BACKGROUND: Sevoflurane has a low blood-gas partition coefficient, resulting in rapid induction and recovery. We compared the effects of sevoflurane with those of enflurane anesthesia on parturients and neonates during and after elective cesarean section. METHODS: Ninety-six parturients were divided into two groups: E (enflurane, n = 47) and S (sevoflurane, n = 49). After endotracheal intubation with intravenous administration of thiopental 4 mg/kg and succinylcholine 1.5 mg/kg, anesthesia was maintained with 50% nitrous oxide in oxygen and enflurane 1 vol% or sevoflurane 1 vol%. Maternal hemodynamic parameters, blood loss, and recovery were monitored. Neonatal outcome was evaluated by Apgar scores, umblical artery blood gas analysis and acid-base status. RESULTS: Recovery times were faster with sevoflurane anesthesia (P < 0.05). All patients in two groups developed transient hypertension and tachycardia after intubation, which returned to baseline in approximately 5 minutes. Maternal blood loss did not differ significantly between the two groups, and one patient in S group developed postoperative recall. Neonatal outcome was equally good in the two groups. CONCLUSIONS: Parturients anesthetized with sevoflurane for cesarean section recovered more rapidly compared with enflurane without any differences in hemodynamic parameters and neonatal outcome.
Administration, Intravenous ; Anesthesia* ; Arteries ; Blood Gas Analysis ; Cesarean Section* ; Enflurane* ; Female ; Hemodynamics ; Humans ; Hypertension ; Infant, Newborn ; Intubation ; Intubation, Intratracheal ; Nitrous Oxide ; Oxygen ; Pregnancy ; Succinylcholine ; Tachycardia ; Thiopental

High frequency jet ventilation(HFJV) administered through a thin catheter instead of a standard endotracheal tube provides improved operation field during laryngeal microsurgery. In this study, effect of changes in inspiration time and frequency on gas exchange was observed. Sixty five patients(ASA class 1-2) underwent laryngeal microsurgery were divided into 3 groups according to inspiration time(50%, 40% and 30%) and then subdivided into 3 groups according to frequency(3.3 Hz, 2.5 Hz and 1.7 Hz). Driving pressure was same in all groups(2.4 kg, cm). Anesthesia was induced with thiopental sodium, fentanyl and succinylcholine with 100% oxygen mask ventilation and maintained with intermittent intravenous anesthetics during jet ventilation via 10 Fr. catheter with 100% oxygen. Jet cannular was located 1 cm proximal to carina. Arterial blood gas analysis and hemodynamic data(blood pressure and heart rate) were measured at 0 minute(just after catheter intubated and jet ventilation started), 5 minute, 10 minute and after then, every 10 minutes. There was significant change in PaCO; by varing inspiration time but, no significant change by frequency except in group of 3.3 Hz at inspiration time 40% and 30%. Number of patients who showed in excess of 45 mmHg of PaCO2 at 20 minute were 2 out of 19, 9 out of 23 and 9 out of 23 in inspiration time 50%, 40% and 30%, respectively. In summary, HFJV via thin catheter located 1 cm proximal to carina during laryngeal microsurgery can be done safely with inspiration time 50% under good operation field at driving pressure 2.4 kg/cm and frequency 3.3, 2.5 and 1.7 Hz.
Anesthesia ; Anesthetics, Intravenous ; Blood Gas Analysis ; Catheters ; Fentanyl ; Heart ; Hemodynamics ; High-Frequency Jet Ventilation* ; Humans ; Masks ; Microsurgery* ; Oxygen ; Succinylcholine ; Thiopental ; Ventilation

BACKGROUND: Succinylcholine is the muscle relaxant of choice for rapid endotracheal intubation, but may produce many side effects such as hyperkalemia, myalgia, increase intraocular pressure. Nondepolarizing muscle relaxants were used instead of succinylcholine, still late onset time was be dangerous. For this reason, priming principle was reported and applied to rapid intubation using nondepolarizing muscle relaxation. We studied the effect of priming with vecuronium and atracurium on elderly and young patients. METHODS: We were randomly assigned 40 patients and observed the effects of priming doses of vecuronium (0.01 mg/kg) and atracurium (0.05 mg/kg). Ten young (20-35 yrs) and ten elderly (65-75 yrs) patients were each placed in vecuronium and atracurium group. Arterial blood gas analysis and train of four (TOF) were determined before priming. All tests were performed again 4 min after vecuronium and 3 min after atracurium. We asked for symptoms and signs of muscle weakness. RESULTS: In arterial blood gas analysis and TOF ratio were decreased in both groups. There is no significant difference between two groups in all tests. PaO2 and TOF ratio were reduced more in elderly patients, significantly (P<0.05). Symptoms and signs of muscle weakness such as ptosis, dizziness, diplopia, swallowing difficulty and respiratory difficulty in elderly patients were more frequent than in young patients. CONCLUSIONS: Priming doses of vecuronium and atracurium produced greater decrease in muscle strength, PaO2 and TOF ratio in the elderly than in their younger counterparts. So using priming method in elderly patients, we need adequate pre-oxygenation and thorough monitoring before endotracheal intubation.
Aged* ; Atracurium* ; Blood Gas Analysis ; Deglutition ; Diplopia ; Dizziness ; Humans ; Hyperkalemia ; Intraocular Pressure ; Intubation ; Intubation, Intratracheal ; Muscle Relaxation ; Muscle Strength ; Muscle Weakness ; Myalgia ; Succinylcholine ; Vecuronium Bromide*

BACKGROUND: We experienced unintentional hyperventilation during mechanical ventilation in pediatric general anesthesia. It is very difficult to decide respiratory rate or tidal volume with a patient's condition for adequate ventilation while respiratory gas monitoring is unavailable in many cases. Therefore, we studied to find a proper respiratory rate (RR) with a fixed tidal volume during mechanical ventilation in general anesthesia. METHODS: We studied 70 children weighing 10-30 kg during general anesthesia. An endotracheal tube was selected according to 3.5+age (yrs)/4. After intubation with midazolam, thiopental sodium and succinylcholine, mechanical ventilation was applied: tidal volume 8-10 ml/kg, peak inspiratory pressure 15-20 mmHg, RR 20 (infant), 18 (under 3 yrs), 16 (under 5 yrs), 14 (above 5 yrs) breaths/min. We adjusted the RR for a PetCO2 30 33 mmHg and arterial blood gas analysis was done 30 minutes each change. We calculated the RR for a PaCO2 of 36 mmHg according to the equation: RR (applied) = estimated RR estimated PaCO2/ideal PaCO2. In addition, the linear regression was analyzed between the age and RR. RESULTS: The estimated regression for RR using Pearson's correlation coefficient was as follows: RR = 19.25-0.07Xage (month). CONCLUSIONS: The equation (RR = 19.25-0.07Xage [month]) could be an index for safe ventilatory management without severe hyper- or hypo-carbia in the pediatric general anesthesia.
Anesthesia, General* ; Blood Gas Analysis ; Child ; Humans ; Hyperventilation ; Intubation ; Linear Models ; Midazolam ; Respiration, Artificial* ; Respiratory Rate* ; Succinylcholine ; Thiopental ; Tidal Volume ; Ventilation

Abstract: Suxamethonium chloride is a depolarizing muscle relaxant used in general anesthesia. In overdose, it causes adverse reactions such as bradycardia, arrhythmia, cardiac arrest, and death. The article reviews the progress on testing methods of suxamethonium chloride such as infrared spectroscopy, chemical color reaction, chemical titration, enzyme electrode, chromatography and mass spectrometry.
Anesthesia, General ; Arrhythmias, Cardiac/chemically induced* ; Biosensing Techniques ; Bradycardia/chemically induced* ; Chromatography ; Drug Overdose ; Heart Arrest/chemically induced* ; Humans ; Mass Spectrometry ; Neuromuscular Depolarizing Agents/analysis* ; Spectrophotometry, Infrared ; Succinylcholine/analysis*

BACKGROUND: Total spinal anesthesia (TSA) anesthetizes cranial nerves as well as peripherial nerves, leading to specific circulatory perturbations related to autonomic imbalance between sympathetic and parasympathetic tone. Heart rate variability (HRV) result from moment-to-moment changes in sympathetic and parasympathetic activity in response to many conditions. Using a power spectral analysis of heart rate variability, we evaluated the effect of TSA on the changes in the autonomic nervous system. METHODS: Twenty-four Sprague-Dawley rats, during halothane anesthesia, were placed in a stereotaxic head holder. Polyethylene tubing (PE-10) was passed caudally from the cisterna magna, and these rats were anesthetized by a urethane intraperitoneal injection (1.5 g/kg). Succinylcholine was infused intravenously at 1 mg/kg/min. During mechanical ventilation, ECG signals and mean arterial blood pressure were recorded for 5 min after a period of 10 min of anesthetic stabilization (baseline). Lidocaine (40 mg/kg) was administered intrathecally and then two subsequent 5-min ECG signals and mean arterial blood pressure were recorded (TSA 0 5 min, 5 10 min). A power spectral analysis of the data was computed using a short-time Fourier transform. The spectral peaks within each measurement were calculated; low frequency area (0.25 0.75 Hz), high frequency area (0.75 3.0 Hz), total frequency area (0.25 3.0 Hz). RESULTS: Mean R-R interval increases progressively during the 5 minutes after TSA but mean blood pressure decreases to the level of blood pressure of TSA within 2 minutes after TSA (p < 0.05). TSA diminished HRV within 2 minutes after a spinal injection of lidocaine (p < 0.05). CONCLUSIONS: These results suggest that total spinal anesthesia depresses both sympathetic and parasympathetic tone within 2 minutes.
Anesthesia ; Anesthesia, Spinal* ; Animals ; Arterial Pressure ; Autonomic Nervous System ; Blood Pressure ; Cisterna Magna ; Cranial Nerves ; Electrocardiography ; Fourier Analysis ; Halothane ; Head ; Heart Rate* ; Heart* ; Injections, Intraperitoneal ; Injections, Spinal ; Lidocaine ; Polyethylene ; Rats* ; Rats, Sprague-Dawley ; Respiration, Artificial ; Succinylcholine ; Urethane

A 49 year-old male was scheduled for a cholecystectomy, thereafter a 37 year-old female scheduled for removal of a epidural hematoma in the same operating room. Both of them had no specific medical problems and past medical histories for anesthesia. For those reasons, anesthesia was induced with thiopental sodium and succinylcholine with endotracheal intubation. After induction, vital signs including body temperatures were stable. But moisture dew in the unidirectional valves and corrugated tubes, and color changes of soda lime were discovered. At that time, severe hypercarbia was recognized by arterial blood gas analysis in both cases. In both cases, there were no malfunctions in unidirectional valves, expiratory valves, corrugation tubes, soda lime, ventilators and there connection parts in the anesthetic machines. Also there were no abnormalities of blood pressures, electrocardiograms, pulse oxymeters, temperatures and the pulse in the patient monitoring systems except capnography. At first, we thought that medical signs revealed malignant hyperthermias. But vital signs, air way pressures and functions of all kinds of anesthetic machine components including ventilators were normal. After discontinuing N2O gas deliveries in the operation room, hypercarbias disappeared. Thus, anesthetic gas delivery systems via central piping systems were checked and it was discovered that CO2 gas was in the N2O gas tank instead of N2O.
Adult ; Anesthesia ; Blood Gas Analysis ; Body Temperature ; Capnography ; Carbon Dioxide* ; Carbon* ; Cholecystectomy ; Electrocardiography ; Female ; Hematoma ; Humans ; Intubation, Intratracheal ; Male ; Malignant Hyperthermia ; Middle Aged ; Monitoring, Physiologic ; Nitrous Oxide* ; Operating Rooms ; Succinylcholine ; Thiopental ; Ventilators, Mechanical ; Vital Signs

We had a 52-year-old male presented for a surgery for old fracture of the 7th cervical vertebra. Generalized muscle rigidity and high fever with tachycardia was revealed 25 minutes after succinylcholine and enflurane administration. Then the body temperature was risen from 37.8 degrees C to 40.5 degrees C within 20 minutes and the arterial blood gas analysis showed a severe respiratory and metabolic acidosis. Under the suspicion of malignant hyperthermia, all anesthetics were discontinued, refrigerated intravenous solutions were started, and gastric lavage with cold saline was initiated together with packing the body with ice. Oral dantrolene 125mg, the only drug we could obtain, was administered through Levins tube after lavage. Serial serum CPK level were 4414 IU/L on third day and 74 IU/L on seventh day postoperatively. The postoperative course was uneventful and the patient could be walked after fifth day postoperatively and discharged without any sequelae.
Acidosis ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Blood Gas Analysis ; Body Temperature ; Dantrolene ; Enflurane ; Fever ; Gastric Lavage ; Humans ; Ice ; Male ; Malignant Hyperthermia ; Middle Aged ; Muscle Rigidity ; Pharmacology ; Spine ; Succinylcholine ; Tachycardia ; Therapeutic Irrigation

Malignant hyperthermia is a genetically transmitted, catastrophic, hypermetabolic syndrome that is induced by potent volatile anesthetics and/or depolarizing muscle relaxants. It is now well established that the pathophysiology is related to a malfunction of the intracellular calcium homeostasis in skeletal muscle. Morbidity has been correlated to the duration of symptoms. Dantrolene decreased release of calcium from the sarcoplasmic reticulum. We recently encountered a fulminant case during halothane anesthesia. Anesthesia was induced with thiopental and succinylcholine without jaw tightness or stiffness. After induction, tachycardia, arrhythmias, increased end-tidal CO2, and high body temperature were noted. Arterial blood gas analysis showed a severe, mixed acidosis. Intensive treatment with body cooling was immediately initiated. But dantolene could not be available. The patient died of renal failure and disseminated intravascular coagulation 41 hours after induction of anesthesia.
Acidosis ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Arrhythmias, Cardiac ; Blood Gas Analysis ; Body Temperature ; Calcium ; Dantrolene ; Disseminated Intravascular Coagulation ; Halothane ; Homeostasis ; Humans ; Jaw ; Malignant Hyperthermia* ; Muscle, Skeletal ; Neuromuscular Depolarizing Agents ; Renal Insufficiency ; Sarcoplasmic Reticulum ; Succinylcholine ; Tachycardia ; Thiopental

A 27 year-old male patient, who had cervical tracheal stenosis due to accidental inhalation of zinc dichloride gas, underwent tracheal reconstruction (tracheal resection and end to end anastomosis). Preoperatively, a special radiologic study (tracheography), pulmonary function tests and arterial blood gas analysis were performed for accurate diagnosis (to determine the location, degree and extent of the stricture) and to detect any associated abnormalities in the lung-function. Atropine and diazepam were given for premedication. After intramuscular injection of ketamine and succinylcholine, orotracheal intubation was done above the lesion, and N2O and halothane were added for maintenance of anesthesia. Respiration was assisted or controlled when necessary with gallamine. The lesion was approached through an anterior transverse cervical incision. The trachea. was dissected clear and transected distal to the lesion. The distal tracheal segment was then intubated through the operating field with a sterile cuffed endotracheal tube (the 2nd tube). This was connected to the anesthetic machine. After resection of the lesion and anastomosis. of the posterior tracheal wall, the 2nd tube was removed and orotracheal tube was pushed into the distal trachea. After complete anastomosis the orotracheal tube was placed above the suture line.Continuous arterial blood gas analysis during and after anesthesia was helpful for evaluation of the state of arterial blood oxygenation and ventilation.
Adult ; Anesthesia* ; Atropine ; Blood Gas Analysis ; Diagnosis ; Diazepam ; Gallamine Triethiodide ; Halothane ; Humans ; Inhalation ; Injections, Intramuscular ; Intubation ; Ketamine ; Male ; Oxygen ; Premedication ; Respiration ; Respiratory Function Tests ; Succinylcholine ; Sutures ; Trachea ; Tracheal Stenosis ; Ventilation ; Zinc