BACKGROUND: Total intravenous anesthesia with propofol can cause respiratory depression and apnea especially during induction of anesthesia. To study the possibility of reversal of respiratory depression during anesthesia with propofol, pretreated with nabuphine or not, the respiratory effects of doxapram to spontaneously ventilating patients were investigated. METHODS: Patients were divided into 4 groups - saline-propofol-saline group (SPS), saline-propofol- doxapram group (SPD), nalbuphine-propofol-saline group (NPS), and nalbuphine-propofol-doxapram group (NPD). After saline or nalbuphine pretreatment, anesthesia was induced with propofol and then doxapram or saline was intravenously injected. Apneic time interval, blood pressure, heart rate, respiratory rate, minute ventilation, end tidal CO2 partial pressure and oxygen saturation were measured in every minutes during induction of anesthesia. Percent changes of each values were compared. RESULTS: There is no differences in apneic time intervals in each groups. The percent change of first minute ventilation in SPD group after doxapram injection unchanged significantly compared with those depressions of SPS, NPS and NPD group (p<0.05). Respiratory rates increased in SPD and SPS groups after laryngeal mask insertion. There is no differences in minute ventilation, respiratory rate and end-tidal CO2 concentration between nalbuphine pretreated groups regardless of doxapram injection. CONCLUSIONS: Doxapram has effect in increasing minute ventilation after propofol induction within first few minutes, but it cannot reverse respiratory depression during propofol induction pretreated with nalbuphine.
Anesthesia ; Anesthesia, Intravenous* ; Apnea ; Blood Pressure ; Depression ; Doxapram* ; Heart Rate ; Humans ; Laryngeal Masks ; Nalbuphine* ; Oxygen ; Partial Pressure ; Propofol* ; Respiratory Insufficiency ; Respiratory Rate ; Ventilation

The recovery time of the blood glucose level after anesthetic and surgical stress in 30 surgical pediatric patients with A.S,A. physical status class 1 or 2 was evaluated Although they had fasted from 4 to ll hours, none of the patients exhibited hypoglycemia, dehydration or hypotension; This showed that the duration of fasting, age, body weight, and sex did not influence hypoglycemia, dehydration. and hypotension. All patients were anesthetized with Halothane(0.5~1.5 Vol. %)-N2O(1.5L/min) under endotracheal intubation. Just after surgical stimulus, the blood glucose concentration increased about 27mg%, and then returned to pre-operative values within 30 minutes. The author concluded that the hormonal effects arising from the strong stimuli disappeared within 30 minutes. Also, the increase in blood glucoee concentration during intraabdominal surgery was more notable than in surgery to the skin, head or neck. Changes in blood glucose concentration in the recovery room are poasibly related to postoperative pain control.
Anesthesia* ; Blood Glucose* ; Body Weight ; Dehydration ; Fasting ; Head ; Humans ; Hypoglycemia ; Hypotension ; Intubation, Intratracheal ; Neck ; Pain, Postoperative ; Recovery Room ; Skin

No abstract available.
Cervix Uteri* ; Female

In patients undergoing intracranial surgery, the drugs used for anesthesia and the opera-tive procedure can effect an increase in intracranial pressure. Especially in patients whose intracranial pressure has already increased significantly, if the pressure is further increased br these factors, then the patient's neurological condition may be aggravated and the post-operative prognosis may be affected. Thus it is desirable to use drugs which reduce intrac-ranial pressure during this type of surgery. In this study, the spinal subarachnoidal pressures of two groups were compared. One group received a combination of thiopental sodium and lidocaine which are known to relatively reduce intracranial pressure, white the other group was given halothane which is known to increase intracranial pressure. The summary of this study is as follows : 1) The spinal subarachnoidal pressure began to increase 1~4 minutes after the administra-tion of halothane, and the duration of increament was 15-38 minutes with a maximal pressure change from 346+/-63 mmHaO to 417+/-90 mmH2O. Thereafter the pressure returned to the pre-induction level spoataneously. 2) The spinal subarachnoidal pressure began to decrease 2~4 minutes after the admini-stration of thiopental sodium and lidocaine. The greatest decrease in pressure occurred within 10~15 minutes level as the Preseure fell form 324+/-41 mmH2O to 210+/-73 mmH2O, thereafter the pressure remained decreased.
Anesthesia ; Anesthesia, General* ; Halothane ; Humans ; Intracranial Pressure* ; Lidocaine ; Nitrous Oxide* ; Prognosis ; Thiopental*

The long-term studies of total knee arthroplasty (TKA) have confirmed reliable relief of pain and maintenance of function. However there have been few generalized studies of factors influencing the results of TKA. We evaluated retrospectively 187 TKAs (137 patients) which had been performed between January 1987 and May 1995. The follow-up period was from one year to eight years (mean, 3 years and 8 months). There were 133 knees of osteoarthritis (OA), 43 knees of rheumatoid arthritis (RA) and 11 knees of other causes including septic knee sequelae. We considered the preoperative factors as age, sex, side (right or left), body weight, height, primary disease, flexion contracture (FC), further flexion (FF), range of motion (ROM) of joint, deformity of varus and valgus and pain score, muscle strength score, instability score, total knee score according to the knee rating scale of the Hospital for Special Surgery (HSS). We considered the clinical results as FC, FF, ROM, pain, muscle strength, instability, total knee score according to the knee rating scale of the HSS and the radiological results as Roentgenographic Evaluation and Scoring System of American Knee Society and radiolucent line more than 2mm in width. We evaluated the clinical and radiological results of TKAs followed up more than I year and analyzed the results based on above factors. The results were as follows: 1. The preoperative factors influencing final FC were not the primary disease and FC, but the FF and ROM. The preoperative factors influencing final FF and ROM were the primary disease, the FF and ROM. 2. The pain, muscle power, instability scores were improved but there was no significant factor influencing them. The HSS knee scores were higher in OA group than RA group postoperatively. 3. There was no preoperative factor influencing the complication, revision, the radiological results. The preoperative factors influencing the results of TKA were the FF, ROM and the primary disease.
Arthritis, Rheumatoid ; Arthroplasty* ; Body Weight ; Congenital Abnormalities ; Contracture ; Follow-Up Studies ; Joints ; Knee* ; Muscle Strength ; Myalgia ; Osteoarthritis ; Range of Motion, Articular ; Retrospective Studies

Nineteen revision total knee arthroplasties (TKAs) performed from March 1991 to March 1995 were evaluated to determine the clinical and roentgenographic results and the problems in revision TKA. The mean age was 63 years (range, 23-85 years) and the mean follow-up time was 19 months (range, 12 months-4.4 years). The primary revisions were done in eighteen knees and a re-revision, in one. Four revision TKAs were performed for failed unicompartmental arthroplasty and fifteen, for failed TKA. The mean interval from initial to revision TKA was 4.1 years (range, 3.3 years-5 years) in failed unicompartmental arthroplasty and 5.7 years (range, 4 months-14 years) in failed TKA. The initial diagnosis was degenerative arthritis in 16 knees, tuberculous arthritis in two and rheumatoid arthritis in one. The main cause of revision for both of the failed unicompartmental arthroplasties and failed TKAs was aseptic loosening. The HSS knee score improved from 43+/-14 to 82+/-7 in the failed unicompartmental arthroplasties and from 46+/-16 to 79+/-14 in the failed TKAs. The clinical success rate of revision TKA was 78%. The coronal tibiofemoral angle improved from valgus 0.2degrees to valgus 5.1degrees. At final follow-up, radiolucent line greater than 2mm in width was found around femoral component in one knee. In our series, four complications were occurred. One knee was fused due to mas-sive bone loss and ipsilateral femur shaft fracture. Deep wound infections were developed in two knees and loss of fixation after tibial tuberosity osteotomy in one. In conclusion, significant improvements of clinical and radiological results were achieved in revision TKA but the success rate was relatively low and the complication rate was relatively high compared with primary TKA. So, especially appropriate skillful surgical techniques and postoperative cares were required to overcome the soft tissue problem and infection which was encountered in revision TKA.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty* ; Diagnosis ; Femur ; Follow-Up Studies ; Knee* ; Osteoarthritis ; Osteotomy ; Wound Infection

BACKGROUND: Fiberoptic bronchoscope guided intubation is an important method of difficult airway management. The use of specific airways has been devised to assist the fiberoptic intubation. The authours compared effectiveness of separated airway with fiberoptic bronchoscope guided intubation and the hemodynamic responses. METHODS: 104 adult patients of American Society of Anesthesiologists grading (ASA) I-II who scheduled for surgery under general anesthesia were randomly divided into the Laryngoscope group (L group, n = 30) or the Fiberoptic bronchoscope group (F group, n = 36) or the Fiberoptic bronchoscope with separated airway (MF group, n = 38). A Fiberoptic bronchoscope guided intubation and a fiberoptic bronchoscope with separated airway and a direct laryngoscope was performed after inducing anesthesia. Intubation time, Jaw thrust incidence, mean blood pressure and heart rate after anaesthesia induction, at intubation and every two minute for a further 7 min were recorded. RESULTS: The intubation time was significantly shorter in the MF group (58.3 +/- 13.7 sec) than F group (71.9 +/- 22.1 sec). Jaw thrust incidence was lower in the MF group (60.5%) than F group (100%). The changes of MAPs and HRs during the observation were not significantly different in three group. CONCLUSIONS: Fiberoptic intubation using separated airway reduced intubation time and the incidence of jaw thrust.
Adult ; Airway Management ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Bronchoscopes ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Jaw ; Laryngoscopes

12 mongrel dogs were divided into two groups and anesthetized with 100% O and isoflurane in different concentrations (1MAC and 2MAC). Blood pressures and heart rates were monitored and cardiac outputs were measured during all experiments. Cardiovascular effects of isoflurane in different concentrations were investigated. And then, intra-venous verapamil was injected slowly in bolus (0.2mg/kg) in each group and its cardiovascular effects were also investigated. The results were as follows: 1) Heart rate was decreased when the concentration of isoflurane was increased (p<0.05) but there was no significant change after administration of verapamil. 2) Mean arterial pressure was decreased when the concentration of isoflurane was increased (p<0. 01), and after verapamil was injected intravenously in each group (p<0.01). 3) Cardiac index and stroke volume were decreased when the concentration of isoflurane was increased (p<0.05). 4) Left ventricular stroke work index was decreased when the concentration of isofiurane was increased (p<0.01) and it was also decreased significantly after administration of verapamil in high concentration of isoflurane (2 MAC) (p< 0.01), and the degree which was decreased by the administra- tion of verapamil was much more in high concentration of isoflurane than that of low concentration (p< 0.05). 5) There were no statistically significant changes in central venous pressure, pulmonary arterial pressure, pulmonary capillary pressure, vascular resistances, and right ventricular stroke work index.
Anesthesia* ; Animals ; Arterial Pressure ; Capillaries ; Cardiac Output ; Central Venous Pressure ; Dogs ; Heart Rate ; Isoflurane* ; Stroke ; Stroke Volume ; Verapamil*

Understanding depth of anesthesia is essential for the anesthesiologist. Although electroencephalogram (EEG) has been proposed and studied as a method of determining anesthetic depth, major limitations restrict its usefulness. For example, spectral edge frequency (SEF) dose not correlate well with the level of sedation. However, recently introduced bispectral index (BIS) which is derived from frequency, amplitude and coherence of the EEG is strongly correlated with clinical measurements of sedation and hypnosis. BIS monitoring may be used to guide the titration of anesthetic agents to achieve effective dosing without increasing the risk of awareness and to allow a better balance of hypnotic and analgesic administration. We report two cases of successful BIS monitoring for the measurement of intraoperative hypnotic state of patient during propofol target controlled infusion (TCI).
Anesthesia ; Anesthesia, General* ; Anesthetics ; Electroencephalography ; Humans ; Hypnosis ; Propofol*

BACKGROUND: Myocardial dysfunction after cardiopulmonary bypass (CPB) is a significant cause of morbidity and mortality after congenital cardiac surgery. The aim of this study was to evaluate myocardial function on sevoflurane anesthesia after CPB during ventricular septal defect repair. METHODS: Forty patients were randomly allocated into two groups: sevoflurane-fentanyl was used in group S, midazolam-fentanyl in group M. Myocardial performance index (MPI) and ejection fraction (EF) were measured by transesophageal echocardiography before incision and after operation. Serum cardiac Troponin-I (cTnI) levels were measured before incision, and at 0, 12, and 24 h after operation. RESULTS: MPI increased after operation in both groups (S: 0.35 +/- 0.06 vs. 0.43 +/- 0.05, M: 0.36 +/- 0.07 vs. 0.46 +/- 0.06 [P < 0.05]), but there was no significant difference between groups. EF decreased after operation in both groups (S: 65.1 +/- 5.5% vs. 62.7 +/- 3.9%, M: 64.9 +/- 5.3% vs. 61.4 +/- 4.4% ([P < 0.05]), but there was no significant difference between groups. cTnI was markedly elevated after operation, and decreased thereafter. There was no significant difference between groups. CONCLUSIONS: Both groups showed decreased myocardial function after CPB, but there were no difference between groups. Sevoflurane did not adversely affect intraoperative myocardial function compared to midazolam.
Anesthesia ; Cardiopulmonary Bypass ; Child* ; Echocardiography, Transesophageal ; Heart Septal Defects, Ventricular* ; Humans ; Midazolam ; Mortality ; Thoracic Surgery ; Troponin I