A Case of Lipid Pneumonia by Green Perilla Oil / 결핵및호흡기질환

Exogenous lipid pneumonia is a rare disease resulting from the aspiration or inhalation of vegetable, animal, or mineral oils. In Korea, the most frequently implicated agent is squalen, which can be obtained from shark liver oil. Lipid pneumonia by aspiration of the vegetable oil is very rare. We experienced a 77-year-old man with a history of ingestion of green perilla oil. His clinical course was favorable; after exposure to the oil was stopped, the patient's symptoms improved.

The Bispectral Index and Modified Observer's Assessment of Alertness/Sedation Scale Comparable to Effect Site Concentration of Propofol in Koreans / 대한마취과학회지

BACKGROUND: Propofol has been frequently used for sedation or hypnosis in anesthesia and is relatively accurate in the dose-response relationship for hypnosis. The aim of this study was to define the bispectral index and modified observer's assessment of alertness/sedation (OAA/S) scale at various effect site concentrations (Ce) of propofol in Koreans. METHODS: Fifty premedicated (atropine 0.5 mg, I.M.) adult patients (ASA class I or II, 20 55 yrs) scheduled for elective orthopedic surgery were studied. Propofol was infused until 2 min after the target concentration equilibrated with the effect site concentration (Ce) of propofol using Master TCI. The target concentration of propofol was stepwise increased at intervals of 0.5 microgram/ml until BIS reached 40, BIS and OAA/S at each Ce of propofol were checked. If SpO2 decreased below 90%, oxygen (4 l/min) was given via nasal cannula. RESULTS: BIS was 97.9 +/- 0.2 and OAA/S 5 +/- 0.0 at a Ce of propofol of 0 microgram/ml; the Ce of propofol was 3.5 microgram/ml and OAA/S 0.1 +/- 0.3 at a BIS of 41.1 +/- 2.5. Also, systolic BP at a Ce of propofol above 1.0 microgram/ml and diasolic BP at a Ce of propofol above 1.5 microgram/ml significantly decreased compared to the control (P < 0.05). However, heart rate did not show any difference compared to the control value. Above a 1.0 microgram/ml Ce, fifty-eight percent of patients showed SpO2 < 90%, but there was no incidence of apnea. There were significant correlations between Ce of propofol, BIS and OAA/S. CONCLUSIONS: BIS showed a significant correlation with Ce of propofol (Spearman's r = 1.0) (P < 0.0001). The Ce of propofol was above 3.0 microgram/ml for BIS50.

The Effect of Concentration of Nitrous Oxide on Bispectral Index and Sedation Score / 대한마취과학회지

BACKGROUND: Bispectral index (BIS) has been designed to measure objectively the degree of sedation and hypnosis for several anesthetics. It is predicted that sedation and hypnosis during nitrous oxide inhalation affect BIS in an unusual manner due to a different mechanism compared to usual hypnotics. The aim of this study was to evaluate the effect of different concentration of nitrous oxide inhalation on BIS and sedation score. METHODS: Forty unpremedicated ASA physical status I or II patients scheduled for lower extremity surgery were studied. After performing epidural anesthesia, patients inhaled gradually increasing concentrations of nitrous oxide from 0 to 67% (15 minutes for each concentration) via a tightly sealed face mask. At the end of each inhalation, BIS and OAA/S scale (Observers's Assessment of Alertness/ Sedation scale) were assessed. RESULTS: The increasing concentrations of inhaled nitrous oxide resulted in significant reduction of the OAA/S scale but in no change of BIS. Concentrations of nitrous oxide exceeding 50% affected behavior or emotion of the patients. CONCLUSIONS: Following increasing concentrations of inhaled nitrous oxide, sedation score was reduced significantly but BIS was not affected.

Four cases of kerosene pneumonitis / 대한내과학회지

Kerosene is one of the petroleum distillates with low viscosity and high volatility. Kerosene is widely used in Korean home in heating and cooking. Kerosene ingestion or aspiration is one of the most common poisonings in young children but extremely rare in adults because kerosene is not taken with the intention of committing suicide. We report four adult cases of aspiration pneumonitis by accidental aspiration of kerosene with similar clinical presentation.

Hypnotic Dose Response of Etomidate Using a Bispectral Index during Anesthesia Induction / 대한마취과학회지

INTRODUCTION: Several methods, including loss of eye lash (eyelash) reflex and loss of verbal contact, have heen used as criteria for estimating the optimal hypnosis for anesthesia induction. However, these methods are too objective. We examined the hypnotic dose response of etomidate, using a bispectral index as a more subjective criterion for anesthesia induction. METHODS: Fourty-Five ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to induction dose of etomidate. They were Group 1: 0.1 mg/kg ; Group 2: 0.15 mg/kg; Group 3: 0.2 mg/kg (n = 15 for each group), respectively. Etomidate diluted as 10 ml in a syringe injected through an 18G forearm intravenous catheter, using a syringe pump at the rate of 20 ml/min. Observer's Assessment of Alertness/sedation (OAA/S) scale of 1 was considered optimal for hypnosis. Bispectral index, OAA/S scale, and vital signs were checked every minute until spontaneous eye opening after end of drug infusion. Also, the correlation coefficient between BIS and OAA/S scale was checked for evaluating the bispectral index; this was a useful tool for estimating the degree of hypnosis. RESULTS: BIS and OAA/S showed their lowest scores around 60 sec. after the etomidate injection, which was very different from time to peak effect known to be the 2 min. The correlation coefficient (r) between BIS and OAA/S was 0.84 on average, suggesting the BIS as an good subjective indicator of optimal hypnosis for anesthesia induction. Vital signs were stable in all groups. Hypnotic ED50 and ED95 were 0.12 and 0.19 mg/kg, respectively. CONCLUSIONS: Bispectral index can be a useful tool for estimating the optimal hypnosis for anesthesia induction. Hypnotic ED50 of etomidate was 0.12 mg/kg.

Hypnotic Dose Response of Etomidate Using a Bispectral Index during Anesthesia Induction / 대한마취과학회지

INTRODUCTION: Several methods, including loss of eye lash (eyelash) reflex and loss of verbal contact, have heen used as criteria for estimating the optimal hypnosis for anesthesia induction. However, these methods are too objective. We examined the hypnotic dose response of etomidate, using a bispectral index as a more subjective criterion for anesthesia induction. METHODS: Fourty-Five ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to induction dose of etomidate. They were Group 1: 0.1 mg/kg ; Group 2: 0.15 mg/kg; Group 3: 0.2 mg/kg (n = 15 for each group), respectively. Etomidate diluted as 10 ml in a syringe injected through an 18G forearm intravenous catheter, using a syringe pump at the rate of 20 ml/min. Observer's Assessment of Alertness/sedation (OAA/S) scale of 1 was considered optimal for hypnosis. Bispectral index, OAA/S scale, and vital signs were checked every minute until spontaneous eye opening after end of drug infusion. Also, the correlation coefficient between BIS and OAA/S scale was checked for evaluating the bispectral index; this was a useful tool for estimating the degree of hypnosis. RESULTS: BIS and OAA/S showed their lowest scores around 60 sec. after the etomidate injection, which was very different from time to peak effect known to be the 2 min. The correlation coefficient (r) between BIS and OAA/S was 0.84 on average, suggesting the BIS as an good subjective indicator of optimal hypnosis for anesthesia induction. Vital signs were stable in all groups. Hypnotic ED50 and ED95 were 0.12 and 0.19 mg/kg, respectively. CONCLUSIONS: Bispectral index can be a useful tool for estimating the optimal hypnosis for anesthesia induction. Hypnotic ED50 of etomidate was 0.12 mg/kg.

Clinical Evaluation of One: Syringe Total Intravenous Anesthesia ( TIVA ) / 대한마취과학회지

BACKGROUND: In TIVA, it was controversy which was more appropriate to increase the concentration of the analgesic or of the hypnotic according to the intensity of the surgical stimulus. We used preset infusion dose of propofol and fentanyl mixed with pancuronium through a single syringe for expected better control of hemodynamics. METHODS: Vital signs and recovery scores were observed in thirty patients undergoing total abdominal hysterectomy using one-syringe TIVA in which we used premixed fentanyl(150mcg), propofol(450mg) and pancuronium(2 mg) in one syringe. Induction of anesthesia was performed by injection of propofol 1.5~2 mg/kg, fentanyl 1.5~2 mcg/kg, pancuronium 0.1 mg/kg and ventilated with 100% oxygen after endotracheal intubation. Infusion was started by 1 ml/kg/hr of mixed solution immediately after intubation. If the vital sign changed more than 15% compared with preoperative value, flow rate either increased or decreased by 50%. If stable vital signs were maintained for more than 15 minutes, the flow rate decreased by 20% every 15 min, but were maintained above 0.5 ml/kg/hr. Two to four minutes before skin incision and peritoneal traction, an additional 10 ml of mixed solution was infused. Solution without fentanyl and pancuronium was infused after peritoneal closure for early recovery. Ten to fifteen minutes before the operation was completed, infusion was discontinued and neuromuscular block was reversed. RESULTS: Blood pressure and pulse rate were stable and did not significantly change even after intubation or peritoneal traction compared with preoperative value. And, recovery from anesthesia was prompt 15 min after extubation except 2 cases of respiratory depression. CONCLUSIONS: One-syringe TIVA may be an feasible alternative method to replace conventional multi-syringe TIVA.

Dose-Response and Hypnotic Synergism of Midazolam and Thiopental Sodium for Induction of Anesthesia in Korean / 대한마취과학회지

BACKGROUND: Thiopental sodium and midazolam are frequently used to induce anesthesia. It has been known that barbiturates enhance the binding of benzodiazepines to the benzodiazepine receptors and also enhance the anesthetic effect of benzodiazepines. As a results, the combined effect of a barbiturate and a benzodiazepine should be more than the sum of the separate effects of the two drugs. The purpose of this study was to evaluate hypnotic interaction between the two drugs during induction period. METHODS: The effect of midazolam on the induction dose-response curve for thiopental sodium was studied in unpremedicated 240 ASA physical status I and II female patients. As an endpoint of hypnosis, ability to open eyes on command was used. Dose-response curves for thiopental sodium, midazolam, and their combination were determined with a probit procedure and compared with a isobolographic analysis. RESULTS: For hypnosis, significant(P<0.05) synergistic interaction was found between the two drugs. The dose of thiopental sodium required to produce hypnosis was reduced by 64% in the presence of equi-effective dose of midazolam. CONCLUSIONS: The interaction between thiopental sodium and midazolam for hypnosis is synergistic.

A Comparison of Midazolam and Propofol on Hemodynamic Changes and Postanesthetic Recovery as Hypnotics for Total Intravenous Anesthesia(TIVA) / 대한마취과학회지

Total intravenous anesthesia(TIVA) is a anesthetic technique where hypnosis, analgesia and muscle relaxation are provided solely by intravenously administered drug without the use of anesthetic vapors or gases including nitrous oxide. For TIVA, midazolam and propofol have been used as hypnotics because of their relatively short elimination half life. Hemodynamic function during induction of anesthesia, the fentanyl and naloxone requirements, and speed of recovery from TIVA with midazolam/fentanyl(group M, n=20) or prapofol/fentanyl (group P, n=20) were compaired in patients undergoing surgery. Forty patients were randomly assigned to receive either 0.2 mg/kg midazolam in 5 min followed by 0.4 mg/kg/hr for 20 min, 0.3 mg/kg/hr for next 20 min, 0.05~0.2 mg/kg/hr until 10~15 min before skin closure, or 2 mg/kg propofol in 5 min followed by 9 mg/kg/hr for 30 min and 4.5 mg/kg/hr until 10~15 min before skin closure. Simultaneously, a variable rate infusion of fentanyl was given. Patients were intubated with an aid of vecuronium and ventilated with 40% oxygen in air. In both groups, mean arterial pressure decreased significantly(P0.05). The total dose, duration and rate of infusion of fentanyl was similar in both groups. 16 patients in group M and 9 patients in gmup P needed naloxone for recovery of respiration and 10 patients in group M needed flumazenil for recovery of consciousness. Recovery as judged by scoring system(sedation score, comprehension score, orientation score) was shorter in group P than group M. Among side effects, resedation was more frequent in group M(9 pts) than P group(0 pt). In conclusion, both midazolam and propofol were useful hypnotics for TIVA. But, group M showed more stable hemodynamics than group P during induction period and P group showed earlier recovery than group M. We concluded that the selection of hypnotics between midazolam and propofol for TIVA depends on situation such as better hemodynamics during induction period or earlier recovery.

Midazolam and Propofol Synergism for Induction of Anesthesia / 대한마취과학회지

The mechanism by which propofol exerts its action is poorly understood, but may involve a non-specific effect on lipid membrane and has been shown to potentiate GABA-mediated synaptic inhibition. And, midazolam also acts through GABA receptor mediated increased chloride conductance. The aim of this study was to evaluate the dose response of midazolam, propofol and combination of these drugs, and determine possible interaction between two drugs in patients. The effect of propofol on the dose response curve for midazolam was studied in 260 nonpremedicated ASA physical status I or II female patients who were scheduled for elective operation. The response to the verbal command was used as an end-point of hypnosis. Dose response curves for midazolam, propofol, and their type of interaction was determined using Instat software package, nonlinear regression analysis, and algebraic(fractional) analysis of interaction. ED of midazolam and propofol was 0.11 mg/kg, 1.13 mg/kg and ED95 was 0.18 mg/kg, 1.67 mg/kg respectively. ED50 of combined drug(midazolam+propofol) in comhined dose response curve was 29% of each drug and the type of interaction between two drugs was found to be synergistic.

The Effect of Tetraethylammonium Chloride on the Impulse Conduction Block by bupivacaine / 대한마취과학회지

Potassium channel blockers slow depolarization, broaden the action potential, and thus pro- mote the open and inactivated Na+ channel states. The ability of local anesthetics to reduce the amplitude of compound action potential(CAP) of rat sciatic nerve was examined in the presence and absence of teteraethylammonium chloride(TEA) that selectively block K+ channels, In the presence of 1.3X10-5 M bupivacaine that inhibit the CAP by 22.5% at tonic stimulation, the addition of TEA(10-1M) increased this inhibition by another 27.5% and increased another 50% by phasic stimulation(20Hz). Also, dose response curve of bupivacaine in the presence of TEA(10-1M) showed marked shift to left of curve. The re- covery kinetics of bupivacaine in the presence of various coneentration of TEA(10-2-10-1M) showed marked delay of recovery(2X10-2 M), reocurrence of inhibition(90min,5X10-2 M), even no recovery(10-1M). TEA alone slightly depolarized the resting membrane which was represented as increment of CAP height from 0.9%(3min) to 12.3%(80min), and broadened mid-peak amplitude width by 2 times in 5X10-1M, 5.3 times in 1M. These experiments directly demonstrated that TEA potentiated the inhibition of CAP by bupivacaine and showed the poesibility of mixture of TEA and local anesthetics to potenti- ate impulse conduction blockade.