BACKGROUND: Acute normovolemic hemodilution (ANH) is accepted to be the easiest and most economical method of autotransfusion. This study was performed to investigate the clinical usefulness of ANH in patients undergoing off-pump CABG. METHODS: Thirty patients were randomly divided into two groups. In the ANH group, 753.3 +/- 51.6 ml of fresh autologous whole blood were sequestrated from a pulmonary artery catheter following induction of anesthesia with simultaneous infusion of colloids and crystalloid solution from a separate line. Perioperative changes of hemoglobin, hematocrit level, platelet counts, prothrombin time, cardiac output, transfusion requirement and the amount of postoperative drainage were compared between the two groups. RESULTS: Perioperative changes of platelet counts and PT showed no significant differences between the two groups. Less allogenic blood was used in the ANH group (0.27 +/- 0.46 unit) than in the control group (1.27 +/- 0.80 unit) in the operation room. CONCLUSIONS: ANH can decrease the transfusion requirement in off-pump CABG.
Anesthesia ; Blood Transfusion, Autologous ; Cardiac Output ; Catheters ; Colloids ; Drainage ; Hematocrit ; Hemodilution* ; Humans ; Platelet Count ; Prothrombin Time ; Pulmonary Artery

BACKGROUND: The Cobra Perilaryngeal Airway(TM) (Cobra PLA) and the Proseal Laryngeal Mask Airway(TM) (Proseal LMA) provide higher sealing pressures than the classic LMA. The authors compared the clinical effectiveness of these two airway types for controlled ventilation during laparoscopic cholecystectomy. METHODS: One hundred and twenty patients (ASA physical status I-II, aged 18-65 yrs) scheduled for laparoscopic cholecystectomy were randomly allocated for airway management with the Cobra PLA or the Proseal LMA. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion system. Insertion characteristics, anatomical positions, airway adequacies, ventilation efficacies, degrees of gastric distension, and postoperative adverse events (sore throat, dysphagia, and dysphonia) were noted. RESULTS: The number of insertion attempts, insertion times, airway sealing pressure, and airway positions were similar in the two groups. In one Cobra PLA patient, tracheal intubation was needed due to inadequate ventilation before pneumoperitoneum. During pneumoperitoneum, oxygenation and ventilation were optimal in all patients in both groups, and degrees of gastric distension were similar. Furthermore, no differences were found in terms of the incidences of adverse effects. CONCLUSIONS: Cobra PLA and Proseal LMA were found to have similar insertion characteristics and both provided adequate airways and effective ventilation during laparoscopic cholecystectomy.
Aged ; Airway Management ; Anesthesia ; Cholecystectomy, Laparoscopic ; Deglutition Disorders ; Elapidae ; Humans ; Incidence ; Intubation ; Laryngeal Masks ; Oxygen ; Pharynx ; Piperidines ; Pneumoperitoneum ; Propofol ; Ventilation

BACKGROUND: The Cobra Perilaryngeal Airway (CobraPLA) and the Laryngeal Mask Airway (LMA) Classic are supraglottic airway devices. We compared the performance of the CobraPLA and the LMA Classic devices during volume-controlled ventilation in children. METHODS: Eighty children, ASA physical status I-II, aged 1-10 years were randomly assigned with either the CobraPLA or the LMA Classic for airway management. Anesthesia was induced with 1 mg/kg ketamine and 2.0 mg/kg propofol, and muscle relaxation was obtained with the use of 0.5 mg/kg rocuronium. All patients were mechanically ventilated with a tidal volume of 10 m/kg in 1-3% sevoflurane, oxygen and air. The number of insertions, oropharyngeal leak pressure, and fiberoptic airway position were measured. Measurements of blood pressure, heart rate, oxygen saturation, end-tidal carbon dioxide, and peak inspiratory pressure were recorded every 5 minutes. Postoperative adverse events were assessed. RESULTS: There was no significant difference between the use of the two devices with respect to the number of insertions, time of insertion, and fiberoptic score. The oropharyngeal leak pressure was significantly higher for the CobraPLA than the LMA Classic (25.4 +/- 4.9 cmH2O versus 20.3 +/- 5.4 cmH2O; P < 0.001). Hemodynamic and respiratory variables were similar with the use of both devices. The incidence of adverse events was not different with the use of both devices. CONCLUSIONS: Both airway devices provided an adequate airway and effective ventilation during volume-controlled ventilation in children. The CobraPLA had a higher sealing pressure than the LMA Classic.
Aged ; Airway Management ; Androstanols ; Anesthesia ; Blood Pressure ; Carbon Dioxide ; Child ; Elapidae ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Ketamine ; Laryngeal Masks ; Methyl Ethers ; Muscle Relaxation ; Oxygen ; Propofol ; Tidal Volume ; Ventilation

BACKGROUND: Partially paralyzed patients may be placed in the risk of pharyngeal dysfunction. Bupivacaine acts as acetylcholine receptor ion channel blocker and may synergistically interact with rocuronium to augment NM blockade. Thus, this study aims to elucidate whether or not, at a therapeutic concentration, bupivacaine by itself may cause NM blockade and reduce an effective concentration of rocuronium. METHODS: Twenty-two left phrenic nerve-hemidiaphragms (Male SD rats, 150-250 g) were hung in Krebs solution. Three consecutive ST, 0.1 Hz and one TT, 50 Hz for 1.9 s were obtained before drug application and at each new drug concentration. A concentration of bupivacaine in Krebs solution (n = 5) was cumulatively increased by way of 0.01, 0.1, 1, (1, 2, 3, 4, 5, 6, 7) x 10 microM. In a Krebs solution, pre-treated with bupivacaine 0 (n = 5), 0.1 (n = 5), 1.0 (n = 5), 10 (n = 2) microM, and then concentrations of rocuronium were cumulatively increased by way of 1, 3, 5, 7, 9, 12, 14, 16, 18, 20 microM. EC for each experiment were determined by a probit. The EC50's of rocuronium were compared using a Student's t-test with Bonferroni's correction. Differences were considered significant when P < 0.05. RESULTS: The potency of bupivacaine for normalized TF was 11.4 (+/- 1.1) microM. Below 30 microM of bupivacaine, the single twitch potentiation sustained despite the development of tetanic fade and partial inhibition of PTT. Bupivacaine significantly facilitated the NM blockade induced by rocuronium. CONCLUSIONS: Clinicians should be aware that bupivacaine by itself at its therapeutic concentration inhibit NM conduction and enhances rocuronium-induced muscle relaxation.
Acetylcholine ; Androstanols ; Animals ; Bupivacaine ; Humans ; Ion Channels ; Isotonic Solutions ; Muscle Relaxation ; Neuromuscular Blockade ; Rats ; Refractory Period, Electrophysiological

BACKGROUND: Bispectral index (BIS) is a useful tool to assess depth of anesthesia. Recently, spectral entropy has been promoted as a monitor of anesthetic depth in adult, but its characteristics in children remains poorly defined. This study was to compare BIS and entropy indices during sevoflurane anesthesia in children. METHODS: Forty children (aged 1-12 yr) scheduled for ENT surgery, were included. Anesthesia was induced with 5.0% sevoflurane in O2 6 L/min. Tracheal intubation was performed with rocuronium 0.6 mg/kg. Heart rate, blood pressure, end-tidal sevoflurane concentration (Etsev), BIS, response entropy (RE) and state entropy (SE) were measured every 5 minutes. The correlation between BIS and entropy index and Etsev was calculated, RESULTS: The BIS, SE and RE values decreased with induction and increased with recovery. The BIS, RE, and SE values were inversely proportionally related to the Etsev. The RE and SE values were closely correlated with the BIS values (respectively r = 0.948 and r = 0.946, P< 0.001). CONCLUSIONS: We demonstrated a close correlation of SE and RE with Etsev and with BIS during sevoflurane anesthesia in children. State entropy and RE seem to be useful electroencephalographic measures of sevoflurane drug effect in children.
Adult ; Androstanols ; Anesthesia ; Blood Pressure ; Child ; Entropy ; Heart Rate ; Humans ; Intubation ; Methyl Ethers ; Organothiophosphorus Compounds

BACKGROUND: Acute normovolemic hemodilution (ANH) is recognized as the easiest, the most economical and valuable autologous blood saved method among the types of autotransfusion. We studied whether this method could reduce the transfusion requirement of allogenic blood in total knee arthroplasty to investigate the efficacy of ANH. METHODS: The thirty patients were randomized and divided into two groups. In the ANH group (n = 15), 2 units of autologous blood were procured from a CVP catheter immediately before or after anesthetic induction, while Ringer's lactate and colloid solution were infused to maintain normovolemia via a different venous catheter. Perioperative changes of hemoglobin, hematocrit, platelets, prothrombin time (PT), transfusion requirements and the amount of postoperative drainage were compared. RESULTS: There were no significant difference between the two groups in terms of perioperative changes of hemoglobin, hematocrit or platelets. And, there was significantly reduced demand for packed RBC transfusion in the ANH group (362.7+/-236.4 ml) compared with the control group (668.0+/-259.3 ml) (P <0.05). However, no significant difference was observed between the two groups in terms of postoperative drainage amount. CONCLUSIONS: ANH can reduce transfusion requirements in total knee arthroplasty surgery if this is accompanied by appropriate patient selection and monitoring.
Arthroplasty* ; Blood Transfusion, Autologous ; Catheters ; Colloids ; Drainage ; Hematocrit ; Hemodilution* ; Humans ; Knee* ; Lactic Acid ; Patient Selection ; Prothrombin Time

BACKGROUND: The oculocardiac reflex (OCR) can be elicited during manipulation of the orbital structures in the strabismus correction surgery. A sinus bradycardia is the most common manifestation of OCR; and cardiac dysrhythmia and asystole may also occur. Various efforts to reduce OCR have been attempted, but without coherent outcome results. METHODS: Sixty one children, undergoing elective strabismus surgery, were randomly allocated into 2 groups: Group K received ketamine 1.0 mg/kg; and Group M received midazolam 0.15 mg/kg for induction of anesthesia. Anesthesia was maintained with 1-1.3 MAC of sevoflurane with 50% N2O in O2. Heart rate and blood pressure were measured 30 seconds before extraocular muscle (EOM) traction and immediately after traction. The OCR was defined as a decrease in heart rate more than 20% of the baseline heart rate, following manipulating EOM. Postoperative nausea and vomiting (PONV) and emergence agitation (EA) were assessed in postanesthetic care unit (PACU). RESULTS: Blood pressure before tightening EOM in Group K was higher than that in Group M (P < 0.05). However Delta HR (2.7 +/- 15% vs. - 0.9 +/- 16%) and incidence of OCR (10.0% vs. 19.4%) after traction an EOM were not different between the two groups. The occurrence of PONV (6.7 vs. 9.7%) and EA (30.0% vs. 22.6%) were similar. CONCLUSIONS: Ketamine does not reduce the incidence of OCR compared with midazolam in pediatric strabismus surgery. In addition, ketamine does not increase the incidence of PONV and EA. In conclusion, it is reliable to use ketamine in pediatric strabismus surgery.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Bradycardia ; Child ; Dihydroergotamine ; Heart Arrest ; Heart Rate ; Humans ; Incidence ; Ketamine ; Methyl Ethers ; Midazolam ; Muscles ; Orbit ; Postoperative Nausea and Vomiting ; Reflex, Oculocardiac ; Strabismus ; Traction

BACKGROUND: Minimal-flow and low-flow anesthesia provide many advantages, including reduced costs and pollution, and conservation of body heat and airway humidity. However, low-flow sevoflurane anesthesia is associated with an increase in the circuit concentration of compound A, which causes nephrotoxicity in rats. Therefore, this study was conducted to assess the effects of prolonged minimal-flow sevoflurane anesthesia on hepatic and renal function. METHODS: Forty female patients who underwent free flap surgery lasting more than 8 hours randomly received either high-flow (5 L/min) or minimal-flow (0.5 L/min) sevoflurane anesthesia. Hepatic functions were then assessed by measuring the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin levels. In addition, renal functions were assessed by measuring the blood urea nitrogen (BUN) and serum creatinine levels and by spot urinalysis. Venous blood and spot urine samples were obtained prior to administration of the anesthesia, and then on the first, third and fifth days following administration of the anesthesia. RESULTS: The anesthetic time (9.9 +/- 1.7 vs. 9.6 +/- 2.0 h) and sevoflurane exposure (8.2 +/- 1.7 vs. 7.4 +/- 1.9 MAC-h) were not different between the high-flow and minimal-flow anesthesia group. The serum AST, ALT, ALP and total bilirubin levels were within the normal range throughout the study period in both groups. Additionally, the BUN and serum creatinine levels were within the normal range throughout the study period in both groups. Furthermore, there were no significant differences in any hepatic or renal biomarkers between the two groups. CONCLUSIONS: No significant differences in postoperative hepatic and renal function were observed between the minimal-flow and high-flow sevoflurane anesthesia groups.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Animals ; Aspartate Aminotransferases ; Bilirubin ; Blood Urea Nitrogen ; Creatinine ; Female ; Free Tissue Flaps ; Hot Temperature ; Humans ; Humidity ; Methyl Ethers ; Rats ; Reference Values ; Urinalysis ; Biomarkers

Hemostasis and a clear field are obtained by the local infiltration of a local anesthetic mixed with epinephrine. However, epinephrine may in itself, due to its cardiovascular effect, cause arryhthmia, heart failure, pulmonary edema, and even cardiac arrest. We describe a 10-year-old patient who developed ventricular premature contraction and acute pulmonary edema due to epinephrine infiltration during tonsillectomy. The patient recovered without any sequelae after intensive treatment involving fluid restriction, diuretics, dobutamine infusion, and oxygen by mask at 5 L/min.
Child ; Diuretics ; Dobutamine ; Epinephrine* ; Heart Arrest ; Heart Failure ; Hemostasis ; Humans ; Masks ; Oxygen ; Pulmonary Edema* ; Tonsillectomy*

No abstract available.
Cholangiopancreatography, Endoscopic Retrograde ; Dexmedetomidine