OBJECTIVE: To estimate the application of prognosis evaluation of ulnar nerve injury by 1H-magnetic resonance spectroscopy (1H-MRS). METHODS: The metabolites of first dorsal interossei (FDI) of two hands from 12 healthy volunteers and 1 volunteer with complete ulnar nerve injury were detected by 1H-MRS and the data were statistically analyzed. RESULTS: For the FDI of healthy adults, the female peaks area of extra-myocellular lipids (EMCL) was higher than the male (P < 0.05); There was no significant difference in Cho, Cr and intra-myocellular lipids (IMCL) between male and female (P > 0.05); There was no significant difference in all the peaks area between the left and right hand (P > 0.05). The EMCL peak of the injury side was higher than that of the healthy side, and the area of FDI was reduced in the volunteer with ulnar nerve injury. CONCLUSION Noninvasive and quantitative detection of 1H-MRS may be valuable for prognosis evaluation of peripheral nerve injury.
Adult ; Female ; Humans ; Male ; Peripheral Nerve Injuries/diagnosis* ; Prognosis ; Proton Magnetic Resonance Spectroscopy/methods* ; Sex Distribution ; Ulnar Nerve/metabolism*

BACKGROUND: Atracurium is eliminated by Hofmann elimination and ester hydrolysis, with minimal renal and hepatic excretion. It's action duration is not affected by renal function. Although metabolism of vecuronium is less dependent on the renal function than other steroid type neuromuscular blockers, the action duration of vecuronium is prolonged in renal failure. The purpose of this study is to compare the differences of the action duration of atracurium and vecuronium in patients with renal failure. METHODS: Forty patients with normal renal function and 40 patients with chronic renal failure were assigned to one of four groups: atracurium-normal (n=20, AC group), atracurium-renal failure (n=20, AK group), vecuronium-normal (n=20, VC group), vecuronium-renal failure (n=20, VK group). Anesthesia was induced with thiopental and maintained with the inhalation of nitrous oxide (50%) and isoflurane (0.5~1.5 vol%). Atracurium (0.5 mg/kg) or vecuronium (0.1 mg/kg) was given and endotracheal intubation was performed after twitch response was depressed more than 80%. Neuromuscular blockade was assessed by train-of-four at the adductor pollicis with supramaximal stimulation of ulnar nerve of 2 Hz every 12 sec. The onset time, duration of 5, 25, 50, 75% recovery time and recovery index were checked. RESULTS: Onset of block was not significantly different among four gorups. Recovery time of 5, 25, 50, 75% and recovery index were longer in the both renal failure groups. Action durations in renal failure were not significantly different between AK and VK groups. CONCLUSION: It is concluded that action duration of atracurium and vecuronium are affected by renal function. We would better monitor muscle relaxation and titrate dose of muscle relaxant.
Anesthesia ; Atracurium* ; Humans ; Hydrolysis ; Inhalation ; Intubation, Intratracheal ; Isoflurane ; Kidney Failure, Chronic ; Metabolism ; Muscle Relaxation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Nitrous Oxide ; Renal Insufficiency* ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide*

The elimination of most anticholinesterases depends on the kidney, even if the main organ for their metabolism is the liver. Renal excretion of pyridostigmine, edrophonium and neostigmine accounts for 15%, 70% and 50%, respectively. In the absence of renal function, the serum half-life of neostigmine is prolonged, its plasma clearance is decreased However, the pharmacodynamics of neostigmine have not been determined in renal failure. This study was designed to compare the neostigmine dynamics in 18 patients with normal renal function to that in 18 patients with renal failure(Group I & II, respectively). Using the flexor carpi ulnaris EMG via ulnar nerve stimulation with Train-Of-Four(TOF) under the constant infusion of vecuronium to produce about 85%-twitch depression, the responses of neostigmine with three different doses were obtained. The results are follows; 1) The constant infusion rates of vecuronium to maintain sbout 15&-twitch height prior to the administration of neostigmine showed no significant difference between two groups. 2) Immediately prior to each dose of neostigmine, the mean values of twitch heights were 11.7 to 13.7%. 3) There was no significant difference in the onset time, maximum twitch responses and antagonism effects between two groups in respect to each same dose of nesotigmine. 4) The duration of neostigmine with the half of ED only in Group II was significantly longer than that in Group I, even if the durations with the other doses in Group II were not significantly longer than those in Group L These results suggest that the reversal effect of neostigmine to vecuronium-induced block- ade may be outlasted in patients with renal failure and the prolongation of neostigmine effeet may render some benefits to reverse the relaxants which have the limitation of its elimination in this patients.
Cholinesterase Inhibitors ; Depression ; Edrophonium ; Half-Life ; Humans ; Kidney ; Liver ; Metabolism ; Neostigmine* ; Neuromuscular Blockade* ; Plasma ; Pyridostigmine Bromide ; Renal Insufficiency* ; Ulnar Nerve ; Vecuronium Bromide*

Anesthesiologists may have close relationship with muscle relaxants in clinical practice fortunately, few of the new muscle relaxants were discovered and used in clinic recently. In this moment we have to look back the old muscle relaxants. Undesirable side effects of thIn old ones are less common, but encountered often enough to be troublesome. For example, succinylcholine(depolarizer) mar enhance drsrhythmia, rise in plasma pot-assium, increase in intraocular pressure, rise in intragastric pressure, triggering malignant hrperpyrexia Trestle Pain and dual block etc. Is there a simple screen test for the atypical cholinesterase? Unfortunately it's not available now. Nevertheless depolarizer was still used in many decades. That's the matter? Muscle relaxants are also affected by many factors those are renal excretion, metabolism of the drug, lilver or disease, effect of jaundice, muscle blood flow, production and release of acetylcholine, bod)'temperature, antibiotics, other drug interactions, electrolyte imbalance, pathological status, individual differences and species differences etc. Sometimes it will make a trouble for the anesthesia practice. So anesthesiologists must be familiar with the use of muscle relaxants. And also we have to think twice about it's clinical use before given to the patients. What Is the right methods of rational use of muscle relaxants? What is the right way to reverse muscle relaxation? Obviously, return of normal muscle function followin? muscle relaxant administration is of prime importance to restoration of adequate spontaneous ventilation because it is clini-call velr i rnportant. In human study; supramaximal ulnar nerve stimulation was delitrered br a Peripheral nerIFe stimulatur(Ml'oftest, Biometer MK II) through electrode at the wrist. Stimuli were detail erect continuousl) by either 7 TOF or sin 91e twitch stimuli. The resultant force of thumb adduction was measured and recorded by Biophysiograph(San Ei, Japan) through the force displacoment transducer. In animal study: all animals were intubated through a tracheostomr under the intraper-itoneal urethane anesthesia with nembutal given intravenously. Respiration was controlled by means of Shinano animal respirator. The body temperature 7as kept at 35 degrees C with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and nerve stimulator was applied to the nerve-muscle preparation. The twitch height of the muscle contraction was recorded on a Biophrsiograph through the force displacement Ira-nsfucer. The common peroneal nerve was stimulated supramaximally using a peripheral nerve stimulator with a "TOF" stimulation or single twitch stimulation. Obviously, newly introduced muscle relaxants are certainly have advantage over the old ones but we should hatre further studies on them. Conclusions ; 1) Minimal dose of muscle relaxant which may produce 90~100% of twitch depression may use depend on the types of surgery. 2) To evaluate the type and degree of muscle relaxation intermittently by use of the peripheral nerve stimulator is essential. 3) Best choice of the muscle relaxants are should be non-depolarizers those mar promp-tly reversed by anticholinesterases.
Acetylcholine ; Anesthesia ; Animals ; Anti-Bacterial Agents ; Body Temperature ; Cholinesterase Inhibitors ; Cholinesterases ; Cimetidine ; Depression ; Drug Interactions ; Electrodes ; Humans ; Individuality ; Intraocular Pressure ; Jaundice ; Metabolism ; Muscle Contraction ; Muscle Relaxation ; Muscle, Skeletal ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents* ; Neuromuscular Junction ; Pentobarbital ; Peripheral Nerves ; Peroneal Nerve ; Plasma ; Respiration ; Thumb ; Transducers ; Ulnar Nerve ; Urethane ; Ventilation ; Ventilators, Mechanical ; Wrist