The effects of etomidate on the contraction of pregnant rat uterine smooth muscle / 대한마취과학회지

BACKGROUND: It has been reported that etomidate has the relaxant effects on vascular, tracheal, and non-pregnant uterine smooth muscle in vitro. The purpose of this study was to investigate the relaxant effects of etomidate on the contraction of the pregnant rat uterine smooth muscle. METHODS: Uterine muscle tissues were obtained from pregnant rats (n = 15). The uterine segments were mounted in organ baths filled with Krebs solution. After oxytocin-induced contractile activity had been established, etomidate in incremental concentrations (10(-7) to 10(-3) M) was added cumulatively to the bath, each administered 20 min apart, and resultant changes in contractile activity were continuously recorded. EC5 (effective concentration of 5% reduction), EC25, EC50, EC75, and EC95 on active tension were calculated using a probit model. RESULTS: Etomidate (10(-7) to 10(-3) M) induced dose-dependent decreases in amplitude and frequency of uterine contraction. The EC50 of etomidate on active tension were 5.91 x 10(-5) M. CONCLUSIONS: These results demonstrate that etomidate had inhibitory effects on pregnant rat uterine muscle at supraclinical concentration (5.91 x 10(-5) M).

Effect of tramadol on bispectral index during anesthesia with desflurane / 대한마취과학회지

BACKGROUND: This study is aimed to investigate the effect of tramadol on the bispectral index (BIS) during anesthesia with desflurane. METHODS: One hundred fifty adults, ASA class 1 and 2 patients, scheduled for general anesthesia for elective surgical procedures were included in this study. None of the patients were premedicated and anesthesia was induced with propofol 2 mg/kg and maintained with air-oxygen (FiO2 0.5) and desflurane, adjusted to keep the BIS between from 50 and 60. Forty minutes before completing surgery, the subjects were randomly allocated into 3 groups to receive saline (control group), tramadol 1.5 mg/kg (T1 group) or 3.0 mg/kg (T2 group) intravenously. Hemodynamics and BIS values were then recorded every 5 minutes until completion of the operation, during which time the concentrations of desflurane were not modified. RESULTS: The mean BIS values after tramadol administration weren't significantly different from the control group throughout the period of observation. No significant changes in the hemodynamics were noted, except systolic and diastolic arterial blood pressure in the T1 and T2 groups significantly increased in the first 5 minutes after the tramadol injection. CONCLUSIONS: The results indicate that the administration of tramadol while maintaining anesthesia with desflurane, adjusted to keep the BIS between 50 and 60, does not modified BIS values. So, we propose that tramadol can be safely administered as an immediate postoperative analgesia without concern about intra-operative awareness.

The Dose-Dependent Analgesic Effect of Ondansetron for Pain on Injection of Rocuronium in Adult / 대한마취과학회지

BACKGROUND: Intravenous injection of rocuronium produces intense discomfort at the site of injection in conscious patient. The purpose of this study was 2 folds; First, to determine the incidence of pain associated IV injection of rocuronium in adult patients. Second, to determine whether pretreatment with IV ondansetron affects the incidence of pain associated with the injection of rocuronium. METHODS: Eighty adult patients were randomly assigned to four groups. Before general anesthesia was induced with thiopental sodium (5 mg/ml), manual occlusion (70 mmHg) with tourniquet of venous inflow was performed. Randomly associated 20 patients received 4 ml of normal saline as a placebo control (Group 1). Other 60 patients allocated randomly to one of three groups: ondansetron 4 mg (Group 2), 6 mg (Group 3), 8 mg (Group 4) respectively. The patients' pain response to rocuronium injection was graded with using Memis' 4-point scale and withdrawal response was graded with using Kim's 4-point scale. RESULTS: Nineteen patients (95%) in the group 1, 18 patients (90%) in the group 2, 19 patients (95%) in the group 3, and 14 patients (85%) in the group 4 reported pain. Moderate to sever pain was 17 patients (85%), in the group 1, 11 patients (55%) in the group 2, 9 patients (45%) in the group 3, and 1 patient (5%) in the group 4. CONCLUSIONS: Ondansetron 4 mg, 6 mg, and 8 mg IV given before administration of rocuronium did not reduce incidence of pain on injection of rocuronium but significantly reduced severity of pain on injection of rocuronium and the 8 mg was more effective.

The Effects of Epidural Clonidine Added to Bupivacaine , Fentanyl and Epinephrine after Total Abdominal Hysterectomy / 대한마취과학회지

Epidurally administered clonidine, a selective alpha2-adrenergic agonist, has been reported to produce postoperative analgesia. The aim of this study was to see if the addition of a small dose of clonidine to a mixture of bupivacaine, fentanyl and epinephrine prolonged the duration of analgesia and reduce the number of injections or the total bupivacaine requirement and the incidence of side effects. Forty patients presenting for TAH in ASA physical status 1 or 2, were randomly divided into two groups group 1 was given a 10 ml epidural solution of bupivacaine 12.5 mg combined with fentanyl 50 pg and epinephrine 50ug ; group 2 was given the same solution with clonidine 75 ug. Changes in the systolic and diastolic blood pressure and the pulse rate were recorded at 5, 10, 20, 30, 45, 60, 75, 90, 105 and 120 minutes after drug administration, and the analgesic effects were assessed by measuring pain score (Prince Henry Score), analgesic duration, total bupivacaine requirement for 24 hours and side effect. The results were as follows; 1) Heart rate changed little in group 1 and decreased significantly in group 2. 2) Systolic and diastolic blood pressure decreased significantly in all groups (earlier in group 2 than in group 1). 3) The mean duration of analgesia was significantly prolonged in group 2, compared with group 1 (437 min in group 2; 229 min in group 1). For 24 hours after the first injection, numbers of injections (6 in group 1; 3.15 in group 2) and total bupivacaine requirements (75.0 mg in group 1 ; 39.1 mg in group 2) were significantly reduced. 5) The side effects including hypotension, nausea and vomiting, pruritus, and respiratory depression were not significantly different from each other. These results show that epidurally administered clonidine helps to prolong analgesic duration, and decreased need for supplemental bupivacaine, after lower abdominal surgery.

The Effect of Atropine-Neostigmine and Glycopyrrolate-Neostigmine Mixture on Heart Rate / 대한마취과학회지

Clinically, neostigmine is most commonly used as the reversal agent for to the competitive muscle relaxants. Atropine (group 1) and glrcopyrrolate (group 2) were studied in doses of 15ug/kg, 20 ug/kg and 77ug/kg, 10ug/kg given intravenously in a mixture with neostigm-ine 40ug/kg, during operation and at the end of operation 20 ASA class I patients, aged between 15 to 60, were selected in each group. Anesthesia was maintained with enflurane (1-1.5%), N2O (2L/min), O2(2L/min) and pancuronium (50ug/kg) was used as a muscle relaxant. The results were as fellows : 1) Group 1 showed significant increase and decrease in purse rate compared with group 2. 2) Atropine neostigmine mixture significantly showed initial increase and late decrease in pulse rate than glycopyrrolate-neostigmine mixture. 3) In group 2, 20ug/kg dose of atropine, when administered in a mixture with neostigmine, showed significant initial increase in pulse rate, 15ug/kg dose of atropine showed significant late bradycardia. 4) In group 2, 7 ug/kg, 10 ug/kg dose of glycopyrrolate was not associated with initial tachy cardia but late bradycardia was obserred and 10 ug/kg dose of glycopyrrolate was associated with more stable heart rate.

The Changes on Liver Function in Patient with HBsAg Postive after General Anesthesia / 대한마취과학회지

It is well known that most anesthectis and drugs are metabolized and excreted in the liver. There are many controversies regarding postoperative halothane hepatotoxicitr and often reported postoperative hepatic dysfunction following enflurane anesthesia. It appears that the development of hepatic necrosis after anesthesia depends on a chance combination of events but not anesthetics itself. Common causes of postoperative hepatic damages ia possibly due to viral heatitis, since in oar country viral hepatitis B are increasing in frequency recently. This study was performed to evaluate the effect of enflurane on liver function in 25 asy-mptomatic patients hepatitis B surface antigen positive. The results seems favorable for anesthesia and sureery. on asymptomatic viral hepatitis B patients.

Cardiac Arrest due to Excessive Infiltration of Epinephrine during Operation - A case report / 대한마취과학회지

Hemostasis and clear operative field is obtained by local infiltration of local anesthetic mixed with epinephrine. Small amount of diluted solution is usually used to decrease incidence of arrhythmia which can be induced by myocardium sensitizing anesthetics. We experienced a case of cardiac arrest during anesthesia with halothane due to the inadvertent use of a large dose of epinephrine to achieve hemostasis, the patient was resuscitated after 2 hours of CPR.

Spinal Anesthesia with 0.5% Isobaric Bupivacaine and 0.4% Hyperbaric Bupivacaine / 대한마취과학회지

Thie study was conducted in the Anesthesiology Department of Chosun University Hospital from March to August 1987 using 0.5% isobaric bupivacaine and 0.4% hyperbaric bupivacaine as agents for spinal anesthesia. The following results were obtained. 1) The segmental heights and the highest level of sensory loss were significantly increased with increased dosage. In the hyperbaric bupivacaine groups of 15 mg and 20 mg respectively, the sensory lose in comparison with isobaric groups was significantly increased. 2) Less time was needed to achieve, complete motor blockade in the 15 mg hyperbaric bupivacaine group than in the isobaric groups but there were no significant differences between the other groups. The duration of motor blockade was more prolonged in the isdobaric bypivacaine groups using 15mg And 20 mg than in the hyperbaric groups. 3) The Group using 20 mg of hyperbaric bupivacaine demonstrated a significant decrease in blood pressure as coupared wish the group using 20 mg of isobaric bupivacaine. 4) Following spinal anesthesia, headache developed in 5 cases (5.6%). From the above results we conluded that isobaric bupivacaine and hyperbaric bupivacaine are appropriate anesthesia agents for surgery on the lower abdomen and lower extremities.

The Effects of Combined Spinal Epidural Anesthesia for Lower Extremity Surgery / 대한마취과학회지

BACKGROUND: Spinal anesthesia is a simple technique requiring a small dose of local anesthetic to provide intense and reliable block. And epidural anesthesia with the catheter technique gives a better control of the level of analgesia and a good postoperative pain relief using opioids, local anestheties or both. Therefore, the combined spinal epidural (CSE) anesthesia was evaluated to provide rapid onse of action, good muscle relaxation, prolonged duration of the block and postoperative pain relief. METHODS: All patients were placed in a lateral position. Using a midline approach at L interspace, a 18G Tuohy needle was introduced into the epidural space. A 27G Whitacre spinal needle was passed through the Tuohy needle until free flow cerebrospinal fluid, and than 0.5% heavy bupivacaine 3ml(15mg) was injected. The spinal needle was withdrawn and the epidural catheter was inserted. The dermatome level and time of sensory block was evaluated using loss of sensation of pinprick test every 1 minute for 30 minutes, until the maximum sensory block was established. Motor block was assessed using the Bromage scale. And postoperatively we interviewed the patients for opinioes on the blockade and complication. RESULTS: The mean values of maximum sensory block level were T8 (T8.0+/-1.7 dermatome) and at that time was 8min 30sec (8.5+/-1.2min). The motor blockade of lower extremity was Bromage 3 in all patients. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Subjective evaluation by the patients about postoperative pain control was excellent. CONCLUSIONS: CSE anesthesia appears to combine the reliabiIity and rapid onset of spinal block, and the ability to extend the block and postoperative analgesia by using the epidural catheter while minimizing their drawbacks.

Effect of Clonidine on the Blood Pressure, Heart Rate and Plasma Catecholamine Concentration during General Anesthesia / 대한마취과학회지

BACKGROUND: Induction of general anesthesia with tracheal intubation and skin incision are potent stimuli that can induce increased sympathetic activity, heart rate and blood pressure. We compared the hemodynamic response and catecholamine concentration during general anesthesia with intravenous clonidine pretreatment, a centrally acting -2 adrenoceptor agonist, and without pretreatment. METHODS: Forty ASA I or II patients aged from 20 to 60 years undergoing elective surgery were randomly allocated to two groups. In group I, 5 ml of 0.9% normal saline as control administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O (2.5L/min)-O2 (2.5L/min)-enflurane (1.3~1.8 vol%). In group II, 4 g/kg clonidine diluted in 5ml of normal saline administered intravenously 10 minutes before induction of anesthesia, and anesthesia was induced with thiopental sodium, succinylcholine and maintained with N2O-O2-enflurane (0.5~1.0vol%) and 2 g/kg/hr clonidine was continuously infused. We measured blood pressure, heart rate and plasma catecholamine at preinduction, 1 minute after intubation (T1), 1 (T2) and 30 minutes after skin incision (T3) and compared with group I. RESULTS: There was statistical significance in systolic and diastolic pressure at T1 between two groups. There was statistical significance in heart rate, epinephrine and norepinephrine at T1, T2 and T3 between two groups. CONCLUSION: The elevation of blood pressure, heart rate and plasma catecholamine accompanying tracheal intubation and skin incision may be prevented by administration of intravenous clonidine.

The Analgesic Effect of Continuous Suprascapular Nerve Block after Arthroscopic Shoulder Surgery / 대한마취과학회지

BACKGROUND: Arthroscopic shoulder surgery is often associated with severe postoperative pain. It is important to control pain in this setting, not only to improve the patient's well-being but also to facilitate rehabilitation. The aim of this study was to investigate the efficacy of a continuous suprascapular nerve block for pain relief after arthroscopic shoulder surgery. METHODS: Forty patients (20 in each group) scheduled for elective arthroscopic shoulder surgery received a suprascapular nerve block and a catheter was introduced before surgery. The patients were received standardized general anesthesia. After surgery, a single bolus of normal saline (Group I) or 0.2% ropivacaine (Group II) 6 ml was injected through a catheter in each group. All patients received either a continuous infusion of normal saline (Group I) or a continuous infusion of 0.2% ropivacaine (Group II) through the catheter at a rate of 3 ml/hr plus a bolus of 3 ml with a lock out time of 30 min. Pain relief was assessed at 2, 4, 8, 12, 24 hours using visual analog scale (VAS) and verbal pain scores (VPS). RESULTS: VAS and VPS were lower in the ropivacaine group (Group II) than in the normal saline group (Group I). There were no complication in either group. CONCLUSIONS: Continuous suprascapular nerve block using 0.2% ropivacaine is a safe and efficacious treatment for postoperative shoulder pain.

The Effect of Music on Intraoperative Anxiety during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Most surgical patients experience perioperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contributes to postoperative pain. The effect of music on perioperative patient anxiety was studied. METHODS: Forty patients undergoing surgery with spinal anesthesia, were divided into two groups. Group I (n = 20) did not listen to music, and Group II (n = 20) listened to music selected by the patient. At ward, hemodynamic variables including systolic and diastolic blood pressures and pulse rates were measured as control values. Hemodynamic variables and the anxiety scores by the Hamilton anxiety rating scale and the Visual Analogue Scale (VAS) were prepared for Group I and Group II in the operating room. RESULTS: No difference was observed between the groups with regard to systolic blood pressure, diastolic blood pressure, mean arterial pressure, or pulse rate when patients arrived at the operating room. In Group II, 30 minutes after listening to music, anxiety scores, VAS, systolic blood pressures, and mean arterial pressures were significantly lower than in Group I. CONCLUSIONS: Music was found to effectively reduce intraoperative anxiety.

Anesthesia for a Patient with Moyamoya Disease presenting for Emergency Cesarean Section: A case report / 대한마취과학회지

Moyamoya disease is a rare, progressive, occlusive cerebrovascular disorder characterized by bilateral stenosis of the intracranial portion of the internal carotid artery. Symptoms including transient ischemic attacks, seizures, intracranial hemorrhage and cerebral infarction, are variable. There are few case reports of moyamoya disease in pregnancy. Since hyperventilation-induced cerebral ischemia and hypertension are provoked by active labor, cesarean section has been recommended to avoid neurologic complications for pregnant women with moyamoya disease. The optimal anesthetic management for cesarean section in these patients has not been discussed. We report a case of moyamoya disease in a patient presenting for cesarean section at 40 weeks' gestation. Epidural anesthesia was administered using 0.5% bupivacaine and fentanyl. Intraoperative hemodynamic state was stable. The patient has no significant postoperative complications.

The Analgesic Effects of Epidural Dexamethasone after Simple Lumbar Discectomy / 대한마취과학회지

BACKGROUND: Epidural steroids have been suggested to prevent postoperative epidural fibrosis after lumbar laminectomy. The purpose of this prospective study was to compare the degree of postoperative pain in patients undergoing simple lumbar discectomy with and without epidural dexamethasone administration. METHODS: Thirty-six patients undergoing simple lumbar discectomy were randomly allocated to two groups to be given the following agents, just after the end of surgery via an epidural lumbar catheter previously inserted by the surgeon: normal saline 6 ml (group I), and a total of 6 ml normal saline with dexamethasone 5 mg (group II). The outcome measures included pain scores at 1, 2, 6, 12, and 24h and total morphine consumption over the first 24 postoperative hours. RESULTS: There were significant differences in the postoperative visual analogue scale (VAS) score at 1 and 2 h between the two Groups, and the 24h total morphine consumption in Group II was significantly lower than in Group I. CONCLUSIONS: Epidural administration of dexamethasone decreased the degree of postoperative pain after simple lumbar discectomy.

Airway Obstruction by Displaced Cuff of Armored Tube: A case report / 대한마취과학회지

A thirty nine year-old male patient was scheduled for emergent craniotomy and epidural hematoma evacuation under general anesthesia. All data of the preoperative check lists for emergent operation were within normal limits and vital signs of the patient were stable. During the induction of anesthesia an armored tube was inserted into the trachea for this operation. Approximately 110 minutes after the induction of anesthesia, signs of complete airway obstruction developed abruptly. At that time we deflated the cuff balloon to exchange the tube. Then, the signs of airway obstruction disappeared completely. Therefore the deflation of cuff balloon is recommended in order to exclude the obstruction by the displaced cuff.

The Comparative Effects of Caudal Block and IV Ketorolac on Emergence Delirium after Sevoflurane Anesthesia in Children / 대한마취과학회지

BACKGROUND: Children usually exhibit pain-related behavior in the postanesthetic care unit. The aim of the present study was to compare the recovery and emergence profiles of children who received sevoflurane with caudal block or IV ketolorac or none for inguinal herniorrhaphy. METHODS: Forty five children, ASA 1, scheduled for herniorrhaphy were randomly assigned to receive either caudal block(n = 15), IV ketorolac (n = 15), or none (n = 15). All children were premedicated with midazolam(0.05 mg/kg) and glycopyrrolate (0.004 mg/kg) an hour before anesthesia induction. Thiopental sodium (5 mg/kg) and mask inhalation of sevoflurane 2 vol% in N2O/O2 50/50 were used to induce anesthesia. After induction, group 1 received none, while groups 2 and 3 received a caudal block and IV ketorolac, respectively. Anesthesia was maintained by sevoflurane with N2O/O2 inhalation via an endotracheal tube. Recovery was assessed by an independent observer using a postansthetic recovery score. Pain score was also assessed by an independent observer using a pain/discomfort scale. Recovery and agitation characteristics on emergence were compared between the three groups. RESULTS: There were no difference between the groups with respect to age, weight, duration of inhalation exposure, or recovery score. Agitation and pain scores were less in both the caudal block and IV ketorolac groups (P <0.05). Emergence delirium occurred less frequently in the caudal block and IV ketorolac groups (P <0.05). There was no significant difference between the caudal block and the IV ketorolac groups in emergence delirium. CONCLUSIONS: Emergence delirium after sevoflurane anesthesia was less common in the caudal block and IV ketorolac groups. Thus, it is presumed that the postoperative analgesic actions of caudal block or IV ketorolac reduce emergence delirium during recovery from sevoflurane anesthesia.

The Postoperative Analgesic Effects of Epidural Clonidine during General Anesthesia / 대한마취과학회지

BACKGROUND: Epidurally administered clonidine produces analgesia by an alpha 2-adrenergic mechanism and may provide postoperative analgesia without nausea, pruritus and respiratory depression associated with opioid administration. Many studies have shown the beneficial effects of epidural clonidine in postoperative pain management. Pre-administered epidural analgesic agent before the skin incision may prevent the nociceptive input. We provided the pre-emptive analgesia and compared the postoperative analgesic effects of epidural clonidine when used as the sole analgesic agent with epidural fentanyl and epidural bupivacaine. METHODS: Thirty-nine gynecologic patients, ASA physical status 1, 2, undergoing elective lower abdominal surgery under general anesthesia, were studied. They were not taking any premedications. Before anesthesia, an epidural catheter was inserted at the L2~3 interspace. Patients were divided into 3 groups randomly. Group 1 received 0.125% bupivacaine 20 ml through the epidural catheter, group 2 received 100 microgram fentanyl in normal saline 20 ml, and group 3 received 150 microgram clonidine in normal saline 20 ml. During the operation, we recorded the vital signs and side effects. Just before suturing peritoneum, we injected the corresponding drugs on individual groups through the epidural catheter. In the recovery room, the postoperative analgesia was assessed by VAS (visual analogue scale). Vital signs, sedation score and side effects were also checked. RESULTS: VAS and systolic blood pressure were significantly lower in group 3 than group 1 or group 2 at the recovery room. The diastolic blood pressure, heart rate and sedation score were not significantly different between three groups at the recovery room. Also the vital signs during the operation were notsignificantly different between three groups. The incidence of hypotension was 3 out of 13 in group 3 and 1 out of 13 in group 1. CONCLUSION: Epidural bolus clonidine 150 microgram produces more profound and longer postoperative analgesic effects than fentanyl 100 microgram or 0.125% bupivacaine at the lower abdominal surgery. But hypotension may occur more frequently. So, if we select the patient cautiously, epidural clonidine is a good alternative analgesic agent for the postoperative analgesia.

Spinal Anesthesia with 0.25 % Hyperbaric Bupivacaine : Effect of Different Dosage / 대한마취과학회지

Authors selected 54 patients in ASA class I, II, aged from 20 to 60 years old undergoiag operations of lower limbs and lower abdomen. In the different dosage of 0.25% hyperbaric bupivacaine, these were divided into 3 groups ; group A(22 patients) using l0 mg(4 ml), group B(17 patients) using 15 mg(6 ml), group C(15 patients) using 20 mg(8ml), which were injected into subarachnoid space. The following results were obtained. I) Maimum level of sensory loss was significantly increased with increase dosage, and the time of onset was significantly faster with decrease dosage. 2) Duratioan of sensory loss was significantly longer with increase dosage. 3) Onset time of motor block was signficantly faster in the group C of Bromages scale degree l, Duration of motor block was signficantly longer with increase dosage. 4) Systolic and diastolic blood pressure were little decreased with increase dosage. No signficant changes were noted in the pulse rate. 5) Post spinal headache developed in 5 patients out of 54 patients(9.3%). In the study of the group C, urinary retention developed in 4 patients out of 15 patients. From above results, we conclude that 0.25% hyperbaric bupivacaine can be used for operations lasting than 1~2 hours of lower limbs and lower abdomen because cardiovascular system is little affected with increase dosage.

Cardiac Arrest During Pediatric Anesthesia / 대한마취과학회지

It is a well known that cardiac arrest can occur during general anesthesia. We had experienced of a cardiac arrest during anesthsia in a child with halothane just after the use of a thiopental sodium and vecuronium bromide. When the cardiac asystole was noted by E.C.G., immediate treatment was performed. In this case, We think that Cardiac arrest being related to several factors, anxiety about operation, rough sugical maniplation, light anesthesia and drugs.

Exacerbated Pulmonary Edema in a Toxemia Patient with Mitral Regurgitation during Emergency Cesarean Section: A case report / 대한마취과학회지

Pregnancy-induced hypertension(PIH) is a syndrome of hypertension, proteinuria, generalized edema and occasionally superimposed convulsions after the 20th weeks of gestation. It is a cause of maternal morbidity and mortality. Causes of marternal mortality from PIH include intracranial hemorrage, cerebral edema and pulmonary edema. Mitral regurgitation(MR) is the second most common valvular defect in pregancy, but well tolerated by pregnant women. The reduced systemic vascular resistance characteristic of pregnancy may even reduce the intensity of the murmur of MR becauce of increased forward flow and less backward flow. Acute MR result in a sudden and dramatic increase in left atrial pressure that can lead to pulmonary congestion, pulmonary hypertension and right heart failure. This is a case report of patient with toxemia and MR who underwent emergency cesarean section. She was treated with oxygen, diuretics, steroids, bronchodilators, digitalis, semisitting position, suction and positive end-expiratory pressure(PEEP). She recovered completely.