Antibiotics were reported to be able to alter bacterial surface properties in subinhibitory concentrations (sub-MICs). The effects of sub-MICs of certain antibiotics on a bacterial surface property such as hemagglutination, as well as on the cell morphology were studied using Streptococcus gordonii and Staphylococcus aureus. The effect of sub-M1Cs of antibiotics on the binding of these bacteria to immobilized fibrinogen were also investigated. The MICs of antibiotics were determined by culturing S. gordonii and S. aureus in media supplemented with serially diluted drug solutions, and one-half the MIC was used as the sub-MIC of the drugs, unless stated otherwise. Sub-MICs of antibiotics did not affect bacterial agglutination of erythrocytes. Microscopic observation of S. gordonii grown at sub-MIC concentration of 0.02 ug/ml of amoxicillin revealed cell enlargement of 1.6 times those grown without the drug. When grown in the sub-MIC amount of 0.08 ug/ml of cefazolin, most S. gordonii cells were enlarged and elongated into rod-shape, resulting in 3 times the size of the cells grown without the antibiotic. The data from the fibrinogen-binding experiments showed that the binding of S. gordonii to immobilized fibrinogen was increased with all the B-lactam drugs tested; the binding of S. aureus to immobilized fibrinogen, on the other hand, was decreased with the same drugs. The results show that low concentrations of certain B-lactam antibiotics are able to cause alterations in cellular morphology of S. gordonii and affect the binding of S. gordonii and S. aureus to immobilized fibrinogen.
Agglutination ; Amoxicillin ; Anti-Bacterial Agents* ; Bacteria ; Cefazolin ; Cell Enlargement ; Erythrocytes ; Fibrinogen ; Hand ; Hemagglutination ; Staphylococcus aureus* ; Staphylococcus* ; Streptococcus gordonii* ; Streptococcus* ; Surface Properties*

Deliberate hypotension reduces bleeding into a wound, thereby providing the surgeon with both better visilibility and technical freedom for a more definitive dissection and minimizes the need for blood transfusion, thereby reducing the risks of transfusion reasctions, hepatitis and acquired immunodeficiency syndrome (AIDS). In this study we evaluated the hypotensive anesthesia induced by sodium nitroprusside for maxillofacial reconstruction and plastic surgery performed at Seoul Paik Hospital from March 19S8 to February 1989: The results of our study were as follows: 1) Halothane and enflurane were used as the main anesthetics in 77 and 6 cases respectively. Nitroprusside was used for inducing hypotension and the mean amount infused was 10.5+/-7.7 mg. 2) The mean arterial pressure at 30min after inducing hypotension was 64.5+/-5.3mmHg. 3) The mean blood loss was 736.9+/-394.5ml and the mean amount of transfused blood was 497.1+/-451.1 ml. 4) The intraoperative arterial blood gas analysis shoueds no significant abnormality. 5) There were no significant perioperative and postoperative complications due to induced hypotension itself. In conclusion, the technique of using induced hypotension with inhalation anesthesia supplemented by nitroprusside under 10 head up position is relatively safe and useful one to use in performing maxillofacial reconstruction and plastic sugery.
Acquired Immunodeficiency Syndrome ; Anesthesia* ; Anesthesia, Inhalation ; Anesthetics ; Arterial Pressure ; Blood Gas Analysis ; Blood Transfusion ; Enflurane ; Freedom ; Halothane ; Head ; Hemorrhage ; Hepatitis ; Hypotension ; Nitroprusside ; Postoperative Complications ; Seoul ; Surgery, Plastic ; Wounds and Injuries

BACKGROUND: The sources of pulmonary blood flow in patients with pulmonary atresia and ventricular septal defect (PA/VSD) are very diverse, and detailed informations for the pulmonary circulation are essential for successful treatment. The purpose of this study is to examine and define the origins, distributions and characteristics of collateral circulations in patients with PA/VSD and major aortopulmonary collateral arteries (MAPCAs). METHODS: 34 patients diagnosed as PA/VSD and MAPCA were studied between May 1992 and April 1996. 85 MAPCAs were investigated for the sites of origin, distributions and characteristics by review of biplane angiograms. The characteristics of MAPCAs were examined in the aspects of anastomosis sites and sites/types of stenosis. RESULTS: 1) In 34 subjects, a total of 85 MAPCAs existed which supplied blood to 344 bronchopulmonary segments (4.1 BPS/MAPCA). 2) The origin sites of MAPCAs were the descending aorta (72%), the branch of aortic arch (16%), and the aortic arch or ascending aorta (12%). 3) The BPSs which frequently take primary blood supply from MAPCA were the 3 BPSs of upper lobe and superior / posterior basal segment of lower lobe in the right lung, and the superior / posterior basal segment of lower lobe in the left lung. 4) The BPS having apparent dual blood supply was 13.4% and the most frequent was the superior and posterior basal segment of the right lower lobe. 5) In total, 64% of MAPCA had anastomosis, and anastomosis in the lobar pulmonary artery was 48% to be the most frequent. 6) Stenosis was observed in 61% of MAPCAs. The site of stenosis was midportion (33%), originating portion (27%), multiple (26%), peripheral (14%), and the type of stenosis was focal (53%), segmental (31%), diffuse (16%), in the order of frequency. CONCLUSION: In PA/VSD and MAPCA, selective angiogram should be performed in all the different blood-supplying sources of the lung for detailed information of the pulmonary circulation. When the blood sources of the pulmonary circulation is uncertain, elaborated efforts to find the blood sources, by angiograms in the frequent locations of MAPCA, are neccessary. We believe this study to be useful for precise planning in the diagnosis and treatment of PA/VSD and MAPCA.
Angiography ; Aorta ; Aorta, Thoracic ; Arteries ; Collateral Circulation* ; Constriction, Pathologic ; Diagnosis ; Heart Septal Defects, Ventricular* ; Humans ; Lung ; Pulmonary Artery ; Pulmonary Atresia* ; Pulmonary Circulation

BACKGROUND: P300 component of the long latency auditory evoked potentials (LLAEPs) provides information on conscious and cortical funtion. The P300 wave occures only for stimuli that somehow capture the patients attention. Therefore LLAEPs implys a degree of cognitive processing. We studied sedation scale and P300 wave to determine if LLAEPs could be utilized as electrophysiologic predictors of sedation. METHODS: The P300 component of LLAEPs from vertex was recorded from 10 ASA physical status I and II patients undergoing elective surgery while they listened via headphones to a series of clicks which were interrupted unpredictably by a tone burst (2 KHz) before and after diazepam 0.04 mg/kg and 0.08 mg/kg IV. The patients were asked to concentrate on the clicks and to press a button whenever they detected a 2 KHz tone. And sedation scale also was measured. RESULTS: Amplitude of P300 was decreased and latency of P300 was increased in a dose-dependent manner with IV diazepam. Amplitude was greatest and latency was shortest in awake. And sedation scale also was increased according to increased IV diazepam adminstration. CONCLUSIONS: Both amplitude and latency may be highly related to the sedation scale with progressively increasing dose of diazepam. Therefore we conclude that P300 component of LLAEPs can be utilized as an electrophysiologic predictor of awareness and sedation.
Diazepam* ; Event-Related Potentials, P300* ; Evoked Potentials, Auditory* ; Humans

BACKGROUND: Monitoring of PETCO2 in the patients during regional anesthesia may be no less important than under general anesthesia, but will aid in early detection of potentially catastrophic events. However, the utility and accuracy of capnography in non-intubated patients has received little attention. We examined correlation between PETCO2 measured via nasal cannula and PaCO2 values in the sedated spontaneously breathing patients during spinal anesthesia. METHODS: Thirty adult patients who underwent elective surgery were administered optimal doses of tetracaine and epinephrine mixture in their site of operation, length, weight and age. Thereafter, we sampled expired gas by 175ml/min and administered oxygen by 3L/min using oxygen delivery CO2 sampling nasal cannula. End tidal carbon dioxide tension, heart rate, blood pressure and respiratory rate were measured before and 20 min after 0.02 mg/kg midazolam i.v.. And arterial blood gases were once measured 20 min after 0.02 mg/kg midazolam i.v.. RESULTS: The patients, sedation state was asleep or calm in awake. End tidal carbon dioxide tension was significantly increased after midazolam injection (p<0.01), but another values were not different after midazolam injection. Linear regression analysis of arterial carbon dioxide tension and end tidal carbon dioxide tension after midazolam injection yielded y = 0.77x + 4.82 and r2 = 0.76 (p<0.01). CONCLUSIONS: End tidal carbon dioxide tension using oxygen delivery CO2 sampling nasal cannula in the sedated spontaneously breathing patients with midazolam during spinal anesthesia were significantly related with arterial carbon dioxide tension. Therefore, we conclude that monitoring of PETCO2 via nasal cannula is a reliable means during spinal anesthesia.
Adult ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Blood Pressure ; Capnography ; Carbon Dioxide ; Catheters* ; Epinephrine ; Gases ; Heart Rate ; Humans ; Linear Models ; Midazolam ; Oxygen ; Respiration* ; Respiratory Rate ; Tetracaine

BACKGROUND: The hemodynamic superiority of total cavopulmonary anastomosis (TCPA) over atriopulmonary connection as a modification of Fontan-type operation, began to be acknowledged with more applications to clinical cases. The need of adequate resolutions for the investigation and improvement of residual hemodynamic derangements including abnormal distribution of the pulmonary blood flow, is emerging. METHODS: We studied 20 patients (M:F=12:8, age:67.9+/-41.5 months) who have had the TCPA and were followed-up by cardiac catheterization, angiography and lung perfusion scan 24.5+/-15.7 months after the operation. Pulmonary arterial growth and hemodynamic influences including the pulmonary blood flow distribution were investigated to verify the appropriateness of the conventional TCPA method and to aid in the determination of the consequences and prognosis of the operation. RESULTS: The mean pulmonary arterial pressure before and after the operation was 15.1+/-3.2 mmHg and 13.9+/-4.8 mmHg respectively without significant difference and there was no significant postoperative changes in the cross-sectional area index of pulmonary artery in regard to the variability of body surface area. The pulmonary blood flow was distributed with a greater amount in the ipsilateral side of IVC flow entrance (IVCipsi) than the contralateral side (IVCcontra), with an ipsilateral to contralateral perfusion ratio (i/cPR) of 1.24+/-0.42. Comparing the subgroups by the type of superior vena caval inflow, unilateral superior cavopulmonary anastomosis (SCPA) group showed significantly higher i/cPR (1.47+/-0.33) than the bilateral SCPA group (1.07+/-0.21). Comparing the subgroups by the type of IVC inflow, the i/cPR of the intraatrial tunnel group was higher than the hemiazygous continuation group, but there was no statistical significance. CONCLUSION: TCPA does not influence the growth of pulmonary artery, and the type of cavopulmonary anastomosis and the bilaterality of superior vena cava may have major influences on the distribution of the pulmonary blood flow. The details of surgical methods should be evaluated case by case in respect to the associated anomalies in order to achieve adequate postoperative pulmonary blood flow distribution.
Angiography ; Arterial Pressure ; Body Surface Area ; Cardiac Catheterization ; Cardiac Catheters ; Fontan Procedure ; Heart Bypass, Right* ; Hemodynamics ; Humans ; Lung ; Perfusion ; Prognosis ; Pulmonary Artery ; Pulmonary Circulation* ; Vena Cava, Superior

BACKGROUND: Manual ventilation in pediatric anesthesia limits the anesthesiologist's ability to manage patients suffering from unexpected problems. Although modified Mapleson D systems connected to ventilators have been used for controled ventilation of anesthetized infants and children, the complexity of factors affecting rebreathing within the Mapleson D circuit has resulted in a variety of recommendations for fresh gas flow and minute ventilation. The aim of this study was to devise a formula for ventilator settings which would provide normal tidal volume, respiratory rate, and minute ventilation without rebreathing during mechanical ventilation in pediatric anesthesia and compare this method to manual ventilation. METHODS: 56 infants and small children anesthetized with enflurane and nitrous oxide were studied. We have constructed a formula for ventilator settings which would generate a predictable normocapnia. PetCO2, PaCO2, SpO2, and SaO2 were measured during manual ventilation (control) and during mechanical ventilation. RESULTS: Mean PaCO2 with the mechanical ventilation was within normal range. PaCO2 was significantly lower (P<0.05) with the manual ventilation than with the mechanical ventilation. CONCLUSIONS: We conclude that our formula for ventilator settings can be safely and competently applied to mechanical ventilation with Jackson-Rees system in pediatric anesthesia.
Anesthesia* ; Child ; Enflurane ; Humans ; Infant ; Nitrous Oxide ; Reference Values ; Respiration, Artificial ; Respiratory Rate ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical

BACKGROUND: Although rare, paralysis secondary to spinal cord ischemia after aortic aneurysm surgery is a devastating complication. Many papers have been published on this topic but without a clear consensus on the best way of minimizing the problem. Mild hypothermia and lamotrigine have been neuroprotective in several models of cerebral ischemia. In this study we compared the effects of mild hypothermia and the lamotrigine on neurologic and histopathologic outcomes, and inflammatory gene expression in transient spinal ischemia. METHODS: Rats were anesthetized with halothane, and divided into 4 groups; the Sham-operated (S) group; the Normothermic ischemic (N) group; the Hypothermic ischemic (H) group; and the Lamotrigine- treated (L) group. Spinal ischemia was produced by induced hypotension and thoracic aortic cross clamping. After spinal ischemia neurologic scores were assessed at 1, 2, 3, 24, and 48 hours after reperfusion. After 48 hours the rats were euthanized and their spinal cords were removed for histopathologic assessment. Also, spinal cords were removed at 1, 3, and 48 hours after reperfusion for the assay of TNF-alpha, IL-1 mRNA. RESULTS: The neurologic scores of the H group were significantly lower than from the N group. There was no significant difference between the L group and the N group. The histopathologic scores in the H and L groups were significantly lower than in the N group, and the histopathologic scores of the L group were higher than those of the H group. The TNF-alpha and IL-1 gene expression was increased in the N group. In the H group, the gene expression was significantly less than in the N group. The L group was not significantly different than N group in gene expression. CONCLUSIONS: The inflammatory gene expressions were increased in transient spinal ischemia. Hypothermia was neuroprotective in transient spinal ischemia. However, the lamotrigine showed only partial neuroprotective effects in transient spinal ischemia.
Animals ; Aortic Aneurysm ; Brain Ischemia ; Consensus ; Constriction ; Gene Expression* ; Halothane ; Hypotension ; Hypothermia* ; Interleukin-1 ; Ischemia* ; Neuroprotective Agents* ; Paralysis ; Rats* ; Reperfusion ; RNA, Messenger ; Spinal Cord ; Spinal Cord Ischemia ; Tumor Necrosis Factor-alpha

Acute fatty liver of pregnancy is a uncommon complication of late pregnancy which may progress to hepatic failure, encephalopathy, disseminated intravascular coagulopathy, and death. A 65 kg 29-yr-old female at 35 weeks gestation complained of epigastric discomfort and jaundice 5 days before adimission. She had icteric sclera but other physical findings were non-specific. Anesthetic induction was achieved with thiopental, succinylcholine and vecuronium and the trachea was easily intubated. Maintenance of anesthesia was accomplished with oxygen : nitrous oxide (3 : 2) and 0.8% isoflurane. The Apgar scores were 8 and 10 at 1 min and 5 min, respectively. After the end of surgery, the patient was awakened and she was extubated after she followed verbal commands. She remained stable during her immediate postoperative course, but her vital signs were worse suddenly on postoperative day 3. On postoperative day 5, she was supported by artificial ventilation. The prothrombin time and the partial thromboplastin time were prolonged. Dopamine, dobutamine and norepinephrine were administered for maintaining her cardiovascular function. After that she was managed with artificial ventilation, cardiovascular drugs, fluid and blood products due to multi-organ failure. On postoperative day 25, she expired due to an acute cardiac arrest which was suspected to be due to multi-organ failure.
Anesthesia ; Anesthesia, General ; Cardiovascular Agents ; Cesarean Section ; Dobutamine ; Dopamine ; Fatty Liver* ; Female ; Heart Arrest ; Humans ; Isoflurane ; Jaundice ; Liver Failure ; Nitrous Oxide ; Norepinephrine ; Oxygen ; Partial Thromboplastin Time ; Pregnancy* ; Prothrombin Time ; Sclera ; Succinylcholine ; Thiopental ; Trachea ; Vecuronium Bromide ; Ventilation ; Vital Signs

Since 1920, when Harvey Cushing first used radiofrequency in electrosurgery, the procedural technique has developed rapidly. Even though this procedure is minimally invasive and safer than other neurodestructive procedures, it is still not free of complications. A 72-year-old female patient had constant facial pain, despite several operations and radiotherapies for her maxillary cancer. The region innervated ophthalmic branch and maxillary branch of the trigeminal nerve was involved, with radiofrequency procedure of the gasserian ganglion for pain control also performed at the area. After the procedure, her blood pressure became elevated and she complained of a headache, and six hours later, she became irritable and distracted. Bacterial meningitis was diagnosed by a spinal tap, with third-generation cephalosporin administered as the treatment. The following day, her symptoms had improved and the pain was also reduced. She was discharged from hospital after 14 days, without any sequelae.
Aged ; Blood Pressure ; Electrosurgery ; Facial Pain ; Female ; Headache ; Humans ; Meningitis ; Meningitis, Bacterial* ; Radiotherapy ; Spinal Puncture ; Trigeminal Ganglion ; Trigeminal Nerve