Severe Bradycardia and Hypotension after Halothane Induction in a Patient Receiveng Beta - adrenergic Blocker / 대한마취과학회지

Patients with severe hypertension present the anesthesiologist with considerable difficulty. Without adequate treatment, serious problems may develop including myocardial ischemia or infarction, cerebral thrombosis or hemorrhage and renal damage during perioperative periods. However, drug interactions between antihypertensives and anesthetics may also be severe enough to produce synergistic bradycardia and hypotension. We have experienced managing a case with severe bradycardia and hypotension following halothane induction in a patient receiving beta-adrenergic blocker. This case illustrates the drug interaction between beta-adrenergic blocker and halothane.

Effects of General Anesthesia in Patients with Abnormal Liver Function / 대한마취과학회지

Recently, halothane has been commonly used as an inhalation anesthetic agent, but it is generally accepted that it can cause postoperative hepatic dysfunction. Therefore, other anesthetic agents which have relatively less hepatotoxic effects have been recommended. This study was undertaken to evaluate the postoperative hepatic changes in patients with abnormal liver function or hepatobiliary diseases. Patients were divided into three subgroups hepatobiliary, other hepatobiliary and jaundice, or HBsAG(+) for the two anesthetic agents, enflurane and Thalamonal. Liver function tests were performed before surgery, and on the 3rd, 5th and 9th postoperative days. The results were as follows: 1) SGOT and SGPT showed a more statistically significant decrease in Thalamonal anesthesia than in enflurane anesthesia in hepatobiliary and jaundice or HBsAg(+) groups. However, in the other hepatobiliary groups, there were no significant differences between the anesthetics. 2) Total protein, albumin, total bilirubin, direct bilirubin and alkaline phosphatase levels were not shown to be significantly different between the use of the two anesthetics in all groups. It is suggested that postoperative hepatic changes may have improved more significantly in Thalamonal anesthesia than in enflurane anesthesia in hepatobiliary patients with abnormal liver function and jaundice or HBsAg(+) patients.

A Clinical Study of Geriatric Anesthesia / 대한마취과학회지

Due to improvements in medical care, the socioeconomic level and public health, life expectancy has dramatically increased. Thus, advances in the development of life-support systems and the control of infection have resulted in many surgical and anesthetic procedures being performed on extremely elderly patients. In contrast to younger patients, elderly patients may manifest more than one pathologic process associated with progressive degenerative changes in various organs of the aged, especially in the heart, brain, and kidney. Since both progressive degenerative change occurring in the elderly population and the cumulative incidence of disease in that population result in death intraoperatively or during the immediate postoperative period, the anesthesiologist must be particularly alert to the possibility of anesthetic risks in the elderly. The elderly patient is more likely to have hypertension, congestive heart failure, cardiac dysrhythmias, chronic pulmonary disease, and diabetes. Preoperative evaluation and treatment of those conditions must be extensively reviewed prior to the induction of anesthesia. To evaluate geriatric anesthetic experiences, 539 cases of patients aged over 60 years of 4,266 anesthetic cases admitted to P.M.C. from January to December, 1986 were analyzed according to age, sex, physical status, anesthetic technique an6 agents, surgical department, preoperative chest X-ray findings, preoperative E.C.G findings, and postoperative complications. The results are as follows. 1) Of 4,266 anesthetic patients 539(12.6%) were over 60 3ears of age and 322(59.7%) were males and 217(40.3%) females. 2) In the classification of physical status, the most common evidence was class 2 in 303 cases. Emergency surgery comprised 27.1%. 3) The anesthesia technique employed was usually general anesthesia and this suggested that balanced anesthesia used with narcotics offers several advantages to geriatric patients. 4) In the surgical department, 310 cases(57.5%) were for general surgery, 75 cases(13,9%), orthopedic surgery; 57 cases(10.6%), urology; and 49 cases(9.1%), neurosurgery, respectively. Cancer was present in 198 cases(36.7%), 5) Preoperative chest X-ray findings: The most common finding was pulmonary tuberculosis in 44 cases(8.2%). Pneumonia, pulmonary emphysema, and so forth were also observed. 6) Preoperative E.C.G findings: The most common findings was myocardial ischemia in 48 cases(8.9%). Also myocardial infarction observed in 8 cases(1.5%) 7) Postoperative complications were as follows: The most common incidence was wourid infection in 29 cases(5.4%) followed by pneumonia. There were a number of miscellaneous complications. but postoperatively, they did not present any significant problems. 8) The overall mortality rate was 3.5%(19 cases). The difference in the mortality rate related to age was not statistically significant(p>0.1), but the mortality rate related to physical status was statistically significant(p<0.001). 9) Optimizing a patient's preoperative condition by the anesthesiologist, consultants, and other physicians was assumed to reduce perioperative morbidity and mortality.

The Effects of Dantrolene Sodium in Prevention of Malignant Hyperthermia / 대한마취과학회지

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome char-acteriged by hyperpyrexia, muscle rigidity, tachycardia, respiratory and metabolic acidosis. cyanosis etc. It ia susceptible in patients with musculoskeletal diaease such as strabismus, kyphosco-liosia, hernia, cleft palate, cryptorchidism, but there is no single diagnostic method to detect a susceptible patient. Fortunately s-CPK is elevated in 70% of carriers, so we checked a-CPK and a-LDH bel- ore operation in patients scheduled for correction of congenital strabismus and classified into group 1 (norirlal a-CPK group) and group 2 (elevated s-CPK group) . We administered Oantrolene sodium to group 2 before operation and compared the changes of s-CPK and s-LDH after operation. The results are as fallows, 1) s-CPK was lowered after administration of Dantrolene sodium in group 2 . (from 76.4 IU/L to 48.5IU/L) 2) s-CPK elevation after operation was much less in group 2 than group 1. (56.1+/-58.7 IU/L vs 164.7+/-127.1 IU/L) In conclusion, it would seem that Dantrelene aodium was affective in prevention of mali-gnant hyperthermia.

Prevention and Management in a Patient with Family History of Malignant Hyperthermia / 대한마취과학회지

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia, skeletal muscle rigidity, tachycardia, respiratory and metabolic acidosis, cyanosis etx. There is no simple noninvasive test to identify the susceptible individuals. A history of hyperpyrexia and/or muscle rigidity during previous general or a family history of such a condition provides the anesthesiologist with valuable information. Avoidance of potent inhalational anesthetic agents and other triggering agenta, and the selective use of regional anesthesia with either a local anesthetic agent or neuroleptic anesthesia, are the usual acceptable guidelines in the anesthetic management of susceptible individuals. Dentrolene sodium has been shown to be effective in the prevention and treatment of malignant hyperthermia in malignant hyperthermia susceptible swine. We gave Dantrolene sodium orally as a part of the prophylaxia for malignant hyperthermia in a 34yearts-old woman who underwent an emergency bilateral salpingectomy and who had a family history of malignant hyperthermia. We report on this patient with a family history of hyperthermia and reviewed the literature concerning malignant hyperthermia.

Anesthesia for Cesarian Section of two High-Risk Teoxemia of Pregnancy / 대한마취과학회지

Pre-eclampain or eclampain is a cause of maternal morbidity and mortality. It is characterized by the triad of maternal hypertension, proteinuria and generlized edema. The etiology of pre-eclampain or eclampsia is thought to be a decreased placental perfusion which results in an increased production of renin, angiotensin, aldosteron, thrombolplastin and a decreased production of prostaglandin. Anesthesiologists have to perform anesthesia technic for high-risk toxemia of pregnancy, and make proper choices of anesthesia method and drugs. Advantages of general anesthesia for Cesarian-section in cases of eclampsia include rapid induction, less hypotension, control of ventilation and fetal oxygenation. Disadvantages include myocardial depression from the anesthetic drugs, hypertension during light anesthesia, the interacion between manesium sulfate and muscle relaxante which might lead to prolonges respiratory paralysis and neonatal depression associated with the general anesthesia. The author used general anesthesis for the Cesarian-section in two severe toxemic patients who had pulmonary edema and bloody sputum because of congestive heartfailure. One patient had cardiac arrest upon arrival at the emergency room and after cardiopulmonary resuscitation the cesarian-section was performed. The mother had complets recovery, but the baby expired in twenty-ninehours. The Mother and twin babies in the other case had complete recovery.

Bilateral Tension Pneumothorax during General Anesthesia - Case report / 대한마취과학회지

Pneumothorax was recognized as a potential hazard of mechanical ventilation shortly after the introduction of the technique of tracheal intubation in the 19th century. Because the gases used in anesthesia are delivered from cylinders and wall outlets at higher than atmoshperic pressure, the possibility of damage to the lung is ever present. Immediate, prompt and adequate management of bilateral tension Pneumothorax are essentil, otherwise the patient dies rapidly. We had a case of bilateral tension Pneumothorax in a 3 year-old boy who underwent a B-E amputation of a severely crushed hand. We report this case along with a review of the literature on Pneumothorax.