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Prone Position on Oxygenation in the Patient with Acute Respiratory Distress Syndrome after Decortication with Bilateral Empyectomy.

Sung Sik CHON ; Bon Nyeo KOO ; Shin Ok KOH ; Mun Seok SEO ; Jin Ho KIM

Korean Journal of Anesthesiology.2001;40(2):265-268. doi:10.4097/kjae.2001.40.2.265

The effects of the prone position on the improvement of oxygenation in patients with ARDS were reported already twenty years ago. Recent studies have shown that the prone position would improve the ventilation and perfusion relationship as it improves the ventilation in the local area without altering the pulmonary blood flow during the support of ventilation in the patients with ARDS. We have applied the prone position repeatly on the patient with ARDS which developed after the removal of a bilateral pulmonary empyema and decortication. The initial effect of the prone position on oxygenation improved the PaO2/FiO2 (arterial oxygen tension divided by inspired oxygen concentration) ratio, 104.3 to 132.9, at FiO2 0.7. Improvement of oxygenation was maintained with repeat position change, three times over 24 hours, from supine to prone position.
Empyema ; Humans ; Oxygen* ; Perfusion ; Prone Position* ; Respiratory Distress Syndrome, Adult* ; Ventilation

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The Two Step Fiberoptic Approach in the Management of a Difficult Pediatric Airway due to a Vallecular Cyst.

Soo Hwan KIM ; Wyun Kon PARK ; Hong Shik CHOI ; Kyoung Mi OH ; Sung Jin HONG

Korean Journal of Anesthesiology.2001;40(2):261-264. doi:10.4097/kjae.2001.40.2.261

A 6-yr-old male weighing 20 kg with the diagnosis of a large vallecular cyst in the oropharynx was scheduled for surgical excision. After a slight loss of consciousness following an IV injection of ketamine 10 mg while maintaining spontaneous respiration, 4% lidocaine was sprayed into the right nostril. An uncuffed 4 mm OD wire-reinforced endotracheal tube was advanced through the right nostril and positioned in the nasopharynx. An ultrathin 60 cm Olympus LF-P fiberoptic bronchoscope (OD: 2.2 mm) was threaded and the vocal cords and surrounding structures were identified as intact. The endotracheal tube and fiberscope were withdrawn. Ketamine 10 mg was injected intravenously again. Following direct insertion of an Olympus fiberoptic bronchoscope (OD: 3.8 mm) through the right nostril without tube placement and visualization of the vocal cords, topical anesthesia of the larynx was achieved by spraying 1 ml 2% lidocaine through the biopsy channel. Thirty seconds later, it was passed into the trachea and 1 ml 2% lidocaine was sprayed intratracheally. The bronchoscope was withdrawn. The 4 mm uncuffed wire-reinforced tube was passed again through the right nostril and an ultrathin fiberoptic bronchoscope (OD: 2.2 mm) was threaded over the tube, and passed smoothly without resistance. There was neither laryngeal spasm nor cough. Anesthesia was maintained with enflurane 2.0 vol%, N2O (1.5 L/min) and O2 (1.5 L/min). The mass was successfully excised and extubated without compromise. The patient was uneventfully discharged the next day.
Anesthesia ; Biopsy ; Bronchoscopes ; Cough ; Diagnosis ; Enflurane ; Humans ; Ketamine ; Laryngismus ; Larynx ; Lidocaine ; Male ; Nasopharynx ; Oropharynx ; Respiration ; Trachea ; Unconsciousness ; Vocal Cords

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The Effect of alpha2 Adrenoceptors and Imidazoline Receptors on the Mechanical Allodynia in Rats with Nerve Ligation Injury.

Jai Hyun HWANG ; Young Kook KIM ; Jong Yeon PARK ; Hee Jung JUN

Korean Journal of Anesthesiology.2001;40(2):252-260. doi:10.4097/kjae.2001.40.2.252

BACKGROUND: Clonidine, an alpha2 adrenoceptor agonist, has been known to have an antiallodynic effect in many animal and human studies. Clonidine, however, acts on imidazoline receptors as well as alpha2 adrenoceptors. Recently, the effect of clonidine on the symapthetic nervous system was reported to be mediated via the activation of the imidazoline receptor system but not the alpha2 adrenergic receptor system. Therefore, we conducted a behavioral test to investigate the effects of alpha2 adrenoceptors and imidazoline receptors on mechanical allodynia in rats with spinal nerve ligation (SNL) injury. METHODS: Male Sprague Dawley rats were prepared with tight ligation of the left lumbar 5th and 6th spinal nerves and chronic lumbar intrathecal catheter implantation for drug administration. Using a von Frey hair (VFH) test, we examined the effects of intrathecal (IT) brimonidine (0.03 - 3 microgram), clonidine (3 - 10 microgram), and rilmenidine (1 - 30 microgram) in SNL rats. Measurements of the baseline value VFH test was conducted at each dose to compare with the preoperative state. In addition, an antagonistic study with rauwolscine or yohimbine was performed to investigate the reversal of antiallodynic effects of each agonist. Allodynic thresholds for the withdrawal response of the left lesioned hindpaw to VFH stimuli were assessed and converted to %MPE. RESULTS: The antiallodynic effects of brimonidine, clonidine, and rilmenidine were produced in a dose dependent manner. The antiallodynic effects of IT brimonidine but not rilmenidine were significantly antagonized by alpha2 antgonists rauwolscine and yohimbine (P < 0.05). CONCLUSIONS: The results suggest that mechanical allodynia produced by a SNL injury is reduced by an imidazoline receptor agonist as well as alpha2 adrenergic receptor agonists and sympathetic activation is more likely mediated by spinal imidazoline receptors.
Adrenergic Agonists ; Animals ; Catheters ; Clonidine ; Hair ; Humans ; Hyperalgesia* ; Imidazoline Receptors* ; Ligation* ; Male ; Nervous System ; Rats* ; Rats, Sprague-Dawley ; Receptors, Adrenergic* ; Spinal Nerves ; Yohimbine ; Brimonidine Tartrate

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The Mechanism of Antiallodynic Effect of Intrathecal Morphine in Neuropathic Pain Induced by Spinal Nerve Ligation.

Jai Hyun HWANG ; Young Kook KIM ; Jong Yeon PARK ; Eun Joo LEE

Korean Journal of Anesthesiology.2001;40(2):244-251. doi:10.4097/kjae.2001.40.2.244

BACKGROUND: Although the efficacy of morphine in a neuropathic pain state is somewhat controversial, intrathecally administered morphine reversed the mechanical allodynia in a previous animal study. Using a behavioral test, we investigated the mechanism of the antiallodynic action of intrathecal morphine by administering opioids, alpha2 adrenergic and cholinergic receptor antagonists in a rat model of neuropathic pain induced by a spinal nerve ligation injury. METHODS: Male Sprague Dawley rats were prepared with a tight ligation of the left lumbar 5th and 6th spinal nerves and insertion of a chronic lumbar intrathecal catheter. Morphine 1 microgram was administered intrathecally to attenuate the mechanical allodynia. Naloxone 10 microgram, yohimbine 30 microgram, prazosin 30 microgram, atropine 10 microgram, pirenzepine 10 microgram, and methoctramine 10 microgram was administered intrathecally before and after the injection of morphine in order to investigate the reversal of an increased allodynic threshold by morphine. The allodynic thresholds for the left hindpaw withdrawal to von Frey hairs were assessed and converted to %MPE. RESULTS: A reduction of mechanical allodynia by intrathecal morphine was produced. Naloxone pretreatment, but not posttreatment, reversed the antiallodynic effect of intrathecal morphine (P < 0.01). All alpha2 adrenergic and cholinergic receptor antagonists used here did not reverse it. CONCLUSIONS: The results suggest that the reversal mechanism of mechanical allodynia by intrathecal morphine appears to be mediated mostly by the opioid receptor system, but not the alpha2 adrenergic and cholinergic receptor systems, at the spinal level in a rat model of a spinal nerve ligation injury.
Analgesics, Opioid ; Animals ; Atropine ; Catheters ; Cholinergic Antagonists ; Hair ; Humans ; Hyperalgesia ; Ligation* ; Male ; Models, Animal ; Morphine* ; Naloxone ; Neuralgia* ; Pirenzepine ; Prazosin ; Rats, Sprague-Dawley ; Receptors, Opioid ; Spinal Nerves* ; Yohimbine

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Neuroprotective Effects of Propofol, Ketamine and Propofol-ketamine after Transient Forebrain Ischemia in the Rat.

Jae Young KWON ; Jae Hyu JEON ; Kyoo Sub CHUNG ; Inn Se KIM ; Seong Wan BAIK ; Hae Kyu KIM

Korean Journal of Anesthesiology.2001;40(2):238-243. doi:10.4097/kjae.2001.40.2.238

BACKGROUND: Intravenous anesthetics such as propofol and ketamine have been known to have neuroprotective effects. However, the combination of these drug is not known. This study was conducted to determine the neuroprotective effects of propofol, ketamine or both after transient forebrain ischemia. METHODS: Twenty Sprague-Dawley rats (250-300 gm) were used. Anesthesia was induced with 4% isoflurane in oxygen and then maintained with 1 - 2% isoflurane in oxygen. Ischemic injury was induced by 10 minutes of both common carotid artery ligation and hypotension (MAP < 50 mmHg). All rats were randomly divided into four groups: group I; control group; group II; ketamine 10 mg/kg was administered 10 minutes before injury; group III; propofol (1 mg/kg/min) was administered until EEG isoelectricity; and group IV; ketamine 10 mg/kg and propofol 1 mg/kg/min was administered. The Rectal temperature was maintained at 38oC. After forebrain ischemia, neurologic scores were estimated at 1 hr, 2 hrs, 1 day and 2 days after recovery. The brain was removed 3 days after and stained with H-E stain. RESULTS: Neurologic and histologic scores of group II, III, IV were significantly lower than that of group I. However, there were no significant difference between group II, III and IV. CONCLUSIONS: Ketamine and propofol have neuroprotective effects in transient forebrain ischemia in rats. However, the combination of propofol and ketamine did not show any synergistic or additive effects.
Anesthesia ; Anesthetics, Intravenous ; Animals ; Brain ; Carotid Artery, Common ; Electroencephalography ; Hypotension ; Ischemia* ; Isoflurane ; Ketamine* ; Ligation ; Neuroprotective Agents* ; Oxygen ; Propofol* ; Prosencephalon* ; Rats* ; Rats, Sprague-Dawley

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Involvement of Protein Kinase C Isoforms and Rho GTPase in Contractile Response of Swine Pulmonary Artery.

Bo Kyung KIM ; Jung Hwan KIM ; Seong Hyop KIM ; Min Jung KIM ; Yoon Soo KIM ; Jeong Ae LIM ; Yun Jung CHOI ; Nam Sick WOO ; Ye Chul LEE ; Sung Il CHO

Korean Journal of Anesthesiology.2001;40(2):229-237. doi:10.4097/kjae.2001.40.2.229

BACKGROUND: It is well established that vascular contraction is caused by not only an increase in cytosolic Ca2+ level but also activations of Ca2+-sensitizing mechanisms including protein kinase C (PKC) and low molecular GTP binding protein. However, the roles of PKC and RhoA, a low molecular GTP-binding protein, on the receptor agonist-mediated contraction in swine pulmonary artery has not been clarified. In the present study, we examined the contribution of PKC isoform and RhoA to the arterial stimulants-induced contraction in swine pulmonary artery. METHOD: The large (> 5 mm), medium (1-3 mm) and small (< 1 mm in outer diameter) sized pulmonary arteries were excised and the contractions were recorded isometrically. The contents and subcellular distribution of PKC isoforms and RhoA were detected using immunoblotting. RESULTS: In medium pulmonary artery, norepinephrine (NE, 10 nM-30micrometer) led contraction in a dose-dependent manner. In large and small pulmonary arteries, however, NE failed to induce a contraction. Adding of 12-deoxyphorbol 13-isobutyrate (DPB, 1micrometer), a PKC activator, developed muscle force in 1 mM EGTA-contained Ca2+-free physiological salt solution. The expressions of PKC alpha, elsilon were significantly increased in medium pulmonary artery. NE (10micrometer) evoked the translocation of RhoA from cytosol to the membrane but not those of PKC isoforms. In Ca2+-free physiological salt solution, DPB (1micrometer) caused a translocation of PKC isoforms. CONCLUSIONS: These results support that NE induces contraction via RhoA pathway but not PKC pathway in swine pulmonary artery.
Cytosol ; GTP Phosphohydrolases* ; GTP-Binding Proteins ; Immunoblotting ; Membranes ; Norepinephrine ; Protein Isoforms ; Protein Kinase C* ; Protein Kinases* ; Pulmonary Artery* ; Swine*

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Electrocardiographic and Hemodynamic Changes during Recovery from Bupivacaine Toxicity in Anesthetized Dogs.

Hyun Sung CHO ; Soo Joo CHOI ; Yu Mee LEE ; Mi Sook GWAK ; Mi Kyung YANG ; Duck Hwan CHOI

Korean Journal of Anesthesiology.2001;40(2):220-228. doi:10.4097/kjae.2001.40.2.220

BACKGROUND: Severe cardiac arrhythmia after accidental intravascular injection of bupivacaine in the practice of regional anesthesia has been reported and is known to be difficult to treat. We evaluated the electrocardiographic and hemodynamic changes during recovery from bupivacaine-induced cardiac toxicity. METHODS: In eight male dogs receiving pentobarbital, after baseline recordings were obtained, 0.5% bupivacaine was infused at a rate of 0.5 mg/kg/min intravenously until cardiac output decreased to 50% or less(1/2 CO), which was defined as the point of cardiac depression in this study. The hemodynamic and electrocardiographic parameters were recorded at 1/2 CO, and 5, 10, 15, 20, 30 and 40 min after 1/2 CO. The following electrocardiographic parameters were measured: duration of QRS complex and T wave, PR interval and the corrected QT interval, all determined on the lead II. RESULTS: Mean arterial pressure was significantly decreased throughout the experimental period after 1/2 CO, and cardiac output and SO2 were significantly decreased until 20 min after 1/2 CO in comparison with those at baseline. All dogs had serious changes on the ECG. Heart rate and ECG changes returned to baseline within 20 min after 1/2 CO, but QRS duration remained increased until 30 min after 1/2 CO. Systemic vascular resistance, pulmonary vascular resistance and serum electrolytes were not changed with time. CONCLUSIONS: In the absence of hypoxia, acidosis, and hyperkalemia, QRS duration returned to control values more slowly than other variables on the EKG after bupivacaine cardiac toxicity. MAP and PCWP recovered the slowest of all hemodynamic variables.
Acidosis ; Anesthesia, Conduction ; Animals ; Anoxia ; Arrhythmias, Cardiac ; Arterial Pressure ; Bupivacaine* ; Cardiac Output ; Depression ; Dogs* ; Electrocardiography* ; Electrolytes ; Heart Rate ; Hemodynamics* ; Humans ; Hyperkalemia ; Male ; Pentobarbital ; Vascular Resistance

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The Development of an Inspiratory Time Adjustable Transtracheal Jet Ventilator and Evaluation in a Human Adult Trachea-Lung Model.

Hoon Do KIM ; Joo Hyun AHN ; Wyun Kon PARK ; Hae KIL ; Deok Won KIM

Korean Journal of Anesthesiology.2001;40(2):211-219. doi:10.4097/kjae.2001.40.2.211

BACKGROUND: Transtracheal jet ventilation (TTJV) has been used for 'Cannot Ventilate/Cannot Intubate' situation, lefe-saving situations, by simply introducing an IV catheter (angiocatheter) through the cricothyroid membrane. To decrease the occurrence of barotrauma caused by a continuous high pressure oxygen supply while applying TTJV, it would be ideal to have a TTJV system equipped with an inspiration time adjustable function which any currently commercially available TTJV does not have. METHODS: Recently, we made a prototype of an inspiration time adjustable TTJV and measured the corresponding injection volumes and peak inflation pressures according to the changes of oxygen supply pressure and inspiration time using catheters ranging from 14 to 20 G in a simulated human adult trachea-lung model. RESULTS: A 16 G angiocatheter provided 465 +/- 5 ml of injected volume with a peak inflation pressure of 25 cmH2O under a 50 psi oxygen supply at 1 second of inspiration, which would be adequate for an adult tidal volume. When a 14 G catheter was used under the same conditions as above, the injected volume was 1128 +/- 9 ml. All injected volumes were under 310 ml when 18 and 20 G angiocathers were used at variosus driving pressures (10 - 50 psi) and inspiration time (0.5, 0.75, and 1 s). CONCLUSIONS: An inspiration time adjustable TTJV can easily provide enough tidal volume to maintain oxygenation, and could be expected to prevent or reduce barotraumatic complications such as pneumothorax.
Adult* ; Barotrauma ; Catheters ; Humans* ; Inflation, Economic ; Membranes ; Oxygen ; Pneumothorax ; Tidal Volume ; Ventilation ; Ventilators, Mechanical*

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The Effects of Ketorolac on T Cell Subsets in Patients Undergoing a Gastrectomy.

Hyun Joo AHN ; Myung Hee KIM

Korean Journal of Anesthesiology.2001;40(2):201-209. doi:10.4097/kjae.2001.40.2.201

BACKGROUND: Perioperative procedures like surgery, anesthesia, pain control etc. induce immunosuppression and this immunosuppression can be the cause of postoperative infection or micrometastasis. PGE2 is the major cytokine related to immunosuppression especially in tissue trauma. NSAIDs blocked the cyclo-oxygenase pathway and then reduced PGE2 production. Therefore, we studied immunologic changes during a gastrectomy, and the effects of ketorolac administration. We used T cell subsets as immunologic indicator. METHODS: Forty patients scheduled for a gastrectomy due to stomach cancer were randomly allocated to the control group or the ketorolac group. The ketorolac group received 60 mg ketorolac before anesthesia and then 30 mg 6 hours later. Blood sampling was done before anesthesia, 2 hours and 24 hours after anesthesia. T cell subsets were studied by a monoclonal antibody technique. We also observed postoperative demerol consumption, side effects, infection, and discharge date. A Student's t-test, Mann- Whitney Rank Sum Test, and Chi-square were used for between groups comparisons, and a repeated measured ANOVA and then multiple comparison by the Tukey or Dunnett test for within-group comparison. RESULTS: T4 was decreased to 89.3%, 81% at 2 hours, and 24 hours in the control group but increased to 128.4%, 104.6% in the ketorolac group. T8 was not different between or within-groups. The T4/T8 ratio was decreased to 83.5%, 84.9% at 2 hours, and 24 hours in the control group but increased to 117.7%, 107.2% in the ketorolac group. 24 hour demerol consumption was higher in the control group than in the ketorolac group. Duration of infection and hospitalization were prolonged in the control group by 1 and 2 days each. CONCLUSIONS: Ketorolac increased the T4/T8 ratio and reduced demerol consumption, infection, and hosipitalization. Therefore ketorolac could help reverse immunosuppression during the perioperative period especially in immunocompromised patients.
Anesthesia ; Anti-Inflammatory Agents, Non-Steroidal ; Dinoprostone ; Gastrectomy* ; Hospitalization ; Humans ; Immunocompromised Host ; Immunosuppression ; Ketorolac* ; Meperidine ; Neoplasm Micrometastasis ; Perioperative Period ; Prostaglandin-Endoperoxide Synthases ; Stomach Neoplasms ; T-Lymphocyte Subsets*

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Comparison of an Effective Dose of Intravenous Postoperative Patient-controlled Analgesia with Nalbuphine.

Sung Tae KIM ; Jong Hun JUN ; Jeong Woo JEON ; Dong Won KIM ; Jae Chul SHIM ; Kyoung Hun KIM ; Jung Kook SUH

Korean Journal of Anesthesiology.2001;40(2):195-200. doi:10.4097/kjae.2001.40.2.195

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.
Analgesia ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee ; Humans ; Nalbuphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Visual Analog Scale ; Vomiting

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