Despite the fact that the anticholinesterases, mainly neostigmine, has been used for many years to antagonize a nondepolarizing neuromuscular blockade, until recently nothing was known about their pharmacokinetics and dynamics in anesthetized patients. This deficiency was largely due to lack of a suitable analytic technique to measure the concentration of these drugs in body fluids, most importantly serum. Recently it was developed a method by which the serum concentrations of neostigmine, pyridostigmine, edrophonium and their metabolities can be measured. Recently,k pyridostigmine and edrophonium have gained popularity to use for reversing a nondepolarizing muscle relaxants. We have studied newly introduced vecuronium effects and its reversal with pyridostigmine. The results were as follows: 1) Spontaneous recovery index by vecuronium 0.1mg/kg was 620.8 sec. 2) Recovery index by the pyridostigmine 160ug/kg reversal was significantly shortened as 134.0sec in vecuronium 0.1mg/kg block. 3) Tetanic stimulation (100Hz, 5sec) was sustained after 75% recovery of twitch height by pyridostigmine 160ug/kg reversal.
Body Fluids ; Cholinesterase Inhibitors ; Edrophonium ; Humans ; Neostigmine ; Neuromuscular Blockade* ; Pharmacokinetics ; Pyridostigmine Bromide* ; Rabbits* ; Vecuronium Bromide*

Six aortocoronary bypass surgeries were performed from May 1987 to September 1987 at Han Yang University Hospital utilizing the following anesthetic regimen. Preoperatively patients were given nitroglycerin, propranolol and nifedipine to maintain the hypodynamic state of the cardiovascular system. Anesthesia was induced and maintained with morphine, diazepam, and oxygen and supplemented with halothane with or without N2O. Nitroglycerin, sodium nitroprusside and dopamine were used to stabilize the hemodynamics during the intraoperative and postoperative periods, respectively. Six cases of aortocoronary bypass surgery were peformed safely without mortality.
Anesthesia* ; Cardiovascular System ; Coronary Artery Bypass* ; Diazepam ; Dopamine ; Halothane ; Hemodynamics ; Humans ; Morphine ; Mortality ; Nifedipine ; Nitroglycerin ; Nitroprusside ; Oxygen ; Postoperative Period ; Propranolol

The Pentaspan is a high molecular weight(250,000), hyperosmolar(320 mOsm/l) colloid solution and blood volume expander in clinical practice. Many researches revealed the decreasing of systemic vascular resistance and pulmonary vascular resistance after Pentaspan administration in vivo. Some colloid solution is contraindicated in acute renal failure. We tried to confirm the direct effects of the Pentaspan and its mechanism on the abdominal aorta and renal artery in vitro. The rat abdominal aorta and renal artery were precontracted with norepinephrine(10(-7) M/1) in 50 ml Krebs solution and 5 ml Pentaspan was infused. Ten mininutes after, changes of the vascular tones were obtained. The results were as follows. 1) The vascular tones were significantly decreased in both vessels. 2) Abdominal aorta group, renal artery group and with or without endothelium group were not significant different each other. 3) The vascular tones were not affected by with or without endothelium, indomethacin and methylene blue pretreatment. Smooth muscles were induced relaxation by the Pentaspan infusion and the relaxation were not dependent to endothelium derived relaxing factor, prostanoid and cyclic guanosinemonophosphate.
Acute Kidney Injury ; Animals ; Aorta, Abdominal* ; Arteries ; Blood Volume ; Colloids ; Endothelium ; Endothelium-Dependent Relaxing Factors ; Hydroxyethyl Starch Derivatives* ; Indomethacin ; Methylene Blue ; Muscle, Smooth ; Rats* ; Relaxation ; Renal Artery* ; Vascular Resistance

A fifty five year-old male patient was scheduled for a total laryngectomy under general anesthesia. A tracheostomy was performed on the administration day due to respiratory difficulty. All data of the preoperative routine check were within acceptable limits including incomplete RBBB on EKG. Just prior to starting the inhalation anesthesia, an armored tube (RUsch) was inserted instead of a silver cannula. Near the end of operation, signs of hypercapnia appeared as tachycardia and hypertension. Therefore, tracheobronchial suction was attempted but the suction catheter did not go through the armored tube. At that time, we decided there was an obstruction inside the tube. So, the armored tube was changed to a Portex tube. Thereafter, tachycardia and hypertension returned to normal intraoperative levels and we disocvered that the armored tube was obstructed almost completely by a blood clot.
Airway Obstruction* ; Anesthesia, General ; Anesthesia, Inhalation ; Catheters ; Electrocardiography ; Humans ; Hypercapnia ; Hypertension ; Laryngectomy ; Male ; Silver ; Suction ; Tachycardia ; Tracheostomy

The incidence of cardiac arrhythmias during anesthesia in a total 5,845 surgical patients who were admitted to Hanyang university hospital from Janury 1 to December 31, 1988 was investigated using on-line continuous EKG monitoring. The results were as follows: 1) Among study patients, 111 patients (1.9%) had pre-existing cardiac arrhythmias before anesthesia and showed significantly higher incidence of arrhythmias (49.5%) than that of patients without pre-existisng arrhythmias before anesthesia (2.9%). 2) Among arrhythmias found during anesthesia, most types of arrhythmias were ventricular premature contractions (77.4% in the patients with pre-existing cardiac arrhythmias and 43.6% in the patients without pre-existing cardiac arrhythmias) except sinus bradycardia and tachycardia. 3) Although the incidence of arrhythmias during the induction of anesthesia was similar to that during anesthesia maintenance, it was somewhat greater on the basis of incidence per unit time. 4) The incidence of arrhythmias was increased with age. 5) The incidence of arrhythmias when anesthesia was induced with halothane (3.7%) was greater than that when anesthesia was induced with enflurane (2.1%). 6) Most of the arrhythmias were controlled with sufficient ventilation and oxygen supply, adjusting concentration of inhaled anesthetics or changing anesthetics, and occasionally, intravenous admininstration of 1% lidocaine (1.0-1.5 mg/kg). Considering the above results, it may be an appropriate conclusion that the continuous on-line EKG monitoring during the induction and maintenance of anesthesia is a noninvasive and simple method for detecting early signs of cardiac arrhythmias and hemodynamic changes during anesthesia, and consequently, improving the overall efficiency of patient care. Therefore, we are impressed with an idea that the continuous EKG monitoring should be mandatory for all surgical patients to be anesthetized.
Anesthesia* ; Anesthetics ; Arrhythmias, Cardiac* ; Bradycardia ; Electrocardiography ; Enflurane ; Halothane ; Hemodynamics ; Humans ; Incidence* ; Lidocaine ; Oxygen ; Patient Care ; Tachycardia ; Ventilation

The serum cholinesterase level is influenced by a variety of disease states, especially in pregnancy as is well established now, although the reasons for the fall in the enzyme in certain conditions and its clinical significance are less clear. This known decrease in plasma cholinesterase activity could lead to the conclusion that the duration of paralysis from succinylcholine will be prolonged in pregnant patients. The purposes of this study were to evaluate the serum cholinesterase activity in nonpregnant women of the child-bearing age group and pregnant women and to evaluate the changes of serum cholinesterase following succinylcholine administration. The results were as follows: 1) The mean value of serum cholinesterase in 60 nonpregnant women of the child-bearing age group was 992.29-1,112.27 U/L. 2) The mean value of serum cholinesterase in 60 pregnant women was 769.40-826-27 U/L. 3) Pregnant women had a diminution of serum cholinesterase activity compared with nonpregnant women of the child-bearing age group, and this diminution was statistically very significant (p<0.01). 4) In Cesarean section patients treated with succinylcholine, there was further diminution of serum cholinesterase activity (P<0.01). With the above results, the possible clinical importance of marked diminution of a serum cholinesterase activity in pregnant women is outlined.
Cesarean Section* ; Cholinesterases* ; Female ; Humans ; Paralysis ; Plasma ; Pregnancy ; Pregnant Women ; Succinylcholine

After the hemodynamic comparison of venous air volume in 32 rabbits, the following conclusions were derived. 1) The precordial doppler ultrasonography was most sensitive and end titdal CO2 pressure was statistically decreased at 0.1 ml/kg of air. 2) The mean arterial pressure was suddenly decreased at 1 minute after injection of more than 0.25 ml/kg of air, and was furether reduced according to the time. 3) The arterial PCO2 was continuously increased and statistically different from 0.25 ml/kg of air, and the arterial PO2 was suddenly decreased to about 1/3 of the control data. 4) The pulse rate was statistically decreased at more than 0.5 ml/kg of air and shown peaked p wave, arrhythmias, ST depression and premature ventricular contraction on the EKG. There 4 dead rabbits at 1.0 ml/kg of air, so we could conclucle that the fatal dose of rabbits was more decreased than that of the dogs in venous air embolism.
Animals ; Arrhythmias, Cardiac ; Arterial Pressure ; Depression ; Dogs ; Electrocardiography* ; Embolism, Air* ; Heart Rate ; Hemodynamics ; Rabbits* ; Ultrasonography, Doppler ; Ventricular Premature Complexes

Atracurium, one of the newly developed nondepolarizing muscle relaxants, is remarkable due to the intermediate duration of action from the other previously known nondepolarizing agents and the broad safety margin in patients with renal or liver disease. There have been many reports suggesting that the pharmacologic effects of the nondepolarizing muscle relaxants are influenced by dosage. In this study, we attempted to identify the specific mechanism of muscle relaxation of atracurium. Particular attention was paid to the actually delivered atracurium dose and to the degree of muscle relaxation in rabbits. The results were as follows; 1) In the atracurium 0.4 mg/kg group, the onset of action was shortened and in the atracurium 0.6 mg/kg group, it was shortened more significantly. 2) The duration of action was increased with the increase of dose: the mean duration was 895 seconds in the atracurium 0.1 mg/kg group, 1,113.7 seconds in the 0.2 mg/kg group, and 1,199.3 second is in the 0.4 mg/kg group. It was prolonged to 1,730 seconds in the atracurium 0.6mg/kg group. 3) The spontaneous recovery index showed no differences in the atracurium 0.1 mg/kg group, 0.2 mg/kg group and 0.4 mg/kg group (196.7 sec., 195.0 sec, 202.7 sec. each). But in the atracurium 0.6 mg/ kg group, it was markedly prolonged to 334 seconds. In conclusion, atracurium, like other nondepolarizing agents, produces a dose related duration of action in muscle relaxation.
Atracurium* ; Humans ; Liver Diseases ; Muscle Relaxation* ; Rabbits*

Absence of response to train of four(TOF) and single twitch stimulation at ulnar nerve did not guarantee ided intubation conditions after vecuronium. The double burst stimulation (DBS) introduced by Viby-Mogensen, made it easier to evaluate postoperative residual neuromuscular blockade manually than did the use of the TOF method. The purpose of this study was to examine which will be the best stimulus among DBS, TOF and single twitch stimulation(STS) for an indicator of the optimal time for tracheal intubation. One hundred and nine healthy patients were randomly allocated to three groups in which DBS(n=34), TOF(n=38) and STS(n=37) group. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained 1% enflurane until intubation. Neuromuscular block was induced by intravenous vecuronium0.1 mg/kg, and applied facial nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher and Paykel Co.) continuously. The complete relaxation time of orbicularis oculi muscle was closely observed with authors naked eyes. Tracheal intubation was performed immediately by the author after disappearance of the response to stimuli. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cords opening, coughing reflex and response to laryngoscopy attempts. The intubation time was 195.9+/-74.7(90-390) seconds in DBS group, 180.9+/-49.8(100-290) seconds in TOF group and 167.7+/-37.9(90-270) seconds in STS group and there were no statistically significant difference. There were also no significance on vocal cords opening and response to laryngoscopy attempts in three groups but DBS group was statistically less cough reflex than TOF group and STS group(p<0.05). With the above results the authors concluded that DBS on the facial nerve with the orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation and the time was about l96 seconds after vecuronium.
Anesthesia ; Cough ; Enflurane ; Facial Nerve* ; Humans ; Injections, Intravenous ; Intubation* ; Laryngoscopy ; Muscle, Skeletal ; Neuromuscular Blockade ; Reflex ; Relaxation ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide* ; Vocal Cords

Positive end expiratory pressure (PEEP) has been used to prevent and treat venous air embolism in patients in the sitting position undergoing neurosurgical operations However, the safety of PEEP has recently been questioned, because of concern that PEEP might incresae right atrial pressure more than left atrial pressure, thereby predisposing patients with a probe-patent foramen ovale to paradoxical air embolism. But it is controversial and needs further evaluation. In a prior study in rabbits with various venous air volume, the authors found that suddenly decreased mean arterial pressure and arterial PO2 showed peaked P wave, arrhythmias, ST depression and premature ventricular contraction on the EKG. In the present study, the authors examined the effects of 0, 3 and 5 cmHO PEEP (PEEP0, PEEP3, and PEEP5,) in 30 rabbits positioned supine with intravenous 0.5 mg/kg of air injection. In a prior study, we found that 0.5 mg/kg of air injection has serious change but showed low mortality. The measurements were obtained by the precordial doppler ultrasound, end tidal PCO2, mean arterial pressure, arterial PCO2, arterial PO2, and EKG. The results were as follow; 1) Doppler ultrasound was the most sensitive device even with PEEP and end tidal PCO2 was higher with PEEP5 than with PEEP3 and PEEP0 after suddenly decreased by the air injection. In PEEP statistic singnificance was observed (p<0.05). 2) The mean arterial pressure was significantly decreased by the air injection in PEEP0 PEEP3 and PEEP5 but there were no significant differences in all groups. It seemed likely due to low PEEP. 3) In PaCO2, slightly higher PaCO2 was observed in PEEP5 than in PEEP3 and PEEP. No statistic significance was obaerved. In PaO2, significant decrease was observed in all group but in PEEP3 small decrease was observed. 4) The incidence of bradycardia and ST depression was less in PEEP3 and PEEP5 than in PEEP0. In PEEP5, PVC was appeared relatively short duration than other group due to the air lock phenomenon. It was suspeeted that air was more freely passed according to increased right ventricular pressure after air lock. Authors conclude that PEEP has a benefit effect for the prevention of venous air embolism but after the occurence there is little benefit in the treatment.
Arrhythmias, Cardiac ; Arterial Pressure ; Atrial Pressure ; Bradycardia ; Depression ; Electrocardiography* ; Embolism, Air* ; Foramen Ovale ; Humans ; Incidence ; Mortality ; Positive-Pressure Respiration ; Rabbits* ; Ultrasonography ; Ventricular Premature Complexes ; Ventricular Pressure