Background: The major complications of spinal anesthesia are hypotension and bradycardia. In normal condition, hypotension stimulates baroreceptor reflex and compensatory tachycardia is occured. But during spinal anesthesia, there is possibility of a blockade of cardiac sympathetic nerve fibers which would result in increased vagal tone and depress compensatory baroreceptor reflex which is activated during hypotension. Atropine is an anticholinergic agent whose predominant cardiovascular effect was known as increasing heart rate at clinical dose. The purpose of this study was to evaluate hemodynamic effect of atropine during spinal anesthesia. Methods: We compared heart rate, systolic, diastolic and mean arterial pressures and cardiac output in 26 patients of ASA physical status 1, 2 before and after intravenous injection of atropine sulfate 0.01 mg/Kg during spinal anesthesia. Hemodynamic parameters were measured just prior to and 1, 2, 3, 4, 5, 10 minutes after atropine sulfate intravenous injection. The data were analyzed by repeated measures ANOVA. Results: Heart rate, mean blood pressure and diastolic blood pressure after atropine sulfate injection increased with significance. Conclusion: These findings suggest that during spinal anesthesia atropine is effective to produce tachycardia with a dosage of 0.01 mg/Kg in humans. Also hypotension might be improved because atropine makes mean blood pressure and diastolic blood pressure increase.
Anesthesia, Spinal* ; Arterial Pressure ; Atropine* ; Baroreflex ; Blood Pressure ; Bradycardia ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Injections, Intravenous ; Nerve Fibers ; Tachycardia

No abstract available.

The authors reviewed the clinical results of treatment for the impingement syndrome in 33 patients, 36 cases at the Department of Orthopaedic Surgery, Medical College, Kyung Hee University from November 1989 to March 1992. Follow-up evaluations averaged 23 months. The average age was 49 years old and there were 16 men and 17 women. The right shoulder was involved in 25 cases and the left in 11. The prominent complaint was pain with impaired shoulder function, especially in abduction, external rotation and flexion. The average duration of symptoms was 11 months ranged from 1 month to 7 years. Twenty one cases were managed with conservative therapy only, consisting of rest, physical therapy, analgesic and antiinflammatory drugs. Operation was performed in 15 of 36 cases. Anterior acromioplasty was done in 11 cases and arthroscopic decompression in 4 cases. In all patients with operative management, relief of pain and improvement of shoulder function were obtained and complications were not observed. Average preopperative shoulder rating score was 38.2 and postoperative score was 87. In 14 cases(71%) of conservative management, the symptoms were improved but still persistent in 6 cases(29%). Average initial shoulder rating score was 47 and follow up score was 68.4. In the analysis of above results, operative treatment was effective when symptoms are persistent and fail to respond to conservative management.
Decompression ; Female ; Follow-Up Studies ; Humans ; Male ; Shoulder

The parasympathetic nervous system has been considered to have an important role in bronchospasm. Although vagal reflexes are well documented in animal models of airway hyperresponsiveness, their importance in asthmatic attacks in man is less documented. We report a case of bronchospasm during sclera buckling operation and we believe that this patient's bronchospasm was induced by the vagal reflex.
Anesthetics ; Bronchial Spasm* ; Lung ; Models, Animal ; Parasympathetic Nervous System ; Reflex* ; Sclera

No abstract available.
Arthroplasty* ; Knee*

An anaysis is performed on 424 open heart patients having postoperative respiratory care in respiratory intensive care unit of Seoul National University Hospital in 1986. The analysis was done according to disease prevalence, sex, age, pump time, duration of mechanical ventilation and mortality rate. 1) The most prevalent disease was mitral valvular disease. 2) The mean age of total patients was 35.6 and oldest age group was patients who recieved CABG, and the youngest were with ventricular septal defect combined with other disease. 3) The mean pump time was 110.6 minutes and it was longer in the patients with acquired heart disease than the patients with congenital heart disease. 4) The mean duration of mechanical ventilation was 61.5 hours and it was longer in the patients with the acquired heart disease than with the congenital heart disease. 5) The overall mortality rate was 1.18% and it was higher in the patients with congenital heart disease than with the acquired heart disease. The most prevalent cause of death was low cardiac output syndrome. 6) The length of mechanical ventilation time was not related with pump time.
Cardiac Output, Low ; Cause of Death ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Intensive Care Units ; Mortality ; Prevalence ; Respiration, Artificial ; Seoul

Isoflurane has been known to reveal relatively stable hemodynamic effects on cardiovas-cular system,so many anesthesiologists recommend it as the anesthetic of choice for cardiovascular surgery in spite of its higher cost. Verapamil has been indicated in many cardiovascular diseases and its pharmacological effects are known to be infiuenced by the patients hemodynamic condition, disease state, and concurrent drug therapy. The author performed this experimental study to evaluate the hemodynamic effects of verapamil on cardiovascular system under variable concentrations of isoflurane anesthesia with 7 mongrel dogs. Heart rate (HR), mean arterial pressure(MAP), central venous pressure (CVP), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were measured, and stroke volume (SV), cardiac index (CI), left ventricular stroke work index (LVSWI),systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were calcurated after 0.3 minimum alveolar concentrations of anesthetic (MAC) N2O anesthesia with pancuronium relaxation as controls, after 20 minutes of 1 MAC and 2 MAC of isoflurane anesthesia, after verapamil 0.15 mg/ kg bolus with 0.005mg/kg/min infusion, and after 20 minutes of 1 MAC and 2 MAC of isoflurane anesthesia with verapamil infusion respectively. Following results were obtained by comparing each data, and data between isolfurane alone and isoflurane with verapamil infusion. 1) Most of hemodynamic indices of cardiovascular system were decreased significantly with increase of isoflurane concentration except CVP and PVR. 2) Verapamil infusion decreased HR, MAP and SVR significantly but increased CO, CI and SV significantly. 3) PCWP was increased only under 2 MAC isoflurane, PAP and PCWP were increased slightly after verapamil infusion without significance. 4) Isoflurane with verapamil infusion decreased HR and MAP more significantly that islurane alone in a dose dependent manner but it decreased CO, CI and LVSWI less than isoflurane alone because of verapamil interaction. 5) Comparing with isoflurane alone, isoflurane with verapamil infusion increased CVP significantly by the interaction of verapamil effect. 6) General hemodynamic changes were enhanced according to increasing concentration of isoflurane. With the above results the author concluded that comparing with isoflurane alone, isoflurane with verapamil infusion not only increased CO, CI and HR, so that it is important to control isoflurane concentration prudently in accordance with the changes of MAP and HR for safe anesthetic management.
Anesthesia* ; Animals ; Arterial Pressure ; Cardiac Output ; Cardiovascular Diseases ; Cardiovascular System* ; Central Venous Pressure ; Dogs ; Drug Therapy ; Heart Rate ; Hemodynamics ; Humans ; Isoflurane* ; Pancuronium ; Pulmonary Wedge Pressure ; Relaxation ; Stroke ; Stroke Volume ; Vascular Resistance ; Verapamil*

No abstract available.

This study was undertaken to determine whether intravenous lidocaine could prevent the acute increase in intraocular pressure associated with laryngoscopy and tracheal intubation. Twenty surgical patients(ASA class 1) who do not have any disease influencing on the intraocular pressure(IOP)(e.g. ophthalmic diseases, diabetes, hypertension, etc.) were studied and divided into two groups, experimental group(n= 10) and control group(n=10). After measurement of preinduction IOP, anesthesia was induced by pentothal 5 mg/kg and vecuronium 0.15 mg/kg, and maintained with 100% oxygen for 3 minutes and baseline IOP was measured. Then, saline and lidocaine(1.5 mg/kg) were injected to controls and experimental group, respectively. One minute and 30 seconds after this, IOP was measured and trachea was intubated. After intubation, anesthesia was maintained with 100% oxygen and 1,5 vo1% halothane and IOP was measured on 1, 3 and 5 minutes after intubation. The results were as follows. 1) One minute and 30 seconds after saline or lidocaine injection(immediately before intubation), IOP was significantly lower in lidocaine group than control group. 2) Peak increases in IOP after intubation were significantly less in lidocaine group than control group. From the above results, the use of 1.5 mg/kg of intravenous lidocaine approximately 1 minute and 30 seconds before tracheal intubation significantly attenuates the increase in IOP. This procedure will be useful in the induction of anesthesia in patients in whom the increase in IOP should be avoided.
Anesthesia ; Halothane ; Humans ; Hypertension ; Intraocular Pressure ; Intubation* ; Laryngoscopy ; Lidocaine* ; Oxygen ; Thiopental ; Trachea ; Vecuronium Bromide

An analysis was performed on 270 open heart patients having post-operative respiratory care in the respiratory intensive care unit of Seoul National University Hospital during 1987. The analysis was done according to disease prevalence, sex, age, pump time, duration of mechanical ventilation and mortality rate. 1) The number of cases of acquired heart disease was more than that of congenital heart disease. 2) The most prevalent disease was ventricular septal defect combined with other diseases. 3) The mean age of the total patients was 36.5. The oldest age group was patients who received CABG and the youngest had a ventricular septal defect combined with other diseases. 4) The mean pump time was 93,4 minutes and it was longer in the patients with acquired heart disease than the patients with congenital heart disease. 5) The mean duration of mechanical ventilation was 68.5 hours and it was longer in the patients with acquired heart disease than those with congenital heart disease by about two times. 6) The overall mortality rate was 3.0% which was higher rate than that of the 3rd and 4th reports, and it was a higher in the patients with acquired heart disease than with congenital heart disease. The most prevalent cause of death was low cardiac output syndrome. 7) The length of mechanical ventilation time and death rate were closely related with pump time.
Cardiac Output, Low ; Cause of Death ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Intensive Care Units ; Mortality ; Prevalence ; Respiration, Artificial ; Seoul