The Arteriovenous Differenees for Pco2 and pH during Ether, Methoxyflurane and Halothane Anesthesia / 대한마취과학회지

Arterial carbon dioxide partial pressure (PaCO2) and pH are basic indices of the adequacy of ventilation in anesthetized patients. Previous reports by us and by Frances et al indicate that peripheral venous Pco2 and pH approach values arterial blood during general anesthesia. The present study compares the arterial venous difference for Pco2 and pH during diethyl ether, methoxyflurane and halothane anesthesia in 20 cases each. After induction with thiopental, succinylcholine, the patient was intubated and maintained with N2O-O2 and one of above volatile agents. Venous blood was drawn from the back of the hand and an arterial sample was obtained from the radial artery of the other hand. The results were as follows: 1) The mean arteriovenous Pco2 differences in ether, methoxyflurane and halothane groups were -l. 25, -1. 425 and -0. 065 torr respectively. 2) The mean arterovenous pH differences in each group were 0. 031, 0, 017and 0. 014 respectively. We conclude from above results that the differences for the arteriovenous Pco2 and pH during halothane anesthesia were less than that of the ether or methoxyflurane groups.

The Clinical Study of Nausea and Vomiting after General Anesthesia / 대한마취과학회지

There are many reports about post-anesthetic nausea and vomiting. Pst-anesthetic nausea and vomiting can cause not only severe discomfort but also many complications. McKie (1970) said that the incidence varies from 23% 82%. But nowadays, the incidence seems greatly decreased due to the development of anesthetic techniques and anesthetic agents. We studied the incidence and factors affecting nausea and vomiting in 564 patients under general anesthesia from July 1, 1975. to September 30, 1975. at Severance Hospital, The conclusions are as follows; (1) The over all incidence is 34%. (2) It is more common in women. (3) It is less common below 10 years of age. (4) It is more common after prolonged anesthesia. (5) It is most common with ether. (6) It is more common when parasympatholytic agents are used for premedication. (7) It is most common in abdominal operations. We also studied post-anesthetic headache, and the incidence was 15%. Post-anesthetic headache was most common with halothane. There are many different opinions about the effect of the prophylactic use of antiemetics for post-anesthetic nausea and vomiting. So we studied the prophylactic antiemetic effect in ether anesthesia with the use of perphenazine HCI (Trimin). The antiemetic reduced the incidence from 42% to 3% in cases using ether.

A Statistical Survey of the Patient of Intensive Care Unit in Severance Hospital / 대한마취과학회지

The concept of intensive care has developed from experience in recovery rooms, in anesthetic work, and in early specialized units in different fields of medicine. Between the First and the Second World Wars special units were created in some German hospitals. Intensive care often means a combination of recovery-room service and intensive therapy. Intensive care, especially respiratory care is an important part of the responsibility of the anesthesiologist. So, we have analyzed statistically 3, 072 I.C.U. patients who were admitted during a period of 7 years beginning October 18, 1968 when the I.C.U. at Severance Hospital was opened, The results are as follows: I. Cases admitted to the I.C.U. (March,1970-August, 1975 ) 1) For 5 and a half years, the total number of patients was 2, 479. These patients were 2.7% of 91,400 patients who were admitted into Severance Hospital. 2) The mortality rate was 20.0% . Mortality rate was highest in 1970 (23. 7%) and lowest in 1975 (13. 5%). It has gradually decreased every year. 3) Total occupied bed days were 9,840 days (average 4,0 days). The occupied bed days of the majority of the patients (83.6%) were below 5 days comprising 88.3% of the total expired patients. 4) 50% of the patients were in the 21 to 50 year age group. The highest mortality rate occurred in the 51 to 60 age group (24.3%). 5) The number of patients admitted in the department of internal medicine was 702 cases (28.3%) which was the highest among all departments. The mortality rates of the departments of pediatric and neurosurgery were 40. 3% and 34. 7% respectively and those were relatively high values. 6) All I.C.U. patients have been divided into two categories, operative and non-operative. The operative cases were 1, 264 (51. 0%) and non-operative 1, 215 (49. 0%,). The mortality ,The Journal of The Korean Society of Anesthesiologists VoI. 9, No. 2, 1976 rate of the non-operative cases (22. 5%) was higher than operative (17. 6%). 73 Cardiovascular disease was the commonest cause of death of I.C.U, patients (107 cases) admitted from March, 1974 to August, 1975 (30 cases, 28. 0%). Respiratory support cases (October 18, 1968-August 31, 1975) ;. During the 7 year period, of all I.C.U. admission cases (3,072) 423 cases (13.8%) received respiratory support. These patients gradually increased every year. 2) The mortality rate was 44. 0% which was more than twice the over-all mortality rate of. I.C.U. admission patients. 3) The mortality rate was highest in the 21 30 age group (18. 7%). 4) The department of internal medicine admitted the largest number of cases (153 cases, 36. 2%). 5) Of all conditions, cardiovascular disease was most frequent (126 cases, 29. 8%). Here we have discussed the definition of I.C.U., the responsibility and important role of the anesthesiologist in the I.C.U. by illustrating present situations and presenting problems at the I.C.U. in Severance Hospital.

Anesthesia for Coarctation of Thoracic Aorta under Mild Hypothermis and Partial Bypass / 대한마취과학회지

Special problems face the anesthesiologist in anesthetizing patients with coarctation of aorta. Two patients each 7 years old, a boy and a girl were admitted for surgical correction of coarctation of the thoracic aorta. These patients were premedicated with secobarbital and atropine. One to 1 (1/2) hours later, anesthesia was induced with sodium thiopental and succinylcholine followed by intubation. Anesthesia was maintained with nitrous oxide, oxygen and halothane. A radial artery was cannulated for blood gas sampling and direct arterial pressure, E.K.G., C.V.P. and rectal temperature were monitored continuously. Mild hypothermia (about 34degrees C) was induced by surface cooling technique with mattress. In each case, in order to repair of coarctation by dacron graft and prosthesis, left atriofemoral by pass was used. Acute hemodynamic changes, such as sudden hypertension of the upper extremity and head following cross clamping of the aorta or profound hypotension following declamping, did not develop with this technique. Possible causes and prevention of hemodynamic changes are discussed.