BACKGROUND: Mivacurium has a characteristics of rapid onset and the shortest duration of non- depolarizing neuromuscular relaxants and the onset of action could be accelerate more rapidly by using priming principle. The purpose of this study was to compare the onset time of mivacurium by priming principle with succinylcholine during rapid endotracheal intubation. METHODS: 36 patients were randomly divided into 3 groups: mivacurium group by priming principle (Group 1), mivacurium group by bolus injection (Group 2) and succinylcholine group (Group 3). In Group 1, subparalyzing dose of 0.02 mg/kg was administered 2 minutes before principle dose of 0.25 mg/kg was given. Onset time and intubating conditions were observed when twitch tension was reduced by 25% block in each group. RESULTS: The onset of Group 1 (75 sec) was significantly faster than that of Group 2 (90 sec) (p<0.05) but was significantly slower than that of Group 3 (37.5 sec) (p<0.05). Intubating conditions were excellent in all groups. CONCLUSIONS: The attempts of priming principle with mivacurium could accelerate the onset of action of mivacurium compared with that of bolus injection but their onsets were shorter than those produced by succinylcholine.
Humans ; Intubation, Intratracheal* ; Succinylcholine*

BACKGROUND: This study was designed to determine the efficacy of a combined use of oral clonidine and intravenous esmolol for blunting the sympathetic response during tracheal intubation. METHODS: Forty-eight patients for hysterectomy were randomly divided into four groups: placebo A and B in Group I (n = 12), placebo A and esmolol (1.0 mg/kg) in Group II (n = 12), clonidine (4 microgram/kg) and placebo B in Group III (n = 12), and clonidine (2 microgram/kg) and esmolol (0.5 mg/kg) in Group IV (n = 12) were administered respectively. Premedication with oral clonidine or placebo A at 90 minutes before induction and intravenous esmolol or placebo B just prior to induction were given. Patients were induced with thiopental and ventilated with N2O-O2-enflurane (1.5 vol%). Vecuronium was given immediately after administration of thiopental for tracheal intubation. BP and HR were recorded at the resting state before premedication (control), at 1 min before induction (T - 1), immediately after intubation (T + 0), 3 min and 5 min after intubation (T + 3 and T + 5), and were converted into a percentage (%) of the control value (Vcontrol). RESULTS: SBP increased in Group I (T + 0 and T + 3) and decreased in Group III (T + 5) compared with Vcontrol (P < 0.05). HR increased in Group I (T + 0 and T + 3) and Group III (T + 0) compared with Vcontrol (P < 0.05). SBP% of Vcontrol in Groups II, III and IV (T + 0 and T + 3) were lower than that of Group I (P < 0.05). HR% of Vcontrol in Group II and IV (T + 0, T + 3 and T + 5) were lower than those of Groups I and III (P < 0.05). There were one episode of hypotension in Group II at 5 min after intubation and two cases of intraoperative hypotension in Group III. CONCLUSIONS: Combined administration of oral clonidine and intravenous esmolol was effective in attenuating the increase of BP and HR during tracheal intubation without any side effects. This combined method would be an effective method when dose-related side effects of each drug limit their use.
Blood Pressure* ; Clonidine* ; Heart Rate* ; Heart* ; Humans ; Hypotension ; Hysterectomy ; Intubation* ; Premedication ; Thiopental ; Vecuronium Bromide

Cardiac surgery is frequently associated with an excessive perioperative blood loss requiring transfusion of blood products. Various point-of-care(POC) assessments for coagulation and platelet function allow an appropriate and, targeted therapy and reduce blood loss and transfusion requirements. In particular, a quick evaluation of platelet and coagulation defects with new POC devices can optimize the administration of pharmacological and transfusion-based therapy in cardiac surgery. The main advantages of POC tests are shorter time delay, assessment in whole blood and patient's temperature, potential to measure entire clotting process and to include information of platelet function. A transfusion algorithm using POC tests showed effectiveness in reducing intraoperative bleeding and transfusion requirements. Standardized procedure, strict quality control and trained personnel are highly recommended for optimal accuracy and performance of POC tests.
Blood Platelets ; Hemorrhage ; Quality Control ; Thoracic Surgery

BACKGROUND: Local anesthetics for attenuating sympathetic response have been shown to interact with neuromuscular blockers. Most local anesthetics decrease neuromuscular transmission and potentiate neuromuscular blocks of muscle relaxants. The purpose of this study was to examine the effectiveness of lidocaine on the onset time of atracurium and to compare it with that of uccinylcholine. METHODS: Fifty four patients, ASA physical status I or II, were induced with thiopental (4.0 mg/kg) and maintained with O2 -Enflurane (2.5 vol%). After controlled respiration for 3 minutes, muscle relaxants were given. They were randomly divided into three groups: Atracurium (0.5 mg/kg) was administered intravenously for 1 minute in Group A (n = 18), additional lidocaine (1.0 mg/kg) was given intravenously 1 minute prior to the administration of atracurium in Group L (n = 18), and succinylcholine (1.0 mg/kg) was given in Group S (n = 18). Neuromuscular blockade was assessed by train-of-four (TOF) at the adductor pollicis muscle with supramaximal stimulation of the ulnar nerve (2 Hz, 0.2 msec) every 12 seconds. Endotracheal intubation was performed and intubatin g conditions were evaluated according to the standard scoring method after measuring the onset time (from the end of giving muscle relaxants to the 90 % suppression of the first twitch). RESULTS: The onset time of Group L (116.7 13.2 sec) was shorter than that of Group A (154.2 16.1 sec) (P <0.05), but was not as fast as that of Group S (42.5 5.8 sec) (P <0.05). Intubating conditions were good or excellent in all groups. CONCLUSIONS: Additional lidocaine (1.0 mg/kg) for attenuating sympathetic response can accelerate the onset of atracurium in rapid tracheal intubation.
Anesthetics, Local ; Atracurium* ; Humans ; Intubation ; Intubation, Intratracheal ; Lidocaine* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Research Design ; Respiration ; Succinylcholine ; Thiopental ; Ulnar Nerve

BACKGROUND: Clonidine premedication has many beneficial effects in patients undergoing CABG surgery. Amrinone, having the ability to increase cardiac performance without increasing myocardial O2 consumption, is a valuable drug in postoperative management after cardiopulmonary bypass (CPB). The use of amrinone with a catecholamine is also important clinically because the cathecholamines support perfusion pressure and the combined use exerts synergistic or additive effects. We performed this study to examine whether clonidine premedication could change the amount of dopamine used concomitantly with amrinone for management after CPB. METHODS: Nineteen patients for elective CABG were allocated to two groups according to their premedication; a placebo (Group 1, n = 13) or clonidine 4 microgram/kg p.o. (Group 2, n = 6). All patients arrived in the operating room with infusion of isosorbide dinitrate (ID). Anesthesia was performed with standard techniques. Before initiation of CPB, significant lowering of BP or HR was treated with phenylephrine or atropine respectively. Amrinone was given bolus (0.75 mg/kg) and infusion (10 microgram/ kg/min) was begun instead of ID at the release of aortic cross-clamp. Dopamine infusion (3 microgram/kg/min) was started at 35degree C (rectal) and its rate was adjusted for maintaining acceptable hemodynamics. We compared the amount of infused dopamine within 90 mins after CPB between the two groups. We also compared systolic BP, HR and CVP before induction, 10 mins after induction and 60 mins after CPB. RESULTS: Systolic BP and HR before induction and HR 10 mins after induction were significantly lower in Group 2 (P < 0.05), but they were all within normal range. The proportion of patients who needed phenylephrine or atropine before CPB was not significantly different in the two groups. The amount of infused dopamine was significantly larger in Group 2 (P < 0.05). Hemodynamics were acceptable after CPB although HR 60 min after CPB was significantly lower within the normal range in Group 2 (P < 0.05). Weaning time from CPB was not significantly different in the two groups. No significant adverse effect was observed throughout this study. CONCLUSIONS: Clonidine, used as premedication, increases the need of catecholamine which is concomitantly administered with amrinone for weaning from CPB. But this method provides clinically effective result without jeopardizing hemodynamics in CABG.
Amrinone* ; Anesthesia ; Atropine ; Cardiopulmonary Bypass ; Clonidine* ; Coronary Artery Bypass* ; Coronary Vessels* ; Dopamine* ; Hemodynamics ; Humans ; Isosorbide Dinitrate ; Operating Rooms ; Perfusion ; Phenylephrine ; Premedication ; Reference Values ; Weaning

BACKGROUND: Local anesthetics have been shown to interact with neuromuscular blockers. Most local anesthetics decrease neuromuscular transmission and potentiate neuromuscular block from muscle relaxants. The purpose of this study was to examine the effectiveness of lidocaine on the onset time of vecuronium and to compare that with other method such as simply increasing the dose of vecuronium. METHODS: Sixty patients of ASA physical status I or II were induced with thiopental (4-5 mg/kg) and maintained with O2-enflurane (2.5 vol%). They were randomly divided into four groups: Vecuronium (0.1 mg/kg) was administered intravenously in Group C (n = 15), additional lidocaine (1 mg/kg) was given intravenously 1 min prior to administration of vecuronium in Group L (n = 15), increased vecuronium (0.15 mg/kg) was given in Group V (n = 15) and succinylcholine was given in Group S (n = 15), respectively. Neuromuscular blockade was assessed by train-of-four (TOF) at the adductor pollicis muscle with supramaximal stimulation of ulnar nerve (2 Hz, 0.2 ms) every 12 sec. Endotracheal intubation was performed and intubating conditions were evaluated according to the standard scoring method after measuring the onset time (from the end of giving each muscle relaxants to the 90% suppression of the first twitch). RESULTS: The onset time of Group L (122.0+/-11.0 sec) and that of Group V (98.0+/-16.9 sec) were shorter than that of Group C (135.2+/-16.0 sec) (P<0.05), but these were not shorter than that of Group S (42.0+/-6.2 sec). There was no statistical difference between Group L and Group V. Intubating conditions were good or excellent in all groups. CONCLUSIONS: Additional lidocaine for attenuating sympathetic response could accelerate the onset of vecuronium. But the onset time of this method was not shorter than that of simply increasing the dose of vecuroium nor that of succinylcholine.
Anesthetics, Local ; Humans ; Intubation, Intratracheal ; Lidocaine* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Research Design ; Succinylcholine ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide*

BACKGROUND:Administration of a rapid or large dose of remifentanil (>1.0microg/kg for 30?60 s) should be avoided due to its association with side effects such as muscle rigidity. The present study determined the infusion rate and dosage of remifentanil administered using target-controlled infusion (TCI) varies with the modality selected and the target concentration. METHODS: Data including the age, sex, weight, and height of 10 patients undergoing elective surgery in a university hospital were randomly used for a 3-min simulation of TCI-remifentanil Minto model. In every simulation, TCI targeting both plasma (Cp) and the effect-site (Ce) was performed repeatedly with varying target concentrations (2, 3, 5, 10, and 20 ng/ml). The rate of administration and the cumulative dosages of remifentanil (per min) in all of the TCI simulations were recorded and analyzed. RESULTS: The rates of Ce TCI were significantly greater than those of Cp TCI using the same concentration. The cumulative dosage in the first-minute TCI simulation with Cp 20 ng/ml, and Ce 3, 5, 10, 20 ng/ml exceeded 1.0microg/kg/min. CONCLUSIONS: The target concentration and the infusion modality should be selected carefully to avoid rapid infusion and an overdose of remifentanil.
Humans ; Muscle Rigidity ; Piperidines ; Plasma

BACKGROUND:Administration of a rapid or large dose of remifentanil (>1.0microg/kg for 30?60 s) should be avoided due to its association with side effects such as muscle rigidity. The present study determined the infusion rate and dosage of remifentanil administered using target-controlled infusion (TCI) varies with the modality selected and the target concentration. METHODS: Data including the age, sex, weight, and height of 10 patients undergoing elective surgery in a university hospital were randomly used for a 3-min simulation of TCI-remifentanil Minto model. In every simulation, TCI targeting both plasma (Cp) and the effect-site (Ce) was performed repeatedly with varying target concentrations (2, 3, 5, 10, and 20 ng/ml). The rate of administration and the cumulative dosages of remifentanil (per min) in all of the TCI simulations were recorded and analyzed. RESULTS: The rates of Ce TCI were significantly greater than those of Cp TCI using the same concentration. The cumulative dosage in the first-minute TCI simulation with Cp 20 ng/ml, and Ce 3, 5, 10, 20 ng/ml exceeded 1.0microg/kg/min. CONCLUSIONS: The target concentration and the infusion modality should be selected carefully to avoid rapid infusion and an overdose of remifentanil.
Humans ; Muscle Rigidity ; Piperidines ; Plasma

BACKGROUND:We performed this study to determine the influence of the administration of pneumoperitoneum on the blood flow of the thoracoabdominal aorta during laparoscopic cholecystectomy (LC). METHODS: Ten patients for LC were enrolled in this study. Anesthesia was performed with propofol, fentanyl and rocuronium. Pneumoperitoneum was made by CO2 gas intraperitoneal instillation at an intraperitoneal pressure of 10-12 mmHg. Peak velocity of blood flow in the systolic phase (PV), mean acceleration of blood flow from the start of systole (MA) and systolic flow time corrected for heart rate (FTc), measured by esophageal doppler monitoring (EDM), and heart rate (HR) and mean brachial BP (MBP) were measured 1, 5 and 10 min after the institution of pneumoperitoneum, (T1, T5 and T10) and compared with those before the institution of pnuemoperotoneum (T0). LC was started after recording all measurements and a position change to the reverse-Trendelenberg position. RESULTS: PV, MA, FTc and HR showed no significant change throughout this study, but MBP at T5 and T10 (110.1 +/- 18.5 mmHg and 107.8 +/- 10.4 mmHg) were significantly higher than at T0 (84.9 +/- 12.9 mmHg) (P = 0.002 and 0.005 respectively). CONCLUSIONS: The administration of pneumoperitoneum neither changed nor interferenced with abdominal aortic blood flow.
Acceleration ; Anesthesia ; Aorta ; Cholecystectomy, Laparoscopic* ; Fentanyl ; Heart Rate ; Humans ; Pneumoperitoneum* ; Propofol ; Systole

BACKGROUND: Sufficient accumulations of local anesthetics in the extrapleural space promotes effective access to several intercostal nerves and, consequently, analgesia. The total volume of leakage of these anesthetics from the space can depend on the technique of extrapleural catheter insertion which is chosen. METHODS: Twenty patients due for thoracotomy were randomly selected to be provided with postoperative pain relief by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced at a longitudinal lie in a cephalad direction, before the thoracic cavity was closed. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfactory to patients and thoracic surgeons. The average numbers of analgesic dermatomes obtained by pinprick tests, VAS, and Prince Henry pain scores were 5.2 0.5, 2.0 0.5 cm and 1.6 0.6, respectively. Changes in mean arterial pressure were insignificant, and heart rate increased at the postoperative hours of 1, 4 and 8 (P value < 0.05). FVC and FEV1 were restored to levels up to 67.2 and 71.0% of their preoperative values at the postoperative hour of 48. CONCLUSIONS: These results suggest that the technique of a catheter introduced at a longitudinal lie in a cephalad direction was effective and clinically useful for pain relief following thoracotomy regardless of some leakage of bupivacaine.
Analgesia ; Anesthesia ; Anesthetics ; Anesthetics, Local ; Arterial Pressure ; Bupivacaine ; Catheters* ; Cough ; Epinephrine ; Heart Rate ; Humans ; Intercostal Muscles ; Intercostal Nerves ; Pain Management* ; Pain, Postoperative ; Pleura ; Respiration ; Thoracic Cavity ; Thoracotomy*