• The Korean Journal of Pain
• /
• v.11 no.1
• /
• pp.143-145
• /
• 1998

There are reports on cervical epidural anesthesia for surgery of neck, chest and upper limb. However, there are limited published data on the specific problems with this procedure, including dural puncture, epidural abscess, and vasovagal syncopes. We experienced two cases of vasovagal syncope during cervical epidural anesthesia in the sitting position. These syncopes consisted of sudden hypotention and bradycardia, associated with nausea, dizzness and sweating. The patients were resuscitated successfully and recovered without any adverse effects. Current literature is being reviewed and the possible mechanisms of cardiac arrest under cervical epidural anesthesia in the sitting position are being discussed.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.18 no.3
• /
• pp.169-175
• /
• 2018

Background: The objective of this study was to compare hemodynamic and recovery characteristics of total intravenous anesthesia using propofol target-controlled infusion (TCI) versus sevoflurane for extraction of four third molar teeth. Methods: One hundred patients undergoing extraction of four third molar teeth under general anesthesia were randomized to one of two groups. Group 1 received propofol TCI-oxygen for induction and propofol TCI-oxygen-air for maintenance. Group II received a propofol bolus of 2 mg/kg for induction and sevoflurane-oxygen-air for maintenance. Heart rate, mean arterial pressure (MAP), operating time, time to emergence, nausea and vomiting, and sedation and pain scores were measured in each group. Results: Demographic data, including age, gender, weight, and height, were not significantly different between the two groups. The MAP was significantly higher after intubation (P = 0.007) and injection of anesthesia (P = 0.004) in the propofol group than in the sevoflurane group, with significant reflex bradycardia (P = 0.028). The mean time to emergence from anesthesia using propofol was 25 s shorter than that of sevoflurane (P = 0.02). Postoperatively, the propofol group was less sedated than the sevoflurane group at 30 min (0.02 versus 0.12), but this difference was not significant (P = 0.065). Conclusion: Both propofol TCI and sevoflurane are good alternatives for induction and maintenance of anesthesia for short day-case surgery. However, propofol TCI does not blunt the hemodynamic response to sudden, severe stimuli as strongly as sevoflurane, and this limitation may be a cause for concern in patients with cardiac comorbidities.

• The Korean Journal of Physiology
• /
• v.30 no.1
• /
• pp.105-116
• /
• 1996

Rendering the brain ischemic would evoke the cerebral ischemic reflex which is characterized by an arterial pressor response, apnea and bradycardia. Since the rostral ventrolateral medulla (RVLM) is known to play a key role in the maintenance of normal cardiopulmonary activity, during the cerebral ischemic reflex some cardiac related cells should be excited and respiration related cells inhibited. In this context, the responses of RVLM neurons to systemie and focal hypoxia were analyzed in the present study. Twenty-five adult cats of either sex were anesthetized with ${\alpha}-chloralose$ and the single neuronal activities were identified from RVLM area. For the induction of focal hypoxia in the recording site, sodium cyanide was applied iontophoretically and for systemic hypoxia the animal was ventilated with nitrogen gas for a twenty-second period. Cellular activities were analyzed in terms of their discharge pattern and responses to the hypoxia by using post-stimulus time and single-pass time histograms. Of eighteen cardiac related cells recorded from the RVLM area, twelve cells were excited by iontophoresed sodium cyanide and of twenty-five respiration related cells, fourteen cells were excited by iontophoresed sodium cyanide. Remaining cells were either inhibited or unaffected. Eight of fifteen cells tested with iontophoresed sodium lactate were excited and remaining seven cells were inhibited. Systemic hypoxia induced by nitrogen gas inhalation elevated the arterial blood pressure, but excited, inhibited or unaffected the single neuronal activities. Some cells showed initial excitation followed by inhibition during the systemic hypoxia. Bilateral vagotomy resulted in a decrease of arterial pressor response to the systemic hypoxia, and a slight decrease in the rhythmicity related to cardiac and/or respiratory rhythms. The single neuronal responses to either systemic or focal hypoxia were not affected qualitatively by vagotomy. From the above results, it was concluded that the majority of the cardiac- and respiration- related neurons in the rostral ventrolateral medulla be excited by hypoxia, not through the mediation of peripheral chemoreceptors, and along with the remaining inhibited cells, all these cells be involved in the mediation of cerebral ischemic reflex.

• Clinical and Experimental Pediatrics
• /
• v.46 no.12
• /
• pp.1274-1278
• /
• 2003

Syncope in children and adolescents have a common occurrence according for up to 15% before adulthood. Micturition syncope, a kind of situational syncope, can be considered a form of reflex syncope. It can typically occur in healthy young men after rising from bed in the early morning who experience sudden loss of consciousness during or immediately after urination. The mechanism of micturition syncope is not completely understood, but it has been suggested that vasovagal reflex mediated bradycardia and peripheral vasodilation and decreased venous return due to Valsalva effect and standing position lead to the decrease in cerebral blood flow resulting in syncope. The causes of syncope are variable. So complete history taking, physical examination, electrocardiography, exercise stress test, echocardiography, head-up tilt table test, electroencephalography(EEG), brain magnetic resonance image and urodynamic study should be required for the diagnosis of micturition syncope. There were several reports about micturition syncope. However, literature of micturition syncope at the pediatric age has rarely been reported in Korea so far. Therefore, we report a case of a 9-year-old boy with micturition syncope with typical EEG findings of high amplitude delta wave and flattening during syncope.

• Korean Journal of Head & Neck Oncology
• /
• v.9 no.1
• /
• pp.63-67
• /
• 1993

The syndrome of carotid sinus hypersensitivity is cardovascular symptom complex including lightheadedness, transient loss of consciousness, perspiration, pallor, weakness of lower extremities, transient hypotension, bradycardia and seizure, which occurs from firing of hyperactive carotid sinus reflex. Most cases are idiopathic, but maliganant tumors involving parapharyngeal space have been occasionally implicated. We present a case of carotid sinus hypersensitivity due to nasopharyngeal carcinoma invading the parapharyngeal space with bilateral cervical lymphnode metastases(stage IV, $T_4N_2M_0$). The patient experienced several episodes of severe syncope proceeded by blurring of vision, dizziness and nausea, which were used to occur while he was working in erect position. The tumors were markedly regressed by external radiation therapy with successful resolution of syncope.

• The Korean Journal of Physiology
• /
• v.3 no.2
• /
• pp.25-31
• /
• 1969

Effects of graded increase of positive lung inflation upon heart rates and arterial blood pressure were observed in the anesthetized dogs to analyze the mechanical and neural regulatory factor in response to the positive inflation of the lung. The results obtained were summarized as followings: 1) When the low grade of positive lung inflation was employed under the mild to moderate anesthesia, central venous pressure was linearly increased while heart rate was decreased. After bilateral vagotomy, central venous pressure was obviously increased while heart rate was constant. 2) When the high degree of positive lung inflation was employed, changes of central venous pressure and heart rate were not significant. 3) The low grade of intrapulmonary pressure increase caused reflex tachycardia in phase 2 and overshooting in phase 4 in response to the systemic arterial blood pressure change. 4) On the other hand, the high degree of intrapulmonary pressure increase caused paradoxical bradycardia in phase 2 and lack of overshooting in phase 4 in response to the systemic arterial blood pressure change. 5) It may be noted that the experimental model employed in the present study is a useful tool to evaluate and analyze the neural and mechanical regulatory factor in response to the graded increase of the positive lung inflation.

• Journal of Pharmacopuncture
• /
• v.4 no.2
• /
• pp.35-47
• /
• 2001

Objectives : Through the literatures on the effets of Bufonis Venenum, we are finding out the clinical possibility and revealing the more effective to intractable diseases. Methods : We investigated the literatures of Oriental Medicine and experimental reports about Bufonis Venenum. Results : 1. Bufonis Venenum is made of bufonidae bufo bufo gargarizans cantor or bufo melanostictus schneider of white serum which secreted from parotid gland or dermato gland, and it is dried for using. 2. In oriental medicine, Bufonis Venenum has been mainly used on the tumors, cacanthrax and dermatic disease, and then it has been clinically used on infantile athrepsia, tetanus, sore throat, toothache, and so on. 3. The pharmacological effects of Bufonis Venenum are cardiotonic, respiration stimulation, depressor or vasopressor, topical anesthcsia, hallucination, striped muscle stimulation, antiasthmatic, antibacterial, antiinflammatory, anticancer, diuretic, immuno effects, etc. 4. Bufonis Venenum is largely divided in ether binding steroid compound, hydroxyl steroid compound, carboxyl or aldehyde steroid compound, indole compound, and adrenaline, cholesterole, etc. 5. Symptoms of Bufonis Venenum poisoning in digestive system are vommitig, abdominal pain, diarrhea, dehydration, in circulatory system are palpitation, shock, bradycardia, in nervous system are vertigo, somnolentia, muscle-tendon reflex weakness, and critical conditions to tissue necrosis and heart attack. 6. Ways to treat Bufonis Venenum poisoning include gastric irrigation with $0.2~0.5\%$ potassium permanganate fluid and atropine $0.5{\sim}1.0mg$ subcutaneous injection. From the chinese book of Bon Cho Gang Moke(本草綱目), if white serum of Bufonis Venenum enter the eyes, it happens the edema and pain. And then washed the eyes by juice of Lithospermi Radix(紫草) that the edema is removed. Conclusions and Discussion : The results from above literary studies show that prescriptions and Aqua-acupuncture of Bufonis Venenum could be clinically used to sedative, anticonvulsant, antibacterial, antiinflammatory, anticancer and topical ataralgesia. However it is expected that pharmacological and side effects of Bufonis Venenum are further studied.

• Archives of Plastic Surgery
• /
• v.34 no.4
• /
• pp.531-534
• /
• 2007

Purpose: Plastic surgeons are responsible for the management of spinal cord injury patients with upper and lower extremity reconstruction, pressure sore, and wounds. Derailment of autonomic nervous systems caused by injury to the spinal cord may result in fatal autonomic dysreflexia. Autonomic dysreflexia is a syndrome of massive imbalance of reflex sympathetic discharge occurring in patients with spinal cord lesion above the splanchnic outflow(T6). It is characterized by a sudden onset and severe increase in blood pressure and is potentially life threatening. The other classic symptoms are headache, chest pain, sweating, and bradycardia. In order to lower the blood pressure, it is important to remove the noxious stimulus for autonomic dysreflexia. If such symptoms last for more than 15 minutes despite conservative interventions, antihypertension drugs are recommended. Methods: In this case study, we report an autonomic dysreflexia case that developed in a 45 year-old tetraplegia patient with sacral pressure sore. When he got bladder irrigation, his blood pressure went up very high and his mentality became stuporous. He was sent to ICU for his blood pressure and mental care. ICU care made his vital sign stabilized and his mentality alert. Results: After the patient underwent proper treatment like inotropic agent, he was transferred to the general ward and his pressure sore on sacral area was coveraged with gluteus maximus myocutaneous advancement flap. Conclusion: If treatment is not effective, the patients have to undergo sudden, severe hypertension, which can cause stroke or death. To provide safe and effective care, plastic surgeons should be able to recognize and treat autonomic dysreflexia.

• The Korean Journal of Physiology
• /
• v.19 no.2
• /
• pp.139-153
• /
• 1985

The passive tilt has been performed to study the orthostasis on the cardiovascular system. The orthostasis due to upright tilt was demonstrated as follows: the venous return, cardiac output and systemic arteiral blood pressure were decreased, whereas there was concomitant increase of heart rate, through the negative feedback mediated by such as the baroreceptor . Previous investigators have suggested that the tolerance to the orthostasis could he increased by blocking the cholinergic fiber with atropine which prevented vasodilation and bradycardia through the vasovagal reflex during the orthostasis. However, this hypothesis has not been clearly understood. This study was attempted to clarify the effect of atropine on the tolerance of the cardiovascular system to the upright and head-down tilt, and to investigate the change of the blood flow through head and lower leg with Electromagnetic flowmeter in both tilts before and after atropine state. Fourteen anesthetized dogs of $10{\sim}14kg$ were examined by tilting from supine position to $+77^{\circ}$ upright position (orthostasis), and then to $-90^{\circ}$ head-down position (antiorthostasis) for 10 minutes on each test. And the same course was taken 20 minutes after intravenous administration of 0.5mg atropine. The measurements were made of the blood flow(ml/min.) on the carotid artery, external jugular vein, femoral artery and femoral vein. At the same time pH, $PCO_2$, $PO_2$ and hematocrit (Hct) of the arterial and venous blood, and heart rate(HR) and respiratory rate (RR) were measured. The measurements obtained from upright and head-down tilt were compared with those from supine position. The results obtained are as follows: In upright tilt, the blood flow both on the artery and the vein through head and lower leg were decreased, however the decrement of blood flow through the head was greater than the lower leg And the atropine attenuated the decrement of the blood flow on the carotid artery, but not on the vessels of the lower leg. HR was moderately increased in upright tilt, but slightly in head-down tilt. The percent change of HR after the atropine administration was smaller than that before the atropine state in both upright and head-down tilts. Before the atropine state, RR was decreased in upright tilt, whereas increased in head-down tilt. However after the atropine state, the percent change of RR was smaller than that of before the atropine state in both upright and head-down tilts. In upright tilt, venous $PCO_2$ was increased, but arterial $PO_2$ and venous $PO_2$ were slightly decreased. Hct was increased in both upright and head-down tilts. The findings of blood $PCO_2$, $PO_2$ and Hct were not interferred by the atropine. In conclusion, 1;he administration of atropine is somewhat effective on improving the cardiovascular tolerance to postural changes. Thus, atropine attenuates the severe diminution of the blood flow to the head during orthostasis, and also reduces the changes of HR and RR in both orthostasis and antiorthostasis.