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

No Abstract available.
Anesthesia*

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.
Nitric Oxide* ; Sepsis*

No abstract available.
Nitric Oxide* ; Sepsis*

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

BACKGROUND: Neuronal cell death after brain ischemia occurs predominately by necrosis, whereas only a minor fraction of cell death may occur through apoptosis. Authors investigated DNA fragmentation and apoptotic morphology in the brain cell to determine whether apoptosis contributes to the progression of an ischmic lesion. This study was conducted to determine the effects of dexamethasone and hypothermia on moderate brain ischemic injury by middle cerebral artery occlusion (MCAO) in rats. METHODS: Thirty Sprague-Dawley rats (220 - 280 g) were used. Anesthesia was induced and maintained with isoflurane in oxygen. MCAO was induced by intraluminal monofilament nylon. All rats were divided randomly into three groups. In group I (n = 10), normal saline 1 ml was injected intravenously 10 minutes before MCAO. In group II (n = 10), dexamethasone 3 mg/kg was administered and in group III (n = 10), body temperature was maintained at 32degreesC. After 60 minutes of MCAO, all rats that recovered from anesthesia were returned to cages. After 24 hour reperfusion, brain tissue was quickly removed and cerebral hemispheres were separated. Lesion volumes were measured by TTC staining. TUNEL reactivity was examined in the cortical infarction lesion, and rat brain DNA was run on agarose gel electrophoresis to detect DNA fragmentation. RESULTS: Apoptosis and DNA fragmentation in the nucleus developed in the hippocampal area after transient ischemia in rats. Dexamethasone did not prevent the development of apoptosis and DNA fragmentation in transient brain ischemic rats. Moderate hypothermia could prevent the development of apoptosis and DNA fragmentation in transient brain ischemic rat. CONCLUSIONS: Apoptosis may represent a mode of ischemic cell death, and dexamethasone couldn't prevent apoptotic change in the ischemic brain insult. Moderate hypothermia (32degreesC) was a specifically effective procedure to reduce the development of apoptotic change in ischemic insults.
Anesthesia ; Animals ; Apoptosis* ; Body Temperature ; Brain ; Brain Ischemia ; Cell Death ; Cerebrum ; Dexamethasone ; DNA Fragmentation* ; DNA* ; Electrophoresis, Agar Gel ; Hypothermia* ; In Situ Nick-End Labeling ; Infarction ; Infarction, Middle Cerebral Artery ; Ischemia ; Isoflurane ; Necrosis ; Neurons ; Nylons ; Oxygen ; Rats* ; Rats, Sprague-Dawley ; Reperfusion

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