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Myocardial reperfusion after a brief episode of ischemia is associated with prolonged abnormalities of systolic function and delayed recovery of functional expansion. The postischemic myocardial dysfunction is dependent on the extent and duration of ischemia and drug treatment. This investigation was conducted to compare the effects of verapamil vs atenolol on the functional expansion following coronary occlusion and reperfusion in the dog.Eleven anesthetized open-chest dogs pretreated for 30 minutes with verapamil(n=7), or atenolol(n=4) in doses that decrease systolic blood pressure by 25-30%(28.9 ±6.4mmHg decrease) before occlusion of left anterior descending coronary artery distal to the first diagonal branch for 20 minutes and reperfusion for 40 minutes. Drugs were continued during the ischemic and reperfusion period until the dogs were sacrificed. Hemodynamic parameters such as aortic pressure(AoP), pulmonary arterial pressure(PAP), pulmonary capillary wedge pressure(PCWP) and heart rate(HR) were measured. Cardiac output was measured by thermodilution method. Two-dimensional (2-D) echocardiographic short axis imaging was obtained at the mid-papillary muscle level during coronary occlusion and reperfusion period. Coronary occlusion and reperfusion did not cause any change in HR, PAP, PCWP and cardiac output. But mean AoP was slightly higher in atenolol dogs following reperfusion.PCWP was higher in verapamil dogs but was maintained below 15mmHg. Cardiac output was higher in'verapamil dogs than in atenolol dogs(p<0.05). On occlusion of LAD coronary artery, both ischemic and non-ischemic areas increased(expansion) and remained expanded through occlusion period in both verpamil and atenolol dogs. One minute after occlusion of LAD coronary artery, end-systolic ischemic area and length increased by 142.8% and 33.9%, respectively, and non-ischemic area and length by 85.7% and 27.7%, respectively, in verapamil dogs, end-systolic ischemic area and length increased by 56.1% and 28.5%, respectively, and non-ischemic area and length by 37.3% and 15.9%, respectively, in atenolol dogs. The changes of end-diastolic area and length after coronary occlusion were in similiar fashion to those of end-systolic area and length in both groups. After reperfusion, expanded non-ischemic area returned to pre-occlusion level in 20minutes and ischemic area in 40 minutes in verapamil dogs but not in atenolol dogs. Fractional shortening(%△A) which was decreased in both verapamil and atenolol dogs duringocclusion returned to normal(pre-occlusion level) following reperfusion in only verapamil dogs. These findings suggest that verapamil, but not atenolol, exerts salutary actions on the prompt recovery of functional expansion in open-chest dogs with coronary occlusion for 20minutes and reperfusion for 40 minutes.
Aspiration pneumonia is usually caused by aspiration of gastric contents during anesthesia. It causes severe pulmonary complications. Povidone iodine was used widely as an oral antiseptic. Although povidone iodine is thought to be a safe and effective antiseptic, severe complications from its aspiration may occur. We present a case of pneumonia secondary to aspiration of povidone iodine in a 16 year old female patient who underwent orofacial surgery. Aspiration pneumonia must be treated immediately. Mechanical ventilation with PEEP and periodical bronchial toilet with fiberoptic bronchoscopy were carried in the operating room and ICU. Bronchodilators,antibiotics, steroids and diuretics were also used to treat pneumonia. The patient was treated successfully without any complication.
Background: During general anesthesia, core temperature decreases, largely due to heat loss caused by peripheral vasodilation, resulting in heat redistribution to peripheral tissues. Multiple factors contribute to body temperature regulation during general anesthesia. It was reported that baroreceptor unloading by positive end-expiratory pressure (PEEP) attenuates anesthetically-induced hypothermia. So, we evaluated the effects of PEEP on thermoregulatory responses during total intravenous anesthesia (TIVA). Methods: Forty healthy patients scheduled for tympanoplasty were allocated two groups, Group ZEEP (zero end-expiratory pressure, n = 20) and Group PEEP (PEEP application of 5 cmH_2O, n = 20). Ambient temperature was maintained at 22-24℃, and anesthesia was induced and maintained with propofol-remifentanil. The core temperature and the temperature difference between forearm and fingertip skin were monitored before and after the induction of general anesthesia having a duration of 180 minutes. Results: The core temperature gradient (Ti-Tf ) was higher in patients with ZEEP than with PEEP. The core temperature was maintained at a higher level in patients with PEEP. Additionally, the vasoconstriction threshold was higher in patients with PEEP. Conclusions: It seems that PEEP attenuates anesthetically-induced hypothermia during TIVA.
The purpose of animal research in obstetric anesthesia is to find out the mechanisms of uterine contraction, to develop drugs for prevention of preterm labor, and to evaluate the effects of drugs on uterine contraction and the fetus in pregnant animals. Especially,anesthesiologists are interested in uterine contraction and fetal safety during pregnancy, labor, and cesarean section. As regional anesthesia and analgesia have come into widespread use for women in obstetric procedure, effects of local anesthetics on uterine contraction and umbilical blood flow that may be harmful to fetus are very important. A lot of animal studies about the effects of local anesthetics (e.g. lidocaine, bupivacaine, ropivacaine) on the uterine contraction and fetal safety have been carried. In addition,general anesthesia has also been still frequently utilized for cesarean delivery and nonobstetric procedure during pregnancy. A lot of animal studies about the effects of volatile and intravenous anesthetics on the uterine contraction and fetal safety have been carried. And there are many animal studies about the mechanisms of uterine contraction and effective drugs to prevent preterm labor. Animal research in obstetrics have been carried in vivo/vitro or during pregnancy/non-pregnancy. We need to study further in order to develop effective drugs for prevention of preterm labor, and also to develop neonatal extracorporeal membrane oxygenation (ECMO) or artificial placenta for achieving stable blood gas exchange and oxygen supply to the fetus.
Background: Hydroxyethyl starch (HES), a commonly used resuscitation fluid, has the property to induce hyperglycemia as it contains large ethyl starch, which can be metabolized to produce glucose. We evaluated the effect of 6% HES- 130 on the blood glucose levels in non-diabetic patients undergoing surgery under spinal anesthesia. Methods: Patients scheduled to undergo elective lower limb surgery were enrolled. Fifty-eight patients were divided into two groups according to the type of the main intravascular fluid used before spinal anesthesia (Group LR: lactated Ringer’s solution, n = 30 vs. Group HES: 6% hydroxyethyl starch 130/0.4, n = 28). Blood glucose levels were measured at the following time points: 0 (baseline), 20 min (T1), 1 h (T2), 2 h (T3), 4 h (T4), and 6 h (T6). Results: Mean blood glucose levels at T5 in the LR group and T4, T5 in the HES group, increased significantly compared to baseline. There were no significant changes in the serial differences of mean blood glucose levels from baseline between the two groups. Conclusions: Administration of 6% HES-130 increased blood glucose levels within the physiologic limits, but the degree of glucose increase was not greater than that caused by administration of lactated Ringer’s solution. In conclusion, we did not find evidence that 6% HES-130 induces hyperglycemia in non-diabetic patients.
목적 : 임신여성에서 oxytocinase에 의한 enzymatic degradatin에 대해 TT-235와 oxytocin의 저항성을 비교하여 보기 위한 것이다. 방법 : 진통이 없는 임산부에서 채취한 혈액을 각각 oxytocin과 TT-235와 섞어 배양하였다. Oxytocin분석을 위해 0, 15, 30, 45, 60분 간격으로 배양액에서 sample을 collect 하였고, TT-235분석을 위해 0, 10, 60, 360분 간격으로 collect하였다. Oxytocin은 radioimmunoassay로 분석하였고 TT-235는 radireceptor assay로 분석하였다. 결과 : Oxytocin은 60분 incubation period 동안 83% 이상 대사된 반면 TT-235는 360분 incubatin period 동안 stable했다. 결론 : (1) 임신한 여성의 혈액에 최소한 in vitro 상태에서는 oxytocinase가 존재한다. (2) TT-235는 혈액에서 enzymatic degradation에 저항성을 가진다. 이것은 실제 임신여성에서 TT-235가 oxytocin 길항제로 prolonged activity를 가질거라고 예측해 볼 수 있다. Objective : Oxytocin antagonists maybe useful in inhibiting the uterine contractions of preterm labor. One such compound is TT-235. The purpose of this study was to compare the resistance of TT-235 and oxytocin to enzymatic degradation by oxytocinase in pregnant human. Methods : Blood samples from pregnant women not in labor were incubated in vitro with known amounts of oxytocin and TT-235. Samples were collected at 0, 15, 30, 45 and 60 minute intervals for oxytocin analysis and at 0, 10, 60 and 360 minutes for TT-235 analysis. Oxytocin was analyzed by radioimmunoassay after extraction while TT-235 was analyzed by radioreceptor assay. Results : In human blood, oxytocin was readily metabolized with greater than 83% disappearance over the 60 minute incubation period. In contrast, TT-235 was stable up to 360 minutes of incubation. Conclusion : This study suggests that: (1) blood from pregnant human does contain oxytocinase at least in vitro; and (2) TT-235 was resistant to enzymatic degradation by human blood, implying that this oxytocin antagonist may have prolonged activity in vivo in humans.