BACKGROUND: In order to understand the pathogenetic mechanism of sepsis-induced acute lung injury, inhibition of phospholipase A2 (PLA A2) was carried out in an endotoxin-induced septic lung model. METHODS: Sprague-Dawley rats were divided three groups; sham group, endotoxin group (instillation of E coli endotoxin, 100microgram/rat, type 017) and mepacrine group (the non-specific PLA2 inhibitor, 50 ml/kg intraperitoneal injection after endotoxin treatment). Five hours after endotoxin treatment, protein contents, neurophils counts, gamma-glutamyl transpeptidase (GGT) activity and surfactant concentrations in the bronchoalveolar fluid (BAL), meyloperoxidase (MPO) and PLA2 activity in the lung were measured. A morphological study for the effect of the endotoxin and mepacirne, and a cytochemical electron microscopy for detection of hydrogen peroxide in the lung were also performed. RESULTS: Endotoxin increased the concentrations of protein, the number of neutrophils, and GGT activity in the BAL fluid, MPO and PLA2 activity in the lung but mepacrine decreased these parameters (P < 0.001). The light density of surfactant was increased by the endotoxin (P < 0.001), but mepacrine diminished this pathological change. In the light microscopic findings, the endotoxin caused pulmonary accumulation of neutrophils, atelectasis and transudation of intravascular protein was observed. In contrast, mepacrine lessened these pathological findings. In ultrastructural findings, adhesion of neutrophils to endothelial cells, necroses of type II cells and endothelial cells, and the damage of lamellar bodies were observed after the endotoxin treatment, which recovered with mepacrine. In the cytochemical electron microscopy for detection of hydrogen peroxide in the lung, the deposits of cerrous perhydroxide were increased by the endotoxin but mepacrine decreased deposits of cerrous perhydroxide. CONCLUSIONS: Inhibition of PLA2 in an endotoxin induced acute lung leak showed protection against oxidative stress by a diminution of neutrophilic respiratory bursts and a decreased production of free radicals. It is suggested that PLA2 has a pivotal role in causing acute oxidative stress in endotoxin induced acute lung injury.
Acute Lung Injury* ; Endothelial Cells ; Escherichia coli* ; Free Radicals* ; gamma-Glutamyltransferase ; Hydrogen Peroxide ; Injections, Intraperitoneal ; Lung* ; Microscopy, Electron ; Necrosis ; Neutrophils ; Oxidative Stress ; Oxygen* ; Phospholipases A2* ; Phospholipases* ; Pulmonary Atelectasis ; Quinacrine ; Rats, Sprague-Dawley ; Respiratory Burst

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Sudden, profound hypotensive and bradycardic events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. Although HBEs may be associated with the adverse effects of interscalene brachial plexus block (ISBPB) in the sitting position, the underlying mechanisms responsible for HBEs during the course of shoulder surgery are not well understood. The basic mechanisms of HBEs may be associated with the underlying mechanisms responsible for vasovagal syncope, carotid sinus hypersensitivity or orthostatic syncope. In this review, we discussed the possible mechanisms of HBEs during shoulder arthroscopic surgery, in the sitting position, under ISBPB. In particular, we focused on the relationship between HBEs and various types of syncopal reactions, the relationship between HBEs and the Bezold-Jarisch reflex, and the new contributing factors for the occurrence of HBEs, such as stellate ganglion block or the intraoperative administration of intravenous fentanyl.
Arthroscopy ; Brachial Plexus ; Bradycardia ; Carotid Sinus ; Fentanyl ; Humans ; Hypersensitivity ; Hypotension ; Reflex ; Shoulder ; Stellate Ganglion ; Syncope ; Syncope, Vasovagal

BACKGROUND: Major respiratory problems during spinal anesthesia occur due to several causes, particulary, high spinal block, use of sedatives or opioids, and underlying cardiopulmonary diseases. Pulse oximetry has prevented most of these problems, but has not provided rapid and accurate information of the patient's ventilation. We measured end-tidal CO2 tension via the side-stream capnometer with a small rubber cannula and investigated its effectiveness in ventilatory monitoring under spinal anesthesia. METHODS: Nineteen patients were involved in this study. We performed spinal anesthesia with 0.5% heavy marcaine 12 mg (L3-4 interspace). After fixation of spinal sensory blockade level, 0.035 mg/kg of midazolam was administered intravenously to sedate the patient. A polyvinylchloride catheter with a rubber extending nasal cannula was used for sampling of respiratory gas. PETCO2 was measured at 15 minutes after spinal anesthetic injection (before sedation), and at 5 minutes after midazolam injection (after sadation). Arterial CO2 tension was also measured during PETCO2 measurement. RESULTS: There was no correlation of spinal maximal sensory blockade level with repiratory rate, PaCO2 and PETCO2. Linear regression analysis of arterial vs. end-tidal CO2 yielded a slope of 0.92, r=0.81 and p<0.001 (before sedation), and a slope of 0.98, r=0.79 and p<0.01 (after sedation). Arterial to end-tidal differences were 4.2+/-2.8 mmHg (before sedation) and 4.3+/-3.0 (after sedation), but there was no significant difference in comparing them with each other. Conclusions : We conclude that this form of PETCO2 measurement is useful in continuous, noninvasive monitoring of ventilation in patients under spinal anesthesia.
Analgesics, Opioid ; Anesthesia, Spinal* ; Bupivacaine ; Catheters* ; Humans ; Hypnotics and Sedatives ; Linear Models ; Midazolam ; Oximetry ; Rubber ; Ventilation

Mucous impaction in surgical patients can lead to a large area of atelectasis, hypoxemia, and pulmonary vasoconstriction in sequence. We describe two cases of mucous impaction following endotracheal intubation in children with an upper respiratory infection (URI) that were successfully treated with a rigid or fiberoptic bronchoscopy. These cases show that the administration of general anesthesia to children with a URI is not benign and that these children require close observation and management in the preoperative and perioperative phase of their surgical procedure.
Anesthesia, General ; Anoxia ; Bronchoscopy ; Child* ; Humans ; Intubation, Intratracheal* ; Pulmonary Atelectasis ; Vasoconstriction

BACKGROUND: Many factors affecting the spread of spinal anesthesia have been investigated. But L3-4 or L4-5 interspace was choosen which was known as the site of buffering, in their study. We investigated the effect of some of these factors on sensory blockade level by using L2-3 interspace. METHODS: Eightyfive patients, ASA physical status I - Il, were involved in our study. Sensory blockade level was checked with pinprick test at 10 minutes and 30 minutes. The effect of age, sex, height, weight, CSF pressure and pressure difference generated when full flexed and non-full flexed lateral position on sensory blockade level was studied whereas other factors such as puncture technique, dosage and concentration of drug and patients position after injection, were kept constant under the same condition. And also studied the effect of degree of flexion at injection on the sensory blockade level. RESULTS: Height and CSF pressure were correlated with sensory blockade level at 10 minutes after injection(R2=0.14, P<0.01). Only height was correlated with sensory blockade level at 30 minutes after injection(R2=0.09, P<0.0l). CONCLUSIONS: Only height was correlated with sensory blokade level at 30 minutes. So, height might be considered as the most impressive minor factor affecting the extent of sensory blockade level.
Anesthesia, Spinal* ; Humans ; Punctures

OBJECTIVE: The ovarian cycle is characterized by repeating patterns of cellular proliferation and differentiation that accompany follicular development and the formation and regression of the corpus luteum (CL). That angiogenesis may play an important role in this process. Angiogenesis is supposed to be regulated by vascular endothelial growth factor (VEGF). The goal of the present investigation, therefore, was to determine whether the expression of VEGF was changed in the normally cycling human ovary. We also investigated VEGF expression in the regressed CL (ie, nonfunctiong CL) of normal term pregnancy to define the association with steroidogenic activity. To our knowledge there is no report available on VEGF expression in the CL of term pregnancy. METHODS: We assessed VEGF expression in ovaries obtained from, 26-42 yr of age, and from patients undergoing hysterectomy and salpingo-oophorectomy for nonendocrinological or nonovarian disorders. Tissue samples from premenopausal women included specimens from follicular (n=4) and luteal (n 4) phases. In addition, we studied ovarian specimens from pregnant women (n=3). Immunohistochemical analysis for VEGF was performed using a rabbit polyclonal antibody directed against human VEGF. RESULTS: These data demonstrate a development-related VEGF expression in the follicle and indirectly show that VEGF expression may be up to the existence of LH-receptor. And also, VEGF was overexpressed in the regressed CL of pregnant women compared with the functioning CL of nonpregnant cycles CONCLUSION: This study suggests that the intensity of VEGF expression is not correlated with steroidogenic activity, although both of them are stimulated by LH.
Cell Proliferation ; Corpus Luteum ; Female ; Humans* ; Hysterectomy ; Menstrual Cycle ; Ovarian Follicle ; Ovary* ; Pregnancy ; Pregnant Women ; Vascular Endothelial Growth Factor A*

BACKGROUND: The goal of our study was to investigate the effects of propofol anesthesia on the pulmonary vascular response to prostacyclin during U46619 precontraction in dogs. METHODS: Eight mongrel dogs were anesthetized and instrumented to measure the left pulmonary vascular pressure-flow relation, by loosely positioning a hydraulic occluder around the right main pulmonary artery and placing an electromagnetic flow probe around the left main pulmonary artery. During slowly occlusion of the right main pulmonary artery, the pressure-flow plots were measured in the left main pulmonary artery in the control and propofol-anesthetized (5.0 mg/kg plus 0.5 mg/kg/min intravenously) states at baseline, after preconstriction with the U46619, and during the cumulative intravenous administration of prostacyclin. RESULTS: Propofol had no effect on the baseline pressure-flow relation versus the control state. A lower (P <0.05) dose of U46619 was necessary to achieve the same degree of preconstriction during propofol anesthesia. The pulmonary vasodilator response to prostacyclin was markedly attenuated (P <0.05) during propofol anesthesia compared to the control state. CONCLUSIONS: These results imply that propofol directly inhibits the pulmonary vasodilatory effects of prostacyclin. However the signal transduction pathway of cyclooxygenase-induced pulmonary vasodilation requires further investigation to determine mechanisms involved.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid* ; Administration, Intravenous ; Anesthesia ; Animals ; Dogs* ; Epoprostenol ; Magnets ; Propofol* ; Pulmonary Artery ; Pulmonary Circulation ; Signal Transduction ; Vasodilation*

BACKGROUND: Although used for obtund pain, bupivacaine may itself initially produce pain on injection. This study was designed to evaluate the effect of diluting bupivacaine with normal saline, lactated Ringer's solution, 5% dextrous in water and distilled water on perception of pain associated with intramuscular injection. METHODS: Twenty-five healthy volunteers were involved in this study. Each subject received 4 injections in random order: 0.25% bupivacaine in normal saline, lactated Ringer's solution, 5% dextrous in water and distilled water. Both upper trapezius muscles were used for the intramuscular injection site. Needle size (25-gauge), injection depth (1.5-2 cm), injection volume (2.5 ml), administration speed (0.5 ml/sec), and temperature (room) were controlled for each of the four injections. The intensity of pain was rated on a 0 to 10 visual analogue scale (VAS) score at the point of needle insertion and injecting solutions. RESULTS: There was no statistical difference among each solution in VAS score. However, the VAS scores of drug administration were higher than those of needle insertion in all diluting solutions (P<0.05). CONCLUSIONS: There was no difference in the intensity of pain of an intramuscular injection of bupivacaine between four different kinds of solutions. However, it might be suggested that more effort and investigation will be needed to reduce pain with an intramuscular injection.
Bupivacaine* ; Healthy Volunteers ; Injections, Intramuscular* ; Needles ; Superficial Back Muscles ; Water

Morbidity and mortality are higher in diabetics undergoing surgery, which most often reflect various cardiovascular complications. Ketoacidosis is the most serious acute metabolic complications of diabetes perioperatively. Ketoacidosis has adverse effects such as decreased myocardial contractility and peripheral vascular tone, dehydration and electrolyte imbalances. We encountered a case of a 47 year-old man who presented with ketoacidosis and severe hypotension 15 minutes after being administered epidural anesthesia for femoro-popliteal arterial bypass surgery. This case highlights the need for anesthesiologists to consider the possibility that ketoacidosis can mimic severe hypotension due to epidural anesthesia or cardiogenic shock.
Anesthesia, Epidural* ; Dehydration ; Diabetes Mellitus ; Diabetic Ketoacidosis* ; Humans ; Hypotension* ; Ketosis ; Middle Aged ; Mortality ; Shock, Cardiogenic