No abstract available.
Ventilators, Mechanical*

In 1990, WHO developed the analgesic ladder for rational titration of medication for cancer pain, because 50% of patients with cancer and 75% of those with advanced malignant disease will likely experience moderate to severe pain according to the report of Agency for Health Care Policy and Research(AHCPR). Actually, However, about 62% of cancer pain are not adequately controlled for several reasons, such as inappropriate dosage of analgesics, strict regulation of narcotics, physicians' indifference to cancer pain, and lack of knowledge for pain assessment in Korea. In this chapter, I would like to introduce techniques to relieve pain in cancer patients using some kinds of analgesics including narcotics, adjuvants, and verve blocks. By using medications and nerve block, more than 95% of cancer pain can be relieved effectively. One may be unfamiliar with the fact that cancer pain is not single isolated entity itself, but has multiple etiologies that may or may not be directly related to the cancer itself. This fact has resulted in the awareness that the treatment must be directed toward the perceived etiology of pain once it is identified. Pain does not occur in a vacuum ; the psychological manifestations of pain must be treated as well as any possible side effects of the treatment. With regards to cancer pain, this is generally stressed in all fields of medicine, particularly in the field of pain medicine.
Analgesics ; Delivery of Health Care ; Humans ; Korea ; Narcotics ; Nerve Block ; Pain Management* ; Pain Measurement ; Vacuum

BACKGROUND: It is a well known phenomenon that alveolar and peritoneal macrophages exposed to bacterial lipopolysaccharide (LPS) induce a large output of nitric oxide (NO) and an inducible nitric oxide synthase (iNOS) m-RNA expression. The author elucidate the effects on NO production and iNOS m-RNA expression of various anesthetics, inhalational (halothane, enflurane, sevoflurane) and intravenous (ketamine, propofol), on endotoxemic rats. METHODS: To examine the production of NO in peritoneal macrophages, NO concentrations were measured from the rats following 2 hours exposure to LPS and 2 hours administration of various anesthetics, respectively. Culture supernatants were collected 24 hours after exposure to LPS and anesthetics and assayed by ELISA (Enzyme Linked Immunosorbent Assay) for production of NO. iNOS m-RNA expression was measured using PCR (Polymerase Chain Reaction) techniques and autoradiography. RESULTS: In the control group, the NO concentration was measured at 120 minutes after infusion of LPS to rats, and showed 12+/-4 micrometer. After insufullation of anesthetics to experimental animals, NO concentration increased in the halothane, enflurane, sevoflurane, propofol, and ketamine groups, 132+/-27 (P< 0.05), 49+/-19 (P< 0.05), 23+/-14 (P< 0.05), 37+/-11 (P< 0.05), and 17+/-2 micrometer respectively. The size and brightness of the iNOS m-RNA bands were large in halothane, enflurane, sevoflurane, propofol and ketamine, in order. CONCLUSIONS: Intravenous anesthetics showed more stability than inhalation anesthetics with regand to production of NO and iNOS m-RNA expression in sepsis on rats. The mechanism is not clear, but it is related to the strong stimulating effect to the airway tract in from inhalational anesthetics.
Anesthetics* ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Animals ; Autoradiography ; Enflurane ; Enzyme-Linked Immunosorbent Assay ; Halothane ; Ketamine ; Macrophages, Peritoneal* ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Polymerase Chain Reaction ; Propofol ; Rats* ; Sepsis

BACKGROUND: Esmolol is a short acting sympathetic beta receptor antagonist, and it was successfully applied to induced hypotension. Esmolol lowers blood pressure by decreasing cardiac output, and does not cause vasodilation. This property of esmolol may help to decrease bleeding during induced hypotension. In this study, we tried to elucidate the effect of esmolol on induced hypotension for total hip arthroplasty. METHOD: Twenty patients receiving total hip arthroplasty were randomly divided to two groups. Esmolol group (10 patients) received esmolol as a hypotensive agent, and sodium nitroprusside (SNP) group (10 patients) received SNP as a hypotensive agent. We measured arterial blood gas analysis, vital sign, amounts of bleeding, amounts of transfusion and administered fluid, and various laboratory findings. RESULTS: Induced hypotension was successfully performed in either esmolol and SNP group. Heart rate increased by SNP, and decreased by esmolol. There were no statistically significant differences between the two groups in amounts of bleeding, amounts of transfusion or administered fluid, and laboratory findings. Arterial oxygen tension was relatively constant in esmolol group, but decreased in SNP group. CONCLUSION: Esmolol can be used as a single hypotensive agent during induced hypotension without significant side effects during total hip arthroplasty.
Arthroplasty, Replacement, Hip* ; Blood Gas Analysis ; Blood Pressure ; Cardiac Output ; Heart Rate ; Hemorrhage ; Humans ; Hypotension* ; Nitroprusside* ; Oxygen ; Sodium* ; Vasodilation ; Vital Signs

No Abstract available.
Anesthesia*

No abstract available.
Nitric Oxide* ; Sepsis*

No abstract available.
Nitric Oxide* ; Sepsis*

No abstract available.
Catheterization* ; Catheters* ; Hemothorax* ; Subclavian Vein*

BACKGROUND: Anesthetic techniques for laryngeal microsurgery aims on modulation of sympathetic stimulation, good relaxation and rapid recovery from deep anesthesia. This study was designed to compare the influence of the different anesthetic methods on the cardiovascular responses and the recovery patterns during suspension laryngoscopic surgery. METHOD: Sixty patients of ASA class 1 or 2 scheduled for suspension laryngoscopic surgery were divided into 4 groups randomly. Two groups were anesthetized with inhalational anesthetic, enflurane, and other two groups were anesthetized with intravenous anesthetic, propofol. In each groups, esmolol or fentanyl was used as an adjunctive during anesthesia. When blood pressures increased above 30% of baseline value each adjunctive was added. The changes of blood pressure and heart rate were compared with each others during operation. Postoperatively, the start of spontaneous respiration, consciousness, memory, and the frequencies of other complications were also compared with each others. RESULT: The results were as follows; 1) The blood pressures and heart rates during operations were not different among the groups. 2) The recovery of spontaneous respiration was early in propofol esmolol group. 3) 30 minutes after operation, the consciousness state was better and complications were less in propofol groups compared with enflurane groups. CONCLUSION: From this results, it seems that propofol with nitrous oxide and supplemental fentanyl or esmolol may be useful in laryngeal microsurgery. Especially, esmolol can be a good substitute for those who can't be treated with opioids.
Analgesics, Opioid ; Anesthesia ; Blood Pressure ; Consciousness ; Enflurane ; Fentanyl ; Heart Rate ; Humans ; Laryngoscopy ; Memory ; Microsurgery ; Nitrous Oxide ; Propofol ; Relaxation ; Respiration

BACKGROUND: Nitric oxide (NO) has been known to have antimicrobial activity, and the increased NO production in case of sepsis may play as a physiologic defense mechanism. However the increased formation of NO by the inducible nitric oxide synthase (iNOS) has been known to be implicated in pathophysiology of a variety of disease, including circulatory and septic shock. We measured the iNOS activities of mouse macrophage after application of various drugs with lipopolysaccharide (LPS) and gamma-interferon (IFN). The purpose of this study is to evaluate the inhibiting properties of various drugs to iNOS in case of sepsis. METHOD: Thirty ICR (Institue for Cancer Research) mouse weighting 30~40 gm were anesthetized with diethyl ether, and thiogycol broth was injected into peritoneal cavity. Two days later macrophages were collected from peritoneal cavity, and incubated for 24 hours in the CO2 incubator with LPS and IFN mixture and various concentration of dexamethasone, pentoxifylline, aspirin, aprotinin, regular insulin (RI) and neutral protamine hagedorn insulin (NPH). NO concentration were calculating by measuring nitrite concentration which represent the magnitude of NO production. The activities of iNOS in macrophages were measured by analysing iNOS m-RNA expression by Northern blot analysis with autoradiography using polymerase chain reaction (PCR) method. RESULT: The basic NO concentration was 13.0 +/- 8.0 micrometer. With LPS and IFN, NO concentration was increased to 104.4 +/- 31.9 micrometer. The increase in NO production by LPS and IFN was attenuated by dexamethasone (10 (-6) M only), pentoxifylline (above 10 (-10) M), aprotinin, RI, and NPH in dose dependent manner. The addition of LPS and IFN in the culture media caused increase in the iNOS m-RNA production. The aprotinin, RI, and NPH attenuated the increase in iNOS m-RNA production by LPS and IFN. Coclusion: These results suggest that the aprotinin, RI, and NPH prevent the LPS and IFN induced increase of NO production by attenuating the iNOS activity. These properties of aprotinin and insulin may be applied to the treatment of septic shock to block the enhanced formation of NO production.
Animals ; Aprotinin* ; Aspirin ; Autoradiography ; Blotting, Northern ; Culture Media ; Dexamethasone ; Ether ; Incubators ; Insulin* ; Insulin, Isophane ; Interferon-gamma ; Macrophages* ; Mice* ; Nitric Oxide ; Nitric Oxide Synthase Type II* ; Pentoxifylline ; Peritoneal Cavity ; Polymerase Chain Reaction ; Sepsis ; Shock, Septic