Uneventful Recovery of Hepatic Dysfunction following Isoflurane Anesthesia in a Pateint with Acute Viral Hepatitis B / 대한마취과학회지

Elective operation should be postponed in patient with acute hepatitis because of the increased risk of morbidity and mortality. Especially, surgery carried out in the presence of acute viral hepatitis is associated with high incidence of major complications The authors have recently experienced a patient who was performed emergency craniotomy for epidural hematoma. At that time, the patient was in midst of acute viral hepatitis B. Major in- halational anesthetic was isoflurane and muscle relaxant was atracurium. Fortunately, the preoperative hepatic dysfunction was not exacerbated and recovered uneventfully. The choice of anesthetics and the proper pre-and intraoperative anesthetic managements are reviewed.

Clinical Study of General Anesthesia for Open-Heart Surgery with Hypothermia and Cardiopulmonary By-Pass / 대한마취과학회지

Under hypothermia and extracorporeal circulation 187 cases of open-heart surgery were done between November 1963 and October 1974. The results obtained are summarized as follows. 1. Out of 187 cases, 116 cases were male (62.0%) and 71 cases were female (37. 9%). 2. There were 134 cases (72%) in A.S.D., V.S.D., and T/F, and 70 cases (37%) were under 10 years of age and 154 cases (82%) under 30 year age group. 3. Premedicants were secobarbital (83.8%) and atropine sulphate (27.9%) 4. Induction of anesthesia was mainly by the use of thiopental and succinylcholine after preoxygenation with 100% O2, and anesthesia was maintained by N2O-O2, halothane or methoxyuflrane during maintenance. 5. During by-pass, anesthesia was maintained by hypothermia, muscle relaxants or ketamine. 6. From 1963 to 1966, low flow and moderate hypothermia were used with a Zuhdi-Greer oxygenator and a sigma pump and since then high flow was used, utilizing various bubble oxygenators with a De-Bakey's roller pump. 7. Blood pressure, electrocardiogram (ECG), central venous pressure, respiration, temperature, urine output, hemoglobin, hematocrit, arterial blood gas study, pH, intake, output, and electrolytes were monitored before and during anesthesia. 8. There were 28 fatalities (15%) among 187 cases. Death were mostly from bleeding, renal failure, lung edema, low cardiac output syndrome and complete heart block.

Reappraisal of Ether-Air Anesthesia / 대한마취과학회지

Air can be used as a carrier for volatile agent, ether, with a clear airway, normal pulmonary function and normal oxygenation. In 1858 John Snow, the Father of British Anesthesia stated in his book on Chloroform and Other Anesthetics that he believed it to be almost impossible for death to occur from ether administered with ordinary intelligence and attention. Today ether is probably still the safest anesthetic drug we possess. Ether is cheap and easily obtained; with controlled respiration 3% is adequate. Recovery smooth and rapid. Vomiting may be no different from other agents. Most machines depend upon cylinders of oxygen and other gases, and there are difficulties of refilling cylinders and the cost of transporting them. In such circumstances the E.M.O. Inhaler, allowing ether to be vaporized in known concentrations in air, has many advantages as an alternative to the open method administration. From all types of patients chosen at random 22 patients were studied for ether-air anesthesia. Anesthesia was induced with intravenous thiopental and subsequent endotracheal intubation was performed within 30 seconds with the aid of intravenous succinylcholine. SatO2, PaO2, pH, and Base E. were measured 3 times during pre-anesthesia, immediately after the intubation, and post-operatively by Radiometer, using the oxy-hemoglobin dissociation curve and the Siggard-Anderson alignment nomogram. Vital signs were recorded every 5 minutes. It is the purpose of this paper to present this series of 22 anesthetics by the use of the E.M.O. Inhaler with air and to discuss the possibility of hypoxia, advantages and limitations that became apparent. The results obtained may be summarized as follows. 1. It is essential that endotracheal intubation by carried out rapidly and that everything necessary be ready and immediately at hand before starting the anesthetic. 2. In all patients ventilated room air during anesthetic induction, no significant decreases of PaO2 and SatO2 were observed immediately after the endotracheal intubation. 3. The duration of any period of complete apnea inflicted on the patient must be carefully controlled. 4. 100% oxygen prevented the possibility of hypoxia on extubation after all the reflexes had returned. 5. Ether-air anesthesia is recommended without hesitation for use where economy and portability of anesthetic machine are needed.