No abstract available.

Septic patients portray instable hemodynamic states because of hypotension or cardiomyopathy, caused by vasodilation, thus, impairing global tissue perfusion and oxygenation threatening functions of critical organs. Therefore, it has become the primary concern of anesthesiologists in conducting anesthesia (induction, maintenance, recovery, and postoperative care), especially in the induction of those who are prone to fall into hemodynamic crisis, due to hemodynamic instability. The anesthesiologist must have a precise anesthetic plan based on a thorough preanesthetic evaluation because many cases are emergent. Primary circulatory status of patients, including mental status, blood pressure, urine output, and skin perfusion, are necessary, as well as more active assessment methods on intravascular volume status and cardiovascular function. Because it is difficult to accurately evaluate the intravascular volume, only by central venous pressure (CVP) measurements, the additional use of transthoracic echocardiography is recommended for the evaluation of myocardial performance and hemodynamic state. In order to hemodynamically stabilize septic patients, adequate fluid resuscitation must be given before induction. Most anesthetic induction agents cause blood pressure decline, however, it may be useful to use drugs, such as ketamine or etomidate, which carry less cardiovascular instability effects than propofol, thiopental and midazolam. However, if blood pressure is unstable, despite these efforts, vasopressors and inotropic agents must be administered to maintain adequate perfusion of organs and cellular oxygen uptake.
Anesthesia ; Anesthetics, Intravenous ; Blood Pressure ; Cardiomyopathies ; Central Venous Pressure ; Echocardiography ; Etomidate ; Hemodynamics ; Humans ; Hypotension ; Ketamine ; Midazolam ; Oxygen ; Perfusion ; Propofol ; Resuscitation ; Sepsis ; Shock, Septic ; Skin ; Thiopental ; Vasodilation

No abstract available.
Leukemia, Plasma Cell* ; Plasma Cells* ; Plasma*

No abstract available.
Chorionic Gonadotropin* ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Humans* ; Progesterone* ; Superovulation*

BACKGROUND: When used to reverse the anticoagulant effect of heparin, protamine administration after cardiovascular bypass often can lead to systemic hypotension. During the reversal of heparin-induced anticoagulation, the effects of protamine on both a heparin-protamine complex and free protamine on the cardiovascular system should be considered. METHOD: To determine whether the hypotensive effect of heparin-protamine and/or protamine could be caused by endothelium-dependent and-independent component, we studied rings of the arotic arteries in rats suspended in organ chambers containing Tris Tyrode solution at 37oC and 100% O2. Arterial rings with or without endothelium were contracted with 40 mM KCl or 3 +/- 10-6M phenylephrine and then exposed to increasing concentrations of protamine (final organ bath concentration, 40~400 g/ml) both in the absence and presence of heparin (200 U/ml). RESULTS: Protamine induced concentration-dependent relaxation in arterial rings with endothelium, which were significantly greater than in rings without endothelium. The endothelium-dependent relaxation induced by protamine was inhibited by NG-monomethyl-L-arginine (L-NMMA) (10-5M) pretreatment, but was not inhibited by indomethacin (3x10-6M) pretreatment on rings with endothelium. Furthermore, the contractile inhibition was enhanced by superoxide dismutase (100 U/ml). Also, such vasodilating actions were not influenced in the presence of heparin (200 U/ml). In endothelium-denuded strips, protamine (400ug/ml) inhibited Ca++ induced contraction, which was evoked in Ca++-free solution containing 40 mM K+, and also inhibited the norepinephrine (NE)-induced contraction. Protamine inhibited on the NE-induced contraction, but not the caffein-induced contration in Ca++ free, 2 mM EGTA solution. Also, such inhibition of contracions were not inluenced in the presence of heparin (40 U/ml). CONCLUSION: This study demonstrates that protamine (in the presence or absence of heparin) acts on endothelial cell receptors to stimulate the production of nitric oxide and inhibits both Ca++-influx and the NE-induced Ca++ release from intracellular stores.
Animals ; Arteries* ; Baths ; Cardiovascular System ; Egtazic Acid ; Endothelial Cells ; Endothelium ; Heparin* ; Hypotension ; Indomethacin ; Nitric Oxide ; Norepinephrine ; omega-N-Methylarginine ; Phenylephrine ; Rats* ; Relaxation ; Superoxide Dismutase ; Vasodilation*

The Shy-Drager syndrome is a very rare chronic progressive disease characterised by autonomic failure and multiple system atropy. The main clinical manifestations of this syndrome are orthostatic hypotension, urinary and bowel dysfunction, impaired sexual potency and parkinsonean symptoms. A key in the management of anesthesia is the maintenance of cardiovascular atability. These patient are suffered from defective baroreceptor regulation of the blood pressure as a result of autonomic failure. We report a successful epidural anesthesia for vwicolithotomy in a female patient with Shy-Drager syndrome.
Anesthesia ; Anesthesia, Epidural ; Blood Pressure ; Female ; Humans ; Hypotension, Orthostatic ; Pressoreceptors ; Shy-Drager Syndrome

The Shy-Drager syndrome is a very rare chronic progressive disease characterised by autonomic failure and multiple system atropy. The main clinical manifestations of this syndrome are orthostatic hypotension, urinary and bowel dysfunction, impaired sexual potency and parkinsonean symptoms. A key in the management of anesthesia is the maintenance of cardiovascular atability. These patient are suffered from defective baroreceptor regulation of the blood pressure as a result of autonomic failure. We report a successful epidural anesthesia for vwicolithotomy in a female patient with Shy-Drager syndrome.
Anesthesia ; Anesthesia, Epidural ; Blood Pressure ; Female ; Humans ; Hypotension, Orthostatic ; Pressoreceptors ; Shy-Drager Syndrome

BACKGROUND: The aim of this study was to investigate the effect of doxapram on recovery following propofol-remifentanil anesthesia. METHODS: Forty patients scheduled for gastrectomy were randomly allocated to receive either doxapram 1 mg/kg or normal saline at the end of surgery under propofol-remifentanil anesthesia. Clinical recovery from anesthesia was assessed by times to spontaneous breathing, eye opening on verbal command, extubation, and discharge from the postanesthetic care unit (PACU). Bispectral index (BIS) values, blood pressure, and heart rate were recorded every 2 min for 16 min after the administration of doxapram or saline. The incidences of side effects were checked in the recovery room. RESULTS: Spontaneous breathing was recovered after 6.2 +/- 1.1 minutes in the Doxapram group versus 9.2 +/- 1.8 minutes in the normal saline group (P < 0.001). Times to eye and extubation were also shorter in the Doxapram patients than in the normal saline patients (6.9 +/- 1.0 and 8.1 +/- 1.7 min versus 10.4 +/- 2.0 and 12.0 +/- 2.6 min, respectively) (P < 0.001). However, the times to PACU discharge were not different between the two groups (46.9 +/- 4.9 min versus 47.0 +/- 6.0 min, respectively). The patients in the Doxapram group showed higher mean BIS values compared with the normal saline group during emergence, but there were no differences in arterial blood pressure, heart rate and incidences of side effects between the two groups. CONCLUSIONS: Doxapram 1 mg/kg hastens early recovery from TIVA with propofol and remifentanil, and this emergence effect correlates with higher BIS values. Doxapram, however, does not affect the discharge time from the PACU and incidences of side effects.
Anesthesia ; Anesthesia, Intravenous ; Arterial Pressure ; Blood Pressure ; Doxapram ; Eye ; Gastrectomy ; Heart Rate ; Humans ; Incidence ; Piperidines ; Propofol ; Recovery Room ; Respiration

BACKGROUND: The aim of this study was to investigate the effect of doxapram on recovery following propofol-remifentanil anesthesia. METHODS: Forty patients scheduled for gastrectomy were randomly allocated to receive either doxapram 1 mg/kg or normal saline at the end of surgery under propofol-remifentanil anesthesia. Clinical recovery from anesthesia was assessed by times to spontaneous breathing, eye opening on verbal command, extubation, and discharge from the postanesthetic care unit (PACU). Bispectral index (BIS) values, blood pressure, and heart rate were recorded every 2 min for 16 min after the administration of doxapram or saline. The incidences of side effects were checked in the recovery room. RESULTS: Spontaneous breathing was recovered after 6.2 +/- 1.1 minutes in the Doxapram group versus 9.2 +/- 1.8 minutes in the normal saline group (P < 0.001). Times to eye and extubation were also shorter in the Doxapram patients than in the normal saline patients (6.9 +/- 1.0 and 8.1 +/- 1.7 min versus 10.4 +/- 2.0 and 12.0 +/- 2.6 min, respectively) (P < 0.001). However, the times to PACU discharge were not different between the two groups (46.9 +/- 4.9 min versus 47.0 +/- 6.0 min, respectively). The patients in the Doxapram group showed higher mean BIS values compared with the normal saline group during emergence, but there were no differences in arterial blood pressure, heart rate and incidences of side effects between the two groups. CONCLUSIONS: Doxapram 1 mg/kg hastens early recovery from TIVA with propofol and remifentanil, and this emergence effect correlates with higher BIS values. Doxapram, however, does not affect the discharge time from the PACU and incidences of side effects.
Anesthesia ; Anesthesia, Intravenous ; Arterial Pressure ; Blood Pressure ; Doxapram ; Eye ; Gastrectomy ; Heart Rate ; Humans ; Incidence ; Piperidines ; Propofol ; Recovery Room ; Respiration

BACKGROUND: Vecuronium and Pancuronium have been proven to be associated with nicotinic receptor of skeletal muscle. Generally, nondepolarizing muscle relaxant is associated with contraction of smooth tracheal muscle, but there have been few studies about effects of nondepolarizing muscle relaxant on the smooth tracheal muscle. METHODS: We studied the acetylcholine dose response curve of the tracheal smooth muscle contraction and effects of propranolol, L-NAME after pretreating with vecuronium and pancuronium. RESULTS: Vecuronium shifted the acetylcholine dose-response curve of the tracheal contraction to the left, and pancuronium shifted the curve to the right. Vecuronium and Pancuronium reduced the contraction of smooth tracheal muscle with the use carbachol. Propranolol and L-NAME had no effect on the contraction of smooth tracheal muscle after pretreating with vecuronium and pancuronium. CONCLUSION: We suggest that vecuronium has an anticholinergic effect, while pancuronium has some effect on the muscarinic receptor in addition to its anticholinergic effect.
Acetylcholine ; Animals ; Carbachol ; Muscle, Skeletal ; Muscle, Smooth* ; NG-Nitroarginine Methyl Ester ; Pancuronium* ; Propranolol ; Rats* ; Receptors, Muscarinic ; Receptors, Nicotinic ; Trachea* ; Vecuronium Bromide*