Abstract: Suxamethonium chloride is a depolarizing muscle relaxant used in general anesthesia. In overdose, it causes adverse reactions such as bradycardia, arrhythmia, cardiac arrest, and death. The article reviews the progress on testing methods of suxamethonium chloride such as infrared spectroscopy, chemical color reaction, chemical titration, enzyme electrode, chromatography and mass spectrometry.
Anesthesia, General ; Arrhythmias, Cardiac/chemically induced* ; Biosensing Techniques ; Bradycardia/chemically induced* ; Chromatography ; Drug Overdose ; Heart Arrest/chemically induced* ; Humans ; Mass Spectrometry ; Neuromuscular Depolarizing Agents/analysis* ; Spectrophotometry, Infrared ; Succinylcholine/analysis*

BACKGROUND: Sevoflurane has a low blood-gas partition coefficient, resulting in rapid induction and recovery. We compared the effects of sevoflurane with those of enflurane anesthesia on parturients and neonates during and after elective cesarean section. METHODS: Ninety-six parturients were divided into two groups: E (enflurane, n = 47) and S (sevoflurane, n = 49). After endotracheal intubation with intravenous administration of thiopental 4 mg/kg and succinylcholine 1.5 mg/kg, anesthesia was maintained with 50% nitrous oxide in oxygen and enflurane 1 vol% or sevoflurane 1 vol%. Maternal hemodynamic parameters, blood loss, and recovery were monitored. Neonatal outcome was evaluated by Apgar scores, umblical artery blood gas analysis and acid-base status. RESULTS: Recovery times were faster with sevoflurane anesthesia (P < 0.05). All patients in two groups developed transient hypertension and tachycardia after intubation, which returned to baseline in approximately 5 minutes. Maternal blood loss did not differ significantly between the two groups, and one patient in S group developed postoperative recall. Neonatal outcome was equally good in the two groups. CONCLUSIONS: Parturients anesthetized with sevoflurane for cesarean section recovered more rapidly compared with enflurane without any differences in hemodynamic parameters and neonatal outcome.
Administration, Intravenous ; Anesthesia* ; Arteries ; Blood Gas Analysis ; Cesarean Section* ; Enflurane* ; Female ; Hemodynamics ; Humans ; Hypertension ; Infant, Newborn ; Intubation ; Intubation, Intratracheal ; Nitrous Oxide ; Oxygen ; Pregnancy ; Succinylcholine ; Tachycardia ; Thiopental

BACKGROUND: It is not clear whether mild hypothermia (34 degrees C) enhances stress hormonal responses during surgery under general intravenous anesthesia. The purpose of this study was determine how mild hypothermia affects hemodymic and stress hormonal responses introperatively and during extubation in patients undergoing cerebral aneurysm surgery under general intravenous anesthesia. METHODS: Anesthesia was induced intravenously with thiopental sodium 5 mg/kg, succinylcholine 1 mg/kg, and maintained with 50% O2, 50% N2O, and propofol using a target controlled system; Diprifusor(R) (3-5 microgram/ml) and muscle relaxation were administered with intravenous vecuronium intermittently. For the normothermia and the hypothermia groups, body temperatures were maintained at 36.9+/-0.3degrees C and 34.2+/-0.2 degrees C, respectively, up to the recovery room. Hemodynamic changes were recorded continuously. Arterial blood gas analysis, glucose, hemoglobin, stress hormones comprising epinephrine, norepinephrine, ADH, ACTH and cortisol were measured at whilst awake, intraoperatively, and just after extubation. RESULTS: Hemodynamic changes from the awake control state to postextubation were not significantly different between the normothermia and hypothermia groups. In the control awake state, all five hormonal concentrations were similar in the two groups. Intraoperatively and during extubation, all hormonal concentrations tended to be lower in the hypothermia group than in the normothermia group, except epinephrine during extubation. During the same period, all except ACTH decreased sufficiently to reach statistical significance (P < 0.05) versus the awake control state. But no significant differents were found between the two groups. CONCLUSIONS: Our data suggest that intraoperative mild hypothermia dose not significantly affect hemodynamic changes or the plasma concentrations of stress hormones.
Adrenocorticotropic Hormone ; Anesthesia ; Anesthesia, Intravenous* ; Blood Gas Analysis ; Body Temperature ; Epinephrine ; Glucose ; Hemodynamics* ; Humans ; Hydrocortisone ; Hypothermia* ; Intracranial Aneurysm ; Muscle Relaxation ; Neurosurgery ; Norepinephrine ; Plasma ; Propofol ; Recovery Room ; Succinylcholine ; Thiopental ; Vecuronium Bromide

BACKGROUND: We experienced unintentional hyperventilation during mechanical ventilation in pediatric general anesthesia. It is very difficult to decide respiratory rate or tidal volume with a patient's condition for adequate ventilation while respiratory gas monitoring is unavailable in many cases. Therefore, we studied to find a proper respiratory rate (RR) with a fixed tidal volume during mechanical ventilation in general anesthesia. METHODS: We studied 70 children weighing 10-30 kg during general anesthesia. An endotracheal tube was selected according to 3.5+age (yrs)/4. After intubation with midazolam, thiopental sodium and succinylcholine, mechanical ventilation was applied: tidal volume 8-10 ml/kg, peak inspiratory pressure 15-20 mmHg, RR 20 (infant), 18 (under 3 yrs), 16 (under 5 yrs), 14 (above 5 yrs) breaths/min. We adjusted the RR for a PetCO2 30 33 mmHg and arterial blood gas analysis was done 30 minutes each change. We calculated the RR for a PaCO2 of 36 mmHg according to the equation: RR (applied) = estimated RR estimated PaCO2/ideal PaCO2. In addition, the linear regression was analyzed between the age and RR. RESULTS: The estimated regression for RR using Pearson's correlation coefficient was as follows: RR = 19.25-0.07Xage (month). CONCLUSIONS: The equation (RR = 19.25-0.07Xage [month]) could be an index for safe ventilatory management without severe hyper- or hypo-carbia in the pediatric general anesthesia.
Anesthesia, General* ; Blood Gas Analysis ; Child ; Humans ; Hyperventilation ; Intubation ; Linear Models ; Midazolam ; Respiration, Artificial* ; Respiratory Rate* ; Succinylcholine ; Thiopental ; Tidal Volume ; Ventilation

BACKGROUND: Total spinal anesthesia (TSA) anesthetizes cranial nerves as well as peripherial nerves, leading to specific circulatory perturbations related to autonomic imbalance between sympathetic and parasympathetic tone. Heart rate variability (HRV) result from moment-to-moment changes in sympathetic and parasympathetic activity in response to many conditions. Using a power spectral analysis of heart rate variability, we evaluated the effect of TSA on the changes in the autonomic nervous system. METHODS: Twenty-four Sprague-Dawley rats, during halothane anesthesia, were placed in a stereotaxic head holder. Polyethylene tubing (PE-10) was passed caudally from the cisterna magna, and these rats were anesthetized by a urethane intraperitoneal injection (1.5 g/kg). Succinylcholine was infused intravenously at 1 mg/kg/min. During mechanical ventilation, ECG signals and mean arterial blood pressure were recorded for 5 min after a period of 10 min of anesthetic stabilization (baseline). Lidocaine (40 mg/kg) was administered intrathecally and then two subsequent 5-min ECG signals and mean arterial blood pressure were recorded (TSA 0 5 min, 5 10 min). A power spectral analysis of the data was computed using a short-time Fourier transform. The spectral peaks within each measurement were calculated; low frequency area (0.25 0.75 Hz), high frequency area (0.75 3.0 Hz), total frequency area (0.25 3.0 Hz). RESULTS: Mean R-R interval increases progressively during the 5 minutes after TSA but mean blood pressure decreases to the level of blood pressure of TSA within 2 minutes after TSA (p < 0.05). TSA diminished HRV within 2 minutes after a spinal injection of lidocaine (p < 0.05). CONCLUSIONS: These results suggest that total spinal anesthesia depresses both sympathetic and parasympathetic tone within 2 minutes.
Anesthesia ; Anesthesia, Spinal* ; Animals ; Arterial Pressure ; Autonomic Nervous System ; Blood Pressure ; Cisterna Magna ; Cranial Nerves ; Electrocardiography ; Fourier Analysis ; Halothane ; Head ; Heart Rate* ; Heart* ; Injections, Intraperitoneal ; Injections, Spinal ; Lidocaine ; Polyethylene ; Rats* ; Rats, Sprague-Dawley ; Respiration, Artificial ; Succinylcholine ; Urethane

A 49 year-old male was scheduled for a cholecystectomy, thereafter a 37 year-old female scheduled for removal of a epidural hematoma in the same operating room. Both of them had no specific medical problems and past medical histories for anesthesia. For those reasons, anesthesia was induced with thiopental sodium and succinylcholine with endotracheal intubation. After induction, vital signs including body temperatures were stable. But moisture dew in the unidirectional valves and corrugated tubes, and color changes of soda lime were discovered. At that time, severe hypercarbia was recognized by arterial blood gas analysis in both cases. In both cases, there were no malfunctions in unidirectional valves, expiratory valves, corrugation tubes, soda lime, ventilators and there connection parts in the anesthetic machines. Also there were no abnormalities of blood pressures, electrocardiograms, pulse oxymeters, temperatures and the pulse in the patient monitoring systems except capnography. At first, we thought that medical signs revealed malignant hyperthermias. But vital signs, air way pressures and functions of all kinds of anesthetic machine components including ventilators were normal. After discontinuing N2O gas deliveries in the operation room, hypercarbias disappeared. Thus, anesthetic gas delivery systems via central piping systems were checked and it was discovered that CO2 gas was in the N2O gas tank instead of N2O.
Adult ; Anesthesia ; Blood Gas Analysis ; Body Temperature ; Capnography ; Carbon Dioxide* ; Carbon* ; Cholecystectomy ; Electrocardiography ; Female ; Hematoma ; Humans ; Intubation, Intratracheal ; Male ; Malignant Hyperthermia ; Middle Aged ; Monitoring, Physiologic ; Nitrous Oxide* ; Operating Rooms ; Succinylcholine ; Thiopental ; Ventilators, Mechanical ; Vital Signs

BACKGROUND: Succinylcholine is the muscle relaxant of choice for rapid endotracheal intubation, but may produce many side effects such as hyperkalemia, myalgia, increase intraocular pressure. Nondepolarizing muscle relaxants were used instead of succinylcholine, still late onset time was be dangerous. For this reason, priming principle was reported and applied to rapid intubation using nondepolarizing muscle relaxation. We studied the effect of priming with vecuronium and atracurium on elderly and young patients. METHODS: We were randomly assigned 40 patients and observed the effects of priming doses of vecuronium (0.01 mg/kg) and atracurium (0.05 mg/kg). Ten young (20-35 yrs) and ten elderly (65-75 yrs) patients were each placed in vecuronium and atracurium group. Arterial blood gas analysis and train of four (TOF) were determined before priming. All tests were performed again 4 min after vecuronium and 3 min after atracurium. We asked for symptoms and signs of muscle weakness. RESULTS: In arterial blood gas analysis and TOF ratio were decreased in both groups. There is no significant difference between two groups in all tests. PaO2 and TOF ratio were reduced more in elderly patients, significantly (P<0.05). Symptoms and signs of muscle weakness such as ptosis, dizziness, diplopia, swallowing difficulty and respiratory difficulty in elderly patients were more frequent than in young patients. CONCLUSIONS: Priming doses of vecuronium and atracurium produced greater decrease in muscle strength, PaO2 and TOF ratio in the elderly than in their younger counterparts. So using priming method in elderly patients, we need adequate pre-oxygenation and thorough monitoring before endotracheal intubation.
Aged* ; Atracurium* ; Blood Gas Analysis ; Deglutition ; Diplopia ; Dizziness ; Humans ; Hyperkalemia ; Intraocular Pressure ; Intubation ; Intubation, Intratracheal ; Muscle Relaxation ; Muscle Strength ; Muscle Weakness ; Myalgia ; Succinylcholine ; Vecuronium Bromide*

We had a 52-year-old male presented for a surgery for old fracture of the 7th cervical vertebra. Generalized muscle rigidity and high fever with tachycardia was revealed 25 minutes after succinylcholine and enflurane administration. Then the body temperature was risen from 37.8 degrees C to 40.5 degrees C within 20 minutes and the arterial blood gas analysis showed a severe respiratory and metabolic acidosis. Under the suspicion of malignant hyperthermia, all anesthetics were discontinued, refrigerated intravenous solutions were started, and gastric lavage with cold saline was initiated together with packing the body with ice. Oral dantrolene 125mg, the only drug we could obtain, was administered through Levins tube after lavage. Serial serum CPK level were 4414 IU/L on third day and 74 IU/L on seventh day postoperatively. The postoperative course was uneventful and the patient could be walked after fifth day postoperatively and discharged without any sequelae.
Acidosis ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Blood Gas Analysis ; Body Temperature ; Dantrolene ; Enflurane ; Fever ; Gastric Lavage ; Humans ; Ice ; Male ; Malignant Hyperthermia ; Middle Aged ; Muscle Rigidity ; Pharmacology ; Spine ; Succinylcholine ; Tachycardia ; Therapeutic Irrigation

General anesthesia for cesarean section usually includes 50% oxygen and nitrous oxide, supplemented by a low concentration of a volatile agent. This is based upon data demonstrating that an increase in maternal FiO2(inspired oxygen concentration) to more than 0.6 did not improve fetal oxygenation, But the use of 100% oxygen supplemented only by volatile anesthetics probably is safe in the case of emergency operation or fetal distress and advantageous in prevention of maternal awareness during cesarean section. The present study was designed to compare the effect of increasing FiO2 upon fetal oxygenation. It was also proposed to determine awareness, by questioning patients as well about dreams or other manifestations of inadequate depth of anesthesia. 30 patients undergoing cesarean section under general anesthesia were selected and they were allocated randomly into three groups according to FiO2 as follows; Group 1(n=10): FiO2 0.33 with 0.75 vo1% isoflurane, Group 2(n=10): FiO2 0.66 with 0.75vo1% isoflurane, Group 3(n= 10): FiO2 1.0 with 0.75 vo1% isoflurane. For the induction of anesthesia, thiopental 4 mg/kg was administered, followed by succinylcholine 1.5 mg/kg. After intubation, the lung was ventilated with different FiO2 and maternal arterial blood was sampled just before delivery and umbilical arterial and venous blood were sampled immediately after delivery. Induction to delivery time(IDT), uterine incision to delivery time(IDT), neonatal birth weight and Apgar score were measured. The patient was interviewed to evaluate the incidence of awareness three days after operation. Our results were as follows; There were statistically significant differences between three groups in maternal PaO2, but there were no statistically significant differences between three groups in umbilical arterial and venous oxygenation. Induction to delivery time(IDT) in group 1 was significantly short, compared to group 2 and 3, but uterine incision to delivery time(UDT) was not statistically difference between three groups. The condition of the neonates at birth was generally good except one in group 2. But, this neonate recovered as 5-min Apgar score of 9 after aspiration of amnionic fluid and oxygen administration. Two patients reported dreaming, pain recall or fact recall and one of them refused to be administrated the same anesthesia once again, respectively in three groups. In conclusion, the use of FiO2 0.33 is probably safe in no fetal distress while the use of FiO2 1.0 results in no increase of oxygen partial pressure of umbilical artery and vein, but it guarantees the safe method in the case of suspecting fetal depression. Our anesthetic method was not enough to prevent the awareness. So, further study about not only deep, but also safe anesthetic method is justified.
Amnion ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Apgar Score ; Birth Weight ; Blood Gas Analysis* ; Cesarean Section* ; Depression ; Dreams ; Emergencies ; Female ; Fetal Distress ; Humans ; Incidence ; Infant, Newborn ; Intubation ; Isoflurane ; Lung ; Nitrous Oxide ; Oxygen ; Partial Pressure ; Parturition ; Pregnancy ; Succinylcholine ; Thiopental ; Umbilical Arteries ; Veins

Preoxygenation is a standard anesthetic technique for preventing a significant hypoxemia during the induction of anesthesia. Complete denitrogenation is especially important in clinical situations of difficult intubation or in patients with decreased functional residual capacity, and in situations where oxygen saturation is critical. Methods for preoxygenation before induction of anesthesia have raised from tidal breathing of 100% O2 to taking four maximal breaths. Pregnancy produces significant physiologic changes in the respiratory system. Oxygen consumption in pregnancy is markedly increased and functional residual capacity decreases by 20-30% at term as compared to the nonpregnant stage. It is important to evaluate how long parturient women can withstand apneic hypoxemia during induction of general anesthesia. The aim of this study is to understand better how pregnancy effects preoxygenation with boths tidal breathing of 100% O2 for 3 min and four maximally deep inspiration of 100% O2 within 30 seconds technique. Twenty ASA 1 and 2 patients scheduled for elective cesarean section under general anesthesia selected for the study. After premedication with atropine sulfate 0.5 mg, we randomly divide the patients into two groups : Group 1 was preoxygenated by tidal breathing of 100% O2 for 3 min (n =10). Group 2 was preoxygenated by taking four maximally deep inspirations of 100% O2 within 30s (n = 10). We administered O2 to both groups at a flow rate of 8 Vmin via a semiclosed circle anesthesia system and a tight-fitting face mask. We performed a rapid-sequence induction of general anesthesia with thiopental 4 mg/kg iv followed by succinylcholine 1.2 mg/kg iv and intubated the trachea. We sampled maternal arterial blood immediately umbilical blood at delivery for blood gas analysis. And induction to delivery time, uterine incision to delivery time, neonatal birth weight, Apgar score were measured. The results were as follows, 1) Induction to delivery times, uterine incision to delivery times and birth weight were similarand no infant had an Apgar score of less than 8 at 1 or 5 min between two groups. 2) There were no significant differences in maternal blood gas values between the two groups. 3) Umbilical artery and venous blood gas values were similar in both groups. In conclusion, either tidal breathing of 100% O2 for 3 minutes or four maximally deep inspiration of 100% O2 within 30 seconds technique improve arterial oxygenation and similar protection against apneic hypoxemia in rapid sequence induction of general anesthesia for Cesarean section.
Anesthesia ; Anesthesia, General* ; Anesthesia, Obstetrical ; Anoxia ; Apgar Score ; Atropine ; Birth Weight ; Blood Gas Analysis* ; Cesarean Section* ; Female ; Functional Residual Capacity ; Humans ; Infant ; Intubation ; Masks ; Oxygen ; Oxygen Consumption ; Pregnancy ; Premedication ; Respiration ; Respiratory System ; Succinylcholine ; Thiopental ; Trachea ; Umbilical Arteries