Tourniquet Induced Hypertension and Vital Sign Changes in Patients with Total Knee Replacement Arthroplasty under General Anesthesia with Enflurane or Propofol / 대한마취과학회지

BACKGROUND: The tourniquet is associated with severe hemodynamic changes and tourniquet-induced hypertension (T-HTN). Propofol is preferred as an anesthetic agent for rapid induction and recovery, and less nausea and vomiting. The aim of this study was to find the difference in hemodynamic changes and the T-HTN in patients with total knee replacement arthroplasty receiving enflurane or propofol anesthesia. METHODS: One hundred patients underwent total knee replacement arthroplasty were divided into four groups; enflurane-control (n = 22), enflurane-elderly (n = 28), propofol-control (n = 22), propofol-elderly (n = 28). Mean arterial blood pressure (MAP), heart rate (HR) and end-tidal CO2 (PETCO2) were recorded throughout the operations of each group. Statistical analysis was done using repeated measures of ANOVA, chi-square test (P < 0.05). RESULTS: MAP increased in the propofol group during the tourniquet inflation period compared to the period before tourniquet inflation. The incidence of T-HTN in the propofol group (58%) was higher than that of the enflurane group (36%). HR increased in the enflurane group just after tourniquet inflation. PETCO2 decreased during 20 60 minutes after tourniquet inflation in the propofol group (P < 0.05). MAP decreased and PETCO2 increased during the 1, 5 minutes after tourniquet deflation in all groups. There were minimal HR changes after tourniquet deflation in all groups. CONCLUSIONS: T-HTN occurrence and MAP were shown to be higher in the propofol anesthesia and both enflurane and propofol can be used as an anesthetic agent for total knee replacement arthroplasty without complications.

Clinical Application of Laryngeal Mask Airway in Cesarean Section / 대한마취과학회지

BACKGROUND: Laryngeal mask airway (LMA) is a useful instrument for routine anesthesia. It permits spontaneous or positive pressure ventilation but its use in obstetric anesthesia has not been described. In this study, we evaluated the effectiveness and the side effects of the LMA during elective cesarean sections. METHODS: Institutional approval and patients' permission were obtained. One thousand sixty-seven patients scheduled for elective an cesarean section, that have been NPO for more than 6 (6-48) hours were evaluated. They were premedicated with an H2 receptor blocker (ranitidine 50 mg i.m.) 1 hour before the operation. They were anesthetized with penthotal sodium (3-4 mg/kg), vecuronium (1 mg/10 kg i.m.) and then a 3 or 4 LMA was inserted after the mask ventilation with 100% oxygen for 1 min. The cuff was inflated with air 15.3 +/- 2.6 ml. On auscultation, air entry was good in both lungs. Anesthesia was maintained by 50% oxygen in N2O with 0.7 - 1.0% enflurane. Analgesics (tramadol 30 mg i.v.) was given incrementally after delivery of the baby. Manual assisted ventilation was used throughout the procedure. The number of insertion attempts, cuff volume and the incidences of complications were evaluated. RESULTS: In 1051 patients, the LMA was inserted on the first attempt. In 16 patients more than 2 attempts were needed and change to endotracheal intubation were needed in 7 cases. The mean cuff volume was 15 +/- 2.6 ml at insertion and increased to 18.5 +/- 3.2 ml after removal. The average airway pressure was 20 cmH2O during positive pressure ventilation, above that pressure air leakage was detected in 16 cases. Complications noted were mild sore throat in 5 cases, and blood tinged after removal of LMA in 3 cases but gastric distention was not detected. No incidence of aspiration was noted. CONCLUSIONS: In this study, the LMA proved to be a useful tool for the management of patients presenting for elective an cesarian section. There is the remote possibility of aspiration which did not happen in our study.

The Clinical Comparative Stndy on Liver Function with Enflurane and Halothane Anesthetics / 대한마취과학회지

Halothane was introduced in 1956. It has been used worldwidely as a relatively safe inhalation anesthetic but it is generally accepted that it can cause decrease of liver function. But the causative factor has not yet been pinpointed. Enflurane also seems to decrease liver function but the exact cause is not yet known. In order to study the effects of enflurane and halothane on liver function, we used 10 cases of spinal anesthesia as a control group, and 20 cases each of enflurane and halothane anesthesia respectively as experimental group. We then checked serum GOT, GPT, total bilirubin, alkaline phosphatase, and eosinophil count in peripheral venous blood before oeration and 6 days after operation and looked for the existence of high fever of more than 39 degrees C 3 days postoperatively. The results are as follows: 1) We found statistical significant change of serum GOT, GPT, total billirubin alkaline phosphatase and eosinophil count in spinal, enflurane, or halothane anesthesia beofre and after operation. There was no statistically significance between the control and experimental groups. 2) No patient developed high fever of more than 39 degrees C until 3 days after anesthesia in any group. 3) No significant change of mean arterial blood pressure was observed before and during anesthesia in each group. In this study no definite conclusion that enflurane and halothane might have affected the liver function.

Influence of Midazolam on Serum Potassium and Creatine Phosphokinase Levels / 대한마취과학회지

Succinylcholine is used most widely for tracheal intubation during induction for general anesthesia. However adverse effects following the administration of succinylcholine which include an increase of serum potassium, creatine phosphokinase, abdominal pressure and the presence of fasciculation are well known to anesthesiologists. Many investigators have studied the influence of pretreatment with d-tuhocurarine and diazepam to prevent the adverse effects following administration of succinylcholine. We studied the effects of serum potassium and creatine phophokinase with midazolam(0.25 mg/kg) the most newly introduced benzodiazepine derivatives and thiopental sodium(4-5mg/kg) the most widely used induction agent for anesthesia in 33 adult healthy surgical patients. We also observed the onset of loss of eyelash reflex and fasciculation, the degree of fasciculation and the adequacy of relaxation for intubation comparing the two agents. The results are as follows: 1) There were no significant increases in serum potassium and creatine phosphokinase levels before succinylcholine and after 10 minutes administration in both agents groups. 2) Loss of eyelash reflex occurred immediately with thiopental and at 63+/-43 seconds with midazolam one minute after administration. 3) Fasciculation appeared at 14.4+/-4.9 seconds with thiopental and at 21.3+/-11.9 seconds with midazolam and continued 66.3+/-20.1 seconds with thiopental and 43.5+/-l8.5 seconds with midazolam. 4) The adequacies of relaxation for intubation were good enough in both agents groups but midazolam seems to be better. Midazolam seems to be a good induction agent for general anesthesia and prevents an increase of serum potassium level after administration of succinylcholine without pretreatment of non-depolarizing muscle relaxants or diazepam.

Influence of Flunitrazepam on the Adverse Effects of Succinylcholine Chloride / 대한마취과학회지

Intravenous succinylcholine is often associated with adverse effects, including muscle fasciculation, postoperative myalgia, increased intraocular and intragastric pressure, along with potassium and creatinine phosphokinase, myoglobinuria, and disturbances in cardiac rate and rhythm. Several methods have been used to modify these side effects, the most popular of which has been the of subparalyzing doses of nondepolarizining relaxants prior to injection of succinylcholine. With such pretreatment however satisfactory muscular relaxation is often not achieve, necessitaing use of larger doses of succinylcholine becauses pretreatment renders the endplateless sensitive to succinylcholine; hence large doses of succinylcholine are necessary to ensure adquate degress of relaxation. The present investigation was undertaken to determine the effects of flunitrazepam on the adverse effects of succinylcholine. This paper covers the period from March, 1981 to March, 1982 in the Department of Anesthesiology, Hanyang University Hospital. The 45 subjects were divided into 3 groups: 1) propanidid (8mg/kg) with succinylcholine 2) flunitrazepam(0.03mg/kg) with succinylcholine 3) flunitrazepam(0.06mg/kg) with succinylcholine. None had existing neuromuscular disease nor were any patients receiving diazepam or any drug known to influence myoneural blocking agent. Patients with burns, muscle injury of muscle atrophy were excluded. In each group, the plasma concentration of potassium and creatinie phosphokinase was observed before and 10 minutes after use of succinylcholine. Also succinylcholine in duced myalgia, fasciculation, onset of loss of eyelid reflex and relaxation were observed and compared. The conclusions are as follows: 1) There were no significant changes of plasma concentration of potassium and creatinine phosphokinase in presuccinylcholine and 10 minutes postsuccinylcholine. Also any statistically significant changes were not observed in the comparison of the propanidid group and the flunitrazepam groups. 2) Flunitrazepam significantly diminished the incidence of postoperative muscle pain and it was shown that the degree of fasciculation has no relationship with succinylcholine induced muscle pain. 3) In the propanidid group, the onset of loss of eyelid reflex was most rapid(22+/-13 second). In the flunitrasepam 0.03mg/kg group, the onset of loss of eyelid reflex was statistically significant (p<0.05), as compared with the 0.06mg/kg group(42+/-27 second). 4) In all groups, excellent conditions of intubation were observed. Propanidid and flunitrazepam did not affect the magnitude nor duration of the succinylcholine neuromuscular block.

The Clinical Investigation of Geriatric Anesthesia / 대한마취과학회지

In contrast to younger patients, old peoples frequently mainfest more than one pathologic process, mainly degenerative diseases and neoplasia. Nearly all have some degree of arteriosclerosis, even if this is not clinically diagnosed, and many have associated chronic cardiac, renal, hepatic, or pulmonary disease. The surgeon and the anesthesiologist must see theat their clinical decisions are tied to a physiologic understanding based on exact quantification of the specific hemodynamic, respiratiory, renal, and metabolic factors which may play a decisive role in influencing the final outcome to a major operative procedure. From May 1972 to Dec 1980, the Department of Anesthesiology, Hanyang University, College of Medicine had 517 geriatric patients(above 65 years) who received anesthesia and these were analyzed clinically according to age, sex, department, physical status, anesthetic technique and agent, anesthesia time, length of admission, laboratory studies(chest X-ray, EKG, arterial blood gas), and postoperative complications(mortality and causes of deathe). The results are as follows. 1) Out of 25,857 anesthetized patients 517(2.0%) were over 64 years of age and 290 were males(56.1%) and 227 females(43.9%). 2) In the surgical group, 246 cases (47.6%) were from general sugery: 81 cases(15.7%), orthopedic surgery: 78 cases (15.1%), urology: and 67 cases (12.9%), neurosurgery respectively. 3) In the classification of physical status, 33 cases(6.4%) were class 1, 269 cases(52.0%) class 2, 181 cases (35.0%) class 3, 28 cases (5.4%) class 4, and 6 cases (1.2%) class 5. Emergency cases were 137 cases(26.5%) and 380 cases (73.5%) were elective. 4) Concerning premedication-150cases(29.0%) were premedicated with atropine sulfate plus valium and 93 cases had no premedication. 5) There were 425 cases of general anesthesia (82.2%) and 92 cases of regional anesthesia (17.8%). The major anesthetic was halothane, 362 cases (70.0%). The technic in 419 cases( 81.0%) was circle type with endotracheal intubation. Anesthesia duration was within 1hour for 70 cases(13.5%), within 2 hours for 158 cases(30.0%), and within 3hours in 144 cases(27.9%). 6) Preoperative laboratory findings were as follows: The chest X-ray suggested that 199 cases (45.9%) were within normal limits, 56 cases (12.9%) had hypertensive heart disease, 56 cases (12.9%) had pulmonary tuberculosis, and 38 cases (5.1%) had senile lung fibrosis. The EKG which was done on 85% of the patients, ravealed that 193 cases (44.0%) were within normal limits, 61 cases(13.9%) showed left ventricular hypertrophy, and 38 cases(8.7%) had myocardial ischemia. In the preoperative arterial blood gas studies of 56 cases the results were almost all within normal limits. 7) Postoperative complications were as follows: 52 cases showed wound infection or bleeding, 20 cases had pneumonia, and 18 cases atelectasis. There were a number of miscellaneous complications. 8) The overall mortality rate was 5.8%. The difference of mortality rate related to the age was not statistically significant,(p>0.1) and the mortality rate related to physical status was statistically significant(p<0.005). 9) As the cause of death-11 cases (36.7%) had transtentorial herniation, 2 cases (6.7%) sepsis, 2 cases (6.7%) hypovolemia, and 1 case (3.3%) had pulmonary edema.

Clinical Evaluation of the Patients who Received Blood Transfusion During Operation / 대한마취과학회지

This study chose 530 patients among the total of 5214 operative cases except open heart and pediatric surgery who received more than 2 pints of blood who were performed general, spinal and epidural anesthesia. This study lated for a year in an operating room. We measured and compared the value of hemoglobin and hematocrit, preoperatively, in recovery room and 24 hours after operation. We also compared the volume of blood transfused with the volume of blood loss during the operation. The results are as follows. 1) According to the operative Department of the transfusion cases, the distributions were 129 cases(Obstetic & Cynecology), 114 cases(Orthopedic Surgery). 2) The mean values of hemoglobin measured preoperatively, in recovery room and 24 hours after operation were 11.9gm/dl, 11.5gm/dl and 11.6gm/dl, respectively. 3) In the comparison and observation about the difference of the hemoglobin value and hematocrit value preoperatively and in recovery room the cases which showed the difference of 10% were 229 cases which was the most frequent cases. The cases which showed the differences of 40% were 24 cases and it was the less frequent cases. 4) In the volume of blood loss on the operative department, maximum volum of blood loss was 4,130ml in hepatic primary closure. 5) In the comparison and observation of the volume of the blood transfusion, the cases whose volume of transfusion was 2~5pint were 430 cases. The cases in which more than 10 pints transfused were 25 cases. 6) In the operation where the patients transfused more than 10 pints of whole blood, vertebral interbody fusion was the most cases. 7) In the patients who transfused more than 10 point of whole blood, urticarias was whon 16 cases among 25 cases. 8) Recording the values of hemoglobin and hematocrit, preoperatively, in recovery room and 24 hours after operation on the blood trasfusion makes anesthesiologist precise to determine the volume of blood transfusion and blood loss. The results from all the cases were considered satisfactory except one case which showed the complication of pulmonary edema.

I.V. Fluid Administration for Prevention of Hypotension during Cesarean Section Performed under Spinal Anesthesia / 대한마취과학회지

Rheomacrodex-D 10% W/V in dextrose(550ml) was prophylactically infused before anesthesia over 15 to 20 minutes to prevent hypotension during spinal anesthesia in 20 patients undergoing elective Cesarean section. Apgar scores and the incidence and severity of hypotension were compared to results obtained in 20 patients who were given 500 ml of Hartmann's solution. The results were as follows: 1) Mean arterial pressure decreased up to 20 torr from control values in patients hydrated with Hartman's solution and also changed significantly in patients given Rheomacrodex-D(p<0.05). 2) The incidence and severity of hypotension at 10 minutes, and 15 minutes, and 15 minutes after spinal anesthesia(p<0.05) was significantly less in patients given Rheomacrodex-D than in patients hydrated with Harmann's solution. 3) The Apgar scores, both at 1 minute and 5 minutes, were significantly higher(p<0.05, p<0.005) in infants born of mothers given Rheomacrodex-D than in infants whose mothers were given Hartmann's solution. 4) The cases of hypotension defined as a decrease in systolic arterial pressure lower than 100 torr or a decrease in mean arterial pressure to 25% from control values were 12 cases in 20 patients hydrated with Hartmann's solution and 6 cases in 20 patients given Rheomacrodex-D.

The Influence of Midazolam on lntraocular Pressure / 대한마취과학회지

Intraocular tension may be acutely changed by many drugs and by various physiologic events. AN acute rise in intracoular tension may be catastrophic if it occurs when the globenis open and leads to expulsion of contents. Most general anesthetics cause a decrease in intraocular pressure, although a few causes increased intraocular pressure. Midazolam is a 1,4-benzodiazepin derivative synthesized by Walser and Freyer in 1975. Earlier studies with midazolam have demonstrated it efficacy for induction of anesthesia and premedication. It is also desirable to know if all anesthetic agents which produce general anesthesia and which are pharmacologically different affect intraocular pressure in a similar manner. Therefore investigation of the influence of midazolam on intraocular pressure in 25 patients was undertaken at the Department of Anesthesiology, Hanyan University. All patients had no known eye abnormalities. The patients were not premedicated. In all patients the intraocular pressure was measured before induction of anesthesia, after instilling a 0.5% tetracaine into the conjunctival sac. A second reading was taken after induction of midazolam (0.2mg/kg of body weight) and a third after injection of succinylcholine(1mg/kg of body weight) and a fourth after endotracheal intubation. A Schiotz tonometer with a 5.5gm and a 7.5gm weight was used. In addition to the tonometric determination, the blood pressure, pulse rate and respiratory rate were recorded before and after induction of midazolam. An attempt was tried to keep the intraocular pressure changed as many and to minimize the other factors affecting intraocular pressure. To achieve this, supine position and constant gas flow was maintained. Special care was taken to avoid pressure on the patients eye and to maintain a fully patent airway to prevent respiratory disturbances leading to straining and increased venou pressure. Endotracheal intubation was performed with the aid of succinylcholine to avoid cough or laryngospasm. The results of the observation with the above mentioned method were tested by student t-test statistically. Each patient acted as his own control. There was a fall in intraocular pressure in 17 patients among 25 patients(average 1.8mmHg), but no significant change followed by the use of midazoam. The blood pressure variations were between 10 and 40 mmHg, during the course of anesthesia and could not be related to intraocular pressure changes. Intraocular pressure changes had no relation to pulse and respiratory rate variations. This finding indicated that benzodiazepine as a class of drugs have well described muscle relaxant properties that are primarily central(supraspinal)rather than peripheral(myoneural) in action. There was a rise in intraocular pressure in 19 patients among 25 patients, followed by the use of succinylcholine and 23 patients among 25 patients, after endotracheal intubation. According to Feldman and Crawley, diazepam potentiated the myoneural blocking effects of gallamine and antagonizes the effects of succinylcholine. Nevertheless Dretchen demonstrated that the clinical doses of diazepam did not potentiated the muscle relants. Our finding showing no apparent succinylcholine interaction with midazolam are consistent with the finding of Dretche.

Change in Total Serum Potasium, Sodium and Calcium by the Administration of Induction Agents with Succinylcholine / 대한마취과학회지

It is important that the clinical anesthetist pay attention to the interaction of anesthetic induction agents and succinylcholine chloride(S,C,C) on the elctrolyte level especially the plasma potassium ion concentration. For instance succinylcholine chloride has a marked effect upon specific conditions such as severe burns, multiple injury, deabetes insipidus and myopathy. Also secondary plasma changes may bring about non synchronous depolarizing action on the muscle and cause cardiac arrhythmai and even cardiac arrest by the increase of potassium concentration in the plasma. With this in mind the author has randomly selected 30 patients who belong to class l physical status by the classification of the American Society of Anesthesiologist had no abnormal symptoms in respiration, circulation or endocrine and metabolism defects. This paper covers the period from the 10th of April 1979 to the 10th of May 1980 in the Department of Anesthesiology, Hanyang University Hospital. The 30 subjects were divided into 3 groups: a) propanidid with S.C.C. b) thiopental sodium with S.C.C. c) diazepam with S.C.C. The plasma concentration of potassium, sodium and calcium were observed and compared in the pre-induction (control group) and two minute post-induction(study group). The results are follows: 1) The plasma potassium ion concentration showed no any significant changes in the whole group. 2) The plasma sodium and calcium ion concentration also showed no any significant changes in the whole group.

Clinical Statistical Analysis of Pediatric Anesthesia / 대한마취과학회지

Within the past decade it has been said that progress it pediatric anesthesia is especially the result of clinical application of developments in baic medicine, added to the anesthetist's technical improvements and experience in the use of apparatus and the knowledge of respiratory control. And so anesthetists sholud perform good pediatric anesthesia after understanding pediatric anatomy, physiology and the phamacology of all the drugs used in pediatric anesthesia. 803 cases (under 15years) of pediatric anesthesia were analyzed statistically according to sex, age, disease, department, physical status, premedication, anesthetic technic, anesthetic agents, length of anesthesia duration of Hospitalization, re-operation incidence, complications and mortality in the Department of Anesthesiology, Hanyang University, College of Medicine from August of 1979 to December 1980. The conclusions are as follows: 1) Sex and Age: 91 cases(11.33%) under 1year and 95 cases(11.83%) under 7years are of interest. The comparison of male (542 cases) to female (261 cases) is 2:1. 2) Departmente: 257 cases(32.00%) from ENT, and 217 cases(27.02% from general surgery were noted ont of the total. 3) Disease: It divided into two groups. 204 cases(25.40%) were congenital disease which comprised mainly of 70 cases of inguinal hernia and 45 cases of eleft lip and palate. 599 cases (74.60%) were acquired disease comprised mainly of 237 cases of tonsillitis and 43 cases of appendicitis. 4) Physical status: The time of operation divided into two groups. One group contained 657 cases of elective surgery and the other 146 cases of emergency surgery. According to the ASA classification of physical status, 741 cases(92.28%) were class 1 and 2, and 52 cases (64.8%) were class 3, and 10 cases(1.24%) were in class 4. 5) Premedication: 400 cases(49.81%) were premedicated with atropine sulfate and valium 161 cases(20.05%) were not premedicated because the patients had fever, dehydration, or tachycadia. 6) Anesthetic method and agents: they were divided into three groups. In the frist group using general inhalation, 206 cases(2565%) ont of 761, had non-rebreathing anesthesia and 555 cases(69.12%) had semiclosed circle technique anesthesia. In the second group 41 cases(5.10%) had intramuscular and intravenous anesthesia. Thirty 1 case(0.12%) was given spinal anesthesia. 711 cases(88.54%) received halothane + nitrone oxide _ oxygen. 7) Incidence of reoperation: 32 cases(3.98%) were reoperated and included colostomy repari, abdominal flap detachment, pin removal, skin graft, post operative bleeding control, remove of laryngeal papilloms, and urethral dilatation. 8) Complications: 20 cases which were made up of 8 cases of pneumonia, 5 cases of wound infection, 3 cases of post operative bleeding control, 2 cases of fistula formation, 1 case of gastroenteritis, 1 case of intestinal obstruction. The relationship between length of anesthesia and complications is statistically in significant(p<0.01). 9) Motality: 10 cases died 3 from respiratory insufficiency, 3 cases of sepsis, 1 case of intestinal obstruction and 3 cases of high intracranial pressure. There is statistical significance in the relationship between the anesthetic time, physical status, and mortality.(p<0.01).

The Clinical Study of Epidural Morphine on the Postoperative Pain / 대한마취과학회지

Thirty two patients wha had undergone operations were given a slow extradural narcotic injection. Patients were divided into three groups: First Group: extradural administration of pentazocine 30 mg to 10 adult patients. Second Group: extradural administration of pethidine 50 mg to 10 adult patients. Third Group: extradural administration of low-dose morphine(2 mg) in 10 ml of poysiologic saline to 12 adult patients. The epidural catheter had been left in situ and the patients instructed to request further analgesia in the postoperativly as neded. All case had considered amelioration of pain which became evident with in 2 to 15 minutes and was effective from 1 hour to complete relieve. They had also received an intramuscular injection of atropine sulfate(0.01 mg/kg) and valium (0.2 mg/kg) for premedication 30 minutes prior to sending to the operating room. The conclusions are as follows: 1) The morphine(2 mg) administered by continuous epidural injection is superior to other groups for relief of pain. It suggested that analgesic effect was concerned with drug dosage (Table 4). 2) Third group(morphine) was signficantly higher than other groups in statistical mean analgesic score analysis compared with the other groups. It suggested that significantIy high analgesic score was concerned with the pharmacologic action of the drug effect. 3) Before and after epidural injection of drugs, a statistical pulse change in the second group was significant but the other vital sign changes in all the group was not significant (Table 7). It suggested that significant pulse change was concerned with direct drug action and operative stress. 4) The subject requires study for mechanism, adverse effect and its prevention of narcotic administration in epidural space. Consequently it is suggested that continuous epidural injection of pethidine or' pentazoine is the optimum method of postoperative pain relief, only that when morphine is given, contin-uous epidural injection should be the method of choice.

The Clinical Study of the New Circle System for Pediatric Anesthesia / 대한마취과학회지

During the last decade, non-rebreathing systems have been used extensively for pediatric anesthesia, but if this is used for long periods, invariable dryness of the airway develops, leading to decreased ciliary functionand reduced transport of secretions, thus producing stagnation which interfs with respiratory function postoperatively. The use of a to-and-from system for infant anesthesia had disadvantages, such as the dead space was excessive at the start of each use increased with the exhaustion of soda lime, the apparatus being clumsy and difficult to handle, and the sodalime crurable, and powder was blown into the patient's face and airway. A new circle system was divided for the Ohio infant circle system, two unidirectional valves removed, a Holm's valve attached to the corrugated tubes. It has been used fo 13 anesthetics in children aged from 3 months to 8 years in the Department of Anesthesiology, Hanyang University, College of Medicine from November to December of 1980. The conclusions are as follows: 1) The degree of the oral temperature was lower in the non-rebreathing system than in the new circle system, but was no significance between the two groups. 2) The systemic temperature of the new circle system was 29.8+0.9 degrees C, and the systemic temperature of the non-rebreathing system was 27.5+0.4 degrees C, so there was a meaningful difference between the two groups. 3) Preansthetic temperature of the soda-lime in the new circle system was 24.5+1.6 degrees C, and 30 min. after the induction was 34.5+3.4 degrees C, so it increased by more than 10 degrees C. This might suggest that it was helped the body temperature and the humidification of the airway. 4) The PCO2 levels 30 min. after induction was meaningfully lower in both systems. This might suggest that it was due to hyperventilation. 5) The gas flow of the non-rebreathing system averaged 6L/min. and the gas flow of the new circle system was 2L/min., so the consumption of fresh gas and anesthetic agent was low in the comparison with the former. Theremer this might suggest that it helped the humidity of the airway, the function of the mucous membrane, and the body temperature. 6) As Holm's valve, its weight 12gm, its resistance 0.5cm-H2O, its deadspace 1ml, was used for both spontaneous and controlled respiration in small children with the circle system. It might suggest that of can compensate for the disadvantages of the old circle systems and non-rebreathing systems.

The Effect of Diazepam on Suecinyleholine-induced Side Effects / 대한마취과학회지

Muscle pain following succinylcholine chloride(SCC) is well documented, as are elevated serum potassium and increased creatine phosphokinase(CPK) levels. Pretreatment with a subparylsing dose of a non-depolarizing muscle relaxant before SCC is standard and accepted clinical practice in prevention of SCC induced fasciculation and associated sequlae but pretreatment redners the end-plate less sensitive to SCC: hence larger doses of SCC: hence larger doses of SCC are necessary to ensure adequate degree of relaxation. Recontly fahmy et al showed in a study that small doses of diazepam suppressed the fasciculation as well as the increase in serum potassium and creatine phosphokinase(CPK). Our study was undertaken to evaluate the effect of pretreatment with diazepam on the potential side effects of SCC. Eight cases were studied in four different groups. In the first group(control group): no diazepam was used, secoun group: with diazepam 0.05mg/kg, third group:: with diazepam 0.1mg/kg, grouth group: with diazepam 0.2mg/kg. As a result of this study, we can summarize as follows: 1) Diazepam pretreatment groups had no significant change in the prevention of muscle fasciculation following SCC than control groups. 2) Conditions for intubation were assessed as excellent to good in diazepam pretreatment and control groups. 3) The increase in serum potassium and CPK produced by SCC was not inhibited by diazepam pretreatment. 4) In the prevention of incidence of muscle pain, there were no significant difference between the control and diazepam pretreatment groups.

Blood Pressure and Pulse Rate Responses to Extubation with and without Topical Tracheal Anesthesia / 대한마취과학회지

Usually, blood pressure and pulse rate are increased in the light planes of anesthesia at the end of operation especially just prior to extubation. The increasing of heart rate and blood pressure produce an elevation in cardiac work and oxygen demand and can lead to mycardial ischemia in patients with coronary artery disease. Tracheal anesthesia with 2 or 4% lidocaine (jelly and liquid) was done as a method which permits patients to be extubated during light planes of anesthesia. The results were as follows: 1) Each groups had similar blood pressure and pulse rate five or ten miriutes before extubation. 2) Lidocaine group did not have a significant elevation in systolic or diastolic blood pressure and pulse rate at or after extubation or in the recovery room. 3) The control group had significantly increases in both pressure and pulse rate(p<0.01). The data suggest that maneuver should be of advantage to patients with coronary artery disease who may not be able to tolerate the increased cardiac dynamics during extubation period.

A Case of Adult Respiratory Distress Syndrome after Massive Blood Transfusion / 대한마취과학회지

A large number of terms has been applied to this clinical and pathophysiologic complex, all of which are encompassed by the designation ARDS. The use of this term,however, should not obscure the fact that the initial insults and mechanisms of lung injury vary and that therapy should be directed not only toward the secondary alterations in pulmonary function but toward the initiating event or events as well. In therapy, the use of continuous positive-pressure ventilaion(CPPV) incorporating PEEP has a well-documented role in the management of patients with ARDS. The veneficial effect of this pattern of ventilation is mainly attributable to the increase in FRC that it produces. As previously discussed, several factors combine to reduce lung volumes in patients with ARDS. Positive end-expiratory pressure overcomes threade by producing a constantly positive distending pressure across the walls of airways and alveoli; this reestablishes their patency and increases FRC. We report a case of ARDS after operation for Vesico-cervical fistula developed in a 34 years old woman and the relevant literature has been reviewed.

Cardiac Arrest in the Operating Room / 대한마취과학회지

This is a report of cardiac arrests which occurred in the operating room of National Medical Center from Jan. 1, 1970 to Dec. 31, 1976. All kinds of operations were performed in this hospital, butlopen heart surgery was excluded from this study. During this period 22, 825 surgical operations were done and 74 cardiac arrests occurred among them. Overall incidence of cardiac arrest was 1: 308 (0. 32%) and 43% of cardiac arrests were successfully resuseitated.

Survey of Patient in the Intensive Care Unit for Last 11 Years / 대한마취과학회지

We have analyzed 2,080 patients who were admitted to the ICU for intensive care during a period of 11 years from April, 1965, when the ICU was opened, to December, 1975. The results are as follows: l. In 11 years, the total number of patients was 2,080 which was 2.5% of 84,933 patients who were admitted to NMC. Among them, operative cases were 724 (35%) and nonoperative were 1, 356(65%). 2. Male patients were more than female Patients (1. 3: l. ) 3. In age groups, the 20 decade had the highest number. 4. The number of patients from Internal Medicine Dept, was highest. 5. Total occupied bed days were 7,497 and majority of patient were in less than 3. 6 days. 6. The patients from the medical department have gradually decreased, but from the surgical department they showed increased pattern. 7. Drug intoxication was the commonest disease among patients. 8. Total mortality rate was 45%, and the highest mortality rate occurred in 30-39 age group.

A Case Report of Anesthesia for Tumor in Carina / 대한마취과학회지

A 29 years old man was scheduled for carinal resection & tracheobronehial reconstruction under the diagnosis of malignant tumor in the carina. 1 ml of morphine-scopolamine was given intramusculary for premedication. After induction with pentothal-Na and succinylcholine, anesthesia was maintained with halothane, N2O, and flaxedil (Gallamine). Radial artery cannula was inserted for blood gas analyze sampling, and EKG was monitored continuously. Tumor mass was infiltrated from carina to right upper lobe opening and right lower lobe had severe bronchiectatic change. Right pneumonectomy, resection of carina and end to end anastomosis of trachea and left bronchus were performed without any trouble. During this procedure, anesthesia had been continued with left bronchial tube which was intubated through operating field. Left bronchial ventilation had increased resistance, elevated PCO2, and lowered pH & PO2. Partial ohstruction of left upper bronchial opening was suspected during this left bronchial ventilation due to deep bronchial intubation.