BACKGROUND: Seizures are common following many cerebral insults, include global and focal ischemia. However, while the mechanism must relate to some change in the relative activities of excitatory and inhibitory pathway, the specific alterations in neurotransmitter concentrations and/or receptor sensitivities which underlie these events, remain unknown. The principal aim of this study was therefore to evaluate the effects of moderately severe forebrain ischemia on lidocaine-induced seizure thresholds, in hopes of gaining some insights into these processes. METHODS: Halothane-anesthetized, normothermic Sprague-Dawley rats were chronically instrumented with screw electrodes and vascular catheters, and were then subjected to 10 min of forebrain ischemia, produced by bilateral carotid occlusion combined with hypotension (MAP = 30 mmHg). After reperfusion, animals were awakened. 6, 24 and 46 hours later, separate groups of awake animals were subjected to intravenous infusion of lidocaine at the rate of 2.6 mg/kg/min. The total dose of lidocaine infused prior to generalized tonic-clonic seizures were noted. Another group of Sham animals (no ischemia) served as control. RESULTS: The lidocaine-induced seizure threshold was significantly increased at 24 h after forebrain ischemia (65.39 12.9 mg/kg vs 36.47 4.24 mg/kg, P < 0.05). Interestingly, at 6 h post-ischemia, rats treated with lidocaine consistently died before seizures. There were no significant differences in seizure threshold between the control and 48 h post-ischemia groups. CONCLUSIONS: Ten minutes of forebrain ischemia is followed by a transient increase in the seizure threshold to infused lidocaine. By 48 h following reperfusion, lidocaine induced seizure threshold had returned to normal.
Animals ; Electrodes ; Hope ; Hypotension ; Infusions, Intravenous ; Ischemia* ; Lidocaine ; Neurotransmitter Agents ; Prosencephalon* ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Seizures* ; Vascular Access Devices

Systemic lupus erythematosus is a systemic disorder which has frequent involvement of gastrointestinal tract. Non specific symptoms such as anorexia, nausea, diarrhea and abdominal pain are well known symptoms when the gastrointestinal tract is involved. The most feared gastrointestinal complication of systemic lupus erythematosus is lupus enteritis. The pathological change in lupus enteritis is usually a result of mesenteric vasculitis. Major complications such as intestinal bleeding and perforation may occur and sometimes result in sugery. Because of high mortality rate in case of major complications, early diagnosis and appropriate treatment is very important. We experienced three patients with lupus enteritis who presented with severe abdominal pain and dirrhea. They were diagnosed by characteristic radiographical findings of small bowel series and barium study. All radiographical findings has been resolved completely with the steroid therapy. Conclusively we can induce complete remission by steroid therapy alone, if we diagnose lupus enteritis in the early period of disease course.
Abdominal Pain ; Anorexia ; Barium ; Diarrhea ; Early Diagnosis ; Enteritis* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Lupus Erythematosus, Systemic ; Mortality ; Nausea ; Vasculitis

Induction of general anesthesia with tracheal intubation may eause hypertension and tachycardia with concomitant increase in plasam catecholamine concentration. These transient stress responses are undesirable, especially in patients with cardiovascular or intracrainal diseases. Many drugs(topical or i.v. lidocaine, inhalation anestheties, opioids, adrenergic blockers, etc) are used in an attempt to blunt these potentially adverse hemodynamic responses. This study was made to examine blunting effect of labetalol and fentanyl for hemodynamic changes after tracheal intubation. Eighty patients, ASA physical status I or II, scheduled for elective surgery were selected randomly. They were divided into four groups. Group l: Control(saline)(n=20) Group 2: Labetalol 0.125 mg/kg(n=20) Group 3: Labetalol 0.25 mg/kg(n=20) Group 4: Fentanyl 3 ug/kg(n=20) Study drugs were injected 3 minutes before induction with thiopental sodium. Patients were induced with thiopental sodium 5 mg/kg and succinylcholine chloride l mg/kg i.v.in all groups. 5 minutes after injection of study drug, laryngoscopy was initiated and performed tracheal in- tubation. After the completion of intubation, 50% nitrous oxide in oxygen and 1.5vol.% halothane was administed. The blood pressure and heart rate were measured using automated noninvasive blood pressure device and E.C.G. monitoring for 10 minutes per 1 minute. Data were analyzed with Stu- dent's t-test within the group and unpaired t-test between the groups. P<0.05 was considered significant. Labetalol or fentanyl pretreatment significantly blunted the increase in heart rate and rate pressure product caused by laryngoscopy and endotracheal intubation. But the increase of arterial blood pressure was blunted significantly in fentanyl 3 ug/kg group. Labetalol and fentanyl may offer an important role in patients in whom an increase in blood pressure, heart rate and/or rate pressure product should be avoided during the endotracheal intubation.
Adrenergic Antagonists ; Analgesics, Opioid ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Fentanyl* ; Halothane ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Inhalation ; Intubation ; Intubation, Intratracheal* ; Labetalol* ; Laryngoscopy ; Lidocaine ; Nitrous Oxide ; Oxygen ; Succinylcholine ; Tachycardia ; Thiopental

Administration of succinylcholine for intratracheal intubation may cause untoward reactions such as elevation of intraocular and intrabdominal pressure, increased plasma potassium level, and development of postoperative muscle pain, ets. The fasciculation of muscle fibers caused by nondepolarizing activity of succinylcholine may be responsible for those reactions, although this is not clearly defined. Several attempts ehterfore, have been made to minimize the development of muscle fasciculation following administration of succinylcholine. Of thest, self-taming of succinylcholine, pretreatment wit small doses of non-depolarizing neuromuscular blockers, or the use of hexafluorenium are examples. The authors observed the effects of succinylcholine on intraocular pressure and the degree of muscle fasciculation after self taming of succinylcholine. pretreating the patients with d-tubocurarine and pancuronlum before administration of succinylcholine was also studied. All three techniques showed significant decreases in the degree of muscle fasciculation. And small doses of d-tubocurarine and pancuronium did not seem to affect intraocular pressure, although a taming dose of succinylcholine itself caused significant increases in intraocular pressures.
Fasciculation ; Humans ; Intraocular Pressure ; Intubation, Intratracheal ; Myalgia ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pancuronium ; Plasma ; Potassium ; Succinylcholine* ; Tubocurarine

Effects of ketamine on the cardiovascular system of tortoises was observed in this study. Ketamine elevated blood pressure and increased contractile performance and heart rate of the tortoise's auricle. The hypertensive effect of ketamine was abolished by treatment with hexametbonium or Regitine, while increment of heart rate due to ketamine was not affected by treatment of hexamethonjum, Inderal, or Regitine. In vitro experiments, ketamine increased contractile performance and heart rate of the auricle. These effects of ketamine were not affected by Regitine, Inderal,cocaine, or reserpine pretreatment. Synergism of ketamine and norepinephrine was also observed. Low bath temperature did not influence the effects of ketamine but high bath temperature inhibited the effects of the drug. In the electrically stimulated preparations, field stimulation did not affect the chronotropic and inotropic effects of ketamir, but direct stimulation abolished these effects of the drug. From the above results, it is possible to say that ketamine probably has dual actions on the cardiovascular system of tortoises, i, e., hypertensive action due to stimulation of sympathetic nervous system, and chronotropic and inotropic actions due to direct stimulation of cardiac muscle.
Baths ; Blood Pressure ; Cardiovascular System* ; Heart Rate ; In Vitro Techniques ; Ketamine* ; Myocardium ; Norepinephrine ; Phentolamine ; Propranolol ; Reserpine ; Sympathetic Nervous System

BACKGROUND: The value of the fiberoptic laryngoscope in difficult tracheal intubation is well established. In recent years there has been a significant interest in and increase in learning this valuable skill by anesthesiologists. This study assesses the minimum number of attempts needed for proficiency in fiberoptic orotracheal intubation. METHODS: Eight anesthesia residents with experience in rigid larygoscopic intubation, but who were beginners in fiberoptic intubation, participated in this study. In a randomized fashion, each resident performed 50 fiberoptic orotracheal intubations. All intubations were performed under general anesthesia and muscle paralysis. Success rate and intubation time of fiberoptic orotracheal intubation and SpO2 were recorded. We have compared success rate with intubation time of fiberoptic orotracheal intubation and grade of laryngoscopic view. RESULTS: The mean success rate of fiberoptic orotracheal intubation was 75% in the first 10 intubations. Thereafter the success rates were higher than 90%. The mean time to achieve successful orotracheal fiberoptic intubation were significantly decreased to 30 attempts. There was no correlation of laryngoscopic grade with intubation time and success rate. No hypoxia occurred in any patient. CONCLUSIONS: We concluded that an acceptable level of technical expertise in fiberoptic orotracheal intubation is achieved after 30 intubation attempts.
Anesthesia ; Anesthesia, General ; Anoxia ; Humans ; Intubation* ; Laryngoscopes ; Learning* ; Paralysis ; Professional Competence

We report 2 cases of unusual ureteral tumor. A case appeared as bladder tumor causing ureteral obstruction by outgrowing of the tumor of terminal ureter into the bladder wall. The surface of bladder mucosa was intact. The other one presented as a large retroperitoneal mass causing obstruction of the external iliac vein such as an ovarian tumor. The literature is reviewed briefly.
Iliac Vein ; Mucous Membrane ; Ureter* ; Ureteral Obstruction ; Urinary Bladder ; Urinary Bladder Neoplasms

Adult respiratory distress syndroms(ARDS) is a clinical syndrome of variable etiology and non specific complex pathophysiology with high mortality. But management would be successful leaving less than 1% of permanent impairment by intensive care including serial blood gas analysis. We experienced a case of ARDS developed after twice of cardiac arrest of which the outcome was favorable despite the conservative management with lack of various modernized equipments.
Adult* ; Blood Gas Analysis ; Heart Arrest* ; Humans ; Critical Care ; Mortality ; Respiratory Distress Syndrome, Adult*

Many studies have been performed in order to evaluate intraocular pressure changes during induction and maintenance of anesthesia in ocular surgery. Use of the laryngeal mask airway permits the maintenance of a clear airway without laryngoscopy. To evaluate the effect of laryngeal mask airway placement with/withaut laryngoscopy on intraocular pressure, sixty patients were randomly allocated to one of three groups; a tracheal intubation group with laryngoscopy (TI, n=20); a laryngeal mask airway placement group with laryngoscopy (LMA-L, n=20); a laryngeal mask airway placement group with blind technique (LMA, n=20). The authors compared the intraocular pressure and hemodynamic responses to the laryngeal mask airway insertion with (LMA-L group) and without (LMA group) laryngoscope to those of tracheal intubation (TI group) in 60 patients during a standardized anesthetic pratice. Baseline measurements of intrao- cular pressure, heart rate, and arterial blood pressures were recorded and repeated at one minute after insertion of the airway device in each group. Insertion of the laryngeal mask airway required significantly more time (LMA-L group, 15.5 sec; LMA group, 14.3 sec) in comparison with that for the tracheal intubation (9.1 sec). The laryngeal mask airway placement did not increase intraocular pressure, or arterial blood pressures except for heart rate above baseline values. However, tracheal intubation was associated with significant increases of intraocular pressure, heart rate, and arterial blood pressure at one minute compared to the baseline values. The mean intraocular pressures at one minute after airway instrumentation in TI group were significantly different from those of LMA or LMA-L group. The authors suggest that a laryngeal mask airway may be a good alternative to tracheal intubation in intraocular surgery if a laryngeal mask airway is not contraindicated.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intraocular Pressure* ; Intubation* ; Laryngeal Masks* ; Laryngoscopes ; Laryngoscopy

Many studies have been performed in order to evaluate intraocular pressure changes during induction and maintenance of anesthesia in ocular surgery. Use of the laryngeal mask airway permits the maintenance of a clear airway without laryngoscopy. To evaluate the effect of laryngeal mask airway placement with/withaut laryngoscopy on intraocular pressure, sixty patients were randomly allocated to one of three groups; a tracheal intubation group with laryngoscopy (TI, n=20); a laryngeal mask airway placement group with laryngoscopy (LMA-L, n=20); a laryngeal mask airway placement group with blind technique (LMA, n=20). The authors compared the intraocular pressure and hemodynamic responses to the laryngeal mask airway insertion with (LMA-L group) and without (LMA group) laryngoscope to those of tracheal intubation (TI group) in 60 patients during a standardized anesthetic pratice. Baseline measurements of intrao- cular pressure, heart rate, and arterial blood pressures were recorded and repeated at one minute after insertion of the airway device in each group. Insertion of the laryngeal mask airway required significantly more time (LMA-L group, 15.5 sec; LMA group, 14.3 sec) in comparison with that for the tracheal intubation (9.1 sec). The laryngeal mask airway placement did not increase intraocular pressure, or arterial blood pressures except for heart rate above baseline values. However, tracheal intubation was associated with significant increases of intraocular pressure, heart rate, and arterial blood pressure at one minute compared to the baseline values. The mean intraocular pressures at one minute after airway instrumentation in TI group were significantly different from those of LMA or LMA-L group. The authors suggest that a laryngeal mask airway may be a good alternative to tracheal intubation in intraocular surgery if a laryngeal mask airway is not contraindicated.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intraocular Pressure* ; Intubation* ; Laryngeal Masks* ; Laryngoscopes ; Laryngoscopy