BACKGROUND: Marcaine is a recently introduced hyperbaric bupivacaine and may be suitable for spinal anesthetic solution in parturients undergoing cesarean section. Therefore, we have compared bupivacaine with tetracaine mostly used for spinal anesthesia in cesarean section, about maximum level of analgesia, the time taken to reach it, degree of motor block of lower extremities, degree of patient's satisfaction and cardiovascular variables. METHODS: Forty eight parturients were allocated to bupivacaine(n=26) or tetracaine(n=22) groups in random order. All patients received an infusion of lactated Ringer' solution(1,000 ml) and no premedication before spinal anesthesia. We used standardized techniques and injected the equal dose(10 mg) in equal volume(2 ml) intrathecally for spinal anesthesia. Maximum level of analgesia and time taken to reach it were checked by pinprick test, and degree of motor block was scored by Bromage scale. Blood pressure and heart rate were measured. RESULTS: There were no differences in maximum level of analgesia, motor block of low extremities, patient's satisfaction, blood pressure and heart rate between two groups. But the time taken to reach maximum level of analgesia was faster in the tetracaine group(8.3+/-2.3 min) than in the bupivacaine group(10.5+/-2.1 min)(p<0.05). The incidences of hypotension(systolic blood pressure<30% of preanesthesia value) were fewer in the bupivacaine(1 of 26) group than in the tetracaine group(6 of 22)(p<0.05). CONCLUSIONS: 0.5% hyperbaric bupivacaine reaches slower the maximum level of analgesia but induces fewer incidences of hypotension than 0.5% hyperbaric tetracaine. Therefore, hyperbaric bupivacaine is a safe and reliable anesthetic solution for spinal anesthesia in cesarean section.
Analgesia ; Anesthesia, Spinal* ; Anesthetics ; Blood Pressure ; Bupivacaine* ; Cesarean Section* ; Extremities ; Female ; Heart Rate ; Humans ; Hypotension ; Incidence ; Lower Extremity ; Pregnancy ; Premedication ; Tetracaine*

BACKGROUND: Relative changes of astroglial volume constitute the major part of brain edema, which is related to delayed neuronal damage. Several factors including glutamate may contribute to astroglial swelling. Intravenous anesthetic, ketamine was known to restore neuronal damage by inhibiting NMDA receptor activity. Therefore, we decided to investigate the effect of ketamine on the astrocyte swelling by glutamate in the present study. METHODS: To analyze cell swelling in vitro, glial cell line, U1242MG was used. The effects of glutamate (1, 2, 3 mM), and glutamate with ketamine (1 mM) on the regulation of astrocyte volume were achieved by flow cytometry system. To eliminate the dead cells from experimental cell suspension and to assess cell viability, fluorescent dye propidium iodide was used. RESULTS: Glutamate addition (1, 2, 3mM) caused astroglial swelling both in calcium present and calcium absent buffer. The difference of cellular swelling dependent on glutamate concentration was only seen in calcium free buffer (p<0.05). Ketamine per se did not affect astroglial volume. However, when it was added to glutamate perfusion, 1 mM ketamine diminished cellular swelling by glutamate during first 10 minutes (p<0.05), and cellular shrinkage by glutamate after 1 hour incubation (p<0.05). CONCLUSIONS: Ketamine (1 mM) is effective in the regulation of astroglial volume alterations induced by glutamate in both short time and long time perfusion.
Astrocytes ; Brain Edema ; Calcium ; Cell Survival ; Flow Cytometry ; Glutamic Acid* ; Ketamine* ; N-Methylaspartate ; Neuroglia ; Neurons ; Perfusion ; Propidium

No abstract available.
Drainage* ; Pancreatic Pseudocyst*

BACKGROUND: Clonidine, an 2-adrenergic agonist, shows the analgesic effect and potentiates the analgesic effect of opioid. However, when it is injected with bolus technique, it reveals the short duration of inadequate analgesia and induces hypotension, bradycardia or sedation. We examined the analgesic and side effects of clonidine administered by continuous epidural infusion over 24 hrs, following epidural morphine injection. METHODS: Sixty parturients, scheduled for elective cesarean section under epidural anesthesia were randomly allocated into three groups. They received an infusion of saline alone (group 1, n= 20), clonidine 20 g/hr (group 2, n= 20), or 40 g/hr (group 3, n= 20) respectively, following epidural morphine 3 mg injection at the end of operation. The total doses and number of request for supplemental analgesic, blood pressure, heart rate, and degree of sedation were measured during 24 hrs. RESULTS: There were significant differences in pain relief between clonidine groups and group 1. The total doses and number of patient's request for supplemental analgesic in clonidine groups, compared to group 1 were significantly decreased (p<0.05), but no significant differences between the two clonidine groups. The diastolic pressure of group 3 was significantly lower than that of group 1 over 24 hrs, and that of group 2 at 18 hr, 24 hr (p<0.05). However, there was no severe hypotension, bradycardia or sedation in the three groups. CONCLUSION: Clonidine administered by continuous epidural infusion over 24 hrs enhances the analgesic effect of epidural morphine, and the infusion of clonidine with 20 g/hr rather than 40 g/hr shows minimal changes of blood pressure. Therefore, administration of epidural clonidine (20 g/hr) following epidural morphine may be considered as a regimen for pain management after cesarean section.
Analgesia* ; Anesthesia, Epidural ; Blood Pressure ; Bradycardia ; Cesarean Section* ; Clonidine* ; Female ; Heart Rate ; Hypotension ; Morphine ; Pain Management ; Pregnancy

BACKGROUND: Hemodilution reduces the concentration of clotting factors in blood and this may induce some degree of impairment of coagulation. But there are some evidence that hemodilution may induce a hypercoagulable state. The goal of this study is to investigate the changes of coagulation status during progressive hemodilution. METHODS: Whole Blood was diluted by 10% increment to 80% with 0.9% normal saline. At each 10% dilution blood coagulation status was analysed using thrombelastography (TEG) and was compared with that of an undiluted control specimen obtained concurrently from the same patients. RESULTS: Hemodilutions up to 40% decrease r and K times and increase values of MA and angle. Hemodilutions more than 70% increase r and K times and decrease values of MA and angle. CONCLUSIONS: Hemodilutions up to 40% increase coagulability and hemodilutions more than 70% decrease coagulability of whole blood in vitro.
Blood Coagulation ; Hemodilution* ; Humans ; Thrombelastography

Since the implementation of the model for end-stage liver disease (MELD) scoring system in 2002, the liver transplantation (LT) society has observed a substantial increase in the number of recipients with renal dysfunction. Intraoperative renal replacement therapy (ioRRT) has emerged as one of the solutions available to manage high-MELD score recipients; however, its usefulness has not yet been proven. To date, we have experienced five cases of simultaneous liver and kidney transplantation (SLKT). Recipients of SLKT tend to have a lower pre-transplant kidney function and the longer operation time mandates a larger amount of fluid than LT alone. Hence, anesthetic care is more prone to be challenged by hyperkalemia, metabolic acidosis, and volume overload, making ioRRT a theoretically valuable intervention. However, in all five cases, recipients were managed without ioRRT, resulting in excellent graft and patient survival. As such, in this case series, we discuss current issues about ioRRT and SLKT.
Acidosis ; Humans ; Hyperkalemia ; Kidney Transplantation* ; Kidney* ; Liver Diseases ; Liver Transplantation ; Liver* ; Renal Replacement Therapy* ; Transplants

BACKGROUND: This study was performed to compare responses to the insertion of an intubating laryngeal mask airway (ILMA) and to the intubation of an endotracheal tube according to insertion time when used with sevoflurane and without muscle relaxant. METHODS: We used 50% N2O-O2-8% sevoflurane and a 10% topical lidocaine spray. Forty-eight patients were randomized into four groups according to insertion time (each, n = 12). The ILMA was inserted at 3, 4, 5, and 6 minutes after sevoflurane induction and intubation was performed at 1 minute after ILMA insertion. Responses to intubation, such as vital signs, jaw relaxation, coughing, biting, movements, and laryngospasm were compared according to ILMA insertion time. RESULTS: At 3 minutes, overall responses to insertion and intubation were worse than at 4, 5, and 6 minutes (P < 0.05). At 4, 5, and 6 minutes, responses to the insertion of the ILMA and the intubation of endotracheal tube were satisfactory. CONCLUSIONS: Insertion of ILMA at 4 minutes after sevoflurane induction proved satisfactory, and this could be applied in clinical practice.
Cough ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngeal Masks* ; Laryngismus ; Lidocaine ; Relaxation ; Vital Signs

BACKGROUND: The conventional electroencephalography (EEG) is commonly used as an aid in the diagnosis of Alzhiemer's disease (AD). Recently developed quantitative electroencephalography (qEEG) provides data that are not achievable by conventional EEG. Nevertheless, the clinical reliability and usefulness of spectral analysis and topographic mapping is still a matter of controversy in the diagnosis of Alzheimer's disease. The aim of this study was to compare the topographical quantitative EEG (qEEG) changes between elderly controls and AD patients. METHODS: We analyzed the absolute, relative spectra power and occipital peak frequency taken from 16 derivations by averaging twenty-2-sec epoch in elderly controls and AD patients. After logarithmic transformations of absolute and relative power, a statistical test was done and occipital peak frequency was compared with each other. RESULTS: (1) Compared with normal controls, AD patients had a significantly lower alpha and beta spectra power as well as a significant higher delta spectra power. (2) In AD patients, the peak frequency in occipital lead had a significantly lower frequency than that of elderly controls. (3) Korean Mini-Mental State Examination(K-MMSE) scores were closely related in delta and alpha band power in nearly all electric leads. (4) Compared to absolute power, relative power was a more sensitive tools in detecting changes of EEG in AD patients. CONCLUSIONS: This study suggests that qEEG is a useful tool for detecting the electroencephalographic changes of AD, and correlated with the severity of cognitive dysfunction. Moreover, absolute and relative spectra power is complementary in the clinical utility of qEEG.
Aged ; Alzheimer Disease* ; Diagnosis ; Electroencephalography ; Humans

The effect of epidural morphine on the mean inspired concentration of isoflurane was inves- tigated in 34 patients undergoing hepatoma surgery, The patients were randomly assigned to the control(CTRL), epidural morphine(MORP) or epidural bupivacaine(BUPI) groups. Before induction of anesthesia, epidural catheter was inserted beween T6-10 intervertebral space in the right lateral decubitus position. MORP group(n=13) received morphine sulfate 4 mg in 4 ml normal saline and BUPI group(n=10) received 0.5% bupivacame 10 md through epidural eatheter. CTRL group(n=11) wss treated in an identical fashion except that, after placement of epidural catheter, nothing was injected. After endotracheal intubation, general anesthesia was maintained during surgery with oxygen-nitrous oxide(1:1 ratio) and isoflurane. Inspired concentration of isoflurane was adjusted to maintain blood pressure in the range of blood pressure at the ward during surgery. Mean inspired concentration of isoflurane was monitored from incision to last skin suture. Mean inspired concentration of isoflurane(+/-SD) of CTRL, MORP and BUPI group was 1.41+/-0.36, 1.52+/-0.39 and 0.37+/-0.16 vol%, respectively. There was no difference in mean inspired concentration of isoflurane between CTRL and MORP group. Under the condition of this study, epidural morphine did not reduce inspired concentration of isoflurane during surgery even though epidural morphine is effective for post operative pain control.
Analgesics ; Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Carcinoma, Hepatocellular ; Catheters ; Humans* ; Intubation, Intratracheal ; Isoflurane* ; Morphine* ; Skin ; Sutures

BACKGROUND: The patient's position cannot be changed in the hyperbaric spinal anesthesia until the anesthesia level is fixed because gravity has an effect on the spread of hyperbaric solutions. The isobaric spinal anesthesia has the advantage that the patient's position can be changed soon after drug is injected into the subarachnoid space because gravity has no effect on the spread of isobaric solutions. Most studies of isobaric spinal anesthesia had been made using plain bupivacaine. In this study, effects of drug dose, volume, and concentration on the spinal anesthesia with isobaric tetracaine were investigated. METHODS: Eighty patients were randomly allocated to four groups: 1), group 1 received 1% tetracaine 14mg, 1.4ml (N=20), 2), group 2 received 0.74% tetracaine 14mg, 1.9ml (n=20), 3), group 3 received 0.5% tetracaine 14mg, 2.8ml (n=20), 4), group 4 received 1% tetracaine 19mg, 1.9ml (n=20). Drugs were administered in lateral position at L3~4 level. Neural block was assessed by pinprick. Changes of analgesic level were evaluated with time. RESULTS: Peak analgesic level of group 4 was higher than that of group 2 after 12 minutes and no difference in analgesic level between group 1, 2, and 3 after 18 minutes. Group 4 resulted in longer duration and a higher peak level of sensory block than group 2. CONCLUSIONS: In spinal anesthesia with isobaric tetracaine, the volume is the major factor affecting initial spread of isobaric tetracaine and the dosage was the major factor affecting peak level. High concentration results in longer duration, and higher peak level.
Anesthesia ; Anesthesia, Spinal* ; Bupivacaine ; Gravitation ; Humans ; Subarachnoid Space ; Tetracaine*