BACKGROUND: We evaluated the correlation between the difference of estimated lean body mass (LBM(E)) with actual lean body mass (LBM(A)) and actual blood concentration of propofol, hemodynamic variables and Bispectral index (BIS) during target controlled infusion (TCI) of propofol in Korean female patients who would take total intravenous anesthesia (TIVA) using propofol-remifentanil combination. METHODS: Eighty Korean women participated in this trial. Demographic data were collected and LBM(A) was measured using body mass analyzer. Target concentration of propofol was set at 6microgram/ml during induction and 3microgram/ml during maintenance. Hemodynamic variables and BIS were measured at 60 minutes after anesthetic induction. Peripheral blood sample was collected from a large forearm vein on the contralateral side of infusion for measurement of whole blood concentration of propofol at 60 minutes after anesthetic induction. Delta lean body mass (delta LBM) was obtained by subtracting LBM(A) from LBM(E). Correlation analyses were done between delta LBM and plasma propofol concentration, blood pressure, and BIS, respectively. RESULTS: Blood concentrations of propofol were 1.9-6.9microgram/ml. Mean plasma concentration of propofol was higher than target concentration. delta LBM had a positive correlation with actual plasma propofol concentration. delta LBM was not correlated with hemodynamic variables and BIS. CONCLUSIONS: TCI of propofol resulted in large variation in measured plasma concentration. We thought delta LBM was one of interpatient variation factors of propofol plasma concentration during TCI. We found that TCI of propofol using Schnider model would result in higher blood concentration than target concentration in Korean women.
Anesthesia, Intravenous ; Blood Pressure ; Female ; Forearm ; Hemodynamics ; Humans ; Plasma ; Propofol ; Veins

BACKGROUND: Propofol sedation using target-controlled infusion (TCI) system can be used in MAC (Monitored Anesthesia Care).Remifentanil is an ultra-short-acting opioid that is advantageous in combination with propofol due to its rapid onset and offset times and analgesic effect.The present study sought to identify the EC50 of propofol for 'loss of response to command' when administered alone or with 2 or 3 ng/ml remifentanil using TCI. METHODS: Seventy patients were randomly allocated to one of three treatment groups:Group 1 = propofol only (n = 20), Group 2 = propofol plus 2 ng/ml remifentanil (n = 25) and Group 3 = propofol plus 3 ng/ml remifentanil (n = 25).The EC50 was determined by calculating the mean of the midpoint dose of all independent pairs of patients who manifested crossover from 'response to command' to 'loss of response to command'. RESULTS: The EC50 of propofol was found to be 3.41 +/- 0.25microgram/ml in Group 1, 2.04 +/- 0.22microgram/ml in Group 2, and 1.98 +/- 0.15microgram/ml in Group 3.Statistical analysis showed the EC50 for Group 1 was higher than those for Groups 2 and 3, and that the EC50 of latter groups were similar. CONCLUSIONS: Using the modified Dixon's up and down method, the present study estimated the EC50 of propofol for 'loss of response to command' when remifentanil was infused in analgesic doses using TCI.Those concentrations can safely and effectively generate sedation and analgesia without clinically significant side effects in MAC.
Analgesia ; Anesthesia ; Humans ; Piperidines ; Propofol

A patient who had previously undergone a subtotal gastrectomy was scheduled for removal of a brain tumor under general anesthesia. Anesthesia was induced with lidocaine and propofol with rocuronium for neuromuscular blockade. She had fasted for 10 hours, but after mask ventilation, she aspirated gastric juice and materials. The oral cavity was suctioned promptly and the trachea was intubated. Intraoperative high FiO2 and dopamine were administrated to maintain the oxygen saturation and blood pressure. She received postoperative ventilatory care in the intensive care unit for 2 weeks. An upper gastrointestinal series and fiber endoscopy were performed but she had no obstruction and reflux esophagitis except delayed passage of the contrast media. She had no risk factors for pulmonary aspiration. As in this case, patients with previous gastrointestinal surgery should be considered preoperative workup for GI motility or pathology, and adequate premedication.
Androstanols ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Brain Neoplasms ; Contrast Media ; Dopamine ; Endoscopy ; Esophagitis, Peptic ; Gastrectomy ; Gastric Juice ; Humans ; Intensive Care Units ; Lidocaine ; Masks ; Mouth ; Neuromuscular Blockade ; Oxygen ; Pneumonia ; Premedication ; Propofol ; Risk Factors ; Suction ; Trachea ; Ventilation

BACKGROUND: Cough reflex in response to extubation of the endotracheal tube is common; however, the effect of remifentanil on cough reflex is uncertain. Therefore, we evaluated the effect of lidocaine and remifentanil on cough reflex following extubation. METHODS: Forty adult patients scheduled to undergo elective surgery in two hours were enrolled in this study. All patients received a standard anesthetic protocol. Following surgery, the patients were randomly divided into two groups, Group L (n = 20), which received 1.5 mg/kg of 2% lidocaine intravenously, and Group R (n = 20), which received 0.5 microgram/kg remifentanil intravenously. Treatment was administered immediately after the patients opened their eyes, after which extubation was performed. We then evaluated breath holding and recorded the number of coughs at 5 minutes, 15 minutes and 30 minutes after extubation. In addition, we checked for sore throat 30 minutes after extubation. RESULTS: The number of coughs was significantly lower in Group R than in Group L at 5 minutes after extubation. However, there was no significant difference in the number of coughs in Group R and Group L at any other times evaluated. CONCLUSIONS: There are no significant differences in suppression of the cough reflex in response to treatment with lidocaine and remifentanil.
Adult ; Breath Holding ; Cough ; Eye ; Humans ; Lidocaine ; Pharyngitis ; Piperidines ; Reflex

BACKGROUND: Laryngoscopy and endotracheal intubation may cause tachycardia and hypertension. Magnesium directly inhibits the release of catecholamine from the adrenal medulla, with has a vasodilating effect. Remifentanil indirectly decreases the release of catecholamine by increasing the depth of anesthetic. The effects of magnesium sulfate and remifentanil at attenuating the sympathetic responses were compared during laryngoscopy and endotracheal intubation. METHODS: Eighty ASA class 1 or 2 patients, scheduled for elective surgery under general anesthesia, and requiring endotracheal intubation, were divided into four groups. The patient received either normal saline, 50 mg/kg magnesium sulfate, 1.0microgram/kg remifentanil or 25 mg/kg magnesium sulfate and 0.5microgram/kg remifentanil Groups C, M, R and MR, respectively, according to their assigned group. The specific drugs for each group were administered over a 30 second period prior to the induction of anesthesia with 2 mg/kg propofol and 1.5 mg/kg succinylcholine. The Systolic blood pressure, diastolic blood pressure and heart rate were recorded prior to induction (T1), immediately prior to intubation (T2), immediately after intubation (T3), and 1 and 3 minutes after intubation (T4 and T5, respectively). RESULTS: The percentage changes in the systolic blood pressure of groups M, R and MR were lower immediately after intubation than that of group C. The systolic blood pressures of groups M and MR increased from those at the baseline, but the systolic blood pressure of group R decreased from that at the baseline immediately after intubation. The heart rate of group M increased from that at the baseline, but the heart rate of group R decreased from that at the baseline immediately prior to intubation. CONCLUSIONS: The blood pressure immediately after endotracheal intubation was increased by the administration of magnesium sulfate, but the induced change was less than that of group C. The blood pressure was decreased by the administration of remifentanil immediately after endotracheal intubation. Magnesium sulfate caused tachycardia, but remifentanil caused bradycardia.
Adrenal Medulla ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Bradycardia ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Magnesium Sulfate* ; Magnesium* ; Propofol ; Succinylcholine ; Tachycardia

Dieulafoy's lesion is a very rare cause of gastrointestinal bleeding that occurs after rupture of an exposed submucosal artery. The majority of lesions are found in the stomach, but rarely it has also been identified in the duodenum, small bowel, colon and rectum. We describe a 78-year-old female with chronic renal failure who presented with melena and was subsequently found to have a Dieufaloy-like lesion in the stomach. The bleeding was successfully managed by endoscopic hemoclipping. During the follow-up, massive gastrointestinal bleeding was developed by a Dieulafoy-like lesion in the rectum. This lesion was managed by endoscopic band ligation, but there was recurrent bleeding from the ulcer site. The ulcer site was locally excised and primary closure was carried out.
Aged ; Arteries ; Colon ; Duodenum ; Female ; Follow-Up Studies ; Hemorrhage* ; Humans ; Kidney Failure, Chronic* ; Ligation ; Melena ; Rectum* ; Rupture ; Stomach* ; Ulcer

BACKGROUND: In intravenous administration of a depolarizing neuromuscular blocker, succinylcholine is reported to produce activation of the electroencephalogram and increase cerebral blood flow and intracranial pressure. In this point, rocuronium was recently introduced as a non-depolarizing relaxant, and recommended as a safe alternative to succinylcholine. The purpose of this study was to evaluate the effects of rocuronium and succinylcholine on cerebral blood flow velocities during anesthetic induction. METHODS: Forty patients were randomly assigned into two groups. Group 1 was administrated rocuronium 0.6 mg/kg and group 2 was administrated succinylcholine 1 mg/kg for tracheal intubation after each group had intravenous administration of thiopental 5 mg/kg. The author observed changes of mean arterial pressure, arterial carbon dioxide tension, and middle cerebral arterial blood flow velocities at 5 times: before induction (control), 30 sec after thiopental administration, 30 sec, 60 sec and 90 sec after muscle relaxant administration. RESULTS: Mean arterial pressure decreased more at 30 sec after thiopental administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30 sec after thiopental administration and 60 sec after rocuronium administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30, 60, 90 sec after rocuronium administration compared with succinylcholine administration (P<0.05). CONCLUSIONS: We conclude that rocuronium has little effects on increasing cerebral blood flow. These result suggest that rocuronium have a less effect on increase in cerebral blood flow during neurosurgical anesthesia.
Administration, Intravenous ; Anesthesia ; Arterial Pressure ; Blood Flow Velocity* ; Carbon Dioxide ; Electroencephalography ; Humans ; Intracranial Pressure ; Intubation ; Neuromuscular Blockade ; Succinylcholine* ; Thiopental

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

BACKGROUND: Restrictive left ventricular (LV) filling patterns after acute myocardial infarction (AMI) predict poor prognosis. Doppler indexes of LV inflow, especially peak velocity ratio of early versus late diastolic flow (E/A) and deceleration time, can predict heart failure or death. Doppler indexes of pulmonary venous flow are also used to diagnose restrictive LV filling, but their prognostic values after AMI are not known. METHODS: Doppler echocardiographic examination were performed in patients with AMI (n=122) between 7 to 10 days after attack, and followed for 30 months. Death group included 9 deaths (7.4%) during follow-up. 18 age-matched patients (control group) were selected from 70 patients without death, heart failure or readmission. Doppler echocardiographic indexes of peak systolic velocity (SV), peak diastolic velocity (DV), and peak reverse flow velocity associated with atrial contraction (AR) of pulmonary venous flow were measured by transthoracic echocardiography. RESULTS: Death group had lower SV (46.1+/-6.3 vs 57.0+/-14.7 cm/sec; p=0.059) and SV/DV ratio (1.26+/-0.50 vs 1.58+/-0.37; p=0.076). Death group had significantly more patients with SV/DV ratio less than 1.3 (67% vs 17%; p=0.026). AR was significantly different between death and control groups (29.7+/-7.8 vs 24.7+/-6.8 cm/sec; p=0.023). Death group had significantly more patients with AR greater than 25 (78% vs 33%; p=0.046). CONCLUSION: SV/DV ratio and AR of pulmonary venous flow predicted death after AMI.
Deceleration ; Echocardiography ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction* ; Prognosis

PURPOSE: In the present study the effects of amiloride on the growth of human gastric adenocarcinoma cell line, AGS cells were examined with or without the addition of 5-fluorouracil (5-FU) in vitro. MATERIALS AND METHODS: The growth of AGS cells was examined by counting number of cells on two and four days post-treatment with 50 micrometer, 100 micrometer, 200 micrometer, 400 micrometer, 800 micrometer, amiloride, and 0.1 microgram/ml, 0.3 microgram/ml 5-FU, after plating AGS cells into 6 well plates at a density of 10 x 10(4) cells/well. The reversibility of the effects of amiloride was examined on two to eight days post-treatment with 400 micrometer amiloride after seeding 2 x 10(4) cells/dish. Cell cycle analysis was performed after four day-treatment with 400 micrometer amiloride. RESULTS: Amiloride (50~800 micrometer) significantly inhibited the growth of AGS in a dose-dependent fashion (p<0.05). The inhibitory effect of amiloride on growth of AGS was reversible since removal of amiloride after 24 hours treatment led to resumption of rapid growth up to control levels. Amiloride combined with 5-FU markedly inhibited the growth of AGS in a dose-dependent fashion compared to that of amiloride or 5-FU alone (p<0.05). The fraction of S phase, G0-G1 phase and G2-M phase was 19.3%, 55.7%, 18.8%, in the amioride group (400 micrometer) and 43.9%, 37.4%, 25.1% in the control group, respectively, showing significantly higher G1 fraction in amiloride group compared to control. CONCLUSION: This is the first paper which reported that amiloride inhibited in vitro growth of human gastric adenocarcinoma cells and that its effect of growth inhibition may be synergistic with 5-FU. Amiloride given with or without 5-FU may be useful agent in the treatment of gastric carcinomas. The inhibitory effects of amiloride on the growth of AGS may be mediated in part by blocking G1-S transition of cell cycle.
Adenocarcinoma ; Amiloride* ; Cell Cycle ; Cell Line ; Fluorouracil ; Humans* ; S Phase