BACKGROUND: A lateral tilt position can affect the size of the femoral vein (FV) due to increased venous blood volume in the dependent side of the body. METHODS: Forty-two patients, aged 20–60 years, were enrolled in this study. The crosssectional area (CSA), anteroposterior, and transverse diameters of the FV were measured 1 cm below the left inguinal line using ultrasound. The value of each parameter was recorded in the following four positions: (1) supine, (2) supine + 10° left-lateral tilt (LLT), (3) 10° reverse Trendelenburg (RT), and (4) RT + LLT. RESULTS: CSAs of the left FV in the supine, supine + LLT, RT, RT + LLT positions were 0.93 ± 0.22, 1.11 ± 0.29, 1.17 ± 0.29, and 1.31 ± 0.32 cm2, respectively. Compared to the supine position, there was a significant increase in CSA and anteroposterior diameter according to the three changed positions. The transverse diameter of the left FV was significantly increased in supine + LLT, RT, RT + LLT positions compared to that in the supine position (P = 0.010, P = 0.043, P = 0.001, respectively). There was no significant difference in the transverse diameter of the left FV between the supine + LLT and RT positions (P = 1.000). CONCLUSIONS: Adding LLT to the supine and RT positions increased the CSA of the unilateral FV significantly.
Adult* ; Blood Volume ; Catheterization ; Femoral Vein* ; Humans ; Posture ; Supine Position ; Ultrasonography

BACKGROUND: The aim of this study was to investigate whether a small dose of midazolam and lessening the propofol dosage could prevent cardiovascular change at tracheal intubation for induction in aged patients. METHODS: Eighty patients over 65 years (ASA physical status 1, 2) scheduled for elective surgery received general anesthesia with remifentanil and propofol or midazolam. Patients in group P (n = 40) were induced with 0.9% NaCl 0.03 ml/kg, propofol 1. 2 mg/kg and remifentanil. Patients in group MP (n = 40) were induced with midazolam 0.03 mg/kg, propofol 0.8 mg/kg and remifentanil. The time taken to reach loss of consciousness (LOC) and the value of bispectral index score (BIS) at LOC were recorded. After LOC, 0.8 mg/kg of rocuronium was given and tracheal intubation was performed. The mean blood pressure (MBP) and heart rate (HR) were recorded before induction as the base value, before intubation, immediately post-intubation and 3 minutes after intubation. RESULTS: Compared with the base values, MBP at before intubation and 3 minutes after intubation was significantly decreased in group P and group MP (P < 0.05). Compared with group P, the decrease of MBP was significantly less at before intubation, immediately after intubation and 3 minutes after intubation in group MP (P < 0.05). The time taken to reach LOC was significantly decreased in group MP compared with that in group P (P < 0.05). There were no significant differences of HR at any time between the two groups. CONCLUSIONS: Co-induction with midazolam and propofol could prevent a marked BP decrease at tracheal intubation for induction in aged patients.
Aged ; Androstanols ; Anesthesia, General ; Blood Pressure ; Cardiovascular System ; Drug Synergism ; Heart Rate ; Humans ; Intubation ; Midazolam ; Piperidines ; Propofol ; Unconsciousness

BACKGROUND: The aim of this study was to investigate whether a small dose of midazolam and lessening the propofol dosage could prevent cardiovascular change at tracheal intubation for induction in aged patients. METHODS: Eighty patients over 65 years (ASA physical status 1, 2) scheduled for elective surgery received general anesthesia with remifentanil and propofol or midazolam. Patients in group P (n = 40) were induced with 0.9% NaCl 0.03 ml/kg, propofol 1. 2 mg/kg and remifentanil. Patients in group MP (n = 40) were induced with midazolam 0.03 mg/kg, propofol 0.8 mg/kg and remifentanil. The time taken to reach loss of consciousness (LOC) and the value of bispectral index score (BIS) at LOC were recorded. After LOC, 0.8 mg/kg of rocuronium was given and tracheal intubation was performed. The mean blood pressure (MBP) and heart rate (HR) were recorded before induction as the base value, before intubation, immediately post-intubation and 3 minutes after intubation. RESULTS: Compared with the base values, MBP at before intubation and 3 minutes after intubation was significantly decreased in group P and group MP (P < 0.05). Compared with group P, the decrease of MBP was significantly less at before intubation, immediately after intubation and 3 minutes after intubation in group MP (P < 0.05). The time taken to reach LOC was significantly decreased in group MP compared with that in group P (P < 0.05). There were no significant differences of HR at any time between the two groups. CONCLUSIONS: Co-induction with midazolam and propofol could prevent a marked BP decrease at tracheal intubation for induction in aged patients.
Aged ; Androstanols ; Anesthesia, General ; Blood Pressure ; Cardiovascular System ; Drug Synergism ; Heart Rate ; Humans ; Intubation ; Midazolam ; Piperidines ; Propofol ; Unconsciousness

BACKGROUND: It was well-known that smoking affects the cardiovascular system, and remifentanil can suppress the sympathetic stimulations induced by tracheal intubation. The purpose of this study was to investigate whether there was any difference in the hemodynamic changes induced by tracheal intubation with using remifentanil between smokers and nonsmokers. METHODS: Eighty patients were enrolled: male smokers (MS), male nonsmokers (MN), female smokers (FS) and female nonsmokers (FN). Anesthesia was induced with diluted remifentanil (20 microgram/ml) at a rate of 10 microgram/kg/hr using an infusion pump, and 2 min later, midazolam 0.05 mg/kg and propofol 0.8 mg/kg were injected for achieving unconsciousness. Rocuronium 1 mg/kg was used for muscle relaxation, and tracheal intubation was performed 2 min after rocuronium injection. After tracheal intubation, the remifentanil was decreased to 2 microgram/kg/hr. The mean arterial pressure (MAP) and heart rate (HR) were checked before induction, on unconsciousness, just before intubation, just after intubation and 1, 2 and 3 minutes after intubation, and these values were compared between the groups. RESULTS: In men, the MAP and HR just after intubation and at 1, 2 and 3 minutes after intubation in Group MS were significantly higher than those of Group MN (P < 0.05). For the women, the HR in both groups (the FS and FN groups) were increased just after intubation and 1, 2 and 3 minutes after intubation compared with that at the baseline, respectively, but there was no difference between the two groups. CONCLUSIONS: There was a difference of the hemodynamic changes induced by tracheal intubation with using remifentanil between the male smokers and nonsmokers, but not in women.
Androstanols ; Anesthesia ; Arterial Pressure ; Cardiovascular System ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infusion Pumps ; Intubation ; Male ; Midazolam ; Muscle Relaxation ; Piperidines ; Propofol ; Smoke ; Smoking ; Unconsciousness

BACKGROUND: Survivin is thought to contribute to stem cell maintenance partly by a hypomethylation mechanism. This study attempted to elucidate the signal transduction pathway of adipocyte-derived stem cells (ASCs) by using a demethylating agent, 5-aza-2'-deoxycytidine (ADC), to analyze the survivin, MEK/ERK, c-Myc and p53 gene expression. METHODS: Demethylation in the ASCs was induced by 1 micrometer ADC treatment. RT-PCR for survivin mRNA was preformed, before and 24, 48 and 72 hours (hr) after ADC treatment. Western blotting analysis was performed for p53, survivin, unphosphorylated and phosphorylated (p)-MEK, and p-ERK. Immunohistochemistry for ERK and survivin was done to evaluate the localization of the proteins. RESULTS: ADC inhibited the population growth of the ASCs and it increased the number of apoptotic cells 24, 48, and 72 hr after treatment. ADC treatment slightly decreased the expression of survivin mRNA after 48 hr and its level was restored after 72 hr of treatment. Otherwise, the level of survivin protein gradually increased up to 48 hr and it was decreased at 72 hr. The levels of p-MEK and p53 were increased time-dependently. c-Myc and p-ERK were elevated after ADC treatment and their highest levels were seen 48 hr after treatment. The ADC treatment increased the nuclear expression of ERK and survivin in the ASCs. CONCLUSIONS: The overexpression of p-MEK/ERK, p53, and c-Myc increased the survivin protein expression of the demethylated ASCs. These results suggest that demethylation could alter the expression of survivin, and p53, c-Myc and the MAPK (MEK/ERK) pathway might play a role in survivin's regulation in ASCs.
Adult Stem Cells ; Azacitidine ; Blotting, Western ; Genes, p53 ; Immunohistochemistry ; Population Growth ; Proteins ; RNA, Messenger ; Signal Transduction ; Stem Cells

BACKGROUND: Hypertensive patients are more prone to exhibit an exaggerated hemodynamic responses to laryngoscopy and tracheal intubation. We compared the effects of remifentanil and lidocaine on the cardiovascular responses during intubation in hypertensive patients. METHODS: Fifty adult hypertensive patients (>140/90 mmHg) were divided into 2 groups (remifentanil group; 1.0 microgram/kg, n = 25, lidocaine group; 1.5 mg/kg, n = 25). After 3 minutes'oxygenation, anesthesia was induced using 0.2 mg glycopyrrolate, 1.5 mg/kg propofol, and 1 of experimental drugs (30 seconds) bolus administration. Tracheal intubation was facilitated 90 seconds after administration of rocuronium; anesthesia was maintained with 2% sevoflurane and air in oxygen. Arterial blood pressure and heart rate were measured at the following times: resting state (baseline), after oxygenation; before intubation; just after intubation; and at 1, 3, and 5 minutes after intubation. RESULTS: There was significant attenuation of mean systolic and diastolic arterial blood pressures, after intubation of the remifentanil group compared to the lidocaine group at just after intubation and at 1 minute after intubation (P < .05). The difference in heart rate was not significant between both groups. CONCLUSIONS: Bolus administration of remifentanil was found to be superior to lidocaine in the attenuation of the blood pressure during intubation in hypertensive patients.
Adult ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Glycopyrrolate ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Laryngoscopy ; Lidocaine ; Methyl Ethers ; Oxygen ; Piperidines ; Propofol

BACKGROUND: Lidocaine blocks sodium channels in nerve membranes, which inhibits sodium influx and prevents development of an action potential. For epidural anesthesia, we usually use lidocaine diluted in normal saline or distilled water. However, diluents containing sodium ions may affect lidocaine activity. METHODS: Fifty patients, ASA physical status class I or II, scheduled for elective epidural anesthesia were randomly divided into two groups.For epidural anesthesia, we used 14 ml of 2% lidocaine solution made with 7 ml of 4% lidocaine plus an equivalent of distilled water (Group DW) or normal saline (Group NS).In the right lateral decubitus position, a 19 G Arrow catheter was inserted 3 cm in the cephalad direction in the L3-4 intervertebral space.In the supine position, 3 ml of 2% lidocaine was injected as a test dose, and the remaining 11 ml of lidocaine was injected 2 minutes later.We used a pinprick test for evaluation of sensory block levels and a Bromage grade for degrees of motor block every 2 minutes during the first 30 minutes. RESULTS: Levels of sensory block were higher in Group DW than Group NS at 12, 14 and 30 minutes. The degree of motor block was also higher in Group DW at 12 and 14 minutes. CONCLUSIONS: Diluent containing sodium ions reduces sensory and motor block compared to sodium-free solution in epidural anesthesia.
Action Potentials ; Anesthesia ; Anesthesia, Epidural ; Catheters ; Humans ; Ions ; Lidocaine ; Membranes ; Organic Chemicals ; Sodium ; Sodium Channels ; Supine Position ; Water

BACKGROUND: The purpose of this study is to determine the optimal dose of remifentanil and propofol for minimizing the cardiovascular changes to tracheal intubation during total intravenous anesthesia (TIVA) using propofol target controlled infusion (TCI). METHODS: One hundred thirty five patients, aged 20-60 years, were randomly divided into three groups. Anesthesia was induced with remifentanil, propofol and rocuronium 1 mg/kg for intubation. Group I received remifentanil 0.1microgram/kg/min and a propofol target concentration 4microgram/ml. Group II received remifentanil 0.2microgram/kg/min and propofol 4microgram/ml. Group III received remifentanil 0.2microgram/kg/min and propofol 3microgram/ml. Remifentanil was infused continuously, and 2 minutes after remifentanil infusion, propofol was infused continuously. Mean arterial blood pressure (MAP) and heart rate (HR) were measured at pre-induction, 1 minute after remifentanil infusion, before propofol TCI, immediately before and after intubation and 1, 2, 3 minutes after intubation, respectively. RESULTS: Compared with pre-induction values, MAP at immediately after intubation was significantly increased in group I, but decreased in group II, with no change in group III. The HR immediately after intubation was significantly increased after intubation in all groups compared to the pre-induction values, but the rate of increase of HR in groups II, III were significantly lower than those of group I (p < 0.05). Hypotension was observed in 6 patients in group II and 3 in group III. CONCLUSIONS: Remifentanil 0.2microgram/kg/min and the propofol target concentration 3microgram/ml are optimal doses for minimizing cardiovascular changes and side effects to tracheal intubation during TIVA.
Aged ; Androstanols ; Anesthesia ; Anesthesia, Intravenous ; Arterial Pressure ; Heart Rate ; Humans ; Hypotension ; Intubation ; Piperidines ; Propofol

BACKGROUND: Residual muscle paralysis after anesthesia is reduced with the advent of intermediate-acting neuromuscular blocking drugs, yet the incidence is as high as about 10 percent. Opioids in patient-controlled analgesia (PCA) may cause respiratory depression and other problems after anesthesia. The purpose of this study is to evaluate the influence of PCA on the SPO2, TOF ratio, head-lift and tongue protrusion during recovery room stay following intraoperative muscle relaxants. METHODS: 120 patients aged from 20 to 65 in ASA class I and II were divided into control or PCA groups. All patients received rocuronium (0.9 mg/kg) or atracurium (0.5 mg/kg) for tracheal intubation, and maintenance of relaxation was done with atracurium 0.2 mg/kg/hr during inhalation anesthesia. Reversal of block was done with pyridostigmine 0.15 mg/kg and glycopyrrolate 0.2 mg. SpO2, TOF ratio, 5 sec-head lift, tongue protrusion tests were evaluated in the recovery room. RESULTS: IV-PCA did not influence the incidence of residual block, SPO2, TOF ratio during recovery room stay for 20 minutes, but influenced negatively 5 sec-head lift test, tongue protrusion test only immediately after arrival at the recovery room. CONCLUSIONS: Since IV-PCA decreased the ability to perform head-lift and tongue protrusion early postoperatively, it is recommended that patients with IV-PCA should be carefully managed against the risk of aspiration or upper respiratory obstruction during their early recovery room stay.
Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Inhalation ; Atracurium ; Glycopyrrolate ; Humans ; Incidence ; Intubation ; Neuromuscular Blockade ; Paralysis ; Passive Cutaneous Anaphylaxis ; Pyridostigmine Bromide ; Recovery Room ; Relaxation ; Respiratory Insufficiency ; Tongue

BACKGROUND: The administration of rocuronium is associated with severe burning pain on injection that lasts for approximately 10-20 seconds. Injection pain is probably caused by the acidic pH of rocuronium. Mixing rocuronium with 8.4% sodium bicarbonate might neutralize the acidic pH thereby decrease the level of injection pain. This study investigated the appropriate sodium bicarbonate dose for preventing injection pain. METHODS: The study examined 250 patients (aged 20 to 60 years) from ASA I and II groups who scheduled for elective surgery. The patients were divided randomly into five groups. The control group (SB0) received rocuronium 50 mg (5 ml) only and the experimental groups received rocuronium 50 mg mixed with 8.4% sodium bicarbonate 1 (SB1), 2.5 (SB2.5), 5 (SB5), 7 (SB7) ml, respectively. The level of pain was evaluated as the withdrawal response as follows: no movement, 0; hand and wrist movement, 1 point; ipsilateral arm movement, 2 points; and general movement 3 points. RESULTS: The incidence of a withdrawal response was 68% in the control group (SB0). On the other hand, the incidence of a withdrawal response was 38%, 28%, 14% and 12% in the SB1, SB2.5, SB5 and SB7 groups, respectively. The withdrawal response was significantly lower in the experimental groups than in the control group (P < 0.01). In the experimental groups, a significant difference was observed between the SB1 and SB5, SB7 groups. However, there was no significant difference observed between the SB2.5, SB5 and SB7 groups. CONCLUSIONS: Mixing 5 ml of 8.4% sodium bicarbonate with rocuronium 50 mg (5 ml) is the most effective in preventing the injection pain associated with rocuronium during the induction of anesthesia.
Anesthesia ; Arm ; Burns ; Hand ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Sodium Bicarbonate* ; Sodium* ; Wrist