No abstract available.
Diazepam* ; Hemodynamics* ; Morphine* ; Pancuronium* ; Respiration, Artificial*

Midazolam, a water-soluble benzodiazepine that is shorter-acting, more potent, and less irritating to veins than diazepam, has been suggested for use for induction of anesthesia. The cardiovascular effects of an induction dose(0.2~0.3mg/kg) of midazolam in ASA class lll cardiac surgical patients (N=15) were compared in a couble-blind fashion with a similar group of patients (N=15) receiving thiopental (5.0mg/kg). The patients were premedicated by triflupromasine, pethidine, hydroxyzine, atropine and diazepam. The results were summarized as follows. 1) The thiopental group were more decreased in blood pressure and increase in heart rates than midazolam group. 2) Spontaneous eye closing time and loss of eyelash reflexes were observed. But those were a poor sign of adequate induction became of heavy preanesthetic sedation. 3) The changes of blood pressure and pulse rate after induction and intubation were almost similar in the two groups, but greater individual variation was seen in midazolam groups, depends on preload state before induction. From the above results, midazolam was sufficient as an induction agent for open heart cases. But a hypovolemic patients and completely beta blocked patients should be used cautiously because they may be developed severe hypotension and tachycardia.
Anesthesia ; Atropine ; Benzodiazepines ; Blood Pressure ; Diazepam ; Heart Rate ; Heart* ; Humans ; Hydroxyzine ; Hypotension ; Hypovolemia ; Intubation ; Meperidine ; Midazolam* ; Reflex ; Tachycardia ; Thiopental ; Thoracic Surgery* ; Veins

Coronary artery disease is an ever-increasing problem to anesthesiologists as more patients with severe coronary artery are being accepted for surgery. Four cases of aortocoronary bypass graft procedure were done at Severance hospital. The procedure itself can result in perioperative myocardial infarction leading to death. Greater understanding of and constant attention to the myocardial oxygen supply and demand may reduce the incidence of perioperative myocardial infarction. Among the four patients, three tolerated the anesthesia and surgery well without gross pre and postoperative complications. However one patient developed hypotension in the recovery room and died 6 hours postoperatively, in spite of an intensive efforts at resuscitation. The problems, complications and precautions for anesthesia are discussed.
Anesthesia* ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Hypotension ; Incidence ; Myocardial Infarction ; Oxygen ; Postoperative Complications ; Recovery Room ; Resuscitation ; Transplants

Introduction: Oxygen delivery to tissue is of major clinical interest in patients with cyanotic congenital heart disease (CHD). The use of pulse oximeter to monitor arterial oxygen saturation (SaO2) is considered accurate and reliable in the range of 90% to 100%. However with desaturation, the accuracy remains controversial below 90%. The aim of this study was to evaluate the accuracy of pulse oximetry in severe hypoxemia. METHOD: In 110 children with cyanotic CHD, pulse oximeter (N-200, Nellcor, USA) readings were compared with the direct measurement of SaO2 by blood gas analyser (Profile10, Stat, USA). All measurements were carried out after induction of anesthesia and devided into 4 groups according to saturation measured by pulse oximeter (SpO2). SpO2 in group I was higher than 90% (n=90), in group II between 80% and 89% (n=75), in group III between 70% and 79% (n=41), in group IV lower than 69% (n=18). Statistical analysis of paired SpO2 and SaO2 values was performed using correlation analysis and paired t-test. The other comparisons were perfomed with ANOVA. p<0.05 was considered statistically significant. RESULTS: Correlation coefficient of group I was 0.89 (p<0.01), group II was 0.67 (p<0.01), group III was 0.63 (p<0.01) and group IV was 0.41. The study demonstrate that SpO2 seems to have good correlation with SaO2 when SpO2 is higher than 70%. This results are contrary to other studies which show that SpO2 is not reliable when SpO2 is below 90%. However, the correlation value r seems to decrease with desaturation. CONCLUSION: The use of pulse oximeter in severe hypoxemic children with CHD is efficient in monitoring oxygenation, even though there is decrease in accuracy of the SpO2.
Anesthesia ; Anoxia ; Child* ; Heart Defects, Congenital* ; Humans ; Oximetry* ; Oxygen ; Reading

As the mitral valve disease becomes long-standing, the patient may develop pulmonary hypertension. It was reported that after surgical correction, the elevated pulmonary vascular resistance(PVR) would fall quickly in association with the fall in left atrial pressure(LAP). This study was performed to evaluate the changes in mean pulmonary artery pressure(PAP) and PVR immediately after mitral valve replacement(MVR). Fifty six patients undergoing mitral valve replacement(MVR) were divided into two groups on the basis of the presence or absence of significant pulmonary hypertension, defined as a resting mean pulmonary arterial pressure greater than 30mmHg. After induction of anesthesia, PAP, PVR, cardiac output(CO) were measured and compared with values in postbypass period. PAP and PVR were significantly decreased(PAP from 39.64+/-1.88 to 29.18+/-1.65 mmHg, P 0.001, PVR from 6.16+/-1.14 to 3.53+/-0.62 units, P<0.05) in Group II(PAP> or = 30mmHg, n=23), whereas not changed in Group I(PAP30 mmHg, n=33)(P<0.05). Persistance of an elevated PVR may cause right ventricular failure and low-output syndrome, so that an attempt to reduce the PVR is needed postoperatiavely. This study demonstrated that the PAP and PVR fall significantly after MVR especially in patients with severe pulmonary hypertension.
Anesthesia ; Arterial Pressure* ; Humans ; Hypertension, Pulmonary ; Mitral Valve* ; Pulmonary Artery ; Vascular Resistance*

We have mnanaged the anesthetic and postoperative care in 9 patients with myasthenia gravis who underwent thymectomy and obtained following resultsa : 1) Premedication was glycoprrrolate 0.004mg/kg or atropine 0.01mg/kg and hydroxyzine 1~2mg/kg, I.M. Anesthetic induction was by thiopental 4~5mg/kg with 7he inhalation of halothane 1~2 % or enflurane 4~5%, and followed by endotracheal intubation. Anesthetic maintanance was done by N2O and halothane or enflurane. 2) Mean duration from the end of operation to intubation was 11.83+/-3.37hrs. 5 patients required reintubation. The mean duration from the extubation to reintubation was 33.11+/- 21.06hrs for these 5 patients. Over all this entire group of patients were placed on the respirator for a mean of 5.33+/-1.46dara. 3) Complication occured were 2 cases of cholinergic crisis, 1 cases of lung abscess, 2 cases of dyspnea and 1 case of tension pneumothorax 4) Abstinence of muscle relaxants, adequate respiratory care and the protection from cholinergic crisis were the most important factora for successful management.
Anesthesia* ; Atropine ; Dyspnea ; Enflurane ; Halothane ; Humans ; Hydroxyzine ; Inhalation ; Intubation ; Intubation, Intratracheal ; Lung Abscess ; Myasthenia Gravis* ; Pneumothorax ; Postoperative Care ; Premedication ; Thiopental ; Thymectomy* ; Ventilators, Mechanical

To evaluate anesthetic experience during open heart surgery, 145 cases of patients under 15kg of body weight from January 1980 to June 1982 were analyzed according to age, sex, technique of anesthesia, anesthetica, premedicants, muscle relaxants, flow rates and mortality. The results were as follows: 1) Premedicants were mainly atropine, meperidine, hydroxyzine, triflupromazine and morphine. 2) Induction agents were thiopental in acyanotic group, but cyanotic group were mainly used ketamine. 3) The inhalation anesthetica that were halothane, methoxyflurane, N@O and enflurane were used in acyanotic group but cyanotic group did not used. 4) Early stage of open heart surgery, gallamine were mainly used but now, pancuronium were used. 5) During cardiopulmonary bypass, the lowest temperature were mean 27 degrees C and flow rate were 80~100ml/kg/m(2). 6) Overall mortality was 17.2%.
Anesthesia* ; Atropine ; Body Weight ; Cardiopulmonary Bypass ; Child* ; Enflurane ; Gallamine Triethiodide ; Halothane ; Heart Defects, Congenital* ; Heart* ; Humans ; Hydroxyzine ; Infant* ; Inhalation ; Ketamine ; Meperidine ; Methoxyflurane ; Morphine ; Mortality ; Pancuronium ; Thiopental ; Thoracic Surgery* ; Triflupromazine

The effect of flunitrazepam on circulation and respiration as an anesthetic induction agent was studied in 28 patiens(11women, 17men) undergoing open heart surgery and sortocoronary bypass graft surgery. The body weight varied between 30~69kg and the age ranged from 10~79yrs. They patients were premedicated with diasepam, triflupromasine, hydroxysine, pethidine and atropine in 19 cases, and morphine, hydroxysine and morphine, hydroxysine and atropine in 9 cases. Before the induction of anesthesia, Hartmann's solution was injected to maintaman adequated preload(CVP). Anesthesia was induced with flunitrazepam 0.03mg/kg and pressure pulse and respiratory rate were continuously monitored for 3 mintues. There after morphine 0.3mg/kg and pancuronium 0.1~1.15mg/kg were injected for endotracheal intubation. AFter the injection of flunitrazepam, spontaneous breathing in room ari was maintained in 19 cases even though the respiratory rate was somewhat decreased. The remaining cases were assisted in this respiration with oxygen because of severe respiratory depression or for prophylaxis of hypoxia in angina cases. Arterial blood gas tension showed normal ranges in all cases 3 min after flunitrazepam injection. Pulse rate, systolic and diastolic blood pressure were decreased 8.66%, 16.32%, and 15.9% respectively: however these are still within normal range. And those parameters were increased transiently following intubation as when other induction agents are used. From the above results, it can be concluded that flunitrasepam can be used safely as an induction agent in cardiac anesthesia with adequate preload and ventilation maintenance.
Anesthesia ; Anoxia ; Atropine ; Blood Pressure ; Body Weight ; Flunitrazepam* ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal ; Meperidine ; Morphine ; Oxygen ; Pancuronium ; Reference Values ; Respiration ; Respiratory Insufficiency ; Respiratory Rate ; Thoracic Surgery* ; Transplants ; Ventilation

The cellular cardiac effects of protamine, the cationic polypeptide employed to reverse heparin anticoagulation, were examined in vitro to define its mechanisms of action. Isometric contractile force and action potential (AP) characteristics after rest (RS) and at frequencies up to 3 Hz were recorded in guinea pig ventricular papillary muscle. The actions of protamine (10-300 ug/ ml) were compared to those of heparin (10, 30 units/ml), and to heparin (10 units/ml) neutralized with equivalent (100 ug/ml) or excess (200 ug/ml) protamine. The effects of protamine were also examined using muscle rapid cooling contractures (RCCs to assess intracellular Ca(z+) stores). Protamine (100-300 ug/ml) depressed contractions by 35-65% at 3 Hz, whereas contractions were enhanced 150-500% at lower rates (RS-0.5 Hz), with a concommitant rise in resting force. Protamine caused a resting depolarization from -84 to -72 mV and depressed AP amplitude. In contrast, heparin minimally altered contractile or AP characteristics. In 26 mM K(+)-solution with 0.1 uM isoproterenol, 30-300 ug/ml protamine caused dose-dependent depression of late peaking force development and slow AP prolongation. After 15 minutes rest, when RCCs were not normally elicited, rest RCCs became prominent in 100-300 ug/ml protamine. Effects of heparin with 100 ug/ml excess protamine were similar to those of 100 ug/ml protamine alone. In conclusion the loss of normal force-frequency relation, partial depolarization, rise in resting tension, and appearance of rested state RCCs suggest that unbound protamine can lead to excess intracellular Ca(2+), mediated by an alteration in memebrane ionic conductances.
Action Potentials ; Animals ; Contracture ; Depression ; Electrophysiology ; Guinea Pigs ; Heparin ; Isoproterenol ; Papillary Muscles

In order to evaluate the effect on cardiopulmonary fuaction and the relaxation brought about by atracurium elective surgical patients, belonging to ASA class 1 or 2 were anesthetixed with thiopental (5-6mg/kg) and intubated after atracurium injection through a central venous catheter. The changes of blood pressure, heart rate, the degree af relaxation and the time interval between atracurium and intubation were observed. The results are as follows 1) There was an average drop of 20mmHg in the systolic blood pressure and an average rise of 12 beate/min, in the pulse after thiopental (p<0.05), and no more significant changes were observed following atracurium. But significant rises of both were observed after intubation. 2) Following an atracurium injection of 0.62+/-0.01mg/kg, the time interval between atracurium and intubation was 167.78+/-11.15 sec. 3) Vocal cord relaxation was poor in 7 of 9 cases, so intubation was somewhat difficult. From the above results, the effect of atracurium for intubation was not satisfactory in this study. The potency of the atracurium may have changed due to unsuitable preservation at room temperature. Other causes for the lack of relaxation may have been the succesaive injection of thiopental and insufficient doses of atracurium.
Atracurium* ; Blood Pressure ; Central Venous Catheters ; Heart Rate ; Humans ; Intubation ; Relaxation ; Thiopental ; Vocal Cords