Functional mapping techniques including functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and magnetoencephalography (MEG) can be used to study the function of the nervous system. Optical imaging is an emerging technique for functional imaging of the nervous tissue. Functional optical imaging can be classified into two major streams; intrinsic signal optical imaging (ISO) and voltage-sensitive dye optical imaging (VDO). ISO is related to hemodynamic changes such as hemoglobin concentration and oxygenation changes, cytochrome oxidation change, and light scattering. On the contrary, VOD measures changes in membrane potentials of neural cells. Therefore, ISO reflects metabolic activity of neurons, while VOD directly reflects neural activity. Recent advances in optical imaging opened the possibility of its application to clinical situations as well as basic researches. Further, development of optical imaging may greatly contribute to the understanding of the function of the nervous system.
Cytochromes ; Hemodynamics ; Hemoglobins ; Light ; Magnetic Resonance Imaging ; Magnetoencephalography ; Membrane Potentials ; Nervous System ; Neurons ; Optical Imaging ; Oxygen ; Positron-Emission Tomography

Heart transplantation is an accepted procedure for treatment of end-staged cardiac failure. A return to near-normal quality on life can be expected in many patients with a nonrejecting cardiac allograft, and many of these patients will return to the operating room for noncardiac surgical procedures. Anesthesiologists should be alert to recognizing problems caused by the presence of infection in immunosuppressed patients, modes of presentation of rejection phenomena and how transplanted organs, notably significantly denervated ones, may behave and respond under the pathophysiologic circumstance that arise during surgery, resuscitation and intensive care. The use of regional techniques require adequate preloading to avoid exaggerated hypotension and aseptic technique to avoid infection. Hypobaric spinal anesthesia has some benefit. It does not depress cardiovascular and respiratory system and keep adequate venous return by trendelenberg position. We report herein a case of successfully undergone total hip replacement in a patient who had previously undergone orthotopic heart transplantation under hypobaric spinal anesthesia.
Allografts ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Heart Failure ; Heart Transplantation ; Heart* ; Humans ; Hypotension ; Critical Care ; Operating Rooms ; Respiratory System ; Resuscitation

Hospital personnel are subject to various occupational hazards. Along with the development of modern medicine, novel and diverse medical appliances have been introduced to enhance the safety of the hospital environment. But paradoxically, some advancement of the appliances have led to exposure to greater risk for the personnel in the operation room. In the past, the greatest risk factor in the operation room was outbreak of fire and explosion, but the risk of explosion has vanished by the development of nonexplosive anesthetics. However, newly introduced electrical appliances and unknown infectious diseases appear to be new risk factors affecting health workers in the operation room. The goal of this review is to investigate the current risk factors and thereby prepare suitable preventive methods. We have reviewed the main occupational hazards affecting health workers in the operation room: accidents such as fires, explosions, electrical accidents; exposure to residual anesthetic gas; radiation; various infections; drug dependencies.
Anesthetics ; Communicable Diseases ; Explosions ; Fires ; Hazardous Substances ; History, Modern 1601- ; Humans ; Operating Rooms ; Personnel, Hospital ; Risk Factors ; Safety Management

BACKGROUND: The purpose of this study is to evaluate what kind of crystalloid solution could function as the best buffer and correct the metabolic acidosis most effectively in rabbits with hemorrhagic shock. METHODS: Twenty eight rabbits were bled until mean arterial pressure(MAP) became 70% of control. Thirty minutes after hemorrhagic shock fluid resuscitation was started with either plasmalyte or Hartmann's solution or 0.9% normal saline until MAP returned to 90% of the control. Hemodynamic and blood gas study, plasma lactate and electrolyte concentration were measured before, during, and 30 minutes after recovery from shock. RESULTS: The amount of shed blood to reduce MAP to 70% of control ranged 76~87 ml. And the volume for fluid resuscitation was 274~324 ml. There was no statistically significant difference among the three groups. The pH decreased during shock in all group and still decreased after resuscitation in Hartmann's solution and normal saline. But it increased significantly after resuscitation in plasmalyte. Lactate was increased in all group during shock and decreased by 22 and 23 mg/dl after resuscitation in plasmalyte and normal saline. But it still increased by 40 mg/dl in Hartmann's solution. Serum potassium level decreased significantly after resuscitation with normal saline. Serum calcium level decreased significantly after resuscitation with plasmalyte and normal saline. CONCLUSION: With the above results the plasmalyte which has pH closer to that of normal blood might be able to avoid the metabolic acidosis and maintain acid-base equilibrium effectively after fluid resuscitation in acute hemorrhagic shock.
Acid-Base Equilibrium ; Acidosis ; Calcium ; Hemodynamics ; Hydrogen-Ion Concentration ; Lactic Acid ; Plasma ; Potassium ; Rabbits* ; Resuscitation* ; Shock ; Shock, Hemorrhagic*

Psoas compartment block for hip arthroplasty was evaluated clinically in 32, either sex, geriatric patients. To perform the block, the patient was placed in a lateral decubitus position and a line was drawn, connecting both iliac crests (intercristal line). 22G teflon-coated needle of 10cm-length was inserted at a point 3cm caudad to the intercristal line and 5cm lateral to the spinal midline on the side to be blocked. The nerve stimulator (1-3mA, 1Hz), Pajunk (GMBH, Geisingen, West-Germany), was used to elicit paresthesia or muscle twitching on the patient's ipsilateral leg. The block was performed with administration of a mixture of 15 ml of 1.5 % lidocaine, 15 ml of 0.5 % bupivacaine and 0.15 mg of epinephrine. The onset time of the block was 4.4+/-1.6 minutes and its duration was 3.8+/-1.5 hours. The mean value of the lowest mean arterial pressure during the first 1 hour after the injection of local anesthetics, 85.7+/-9.8 mmHg was lower, compared to the preanesthetic baseline value, 98.2+/-16.5 mmHg. The failure rate was 9.4% and any significant systemic toxicity was not seen. There were some intraoperative complaints such as the discomfort due to position bars. However, there was no remarkable problem intraoperatively. The results indicate that psoas compartment block is a recommendable safe anesthetic technique for hip arthroplasty in geriatric patients.
Anesthetics, Local ; Arterial Pressure ; Arthroplasty* ; Bupivacaine ; Epinephrine ; Geriatrics ; Hip* ; Humans ; Leg ; Lidocaine ; Needles ; Paresthesia

The study of pain has recently received much attention, especially in understanding its neurophysiology by using new brain imaging techniques, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), both of which allow us to visualize brain function in vivo. Also the new brain imaging devices allow us to evaluate the patients pain status and plan to treat patients objectively. Functional activation of brain regions are thought to be reflected by increases in the regional cerebral blood flow in the brain imaging studies. Regional cerebral blood flow increases to noxious stimuli are observed in second somatic (SII) and insular regions and in the anterior cingulate cortex and with slightly less consistency in the first somatic area (S1), motor area, supplementary motor area, prefrontal area, amygdala and contralateral thalamus. These data suggest that pain has multidimensions such as sensory-discrimitive, motivational-affective and cognitive-evaluative.
Amygdala ; Brain ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurophysiology ; Positron-Emission Tomography ; Thalamus

The study of pain has recently received much attention, especially in understanding its neurophysiology by using new brain imaging techniques, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), both of which allow us to visualize brain function in vivo. Also the new brain imaging devices allow us to evaluate the patients pain status and plan to treat patients objectively. Functional activation of brain regions are thought to be reflected by increases in the regional cerebral blood flow in the brain imaging studies. Regional cerebral blood flow increases to noxious stimuli are observed in second somatic (SII) and insular regions and in the anterior cingulate cortex and with slightly less consistency in the first somatic area (S1), motor area, supplementary motor area, prefrontal area, amygdala and contralateral thalamus. These data suggest that pain has multidimensions such as sensory-discrimitive, motivational-affective and cognitive-evaluative.
Amygdala ; Brain ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurophysiology ; Positron-Emission Tomography ; Thalamus

BACKGROUND: Opioids can produce potent antinociceptive effects by interacting with local opioid receptors in inflamed peripheral tissue. However, reports on pain relief with intra-articular morphine after arthroscopic knee operations are conflicting. In this study we examined the analgesic effects of the intraarticular administration of morphine after knee surgery. METHODS: In a double-blind, randomized trial, we studied 26 patients who had received one of two injections at the end of surgery. The patients in group M(n=11) received 3 mg of morphine intraarticularly; those in group P(n=15), saline 20 ml intraarticularly as a placebo. RESULTS: Patients in the morphine group had significantly lower pain scores throughout the 24-h postoperative period compared with those in the placebo group(P<0.05). There was less requirement for supplementary analgesics in the morphine group. CONCLUSIONS: Low doses of intraarticular morphine can significantly reduce pain after knee surgery without any systemic side effect.
Analgesics ; Analgesics, Opioid ; Humans ; Knee* ; Morphine* ; Postoperative Period ; Receptors, Opioid

Endotracheal tube obstruction during anesthesia can have many causes. Hyperinflation of the remaining lung after a pneumonectomy can severely displace the trachea, and attachment of an endotracheal tube tip to the wall of a deviated trachea may also cause severe airway obstruction. The right lung of the patient was removed 3 years ago due to lung cancer. Compensatory hyperinflation of the left lung and severe right-sided tracheal deviation was seen on a chest X-ray. An armored endotracheal tube without Murphy's eye was used. Two hours after beginning the operation, peak airway pressure and PETCO2 began to increase gradually. A wheezing-like sound was heard. Bronchospasm was suspected, but signs of a spasm were not relieved by medications. The signs completely disappeared after pulling the tube 2 cm proximal. The position of the tube should be confirmed by fiberoptic bronchoscopy or chest X-ray after intubation when the trachea is deviated.
Airway Obstruction ; Anesthesia ; Bronchial Spasm ; Bronchoscopy ; Endarterectomy, Carotid* ; Humans ; Intubation ; Lung ; Lung Neoplasms ; Pneumonectomy ; Spasm ; Thorax ; Trachea

BACKGROUND: The purpose of this study is to examine the effect of Desflurane on myocardial contractility and cellular electrophysiologic behabior in isolated guinea pig and rat right ventricular papillary muscle. METHODS: The isometric force of a guinea pig ventricular papillary muscle was studied in normal and 26 mM Tyrode's solution at various stimulation rates. Experiments using rat papillary muscles under normal Tyrode's solution at resting-state (RS) and using guinea pig papillary muscles under low Na Tyrode's solution (25 mM) were performed to evaluate the effect on Ca2+ release from the sarcoplasmic reticulum (SR). Normal and slow action potentials (APs) were evaluated by using a conventional microelectrode technique. Effects of desflurane on SR function in situ were examined by its effect on rapid colling contractures (RCCs). 1 MAC (end-tidal concentration: 6%) and 2 MAC desflurane were applied. RESULTS: Desflurane equivalent to 6% and 12% depressed guinea pig myocardial contractions in the control to -70% and -40% from RS to 3 Hz stimulation rates. Contractile force after rest in rat and guinea pig myocardium under low Na Tyrode's solution showed modest depression. In the partially depolarized, beta-adrenergically stimulated myocardium, 6% and 12% desflurane caused marked depression of late force (6%: -60%, 12%: -80%) with moderate changes of early peak force (6%: -20%, 12%: -40%). RCCs were abolished at 6% concentration. CONCLUSIONS: The direct myocardial depressant effects of desflurane is slightly greater to those seen with isoflurane. The rapid initial release of Ca2+ from the SR by depolarization seems to be modestly depressed, although certain release pathways induced by rapid colling appear to be markedly depressed.
Action Potentials ; Animals ; Contracture ; Depression ; Guinea Pigs ; Isoflurane ; Microelectrodes ; Myocardial Contraction ; Myocardium ; Papillary Muscles ; Rats ; Sarcoplasmic Reticulum*