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

No abstract available.
Arthroplasty* ; Knee*

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

In 2D surgical paients wihose general anesthsia was maintained with one to one ratio of oxygen and nirtous oxide and 1 vo19 of halothane, 1 mg/kg of lidocaine was administered to the 10 patients in each group intravenously to evaluate the effects of lidocaine on cardiovascular changes. In these clinical study, heart rate (HR), mean arterial pressure (MAP), stroke volume (SV) and cardiac output (CO) were measured iri one minute interval after intravenous administration of lidocaine and these values were compared with the control. The following results were obtained: 1) There are no significant changes of the heart rate. 2) The mean arerial pressure was significantly decreased one minute after that, there was no significant change. 3) There were no signifieant changes in the stroke volume. 4) The cardiac outit was significantly decreased in all patients after the administration of lidocaine and there were also the significant decrease of the cardiac output three and four minutes in patients with 1.0 mg/kg of lidocaine and four and five minutes in patients with 1.5 mg/kg of lidocaine after the administration of lidocaine.
Administration, Intravenous ; Anesthesia* ; Arterial Pressure ; Cardiac Output ; Halothane* ; Heart Rate ; Humans ; Lidocaine* ; Oxygen ; Stroke Volume

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*

The depth from the skin to the thoracic epidural space was measured in 121 patients (41 male and 80 female patients) receiving epidural analgesia. The patients age, sex, height, weight were obtained before measuring the distance. The needle angle to the vertical axis to the skin was obtained during inserting Touhy needle. The mean depth was 6.0+/- 1.3 cm, which correlated with other anatomic measurements except height. The depth was correlated with the needle angle. The group with needle angle greater than 30(0) was greater in depth than the other groups. The mean depth was 6.0+/-1.4 cm in males and 6.0+/-1.3 cm in females and there was no difference in depth between male and female. The mean depth was 5.7+/-1.3 cm at the T5-6 interspace and 6.2+/-1.3 cm at the T6-7 interspace and there was no difference in depth between the two groups.
Analgesia, Epidural ; Axis, Cervical Vertebra ; Epidural Space* ; Female ; Humans ; Male ; Needles ; Skin*

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