No abstract available.
Neurilemmoma*

The normal response of the pulmonary vasculature to one-lung atelectasis is an increase in pulmonary vascular resistance (PVR). The mechanism of the increase in PVR is thought to be due almost entirely to hypoxic pulmonary vasoconstriction (HPV). Regional HPV results in blood flow diversion from hypoxic regions to normoxic regions. The expected pulmonary shunt is thereby reduced and the arterial oxygen tension increased. PEEP improves the arterial oxygen tension as a result of increasing functional residual capacity (FRC) and decreasing intrapulmonary shunt. The aims of the present studies were to observe blood flow diversion from atelectatic lung to normoxic lung and to prove a sustained redistribution of pulmonary blood flow from ventilated with PEEP to atelectatic regions. This study evaluated the interactions between HPV and PEEP. Eight mongrel dogs were anesthetized with pentobarbital. Left pulmonary blood flow was measured with eletromagnetic flow probes following left lateral thoracotomy. Pulmonary arterial pressures, PCWP, systemic arterial pressures were measured via indwelling catheter. Cardiac output was determined by thermodilution in triplicate. The right lung was ventilated continuosly with 100% O2, while left lung was ventilated with 100 O2 (control phase), and unventilated for 60 min. of atelectasis. PEEP of 5 and 10 cmH2O was ed to the right lung. During two-lung ventilation with 100 oxygen, cardiac output was 2890+/-880 ml/min. (mean SD) and left pulmonary blqod flow was 1100+/-220 ml/min. Left lung atelectasis resulted in a reduction of the percent left blood flow compared with cardiac output from 41+/-10% to 29+/-7% at 15 min and to 22+/-9% at 60 min (p<0.05). The ratio of left pulmonary blood flow to mean pulmonary artery pressure decreased from 51+/-25 ml/min/ mmHg in control to 19+/-7 ml/min/mmHg at 60 min (p<0.05). Left pulmonary vascular resistance increased gradually (p<0.01). Arterial oxgen tension was the lowest at 15 min (165+/-66 mmHg) and increased subsequently (p<0.01). Intrapulmonary shunt was 27+/-6% in, control phase and abruptly increased to 37+/-6% at 15 min after atelectasis and decreased to 34+/-10% at 60 min. When 10 cmH2O PEEP was applied to the right hung during left lung atelectasis, the percent ratio of left pulmonary blood flow to cardiac output was significantly increased from 22+/-9% at 60 min of left lung atelectasis to 34+/-8% (p<0.05). Left pulmonary vascular resistance significantly decreased as compared with 45 and 60,min of left lung atelectasis (p<0.05). Arterial oxygen tension incresed by PEEP of 5 and 10 cmH to 257+/-74 mmHg and 252+/-92 mmHg compared with 164+/-65 mmHg and 177+/-28 mmHg at 15 and 30 min. of left lung atelectasis (p<0.05). The present study demonstrated that the response to acute atelectasis is a regional increase in pulmonary vascular resistance and a sustained diversion of blood flow away from the atelectatic lung. In this study, the application of 10 cmH2O PEEP resulted in a redistribution of pulmonary blood flow from normoxic lung to atelectatic lung and didn't affect arterial oxygenation. We conclude that when employing the technique of one-lung anesthesia, PEEP to improve oxygenstion should be cautiously applied and a search for the maximum oxygenation and a minimum redistribution might be started, in an attempt to find the optimal PEEP.
Anesthesia ; Animals ; Arterial Pressure ; Cardiac Output ; Catheters, Indwelling ; Dogs ; Functional Residual Capacity ; Lung* ; One-Lung Ventilation ; Oxygen ; Pentobarbital ; Pulmonary Artery ; Pulmonary Atelectasis* ; Thermodilution ; Thoracotomy ; Vascular Resistance ; Vasoconstriction ; Ventilation

The circulatory responses to acute isovolemic hemodilution were studied in nine mongrel dogs in hypoxic(FIO2=0.15) environment. The animals were bled 20ml/kg of blood. The shed blood was replaced by equivalent amounts of low molecular weight extran(LMWD). Hemodynamic measurements and calculations were performed in control normoxic period, hypoxic period before bleeding, hypoxic period after fleeding and after hemodilution with LMWD. By hemodilution, Hb and Hct were decreased from 13.6+/-0.8gm/dl and 41+/-2% to 12.9+/-0.9gm/dl and 21+/-2%, respectively. Hypoxia itself did not cause any hemodynamic changes. Bleeding caused significant increases in SVR(60%) and PVR(77.9%), and resulted in decreases in CI(40.0%), TI(32.7%) and PCWP(2.0%) compared with the data in control period. Hemodilution reversed hemodynamic changes induced by bleeding. PVR returned to normal and SVR was rather decreased by 24.2%, CI, PCWP and CVP were increased by 25.4%, 6.0%, and 37.5%, respectively. The parameters such as HR and RPP which might be related to oxygen consumption were decreased by 10.6%, compared with control data. This study demonstrated that, in spite of lowered arterial oxygen content during hemodilution, tissue oxygen supply and cardiac performance might be well maintained by combined effects of decreased afterload and oxygen consuming factors, and increased preload. In conclusion, acute isovolemic hemodilution with LMWD might be a safe tolerable method in the aspects of circulatory response in hypoxic dogs.
Animals ; Anoxia ; Dogs* ; Hemodilution* ; Hemodynamics ; Hemorrhage ; Molecular Weight ; Oxygen ; Oxygen Consumption

BACKGROUND: Urinary retention is one of the most common complications after spinal anesthesia, and its inadequate management can result in serious outcomes. Overdistended bladder due to urinary retention should be catheterized. This study determined whether the prophylactic medication of oral bethanechol, a parasympathomimetic drug, results in reduction in the frequency of catheterization due to urinary retention. METHODS: Twenty-seven healthy male patients undergoing lower extremity operation under spinal anesthesia were subjected and randomly allocated into three groups according to the drug which was given. Group I (n = 9) had no medication, Group II (n = 9) and Group III (n = 9) were given bethanechol 50 mg or bethanechol 100 mg orally, respectively, before anesthesia. We measured the number of catheterized patients, the frequency of catheterization per catheterized patient, and perioperative cardiovascular complications in each group after their operations. RESULTS: The number of catheterized patients was nine (100%) in Group I, three (33%) in Group II, and two (22%) in Group III (P < 0.002). There was a significant statistical difference among the groups (P < 0.002). As the dosage of bethanechol increased, its effect increased relatively (P < 0.001). CONCLUSIONS: Prophylactic oral medication of 50 100 mg bethanechol reduces the frequency of catheterization in urinary retention after spinal anesthesia.
Anesthesia ; Anesthesia, Spinal* ; Bethanechol* ; Catheterization ; Catheters ; Humans ; Lower Extremity ; Male ; Premedication* ; Urinary Bladder* ; Urinary Retention

BACKGROUND: Urinary retention is one of the most common complications after spinal anesthesia, and its inadequate management can result in serious outcomes. Overdistended bladder due to urinary retention should be catheterized. This study determined whether the prophylactic medication of oral bethanechol, a parasympathomimetic drug, results in reduction in the frequency of catheterization due to urinary retention. METHODS: Twenty-seven healthy male patients undergoing lower extremity operation under spinal anesthesia were subjected and randomly allocated into three groups according to the drug which was given. Group I (n = 9) had no medication, Group II (n = 9) and Group III (n = 9) were given bethanechol 50 mg or bethanechol 100 mg orally, respectively, before anesthesia. We measured the number of catheterized patients, the frequency of catheterization per catheterized patient, and perioperative cardiovascular complications in each group after their operations. RESULTS: The number of catheterized patients was nine (100%) in Group I, three (33%) in Group II, and two (22%) in Group III (P < 0.002). There was a significant statistical difference among the groups (P < 0.002). As the dosage of bethanechol increased, its effect increased relatively (P < 0.001). CONCLUSIONS: Prophylactic oral medication of 50 100 mg bethanechol reduces the frequency of catheterization in urinary retention after spinal anesthesia.
Anesthesia ; Anesthesia, Spinal* ; Bethanechol* ; Catheterization ; Catheters ; Humans ; Lower Extremity ; Male ; Premedication* ; Urinary Bladder* ; Urinary Retention

No abstract available.
Brain Neoplasms* ; Brain* ; Tomography, Emission-Computed, Single-Photon*

A randomised trial was conducted in 13 patients to assess the circulatory response to endotracheal intubation. None of the patient suffered from heart or lung disease, all were premedicated with lorazepam 0.4 mg/kg, glycopyrrolate 0. 004 mg/kg intramuscularly 30-60 min. beforehand. Patients received vecuronium 0.01mg/kg intravenously for precrurarization and 2 min. later 6 patients received lidocaine 2 mg/kg intravenously and 7 patients received saline 1 ml/20 kg intravenously. Blood pressure and pulse rate were measured repeatedly by an automatic recording device (Datascope 2100A) and cardiac output was measured by noninvasive cardiac output monitor with suprasternal doppler ultrasound. After laryngoscopy and intubation, systolic arterial pressure increased 19.7% mean arterial pressure 18.8% from baseline values in lidocaine group (p<0.05), and systolic arterial pressure increased 21.4% mean artereal pressure 19.8% from baseline values in saline group (p<0. 05). Pulse rate increased 30.9% from baseline values in lidocaine group (p<0.05) and 32.5% from baseline in saline group (p<0.05). But there was no intergroup difference in systolic arterial pressure, mean arterial pressure and pulse rate. Diastolic pressure of both group did not increase significantly and did not show intergroup difference. Cardiac output increased 35.3% from baseline values in lidocaine group (p<0.05). We concluded that lidocaine 2 mg/kg infusion intravenously 2 min prior to laryngoscopy and intubation does not prevent hemodynamic reaction evoked by endotracheal intubation.
Arterial Pressure ; Blood Pressure ; Cardiac Output ; Glycopyrrolate ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine* ; Lorazepam ; Lung Diseases ; Ultrasonography ; Vecuronium Bromide

The anesthetic properties on blockade of tourniquet pain of hyperbaric tetracaine (T-caine) and bupivacaine (marcaine) with or without epinephrine administered intrathecally were compaired in randomized study involving fourty healthy surgical patients. This investigation employed solutions of the two agents with or without epinephrine that contained equal dose (13 mg), concentration (0.5%), and volume (3ml). No statistically significant difference in height, anesthetic time, tourniquet time, tourniquet pressure, and sensory blockade level were observed between the four groups. Tourniquet pain or inadequate anesthesia did not occur in epinephrine-mix groups, But occurred in 20% of the patients in the tetracaine (t-caine) group & bupivacaine (marcaine) group each other. The results suggest that equal concentrations and dosages of hyperbaric tetracaine (T-caine) and bupivacaine (Marcaine) possessed similar anesthetic qualities on blockade of tourniquet pain following subarachnoid administration.
Anesthesia ; Bupivacaine* ; Epinephrine ; Humans ; Tetracaine* ; Tourniquets*

Authors suggest new radiologic lateral view of upper airway which can simultaneously visualize whole length of upper airway for the preanesthetic evaluation. 1) The proper use of special wedge filter and removal of shoulder shadow from the tracheal ahadow were the two essentials for the imagification of the airway. 2) This view gives pretty images of upper respiratory tract ineluding epiglottis, vocal cord and tracheal passage. 3) The potential usefulness of the whole lengt lateral view of upper airway is thought to be promising in many fields. For example, measurement of length of variaus airway structure ia poseible by use of this view. In conclusion, this view is a noninvasive and inexpensive radiologic method as a approach to detect abnormalities of the larynx and trachea both before and after intubation.
Epiglottis ; Intubation ; Larynx ; Respiratory System* ; Shoulder ; Trachea ; Vocal Cords

BACKGROUND: Separation of two lungs during anesthesia is necessary for the purpose of isolation of one lung from the other to prevent spillage or contamination and facilitating surgical exposure by collapsing the lung in the operative hemithorax. Several techniques are available for providing one-lung anesthesia. This study was performed to evaluate which technique is favored and why it is favored for one-lung ventilation. METHODS: We studied 70 patients scheduled for thoracic surgery aided by collapse of the ipsilateral lung. We analyzed frequency of each technique, efficacy of lung collapse, adequacy of one-lung ventilation, blood gases and complications. RESULTS: In the 63 patients out of 70 patients, the double-lumen tubes were used. Left-sided were used in 57 patients and right-sided were used in 6 patients. There were 3 complications: tracheal rupture, right bronchial rupture and post-operative edema of vocal cords. Bronchial blockers were inserted in 7 patients. It was failed in two cases. Ventilation and oxygenation were respectively good in all patients. CONCLUSIONS: We favored the double-lumen endotrachial tube than Univent blocker. Malposition was frequently seen with the Univent and serious complication was occasionally seen with the double-lumen tube. However surgical exposure and oxygenation was provided with any method, when position was corrected adequately.
Anesthesia ; Anesthesia, General* ; Edema ; Gases ; Humans ; Lung ; One-Lung Ventilation* ; Oxygen ; Pulmonary Atelectasis ; Rupture ; Thoracic Surgery ; Ventilation ; Vocal Cords