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Background: Adenosine has been shown to exert an antinociceptive effect under experimental conditions in animals and humans. This study was performed to evaluate the effects of adenosine on postoperative pain and intraoperative blood pressure changes. Methods: We studied 30 patients, aged <65 years, who underwent laparoscopic cholecystectomy under N2O-O2-isoflurane general anesthesia. Patients were randomized into two groups: an adenosine group (adenosine was infused continuously at 100-150 μg/kg/min, n = 15) and a control group (normal saline infused at 4 ml/min, n = 15). Mean arterial blood pressure during the intraoperative period, and pain score at 30 minutes, 6 hours, 24 hours, and 48 hours after operation were checked. On patient request, meperidine was administrated intravenously. Results: Pain scores and the cumulative doses of meperidine were much lower in the adenosine group than in the control group. The elevation of mean arterial pressure during pnemoperiton-eum was significantly attenuated in the adenosine group. Conclusions: This data suggests that intravenous adenosine infusion is effective at post-operative pain control following a laparoscopic cholecystectomy and that it is also effective at attenuating blood pressure elevation during pneumoperitoneum.
Background : Local anesthetics have been shown to interact with neuromuscular blockers. Most local anesthetics decrease neuromuscular transmission and potentiate neuromuscular block from muscle relaxants. The purpose of this study was to examine the effectiveness of lidocaine on the onset time of vecuronium and to compare that with other method such as simply increasing the dose of vecuronium. Methods : Sixty patients of ASA physical status I or II were induced with thiopental (4-5 mg/kg) and maintained with O2-enflurane (2.5 vol%). They were randomly divided into four groups: Vecuronium (0.1 mg/kg) was administered intravenously in Group C (n = 15), additional lidocaine (1 mg/kg) was given intravenously 1 min prior to administration of vecuronium in Group L (n = 15), increased vecuronium (0.15 mg/kg) was given in Group V (n = 15) and succinylcholine was given in Group S (n = 15), respectively. Neuromuscular blockade was assessed by train-of-four (TOF) at the adductor pollicis muscle with supramaximal stimulation of ulnar nerve (2 Hz, 0.2 ms) every 12 sec. Endotracheal intubation was performed and intubating conditions were evaluated according to the standard scoring method after measuring the onset time (from the end of giving each muscle relaxants to the 90% suppression of the first twitch). Results : The onset time of Group L (122.0±11.0 sec) and that of Group V (98.0±16.9 sec) were shorter than that of Group C (135.2±16.0 sec) (P< 0.05), but these were not shorter than that of Group S (42.0±6.2 sec). There was no statistical difference between Group L and Group V. Intubating conditions were good or excellent in all groups. Conclusions : Additional lidocaine for attenuating sympathetic response could accelerate the onset of vecuronium. But the onset time of this method was not shorter than that of simply increasing the dose of vecuroium nor that of succinylcholine. (Korean J Anesthesiol 1999; 37: 763∼768)
Background : Mivacurium is a nondepolarizing neuromuscular blocking agent hydrolyzed by pseudocholinesterase. Anticholinesterase used in the reversal of mivacurium-induced muscle relaxation may also inhibit plasma pseudocholinesterase, and delay hydrolysis of mivacurium. In this study, the effects of edrophonium and/or bovine pseudocholinesterase (BpChE) in the reversal of mivacurium were investigated with the rat phrenic nerve-diaphragm preparation. Methods : Fifty Sprague-Dawley rats (150-200 g) were randomly allocated into 10 groups based on the dosage of edrophonium and BpChE. Each animal was anesthetized with thiopental sodium (40 ㎎/㎏ I.P.). The phrenic nerve-diaphragm was dissected and mounted in a bath containing an oxygenated Krebs' solution at 32℃. The phrenic nerve was stimulated at supramaximal intensity and the single twitch responses and train of four (TOF) ratio were measured. After stabilization of the twitch responese, mivacurium (1 ㎍/㎖) was administered incrementally to obtain more than 95% twitch inhibition. Reversal of the mivacurium-induced block by edrophonium (0.01, 0.1, 1, or 10 ㎍/㎖) and/or BpChE (0.1 u, or 1.0 u/㎖) were tested. A single twitch height more than 75% of the baseline value was considered an adequate reversal. Results : Mivacurium-induced paralysis was recovered more effectively by BpChE 1.0 u/㎖ than the other groups. Edrophonium improved a single twitch in a dose dependent manner. Conclusions : Mivacurium-induced paralysis can be more effectively reversed by BpChE than edrophonium. Inhibition of pseudocholinesterase was not observed by increasing the dose of edrophonium. (Korean J Anesthesiol 2002; 42: 213~220)
Background: Various pressor agents are used to raise systemic vascular resistance (SVR) during liver transplantation. The aim of this study was to investigate the effect of liver denervation on hepatic hemodynamic responses to vasopressors. Methods: This study was conducted in eight anesthetized dogs randomly assigned in to 4 groups [epinephrine-Low dose (L): 0,05 ㎍/kg/min, epinephrine-High dose (H): 0.5 ㎍/kg/min, ephedrine (D): 0.2 mg/kg, phenylephrine (P): 80 ㎍/min]. One hour after surgical denervation of the liver, cardiac output, blood gases and hepatic blood flow were measured before and after administration of vasopressors with an electromagnetic flow meter. Oxygen consumption rate (hepatic artery plus portal vein oxygen delivery-hepatic vein oxygen delivery) was calculated. The Wilcoxon signed rank test and Kruskal-Wallis test were used for statistical analysis; The level of significance was assumed at the P $lt; 0.05 level. Results are expressed as mean±SE. Results: The resulting hemodynamic valuese not significantly different between groups except for hepatic vascular resistance in the P group. Hepatic blood flow decreased significantly in the P and H groups, whereas it increased significantly in the L group. Hepatic oxygen consumption and Base Excess in hepatic venous blood after vasopressors were not significantly different between groups. These results mean there were no significant differences in hepatic oxygenation between groups. Conclusions: Various pressor agents can be used to raise SVR without jeopardizing hepatic oxygenation. However, phenylephrine and high dose of epinephrine are not recommended after liver trans- plantation because decreased hepatic blood flow might affect the intracellular oxygen environment adversely.
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. (Korean J Anesthesiol 1998; 34: 160∼166)
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare hereditary sensory and autonomic neuropathy. CIPA is characterized by inability to sweat, insensitivity to pain, self-mutilation, recurrent episodes of hyperpyrexia, mental retardation, and autonomic nervous system abnormality. Patients with CIPA may undergo surgery because of susceptibility to trauma, bony fracture and osteomyelitis due to insensitivity to pain. We report a child who had undergone anesthesia with total intravenous anesthesia. The anesthetic management of this condition is discussed. (Korean J Anesthesiol 2007; 52: 367~70)
Larsen syndrome is a rare congenital connective tissue disorder which is characterized by multiple dislocation of major joints, typical facial appearance, cervical spine narrowing and instability, and respiratory difficulties secondary to laryngotracheomalacia. We describe a case of general anesthesia for orthopedic operations in female infant consistent with Larsen syndrome. The patient showed hypercapnia intraoperatively, but recovered without any sequelae. (Korean J Anesthesiol 2006; 50: 474~7)