BACKGROUND: The purpose of this study was to evaluate the efficacy of intravenous clonidine-fentanyl to prevent postepidural shivering in patients undergoing an elective orthopedic surgery. METHODS: Forty ASA class 1 or 2 patients who received epidural anesthesia for an orthopedic surgery were allocated randomly to two groups. 10 min before epidural anesthesia group 1 received intravenous clonidine 2.0ng/kg and group 2 received clonidine 1.0ng/kg and fentanyl 1.0ng/kg shivering was determined objectively by observing involuntary muscle activity. Mean arterial pressure, heart rate and sedation score were measured at 5 minute intervals during the first 30 minutes following epidural anesthesia. RESULTS: There were no significant differences between the two groups in the occurrence of shivering, hemodynamic changes and sedation score. CONCLUSIONS: Intravenous clonidine 2.0ng/kg and the combination of clonidine 1.0ng/kg and fentanyl 1.0ng/kg were not significantly different in occurrence of postepidural shivering. Therefore, a combination of small doses of intravenous clonidine and fentanyl may be safe and useful to reduce postepidural shivering.
Anesthesia, Epidural ; Arterial Pressure ; Clonidine ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Muscle, Smooth ; Orthopedics ; Shivering*

BACKGROUND: Intraarticular opioids and local anesthetics may provide effective analgesia following knee arthroscopic surgery. However, there are conflicting results about the analgesic effects of a combination of morphine, bupivacaine and clonidine injected intraarticularly following knee arthroscopic surgery. The goal of this study was to determine whether clonidine added to an intraarticular morphine- bupivacaine combination provide an analgesic benefit. METHODS: Thirty patients scheduled for knee arthroscopic surgery under epidural anesthesia were selected and divided to two groups randomly. The patients in Group 1 received a combination of morphine 3 mg 0.25% bupivacaine 30 ml and patients in Group 2 received a combination of clonidine 3microgram/kg and morphine 3 mg in 30 ml of 0.25% bupivacaine intraarticularly following knee arthroscopic surgery. Postoperative pain was assessed using the visual analogue scale (VAS) and changes of arterial blood pressure, heart rate, requirement of additional analgesics, adverse effects and sedation scale were observed at 1, 2, 4, 8 and 24 hours after intraarticular injection. RESULTS: The VAS observed at 4, 8 and 24 hours after intraarticular injection were significantly lower in group 2 than group 1. Blood pressure and heart rate were not significantly changed between group 1 and group 2. The incidence of side effects, injection of additional analgesics and sedation were similar between the groups. There were no significant differences in hemodynamic changes, analgesic requirements, sedation scale or the increase of side effects between group 1 and group 2. CONCLUSIONS: The results suggest that the combination of intraarticular morphine 3 mg in 30 ml 0.25% bupivacaine plus clonidine provides significantly better analgesia than morphine 3 mg in 30 ml 0.25% bupivacaine alone following knee arthroscopy.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia, Epidural ; Anesthetics, Local ; Arterial Pressure ; Arthroscopy* ; Blood Pressure ; Bupivacaine ; Clonidine ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Injections, Intra-Articular ; Knee* ; Morphine ; Pain, Postoperative

Postoperative residual neuromuscular blockade or residual paralysis in the postanesthesia care unit is associated with postoperative complications such as muscle weakness, difficulty in breathing, airway obstruction, and hypoxemia. Residual paralysis can be defined by inadequate neuromuscular recovery as measured by objective neuromuscular monitoring. The train-of-four ratio threshold less than or equal to 0.9 is considered to indicate inadequate neuromuscular recovery. Careful management of residual paralysis may decrease the occurrence of adverse events associated with residual neuromuscular blockade. In this review, the clinical implications of residual neuromuscular blockade are summarized.
Airway Obstruction ; Anoxia ; Muscle Weakness ; Neuromuscular Blockade* ; Neuromuscular Monitoring ; Paralysis ; Postoperative Complications ; Respiration

BACKGROUND: This study was performed to determine the effect of a endotracheal intubation & induction of anesthesia using propofol 2.0 mg/kg or 2.5 mg/kg and fentanyl 2 g/kg without succinylcholine chloride. Also we have compared this method with technique using succinylcholine 1.5 mg/kg and thiopental sodium 5 mg/kg. METHODS: They were divided into 3 groups as follows: group 1, succinylcholine 1~1.5 mg/kg and thiopental sodium 5 mg/kg; group 2, propofol 2 mg/kg and fentanyl 2 microgram/kg; group 3, propofol 2.5 mg/kg and fentanyl 2 microgram/kg. Systolic arterial pressure (SAP) and diastolic arterial pressure (DAP), and heart rate (HR) were measured before induction, after induction, after tracheal intubation immediately, at 1, 2, 3, and 5min. after tracheal intubation in all patients. The incidence of adverse effects and the quality of condition for intubation were measured in all patients. RESULTS: There were significant increases in SAP, DAP, HR after intubation in group 1 but significant decreases in SAP, DAP after induction and at 5min. after intubation in group 2 and group 3. The incidence of adverse effects, and the quality of condition for intubation were no significant difference between group 1 and group 3. CONCLUSIONS: From the above result, use of propofol 2.5 mg/kg and fentanyl 2microgram/kg provided a satisfactory alternative to succinylcholine and thiopental sodium for rapid sequence induction of anesthesia.
Anesthesia ; Arterial Pressure ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Intubation* ; Intubation, Intratracheal ; Propofol ; Sodium* ; Succinylcholine ; Thiopental

BACKGROUND: Earlier studies have reported conflicting results regarding long-term behavioral consequences after anesthesia during the fetal period. Previous studies also suggest several factors that may explain such conflicting data. Thus, we examined the influence of age and sex on long-term behavioral consequences after multiple sevoflurane exposures during the fetal period. METHODS: C57BL/6J pregnant mice received oxygen with or without sevoflurane for 2 hours at gestational day (GD) 14-16. Offspring mice were subjected to behavioral assays for general activity (open field test), learning, and memory (fear chamber test) at postnatal day 30–35. RESULTS: Multiple sevoflurane exposures at GD 14–16 caused significant changes during the fear chamber test in young female offspring mice. Such changes did not occur in young male offspring mice. However, general activity was not affected in both male and female mice. CONCLUSIONS: Multiple sevoflurane exposures in the second trimester of pregnancy affects learning and memory only in young female mice. Further studies focusing on diverse cognitive functions in an age-, sex-dependent manner may provide valuable insights regarding anesthesia-induced neurotoxicity.
Anesthesia ; Animals ; Cognition ; Female* ; Fetus ; Humans ; Learning ; Male ; Memory* ; Mice* ; Oxygen ; Pregnancy Trimester, Second ; Pregnancy*

Controlled hypotension has been used to facilitate the surgical procedure and to reduce blood loss. This study was performed to compare the change of the cardiovascular systerm and intracranial pressure following the controlled hypotension induced by isoflurane, sodium nitroprusside, and labetalol in 28 cats. The results were as follows. 1) Heart rate was decreased with the isoflurane-induced hypotension, increased with the sodium nitroprusside-mduced hypotension. Both were not significant, but labetalol-induced hypotension increased heart rate significantly(P< 0.05). 2) Intracranial pressure was increased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.05), but there was significantly small per cent ehange in labetalol-induced hypotension than sodium nitroprusside-induced hypotension(P< 0.05). 3) Cerebral perfusion pressure was decreased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.01), but there was significantly small per cent change in labetalol-induced hypotension than isoflurane or sodium nitroprusside-induced hypotension(P < 0.01, P< 0.001).
Animals ; Cats* ; Heart Rate ; Hypotension* ; Hypotension, Controlled ; Intracranial Pressure ; Isoflurane* ; Labetalol ; Nitroprusside* ; Perfusion ; Sodium*

Controlled hypotension has been used to facilitate the surgical procedure and to reduce blood loss. This study was performed to compare the change of the cardiovascular systerm and intracranial pressure following the controlled hypotension induced by isoflurane, sodium nitroprusside, and labetalol in 28 cats. The results were as follows. 1) Heart rate was decreased with the isoflurane-induced hypotension, increased with the sodium nitroprusside-mduced hypotension. Both were not significant, but labetalol-induced hypotension increased heart rate significantly(P< 0.05). 2) Intracranial pressure was increased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.05), but there was significantly small per cent ehange in labetalol-induced hypotension than sodium nitroprusside-induced hypotension(P< 0.05). 3) Cerebral perfusion pressure was decreased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.01), but there was significantly small per cent change in labetalol-induced hypotension than isoflurane or sodium nitroprusside-induced hypotension(P < 0.01, P< 0.001).
Animals ; Cats* ; Heart Rate ; Hypotension* ; Hypotension, Controlled ; Intracranial Pressure ; Isoflurane* ; Labetalol ; Nitroprusside* ; Perfusion ; Sodium*

BACKGROUND: We assessed the effect of intravenous induction agents on intubation conditions and hemodynamic changes when using rocuronium 0.7 mg/kg for rapid sequence induction. METHODS: Sixty ASA class I or II patients undergoing elective surgery were divided into a thiopental group (5 mg/kg, n = 20), a propofol group (2 mg/kg, n = 20) and an etomidate group (0.2 mg/kg, n = 20). Anesthesia was induced with intravenous induction agents. After loss of consciousness, rocuronium 0.7 mg/kg was injected. Intubation was attempted at 60 seconds after rocuronium administration. Arterial blood pressure and heart rate were measured before induction, immediately after intubation, and 1, 3, 5, and 10 minutes after intubation. Intubation conditions were assessed by jaw relaxation, vocal cord movement, response to tracheal intubation, and were evaluated as excellent, good, fair, and poor. RESULTS: Excellent intubation conditions were obtained 55% (n = 11) in the thiopental group, 60% (n = 12) in the propofol group, and 45% (n = 9) in the etomidate group. Systolic and diastolic arterial blood pressures were elevated after intubation in all three groups. But these changes were minimal in the propofol group. CONCLUSIONS: Intubation conditions were not significantly different after the intravenous injection of thiopental 5 mg/kg, propofol 2mg/kg, or etomidate 0.2 mg/kg when using rocuronium 0.7 mg/kg for rapid sequence induction.
Anesthesia ; Arterial Pressure ; Etomidate ; Heart Rate ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation* ; Jaw ; Propofol ; Relaxation ; Thiopental ; Unconsciousness ; Vocal Cords

BACKGROUND: BNP and NT-proBNP are very useful predictor of perioperative cardiac events. The authors therefore performed a retrospective study about the relationship between NT-proBNP and intraoperative hemodynamic stability. METHODS: The authors reviewed the chart of 126 patients which were consulted to cardiologists for preoperative cardiac evaluation from 2005 through 2007. All patients were divided into two groups; N-group (NT-proBNP < 300 pg/ml, n = 66) and H-group (NT-proBNP > or = 300 pg/ml, n = 60). The kinds of hemodynamic drugs and dosage and infusion time were calculated. Total amounts of hemodynamic drugs are scored by two methods. Infusion drugs were scored 30 points, bolus drugs (esmolol 30 mg, labetalol 10 mg, phenylephrine 50microg, ephedrine 10 mg, atropine 0.25 mg, nicardipine 0.5 mg) and preclusive nitroglycerin infusion were scored 5 points. Drug score is total sum of all scores. We compared the drug score of two groups. In addition, bivariate and partial correlation analysis were performed for the correlation of drug score. RESULTS: H-group showed a high (P = 0.029) drug score (17.68 +/- 21.78) more than N-group (10.13 +/- 15.79). H-group showed a low (P = 0.000) ejection fraction (51.69 +/- 12.90%) more than N-group (61.80 +/- 7.84%). But, only age (R: 0.234, P: 0.023) and ejection fraction (R: -0.222, P: 0.032) were correlated with drug score by partial correlation analysis. CONCLUSIONS: Patients with preoperative high NT-proBNP had decreased systolic function and demanded more hemodynamic drugs during noncardiac surgery. But, NT-proBNP was not correlated with drug score in itself.
Atropine ; Ephedrine ; Hemodynamics ; Humans ; Labetalol ; Natriuretic Peptide, Brain ; Nicardipine ; Nitroglycerin ; Peptide Fragments ; Phenylephrine ; Retrospective Studies

BACKGROUND: Remifentanil is an opioid agonist with rapid onset and ultra-short duration of action. Rocuronium bromide can elicit a high incidence of pain when intravenous injection. In this study, the quantitative effect of remifentanil pretreatment on the injection pain of rocuronium and cardiovascular response during anesthetic induction were evaluated. METHODS: Eighty adult female patients undergoing gynecological procedures with general anesthesia were analyzed for this study. Patients were randomly allocated to one of four groups. Patients received 2 ml of normal saline (n = 20), 2 ml (40 mg) of 2% lidocaine (n = 20), 2 ml of remifentanil 0.5 microgram/kg (n = 20) or 2 ml of remifentanil 1 microgram/kg (n = 20) 60 seconds prior to administration of rocuronium 0.7 mg/kg. Pain was assessed after rocuronium injection. Systolic and diastolic arterial blood pressure and heart rates were measured before and during anesthetic induction. RESULTS: Both remifentanil and lidocaine have the good effect in minimizing the rocuronium injection pain. But, only 1 microgram/kg of remifentanil blunts the hypertension after endotracheal intubation. CONCLUSIONS: A bolus dose (1 microgram/kg) of remifentanil may be used for minimizing the rocuronium injection pain and blunting the hypertension after endotracheal intubation.
Adult ; Anesthesia, General ; Arterial Pressure ; Female ; Heart Rate ; Humans ; Hypertension ; Incidence ; Injections, Intravenous ; Intubation, Intratracheal ; Lidocaine