Moyamoya disease is a rare progressive occlusive disease in the internal carotid arteries, along with the presence of an abnormal capillary network of vessels at the base of the brain. In moyamoya disease, the manitaining of cerebral perfusion and cerebral oxygen saturation are required to reduce complications of this disease including cerebral ischemia and cerebral hemorrhage. The authors measured regional oxygen saturation (rSO2) nonivasively by INVOS 5100 (Somanetics, USA) in patients with moyamoya disease who were scheduled for an encephalo-duro-arterio-myo synangiosis (EDAMS) operation. We therefore report our findings that deep breathing decreased rSO2 and oxygen, elevated blood pressure, and that the cerebral vasodilating drug increased rSO2.
Blood Pressure ; Brain ; Brain Ischemia ; Capillaries ; Carotid Artery, Internal ; Cerebral Hemorrhage ; Humans ; Moyamoya Disease* ; Oxygen* ; Perfusion ; Respiration

BACKGROUND: The hydrolysis of mivacurium and succinylcholine is impaired in the presence of defects of pseudocholinesterase. Clinical reports are conflicting as to the utility of anticholinesterases, in the reversal of mivacurium- or succinylcholine-induced paralysis. In this study, the role of exogenous bovine pseudocholinesterases (BpChE) and/or neostigmine, pyridostigmine, edrophonium or galanthamine in the reversal of mivacurium- or succinylcholine-induced paralysis, were investigated with the rat phrenic nerve-diaphragm preparation. METHODS: Ninety five Sprague-Dawley rats (200 g, male) were divided into 14 groups (n = 10). The phrenic nerve-diaphragm preparation mounted in a bath containing oxygenated Krebs' solution. Twitch response from diaphragmatic muscle evoked by phrenic nerve stimulation were measured. After stabilization of the twitch responses, mivacurium (0.1 microgram/mlml) or succinylcholine (0.1 microgram/ml) was administered incrementally in the preparation to obtain more than 95% twitch inhibition. BpChE (0.1, 1.0 u/ml), and/or neostigmine (0.1, 1.0 microgram/ml), pyridostigmine (0.5, 5 microgram/ml), edrophonium (0.01, 0.1 microgram/ml) or galanthamine (0.1, 1.0 microgram/ml) were added for the reversal of mivacurium- and/or succinylcholine-induced block in each group and the twitch responses (0.1 Hz) were monitored for 60 min. The effect of BpChE (0.1 u/ml), in combination with each of the above four anticholinesterases at lower concentrations also were examined. Twitch heights more than 75% was considered an adequatereversal. RESULTS: BpChE 0.1 and 1.0 u/ml were effective in reversal of mivacurium-induced paralysis. When anticholinestrases were added, there was no effective improvement of twitch height at the end of 60 minutes. In succinylcholine-induced paralysis, BpChE was effective for reversal, but when anticholinesterases were added, BpChE potency was inhibited. CONCLUSIONS: BpChE will reverse mivacurium-induced block more effectively than anticholinesterase. BpChE is effective in reversing succinylcholine block. The addition of anticholinesterases inhibits the activity of pseudocholinesterase.
Animals ; Baths ; Cholinesterase Inhibitors ; Edrophonium* ; Galantamine* ; Hydrolysis ; Neostigmine* ; Oxygen ; Paralysis* ; Phrenic Nerve ; Pseudocholinesterase* ; Pyridostigmine Bromide* ; Rats ; Rats, Sprague-Dawley ; Succinylcholine

BACKGROUND: Cerebral ischemia causes an increase in extracellular potassium ([K+]e) through activation of the KATP channel. This increase in [K+]e could result in neuronal depolarization and a reversal of the glutamate uptake system in glia. This may further contribute to the excessive concentrations of glutamate and asparate in the extracellular space during ischemia. If the early rise in [K+]e during ischemia could be attenuated, less excitotoxic neuronal damage may be the result. However, activation of KATP channels has been shown to attenuate the anoxia induced depolarization in the hippocampus and may reduce the release of excitatory neurotransmitters during cerebral ischemia. In this study, we address the question of whether KATP channel modulation affects [K+]e and whether it is related with extracellular glutamate concentrations. METHODS: After approval by the Animal Care and Use Committee, 18 New Zealand white rabbits were anesthetized with halothane and mechanically ventilated to maintain normocarbia. Microdialysis catheters were inserted into the left dorsal hippocampus and perfused with artificial cerebrospinal fluid at 2 ml/min. K+ sensitive microelectrodes were inserted into the contralateral hippocampus. A pneumatic tourniquet was placed loosely around the neck. Animals were randomized to receive glibenclamide (n=5, KATP blocker, 3.7 mg/kg) or cromakalim (n=5, KATP opener, 0.5 mg/kg). The control group (n=6) had neither drug. Ten-minute period of global cerebral ischemia was produced by inflation of the tourniquet combined with induced hypotension. Hippocampal [K+]e was measured throughout the periischemic period and glutamate concentrations in dialysate were determined by high-performance liquid chromatography. Peak levels were compared by ANOVA. RESULTS: Glutamate concentration significantly increased during ischemia period for all groups (p<0.05). In glibenclamide treated animals, brain glutamate concentration increased markedly during early reperfusion (t=I+15) compared to other groups (p<0.05). There were no statistical differences on ischemia-induced increases in [K+]e among the three groups. CONCLUSIONS: Although it was not possible to demonstrate an effect of modulators of the ATP sensitive K+ channel on [K+]e, glibenclamide increased glutamate during reperfusion. This paradoxical increase in glutamate after administration of a K+ channel blocker suggests that the mechanism of glutamate release is not related to [K+]e change.
Adenosine Triphosphate ; Animals ; Anoxia ; Brain ; Brain Ischemia ; Catheters ; Cerebrospinal Fluid ; Chromatography, Liquid ; Cromakalim ; Extracellular Space ; Glutamic Acid* ; Glyburide ; Halothane ; Hippocampus* ; Hypotension ; Inflation, Economic ; Ischemia* ; KATP Channels ; Microdialysis ; Microelectrodes ; Neck ; Neuroglia ; Neurons ; Neurotransmitter Agents ; Potassium ; Rabbits ; Reperfusion ; Tourniquets

BACKGROUND: Malignant hyperthermia (MH) is a hypermetabolic disorder of skeletal muscle that manifests after exposure to triggering episodes such as halothane or succinylcholine. The first case was reported in Australia on 1960 by Denborough. In Korea the first case report was made by Lim on 1971. The authors retrospectively analysed the reported cases of MH and/or masseter muscle rigidity in Korea for the establishment of appropriate diagnostic criteria and rapid treatment. METHODS: Twenty-one cases of MH and 2 cases of masseter muscle rigidity were analysed retrospectively form 1971 to 1995. These cases were reported in Journal of Korea Society of Anesthesiology and Journal of Research Institute of Medical Science of Korea. The analyzed items were age, department, anesthesia, symptoms and signs, drugs for treatment, history of patient and family and prognosis of MH. RESULTS: The incidence of MH was higher in male patients below the 4th decade of life. The rate was 0.6 per year from 1971 to 1995. In nineteen patients, inhalation anesthetics with succinylcholine were suspected as triggering agents and 4 patients' conditions were related to spinal anesthesia by tetracaine. Only one case of MH occured within 10 min. after induction, but 22 cases occured during operations or the recovery period, and one case in the ward. The most common initial signs were muscle rigidity, high fever with arrhythmia and increased blood pressure. Related laboratory findings were acidosis, elevated end tidal CO2, and hyperkalemia. Six cases had family histories or past histories related to MH. CONCLUSIONS: The incidence of MH is progressively increasing in Korea. But MH will be prevented and treated effctively. So we should prepare a monitoring system for early detection and a supply of dantrolene for treatment. These precautions will spread nationwide and will need the support of the anesthesiology society and the goverment.
Academies and Institutes ; Acidosis ; Anesthesia Department, Hospital ; Anesthesia, Spinal ; Anesthesiology ; Anesthetics, Inhalation ; Arrhythmias, Cardiac ; Australia ; Blood Pressure ; Dantrolene ; Fever ; Halothane ; Humans ; Hyperkalemia ; Incidence ; Korea* ; Male ; Malignant Hyperthermia* ; Masseter Muscle ; Muscle Rigidity ; Muscle, Skeletal ; Prognosis ; Retrospective Studies ; Succinylcholine ; Tetracaine

BACKGROUND: Since the first successful kidney transplantation from a brain death donor (BDD) was done in 1979, organ transplantations from BDD have steadily increased. The number of BDDs have been increasing year by year. The purpose of this study is to analyze clinical status of organ donor from BDDs. METHODS: We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. RESULTS: The male to female ratio was 3 : 1, and the age distribution was the highest in twenties. The distribution of cause of brain death was the highest in motor vehicle accidents. The distribution of acquired organ was the highest in kidney, heart, liver in order. The distribution of days stayed in ICU before organ donation was the highest in 2 days. The choice of agent for inotropic support of the myocardium is dobutamine. The donors have been transfused with packed red blood cell (PRBC) to maintain the hematocrit between 25~35%. Two units of PRBC should be readily available at all times for transfusion. The failure of organ donation was mainly very poor organ condition. CONCLUSIONS: We wish that these results were made use of bases of status of organ donation from BDDs.
Age Distribution ; Brain Death* ; Brain* ; Chungcheongnam-do ; Dobutamine ; Erythrocytes ; Female ; Heart ; Hematocrit ; Humans ; Kidney ; Kidney Transplantation ; Liver ; Male ; Motor Vehicles ; Myocardium ; Organ Transplantation ; Retrospective Studies ; Tissue and Organ Procurement ; Tissue Donors* ; Transplants

BACKGROUND: The effects of a muscle relaxant may differ in elderly compared with young adult patients for a variety of the pharmacokinetic and pharmacodynamic reasons. Atracurium is eliminated by nonorgan dependent pathway, Hofmann elimination and ester hydrolysis. So there are some arguments for age-related differences. The purpose of this study was to compare the differences of the onset and duration of atracurium in young and elderly. METHODS: Eighteen young adults (21-54 yr) and 18 elderly (>65 yr) patients anesthetized with nitrous oxide and enflurane. Atracurium (0.5 mg/kg) was given and then intubation was performed after T1 response was blocked more than 80%. Neuromuscular relaxation was measured by the first twitch of train-of-four (T1) response at the adductor pollicis after supramaximal stimulation of ulnar nerve at 2Hz every 12 sec. The onset (disappearance of T1) and duration of 5, 25, 50, 75% recovery time of T1 and recovery index (time for 25-75% recovery of T1) were recorded. RESULTS: Onset of block was not significantly different between the young and elderly. Recovery time of 5, 25, 50, 75% and recovery index were not prolonged in elderly compared with young adults. CONCLUSIONS: There were no significant differences between young and elderly adults in onest time, recovery time of 5, 25, 50, 75% and recovery index when atracurium is used in a single bolus dose. The results suggest that atracurium in elderly patients has similar onset and action duration compared with younger patients.
Adult ; Aged* ; Atracurium* ; Enflurane ; Humans ; Hydrolysis ; Intubation ; Nitrous Oxide ; Relaxation ; Ulnar Nerve ; Young Adult

BACKGROUND: It has been a standard practice in many institutions to combine light general anesthesia with epidural block for abdominal and pelvic surgery. We attempted to prove the effectiveness of prehydration and to find an suitable epidural local anesthetic dose in terms of hemodynamic stability for upper abdominal surgery. METHODS: For preliminary studies, 11 patients scheduled for elective upper abdominal surgery had received general anesthesia immediately after epidural anesthesia. After epidural injection of 10~16 mL of 2% plain lidocaine into the T9~10 intervertebral space, the changes in blood pressure were observed. Thirty-two patients scheduled for elective upper abdominal surgery were divided into two groups. In group A (study group), after prehydration with Hartmann solution (10 mL/kg), 5~7 mL of 2% plain lidocaine was injected into T8~9 or T9~10 intervertebral space and general anesthesia was then induced. Group B (control group) received general anesthesia only. RESULTS: There were no significant differences in hemodynamics between the epidural with general anesthesia and the control group except SVR (systemic vascular resistance). SVR in group A increased in contrast to the group B in which it remained unchanged. CONCLUSIONS: The combined epidural and general anesthesia, using prehydration and 0.5~1 mL/segment of 2% plain lidocaine at the T8~9 or T9~10 intervertebral space was safe without significant hemodynamic changes.
Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Hemodynamics* ; Humans ; Injections, Epidural ; Lidocaine

We managed three cases of anesthesia for living related liver transplantation from December 1994 to July 1995. Donors were recipient's parents and two of them were 35-year old man, the other was 25-year-old woman. The recipients were suffered from congenital liver diseases (two of them were diagnosed as biliary atresia and the other Byler's disease). They had presented severe jaundice and cholangitis and their mean age & body weight were 15 +/- 4.9 months and 8.6 +/- 1.22 kg, respectively. Average duration of anesthesia was about 15 hours, and anhepatic time was 140 minutes, 80 m inutes and 50 minutes, respectively. Careful attention was paid to body temperature, serum potassium, ionized calcium, blood coagulation function, as well as to general condition and respiratory function. Hemodynamic value was relatively stable through out the operation and postoperative mechanical ventilatory support was required for about 3 days.
Adult ; Anesthesia ; Biliary Atresia ; Blood Coagulation ; Body Temperature ; Body Weight ; Calcium ; Child* ; Cholangitis ; Female ; Hemodynamics ; Humans ; Jaundice ; Liver Diseases ; Liver Transplantation* ; Liver* ; Parents ; Potassium ; Tissue Donors*

BACKGROUND: Although exact mechanism of adult respiratory distress syndorme (ARDS) is not known, many evidences suggest that inflammatory mediators such as protease and oxygen radicals may be the final common pathway to the endothelial injury. It is gradually accepted that activated neutrophils play a major role in the process. Pentoxifylline is a methylated xanthine with a wide range of actions that make it theoretically useful in the treatment of ARDS. Studies show that it decreases neutrophil phagocytosis and superoxied production. The aim of this experiment is to determine whether pentoxifylline has a preventive effect on oleic acid-induced lung injury. METHODS: Oleic acid (0.08 ml/kg) was infused in 10 mongrel dogs in order to induce acute lung injury. Pentoxifylline (20 mg/kg) was administered 40 mins before oleic acid injection. The author made a comparative studies on the effects of pentoxifylline on hemodynamics and gas exchange before oleic acid injection and at 15, 30, 45, 60, 90 mins after oleic acid injection. RESULTS: There were not significant changes in mean arterial pressure, cardiac output, systemic vascular resistence, pulmonary wedge pressure intrapulmonary shunt in both groups. There were statistical significance in arterial oxygen tension, pulmonary artery pressure, pulmonary vascular resistance between both groups (p<0.05). CONCLUSIONS: Pentoxifylline is a noteworthy drug that could be a candidate as a therapy to help prevent effect in lung injuries that share a common mechanism with oleic acid-induced lung injury.
Acute Lung Injury ; Adult ; Animals ; Arterial Pressure ; Cardiac Output ; Dogs ; Hemodynamics ; Humans ; Lung Injury* ; Lung* ; Neutrophils ; Oleic Acid ; Oxygen ; Pentoxifylline* ; Phagocytosis ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Reactive Oxygen Species ; Vascular Resistance ; Xanthine

BACKGROUND: Blood-brain barrier(BBB) permeability and intravascular hydrostatic pressure are main factors for developing brain edema. Selective cooling of the brain could attenuate the ischemia-induced increase of BBB permeability. Because the method can provide driving pressure for edema formation, a beneficial effect of hypothermic perfusion on reducing edema would be questionable. The goal of this study was to evaluate the effect of isolated cerebral perfusion during the cerebral ischemia on the formation of brain edema. METHODS: Both vertebral arteries were cauterized, right carotid artery was cannulated to provide an infusion route. After left carotid artery was snared, cold saline was immediately perfused into the right carotid artery for 10 min in the perfusion group. To produce ischemia in no perfusion group carotid arteries were clamped bilaterally for 10 min. Brain water contents were measured using the kerosene/bromobenzene density gradient after reperfusion and compared with no perfusion and normal control group. RESULTS: Brain water content of perfusion group measured at 90 min after reperfusion showed increased water content compared to no perfusion and normal control group(p<0.05). However, at 180 min after reperfusion, there were no statistically significant differences between the perfusion and no perfusion group. CONCLUSIONS: Cerebral saline perfusion during the ischemia enhanced the formation of brain edema even though hypothermia could reduce BBB permeability. These results show driving force is more important than permeability for the development of brain edema in this type of experiments.
Brain Edema ; Brain Ischemia* ; Brain* ; Carotid Arteries ; Edema ; Hydrostatic Pressure ; Hypothermia ; Ischemia ; Perfusion ; Permeability ; Reperfusion ; SNARE Proteins ; Vertebral Artery