BACKGROUND: Minimal-flow anesthesia can meet the demands of a modern society that is more sensitive to environmental protection and economic burdens. This study compared the safety and efficacy of minimal-flow desflurane anesthesia with conventional high-flow desflurane anesthesia for prolonged laparoscopic surgery. METHODS: Forty-six male patients (ASA physical status II or III) undergoing laparoscopic urologic surgery for more than 6 hours were randomly divided into two groups: the high-flow (HF) group and the minimal-flow (MF) group. The HF group was continuously administered a fresh gas flow of 4 L/min. In the MF group, a fresh gas flow of 4 L/min was administered for the first 20 minutes and was thereafter lowered to 0.5 L/min. Inspiratory and expiratory desflurane concentrations, respiratory variables, and hemodynamic variables were continuously monitored during administration of anesthesia. Measurements of carboxyhemoglobin (COHb) concentration and arterial blood gas analysis were performed every 2 hours during anesthesia. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were measured on the first and second day after the surgery. RESULTS: Demographic data and duration of anesthesia were not different between the two groups. Significant differences were not observed between the two groups in terms of hemodynamic variables, respiratory variables, and inspiratory and expiratory desflurane concentrations. Inspiratory O2 concentration was maintained lower in the MF group than in the HF group (43-53% vs. 53-59%; P < 0.05). Compared with the HF group, COHb concentrations was higher (P < 0.05), but not increased from the baseline value in the MF group. Serum AST, ALT, BUN, and creatinine were not significantly different between the two groups. CONCLUSIONS: In prolonged laparoscopic surgery, no significant differences were found in safety and efficacy between minimal-flow and high-flow desflurane anesthesia.
Alanine Transaminase ; Anesthesia ; Aspartate Aminotransferases ; Blood Gas Analysis ; Blood Urea Nitrogen ; Carboxyhemoglobin ; Natural Resources ; Creatinine ; Hemodynamics ; Humans ; Isoflurane ; Laparoscopy ; Male

PURPOSE: The aim of this study was to evaluate the effects of a smoking cessation education on endothelial function and carboxyhemoglobin levels in smokers with variant angina. METHODS: A nonequivalent control group pretest-posttest design was used. Participants were 60 male smokers with variant angina admitted to one hospital: the control group (30) between September and December, 2009, and the experimental group (30) between February and May, 2010. Endothelial function, as defined by flow-mediated vasodilation (FMD) of the brachial artery, and serum carboxyhemoglobin (COHb) were determined at baseline and at 3 months after the initiation of education in both groups. RESULTS: Three months after the program, smoking cessation was successful in 22 of the 30 smokers in the experimental group, but only in 4 of 30 smokers in the control group (p<.001). After the education, the experimental group showed a significant increase in FMD, and a significant decreased in serum COHb compared with the control group. CONCLUSION: The findings indicate that this smoking cessation education program is effective for hospitalized smokers with variant angina.
Adult ; Angina Pectoris, Variant/blood/*physiopathology ; Brachial Artery/physiology ; Carboxyhemoglobin/*analysis ; Endothelium, Vascular/*physiology ; Humans ; Male ; Middle Aged ; *Program Evaluation ; Smoking/psychology ; *Smoking Cessation ; Vasodilation

OBJECTIVETo study the expression of heme oxygenase-1 (HO-1) gene and protein and the effect of budesonide (BUD) on the HO-1 expression in lung tissues in rats with asthma.

METHODSFifty male Sprague-Dawley rats were randomly divided into 5 groups: normal control, asthma model, dexamethasone (DXM)-, hemin (HO-1 challenger)-or BUD-treated asthma. The asthma model was prepared by ovalbumin sensitization and challenge. The rats were sacrificed 24 hrs after the last challenge. The blood COHb content,and the total cell count and the percentage of differential cells in bronchoalveolar lavage fluid (BALF) were measured. The expression of HO-1 protein and mRNA in lung tissues was detected with immunohistochemistry and RT-PCR, respectively. The airway inflammation situations were evaluated by histopathology.

RESULTSThe airway inflammatory cell infiltration in the DXM-, hemin- and BUD-treated asthma groups was remarkably alleviated compared with that in the asthma model group. Compared with the normal control group, the expression of HO-1 mRNA and protein in lung tissues and the blood COHb content in the asthma model and the DXM-, hemin- and BUD-treated asthma groups were significantly up-regulated. The DXM-, hemin- and BUD-treated asthma groups showed significantly increased expression of HO-1 protein and mRNA in lung tissues compared with the asthma model group. The blood COHb content in the DXM-and the hemin-treated asthma groups was significantly higher than that in the asthma model group.

CONCLUSIONSThe expression of HO-1 protein and mRNA in lung tissues and blood HO-1 activity increased in rats with asthma,suggesting that HO-1 may be involved in the pathogenesis of asthma. HO-1 may have a protective effect against the airway inflammation in asthmatic rats. BUD and DXM can up-regulate the expression of HO-1 protein and mRNA, thus providing protective effects against the airway inflammation in asthmatic rats.

Animals ; Asthma ; drug therapy ; enzymology ; Budesonide ; pharmacology ; therapeutic use ; Carboxyhemoglobin ; analysis ; Dexamethasone ; pharmacology ; Heme Oxygenase-1 ; analysis ; genetics ; Hemin ; pharmacology ; Lung ; enzymology ; Male ; RNA, Messenger ; analysis ; Random Allocation ; Rats ; Rats, Sprague-Dawley

Carbon monoxide (CO), a metabolite of heme catalysis by heme oxygenase (HO), has been proposed to have anti-oxidative, anti-inflammatory and anti-apoptotic functions. Lipopolysaccharide (LPS)-induced lung injury (LI) is characterized by oxidative stress, inflammatory reaction and excessive pulmonary cell apoptosis. So we supposed that CO might have protection against LI. LI in rats was induced by intravenous injection of LPS (5 mg/kg). To observe the effect of CO inhalation, LI rats were exposed to 2.5 x 10(-4) (V/V) CO for 3 h. CO-induced changes of lung oxidative stress parameters, inflammatory cytokines, cell apoptosis, HO-1 expression and histology were examined. Results revealed that expressions of the tumor necrosis factor-alpha (TNF-alpha) and interlukin-6 (IL-6), activities of maleic dialdehyde (MDA) and myeloperoxidase (MPO), and cell apoptosis in LPS injection + CO inhalation group were (0.91+/-0.25) pg/mg protein, (0.64+/-0.05) pg/mg protein, (1.02+/-0.23) nmol/mg protein, (7.18+/-1.62) U/mg protein and (1.60+/-0.34)%, respectively, significantly lower than the corresponding values in LI group [(1.48+/-0.23) pg/mg protein, (1.16+/-0.26) pg/mg protein, (1.27+/-0.33) nmol/mg protein, (8.16+/-1.49) U/mg protein and (3.18+/-0.51) %, P<0.05]. Moreover, CO inhalation obviously increased the expressions of HO-1 and interlukin-10 (IL-10) and activity of superoxide dismutase (SOD) [(5.43+/-0.92), (0.26+/-0.07) pg/mg protein and (60.09+/-10.21) U/mg protein in LPS injection + CO inhalation group vs (3.08+/-0.82), (0.15+/-0.03) pg/mg protein and (50.98+/-6.88) U/mg protein in LI group, P<0.05]. LI was attenuated by CO inhalation. Our study demonstrates that inhalation of low concentration of CO protects lung against LPS-induced injury via anti-oxidant, anti-inflammation, anti-apoptosis and up-regulation of HO-1 expression.
Administration, Inhalation ; Animals ; Apoptosis ; drug effects ; Carbon Monoxide ; administration & dosage ; Carboxyhemoglobin ; analysis ; Cytokines ; biosynthesis ; Heme Oxygenase-1 ; genetics ; Lipopolysaccharides ; toxicity ; Lung ; drug effects ; metabolism ; pathology ; Male ; Oxidative Stress ; drug effects ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo study the value of carboxyhemoglobin (COHb) in the diagnosis of neonatal jaundice.

METHODSThis study consisted of 189 patients with neonatal jaundice due to hemolytic disease (n=75), infectious disease (n=52), intracranial hemorrhage (n=32) and breast-milk feeding (n=30). One hundred and forty-two neonates without pathological jaundice that were gestational age, postnatal age- and birth weight-matched were used as the Control group. The level of arterial capillary blood COHb was detected by a 270 CO-oximeter connected to an 800 series system. Total serum bilirubin (STB) content was measured using an Abbott Spectrum CCX chemistry analyzer. The levels of COHb and STB were measured at baseline, and again in patients with jaundice due to hemolytic disease after intravenous gammaglobulin treatment for 2 days.

RESULTSThe levels of COHb [(3.64 +/- 0.83)%] and STB (330.84 +/- 77.15 micromol/L) in patients with jaundice due to hemolytic disease were significantly higher than those measured in the Control group [COHb (2.38 +/- 0.35) %; STB 130.18 +/- 32.86 micromol/L] (P < 0.01). The levels in patients with jaundice due to intracranial hemorrhage were also significantly higher than those in the Control group [COHb (2.48 +/- 0.53) % vs (2.24 +/- 0.32) %; STB 184.15 +/- 29.35 micromol/L vs 112.11 +/- 17.45 micromol/L; P < 0.05]. The patients with jaundice due to infectious disease or breast-milk feeding only demonstrated higher levels of serum STB (P < 0.01) while COHb levels were not different compared with the Control group. The patients with jaundice due to hemolytic disease or intracranial hemorrhage presented with hemolytic unconjugated hyperbilirubinemia and had significantly higher COHb levels and lower STB levels than those patients with nonhemolytic unconjugated hyperbilirubinemia (caused by breast jaundice) (P < 0.01). The levels of COHb [(2.68 +/- 0.51) %] and STB (230.18 +/- 42.96 micromol/L) in patients with jaundice due to hemolytic disease decreased markedly after intravenous gammaglobulin treatment (P < 0.01).

CONCLUSIONSThe COHb level can be used as a supplementary indicator of increased bilirubin production. The elevation of COHb can be useful in the diagnosis of neonatal jaundice since COHb is elevated in hemolytic disease and intracranial hemorrhage.

ABO Blood-Group System ; immunology ; Bilirubin ; blood ; Carboxyhemoglobin ; analysis ; Female ; Humans ; Immunoglobulins, Intravenous ; therapeutic use ; Infant, Newborn ; Jaundice, Neonatal ; diagnosis ; therapy ; Male

To investigate the role of endogenous heme oxygenase (HO)/carbon monoxide (CO) system in the lung injury as assessed by lung histology, polymorphonuclear count, malondialdehyde content and wet-to-dry weight ratio following ischemia-reperfusion (I/R) of hind limbs, zinc protoporphyrin (ZnPP), an inhibitor of HO activity, was used, and the lung HO activity and blood carboxyhemoglobin (COHb) level were measured. The results showed that HO activity and COHb level were increased significantly and lung injury occurred after limb I/R. After administration of ZnPP, the lung injury was further aggravated while the HO activity and COHb level were significantly decreased. These findings suggest that upregulation of HO activity followed by subsequent CO production attenuates the lung injury induced by limb I/R in rats.
Animals ; Carbon Monoxide ; physiology ; Carboxyhemoglobin ; analysis ; Heme Oxygenase (Decyclizing) ; analysis ; physiology ; Hindlimb ; Lung Diseases ; etiology ; pathology ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; complications ; metabolism

OBJECTIVETo determine the role of hemoglobin (HB) induced heme oxygenase-1 (HO-1) in injured lungs caused by limb ischemia-reperfusion (I/R) in rats.

METHODSA rat model of ischemia in the hind limbs was made by clamping the infrarenal aorta with a microvascular clip, and lung injury occurred after reperfusion. To induce the expression of HO-1 in the lungs, Hb was administrated intraperitoneally at 16 hours before reperfusion. Northern blotting and Western blotting were used to detect the expression of HO-1 in the lungs, and the carboxyhemoglobin (COHb) level in arterial blood was assayed. The effect of hemoglobin (Hb) on the injured lungs after limb I/R was determined by measuring the changes of lung histology, polymorphonuclear (PMN) count, malondialdehyde (MDA) content and wet-to-dry weight ratio (W/D). Zinc protoporphyrin (ZnPP), an inhibitor of HO, was used to determine whether HO-1 was induced by Hb after lung injury.

RESULTSHb led to a significant increase in HO-1 mRNA and protein expression in the lungs, accompanied by the increase of COHb level in arterial blood. Compared with the sham controls, the lung PMN count, MDA content and W/D significantly increased at 4 hours after limb I/R, which reversed by the pretreatment with Hb at 16 hours before reperfusion. ZnPP blocked this protective role of Hb in the injured lungs.

CONCLUSIONSHb can induce the lung HO-1 expression, which plays an important role in the defense against I/R induced lung injury in rats.

Animals ; Blotting, Northern ; Blotting, Western ; Carboxyhemoglobin ; analysis ; Disease Models, Animal ; Heme Oxygenase (Decyclizing) ; analysis ; biosynthesis ; Heme Oxygenase-1 ; Hemoglobins ; pharmacology ; Lung Diseases ; etiology ; pathology ; Male ; Probability ; RNA, Messenger ; biosynthesis ; Rats ; Rats, Sprague-Dawley ; Reference Values ; Reperfusion Injury ; complications ; metabolism ; Sensitivity and Specificity

Determinant factors for personal carbon monoxide (CO) exposures were sought in Korea, where CO poisoning has been a major public health problem due to coal briquette (Yeontan) combustion for space heating and cooking. Personal 24-hr CO exposures of 15 housewives were measured by CO passive samplers on 2 days of the week (Wednesday and Sunday). Blood samples were taken to measure carboxyhemoglobin (COHb) just after the exposure sampling. Average CO exposure and COHb level were 5.6 ppm and 2.4%, respectively. Personal CO exposures as well as COHb levels were significantly increased by the use of Yeontan, especially on a weekday. Carboxyhemoglobin levels were closely related to the time between blood collection and replacement of Yeontan: the closer the blood collection was to replace Yeontan, the higher the COHb levels were. Assuming a background COHb of 1.34%, COHb increased on average by 1.8% with a 24-hr personal CO exposure of 10 ppm. The relationship between CO exposure and COHb level was provided by simultaneous direct measurements in real environment, although a measurement of COHb at the end of exposure could not represent previous 24-hr exposure thoroughly.
Adult ; Air Pollution, Indoor/*adverse effects ; Carbon Monoxide/*analysis ; Carboxyhemoglobin/*analysis ; Coal ; Environmental Exposure/*analysis ; Female ; Heating ; Human ; Korea ; Middle Age

To obtain the basic data of prognosis of acute carbon monoxide (CO) intoxication, one hundred and sixteen cases of CO intoxication defined by carboxyhemoglobin (COHb) and admitted via emergency room of Yeungnam University Hospital from Oct. '85 to April' 89 have been clinically analyzed and evaluated, including delayed postanoxic encephalopathy (DPE) and the following results were obtained. 1. The ratio of male to female was 1:1.5 and mental state was drowsy mostly (26.2% of 116 cases) 2. The more disturbed the mental state, the more decreased was the arterial pH and PaCO₂, which may be the result of metabolic acidosis. 3. The early laboratory findings in patients of CO intoxication were as follows: leukocytosis-65.5%, increase of hematocrit-23.3%, hyperglycemia-19.8%, increase of GPT-19.8% increase of creatinine-0.9% and glucosuria-12.1%. 4. The early findings of EKG were abnormal in 35.3%: change of rhythm-25.0%, abnormal ST segment 15.5% (change of rhythm and abnormal ST segment-5.2%) but the conduction disorder was not present. 5. The abnormal EEG above mild degree was 93.1%, of which moderate was most frequent (80.2%). 6. The incidence of DPE was 7.8% among all admitted CO patients. DPE cases had long duration of exposure time (8 hours), severe leukocytosis (20,000) and an abnormal EEG (MA).
Acidosis ; Blood Gas Analysis ; Brain Diseases ; Carbon Monoxide* ; Carbon* ; Carboxyhemoglobin ; Clinical Study* ; Electrocardiography ; Electroencephalography ; Emergency Service, Hospital ; Female ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Leukocytosis ; Male ; Prognosis