Anesthetics ; Anti-Bacterial Agents ; Drug Interactions ; Hand ; Humans ; Hypothermia ; Individuality ; Intubation ; Modems ; Neuromuscular Blockade ; Neuromuscular Monitoring* ; Peripheral Nerves ; Respiration, Artificial ; Vecuronium Bromide

Hypoxic pulmonary vasoconstriction(HPV) plays an important role in matching ventilation and perfusion, and in a homeostatic compensatory mechanism for maintaining arterial blood oxygen tension. The purpose of this study was to explore effect of hypoxia on the vascular tension and to elucidate mechanism underlying hypoxic pulmonary vasoconstriction. The ring segments of the pulmonary artery were taken from forty rabbits(2~2.5 kg, male). Each ring was attached to an isometric force transducer(Grass FT-03) and suspended in a tissue bath(37degrees C) filled with 5 ml Krebs solution, aerated with 95% O2 + 5% CO2(pH 7.4) gas mixture. During 90 minutes of equilibrium period, the Krebs solution was changed every 15 minutes and the last resting tension was adjusted to 2 gm. After precontraction of the preparations with K(+) 40 mM, the aerating gas mixture was replaced by hypoxic gas(95% N2 + 5% CO2) and changes in vascular tension of isolated pulmonary artery with(n=36) and without endothelium(n=14) were recorded for 60 minutes. HPV induced biphasic vasoactive effects. To determine the mechanism of the vasorelaxing response, the pulmonary arterial rings were pretreated with indomethacin(n=8), L-nitro(w) arginine methyl ester(L-NAME, n=l0), tetra ethyl ammonium(TEA, n=12), glybenclamide(n=l1). And also to elucidate the mechanism of the hypoxic vasoconstricting response, effects of Ca free solution and pretreatment of ryanodine on the HPV were examined. The results obtained were as follows: 1) Transient phase 1 contraction followed by long lasting(about 30 minutes) relaxation and sustained phase 2 contraction were induced by hypoxic gas(95% N2+5% CO2) in rabbit pulmonary artery. 2) In endothelium removed pulmonary artery, transient phase 1 contraction was not apparent. 3) Vasorelaxation was partially blocked by K' channel blockers(TEA, glybenclamide). 4) Indomethacin and L-NAME pretreatments did not affect on the vasorelaxing response of the HPV to hypoxia. 5) Sustained phase 2 contraction was blocked by calcium free Krebs solution. 6) Indomethacin and ryanodine pretreatments did not change the phase 1 and phase 2 vasocontsricting reponses. The results of present study suggest that hypoxia-induced phase 1 contractile response is endothelium dependent, while phase 2 contractile response is dependent on calcium influx, and that the vasorelaxant response is partially mediated by K(+) channel.
Anoxia ; Arginine ; Calcium ; Characidae ; Endothelins ; Endothelium ; Indomethacin ; NG-Nitroarginine Methyl Ester ; Oxygen ; Perfusion ; Pulmonary Artery* ; Relaxation ; Ryanodine ; Vasoconstriction* ; Vasodilation ; Ventilation

Halothane is a popular inhalation anesthetics in practice, which has been reported to cause a vasodilation through a direct depressant action on vascular smooth muscle, or by an indirect attenuation of vasoconstrictor activity. The membrane potential of the vascular smooth muscle cell is mainly regulated by the flow of Ca2+ and K+ ions through specialized channels. The purpose of this study was to determine whether blockade of the K+ channel alter the response to halothane vasodilating action. This study was done with rat thoracic aorta in tissue bath. Isometric tension of the ring (3~4 mm in length) was recorded. In halothane alone group (n=15), after precontraction with norepinephrine (10(-7) M), ring was exposed with halothane 0.7%, 1.5%, 2.1% concentration for 15 minutes, sequentially. The procedure of calcium activated K+ channel blocker pretreated group (n=12) was same manner as halothane alone group after tetraethylammonium (TEA 20 mM) pretreatment. The result of this study was shown to followings; 1) Vasodilation correlate with halothane concentration (p<0.05). 2) Vasodilation in tetraethylammonium (TEA) pretreated group also augmented 'significantly (p<0.05). 3) Especially, in the halothane 1.5%, 2.1%, the presence of TEA significantly potentiate vasodilating effect: halothane alone group, -35%, -53%: TEA group, -47%, -71%(p<0.05). These result demonstrate that: 1) halothane induce relaxation of rat aorta. 2) K+ charinel blokade potentiate the vasodilating effect of halothane.
Anesthetics, Inhalation ; Animals ; Aorta ; Aorta, Thoracic ; Baths ; Calcium ; Halothane* ; Ions ; Membrane Potentials ; Muscle, Smooth, Vascular ; Norepinephrine ; Rats ; Relaxation ; Tea ; Tetraethylammonium ; Vasodilation*