Effect of Epidural Morphine on Postoperative Pain and Arterial Blood Gas Values / 대한마취과학회지

After the identification by Snyder of specific opiate receptors it the substantia gelatinosa of the posterior horn of the spinal cord, Behar et al. reported that small doses of epidural morphine are effective in treatment of acute and chronic pain. We have administered 3~5 mg of epidural morphine as a single dose with 1.5~2 % lidocaine to 40 patients as a continuous lumber epidural anesthesia and to 20 patients as a single caudal anesthesia. All the patients had remarkable relief of pain and we can confirm that there was no loss of sensation to temperature, touch or pinprick. However the dosage (3. 4 or 5 mg) of morphine administrated did not affect the duration of postoperative pain relief. Arterial blood pressure and heart rate were measured up to 15 minutes after morphine injection at 5 minutes intervals, but were not significantly changed. PaO2, PaCO2 pH and base excess were also not significantly changed.

Clinical Considerations of Anesthetic Management for the Patient with Hypertension / 대한마취과학회지

It has been reported that the number of patients with hypertension increases yearly in the Korean population(Sohn et al, 1968; Lee, 1962; Kang et al, 1989), and this imposes many anesthetic problems during surgery. The etiology of essential hypertension is unknown, but it affects primarily the brain, heart and kindney. The main causes of mortality due to hypertension are cerebrovascular accident. congestive heart failure, myocardial infarction and uremia. For the better anesthetic management of patients with hypertension, it is essential to understand clearly the adrenergic machanism and pharmacologic action of antihypertensive drugs, especially their effects on hemodyamic circulation. About 15 years ago it was generally agreed that antihypertensive medication should be stopped some time before anesthesia and surgery in order to regain the compensatory function of the circulation during anesthesia and surgical stress (Armstrong Davison, 1951; Vadnam et al, 1961. Dingle, 1966). However the present concept is that the better the hypertension is controlled the better the patient's chances of surviving anesthesia and it is recommended that antihypertensive medication should be continued as close as possible to the time of anesthesia(Brown, 1978). The present study was undertaken to learn the effect of antihypertensive medication, given preoperatively, on the arterial blood pressure during general anesthesia, by reviewing the anesthesia courses of hypertensive patients who were admitted to Severance FIospital from March 1969 to February l978. The patients with hypertension were divided into two groups, one group consisting of 100 patients, who received antihypertensive medication in the preoperative period and the other group, consisting of 100 patients, who had not received antihypertensive medication for the control of high blood pressure preoperatively. Changes of arterial blood pressure during anesthesia were analyzed, and data were compared between two groups. The results are as follows; 1) The number of the patients with hypertension, admitted to the hospital, has been increasing yearly for the past 10 year period(March, 1969 to February 1978). 2) The patients who received antihypertensive medication for preoperative anesthetic management showed less arterial blood pressure fluctuation during general anesthesia, compared to the patients who had not received antihypertensive medication (p<0.05). It may be suggested from the above observation that the preoperative control of hypertension is desirable for the maintenance of a stable blood pressure during general anesthesia.

The Effect of Halothane-induced Hypotention on the Kidney / 대한마취과학회지

Hypotensive anesthesia is widely used in an operation since 1) it minimizes bleeding and provides a good operation field, 2) it prevents massive hemorrhage in an operation which otherwise involves a large amount of b1ood loss and 3) it is useful in an operation for hypertensive patients. This procedure also involves a number of risks such as delayed awakening, reactionary bleeding, decrease in urine output and tissue hypoxia. The most dangerous complication can be hypoxia especially in the vital organs. 1t is therefore necessary to treat dehydration or blood loss before hypotensive anesthesia is induced. Since hypotensive anesthesia was introduced by Gardner (1947) for an operation of olfactory groove meningioma, various methods of deliberate hypotension have been developed. The most common method of hypotensive anesthesia in the present day is to use drugs, such as trmetaphan, nitroprusside and halothane. The effect of hypotensive anesthesia an various physiological functions of animals have been investigated is the past. Giffiths and Gillies (1948) reported that, in the hypotension induced by sympathectomy, an arterial systolic pressure of 32 mmHg is the minimum to overcome peripheral resistance. Chung (19743 observed in the halothane-induced hypotensive dogs that a systolic pressure of 30mmHg was required to assure adequate cerebral oxygenation. In the present study, we have investigated the effect of halothanie-induced hypotension on the renal function of dogs. The arterial systolic pressure was successively reduced to 60 and 30mmHg for 30min. each, and changes is various renal functions were studied during 100min. of the recovery period. The results are summarized as follows: 1. The systolic blood pressure was completely reeovered 80min. after the cessation of halothane inhalation. 2. Average renal blood flow Cestimated by Cppe) and glomerular filtration rate (estimated by Cg) during the first 20min. of the recovery phase were 26% ind 45% of the control level. However after 100min. of thy recovery period, repal blood flow was recovered to 63% and glomerular filtration rate to 74%of the control leveL 3. Average urine flow during the first 20min. of that recovery phase was approximately 40% of the control. 4. U/P osm. ratio was reduced to 90% the control level during the first 20min. of recovery, but it exceeded the control value after 20min. of recovery. 5. Thero was only 24% of the-tml value in the first 20min. of receavery phese, but there- after it gradually returned to the control level. 6. FEH2O (fractional excretion of N2) was and significantly changed- by halothane inhalation although there was a tendency to slight reduction at the beginning of the recovery phase. 7. FEK was 47% of the control value dqring ghe initial phase of recovery, but it returned to the control level after 40min. of the recovery period. 8. FE, and FEH2O were reduced to 56% and 50% of the control level after the hypotensive period, but returned to 70% and 82% of the control level after 40min. of the recovery period. These results indicate that although the systemic blood pressure completely recovered after halothane-induced hypotension, renal hemodynamics are not completely recovered with 100min. of the recovery period. However renal functions are mostly reversible, suggesting that halathane -induced hypotension did not induce irreversible damage of renal tissue.