BACKGROUND: It has been said that anesthesia and surgery tend to increse 'stress hormone' followed by reduction of GFR and urine flow. We have been noticed a polyuria during mastoidectomy with anesthesia. We hypothesized that a reduction of ADH secretion related to operative procedure might be a cause of a transient polyuria. METHODS: In 41 patients who were in ASA class I, mean arterial pressure (MAP), heart rates (HR), temperature, central venous pressure (CVP) were measured at before induction, just before drilling with irrigation, 30 minutes and 60 minutes after drilling with irrigation, and on arrival in recovery room by groups (room temperatured irrigating fluid and warm fluid were used in group 1 and group 2) during procedures. In 7 of 41, blood samples for antidiuretic hormone (ADH) and plasma osmolalities (Posm) were withdrawn at the same time points. In all patients, fluid were administered with 4 ml/kg/hour throughout the procedures. RESULTS: In group 1, mean urine volume were 5.0 and 6.4 ml/min during anesthesia and drilling with irrigation that was significantly more than in group 2 (3.6 and 4.2 ml/min). In 7 patients, ADH concentration was decreased during surgery compared to pre-induction level, while the Posm were in normal ranges. None of the MAP, HR and CVP showed significant changes. ADH concentrations were not significantly correlated to Posm. CONCLUSIONS: We suggest that a reduction of ADH secretion may have a major role in transient polyuria during mastoidectomy, which might be related to the mechanism that; 1) lowered temperature of hypothalamo-pituitary system by cold irrigating fluid may induce a transient ischemic changes of pituitary gland, 2) absorption of hypoosmolar irrigating fluid to central circulation may reduce central osmotic pressure.
Absorption ; Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Central Venous Pressure ; Heart Rate ; Humans ; Osmolar Concentration ; Osmotic Pressure ; Pituitary Gland ; Plasma* ; Polyuria ; Recovery Room ; Reference Values ; Surgical Procedures, Operative

BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

BACKGROUND: We observed fentanyl known as centrally-acting antitussive agents provoke a cough response in some patients at induction of anesthesia. This may be of clinical importance. METHOD: 121 patients (ASA class I) were assigned randomly to 4 groups. Each group was given different doses of fentanyll Group 1 (n=30); 0.5ug/kg, Group 2 (n=30); 1ug/kg, Group 3 (n=33); 2ug/kg, Group 4 (n=28); 4 g/kgl, within 1 second through a peripheral venous cannula before induction of anesthesia. All patients were observed carefully in order to detect a cough response and any side effects. RESULT: The incidences of FCR (Fentanyl Cough Response) were 0% in Group 1, 10.0% in Group 2, 30.3% in Group 3, and 39.3% in Group 4. The ED50 of FCR was 4.25ug/kg. The mean onset-time from the end of fentanyl administration to the beginning of coughing was 12.5 seconds. FCR was decreased with aging, but not affected by weight, height, or smoking. Other serious side effects were not accompanied. CONCLUSION: Fentanyl can evoke the pulmonary chemoreflex dose-dependently and the ED50 was 4.25 g/kg.
Aging ; Anesthesia ; Antitussive Agents ; Catheters* ; Cough* ; Fentanyl* ; Humans ; Incidence ; Reflex* ; Smoke ; Smoking

This experimental work was performed on 4 rabbits to demonstrate that administrations of oxygenated Ringer's lactate through the central venous infusion could be used as a means of oxygenation. The oxygen tensions of Ringer's lactate were determined upon changing the amount of oxygen being bubbled and the solutions with the mean PO2 and pH of 575.5 mmHg and 6.34 were used in this study. We did not use the solutions having the values below 416.6 mmHg PO2 and pH 6.08. After the infusion of the oxygenated solution through central vein, PaO2 values throughout the 1 hour experimental procedure were significantly increased above the control value. Other parameters such as pH, PaCOs, HCO3-, BE, O2 saturation did not show any statistically significant changes. Some degree of oxygenation could be obtained by infusing the oxygenated Ringer's solution. This suggested that oxygenation by infusion through the central venous line could used clinically in the treatment of some forms of hypoxia with hypovolemia.
Analysis of Variance ; Animals ; Blood Gas Analysis ; Infusions, Intravenous ; Isotonic Solutions/*administration & dosage ; Oxygen/*administration & dosage ; Rabbits

Anemia ; Hemodilution ; Humans ; Hypothermia

The Humphrey circuit system function with the efficiency of the Lack system for spontaneous respiration and of the Bain system for controlled ventilation. It is designed to incorporate into a single system the advantages of the Mapleson A, D, and E type systems and to be available in coaxial and non-coaxial forms. This study was done to study the functions of a new anesthetic breathing system and to evaluate the adequacy of the recommended fresh gas flow. For spontaneous and controlled ventilation the system required a low fresh gas flow to achieve normocarbia(In the Lack circuit system, 60ml/min., is useded and in the Bain circuit system, 70ml/min.). The advantage of this system was that it was simple to operate and maintain, more easily sterilized and applicable in academic use. Further more the non-coaxial form of the circuit overcame the hazard of the inner tube complication. But this form was thought to have the problem of humidifying the inspired gas which still has to be sutdied. This multicircuit system was used satisfactorily with low fresh gas flow under spontaneous and controlled ventilation maintaining normal range of arterial carbon dioxide. It may become one of the preferred semiclosed breathing systems because of simplicity, multipurpose usefulness and other advantages.
Carbon Dioxide ; Reference Values ; Respiration ; Ventilation

Currently conventional modes of controlled mechanical ventilation, such as intermittent positive pressure ventilation (IPPV) and continuous positive pressure ventilation (CPPV), with high volumes and low rates are utilized for the rhythmic inflation of the lungs. Basically the functional characteristics of these systems have not changed since Bjork and Engstrom first reviewed them in 1955 (Bjork and Engstrom 1955; Sjostrand 1983). Impairment of cardiovascular function and increasing the incidence of barotrauma with high airway pressure were problems which have needed to be solved. Thus respiratory support using high rates and low tidal volumes of ventilation was given. High-frequency ventilation(HFV) is not totally new idea, prototypes of it are found in nature in humming birds, insects and newborn babies. Moreover, HFV was reported in 1915 by Handerson who said that an adequate gas exchange could take place with a tidal volume less than the anatomical deadspace. But since the introduction of HFV in 1967, the basic concept of respiratory physiology has changed (Sjostrand and Smith 1983). HFV has received much attention in the last 20 years, resulting in a considerable accumulation of information. Many experimental and clinical studies have detailed the potential advantages of HFV but indicate that much work needs to be done to define and clarify the clinical role of these techniques and suggest that the standardized, reliable equipment with safety systems be developed. The purpose of this review is not to offer definite information for further investigation, but simply to provide background information for a better understanding of the experimental and clinical results recently achieved by many other researchers. Limited foci are as follows: 1) Definition and classification of HFV. 2) Technical developments and considerations. 3) Physiologic aspects of HFV. 4) Clinical applications. 5) Comparative studies between IPPV and HFV. 6) Problems and looking ahead.
Comparative Study ; High-Frequency Jet Ventilation ; High-Frequency Ventilation*/classification ; Human ; Intermittent Positive-Pressure Ventilation

Currently conventional modes of controlled mechanical ventilation, such as intermittent positive pressure ventilation (IPPV) and continuous positive pressure ventilation (CPPV), with high volumes and low rates are utilized for the rhythmic inflation of the lungs. Basically the functional characteristics of these systems have not changed since Bjork and Engstrom first reviewed them in 1955 (Bjork and Engstrom 1955; Sjostrand 1983). Impairment of cardiovascular function and increasing the incidence of barotrauma with high airway pressure were problems which have needed to be solved. Thus respiratory support using high rates and low tidal volumes of ventilation was given. High-frequency ventilation(HFV) is not totally new idea, prototypes of it are found in nature in humming birds, insects and newborn babies. Moreover, HFV was reported in 1915 by Handerson who said that an adequate gas exchange could take place with a tidal volume less than the anatomical deadspace. But since the introduction of HFV in 1967, the basic concept of respiratory physiology has changed (Sjostrand and Smith 1983). HFV has received much attention in the last 20 years, resulting in a considerable accumulation of information. Many experimental and clinical studies have detailed the potential advantages of HFV but indicate that much work needs to be done to define and clarify the clinical role of these techniques and suggest that the standardized, reliable equipment with safety systems be developed. The purpose of this review is not to offer definite information for further investigation, but simply to provide background information for a better understanding of the experimental and clinical results recently achieved by many other researchers. Limited foci are as follows: 1) Definition and classification of HFV. 2) Technical developments and considerations. 3) Physiologic aspects of HFV. 4) Clinical applications. 5) Comparative studies between IPPV and HFV. 6) Problems and looking ahead.
Comparative Study ; High-Frequency Jet Ventilation ; High-Frequency Ventilation*/classification ; Human ; Intermittent Positive-Pressure Ventilation

BACKGROUND: Korean Journal of Anesthesiology was published in 1968 and its volume has been increased every year. The purpose of this study was to investigate and to clarify the trend of increasing volumes for 28 years (1968~1996) as quantitative analysis. METHODS: Using computerized index of Korean Journal of Anesthesiology (""ART""), the trend, volumes and cumulative records (top ranked 22 frequently cited key words, 16 persons and 10 departments of University) were calculated. Some key words such as ""Anesthetic techniques: spinal, Anesthetics, intravenous:, Anesthetics, volatile: halothane, Complications:"" was traced every year for grasping the trend of academic concerns. RESULTS: 1. Total volumes of articles were about 3,000 (1968~1996). The volumes were increased slowly until 1976 and steeply since 1986. 2. The ratio of clinical case reports has been decreased every year. 3. Key words ""Anesthetic techniques"", ""Surgery"" and ""Complications"" were more frequently cited than the others. 4. Tracing some key words showed their vitality in anesthetic fields. 5. The personal top ranked number of records revealed each author's contribution to Korean Journal of Anesthesiology and the number of records in each department of University could be used as an index of academic activity. CONCLUSIONS: The extent of the increasing volumes was great especially from 1986 to 1996 and the proportion of original articles has been increased every year. The frequency of the investigated key words showed their own vitality in the field of anesthesiology. The rank according to personal and departmental records suggested the possibility of reflecting a measure of academic concerns and activity.
Anesthesiology* ; Anesthetics ; Anesthetics, Intravenous ; Halothane ; Hand Strength ; Humans