Neuromuscular Effect of Succinylcholine during Halothane and Thalamonal Anesthesia / 대한마취과학회지

Thalamonal(Innovar) consisted of droperidol, a tranquilizer, and fentanyl, a short acting narcotic. Supplementation of nitrous oxide with large dose of fentanyl was known to cause contraction of abdominal muscle, often strong enough to produce rigidity. There was some reports of interaction of thalamonal on the depolarizing muscle relaxant. This study was undertaken to quantify the neuromuscular effect of thalamonal-N2O compared with halothane-N2O anesthesia on succinylcholine induced blockade. Forty non-pregnsnt women aged between 20 and 40 years undergoing general anesthesia for elective lower abdominal surgery were randomly divided in halothane(20cases) and thalamonal group (20 cases). All were free from renal, hepatic, endocrine and neuromuscular disease. The patient's forarm and hand secured firmly to an armboard, and a force displacement transducer(San Ei, Japan) was connected to patient thumb and ulnar nerve was stimulated through surface elctrodes at wrist. Supramaximal pulse were delivered using a nerve stimulator(Emerson, USA) at a rate of 1 Hz with a duration of 0.2msec. This isometirc twitch tension produced by this stimulation, as quantified by transducer, was continuously recorded before and during anesthesia on a biophysiograph(San Ei, Japan). Anesthesia was induced with thiopental sodium 4~5 mg/kg and succinylcholine 1mg/kg, and intubation was performed after maximal twitch depression. Immediately after intubation, thalamonal 0.5ml/10kg was injected in one group, and halothane 1% was added in the other group. The onset time, time from onset of action to full paralysis, duration of full paralysis and recovery index were analyzed. The results were as follows. 1) In halothane 1% group: the onset time was 16.6+/-3.21 sec, time from onset to full paralysis was 48.4+/-8.97 sec and duration of full paralysis was 269.1+/-61.81 sec. Recovery index was 77.7+/-19.26 sec. 2) In thalamonal 0.5ml/10kg group: the time to onset of action was 16.0+/-2.74 sec, time from onset to full paralysis was 43.2+/-8.09 sec and duration of full paralysis was 347.7+/-102.03 sec(p0.05).

Interaction with d-Tubocurarine and Ketamine in Rabbits / 대한마취과학회지

Ketamine hydrochloride(ketamine) is a non-barbiturate anesthetic agent chemically designated as dl-2-(0-chlorophenyl)2-(methylamino)-cyclohexanone hydrochloride. Ketamine anesthesia has been found distinctively different from that induced by conventional anesthetic agents, as it provides profound analgesia without significant impairment of respiratory function or stimulation of cardiovascular activities thus avoiding hypotension and are preserved the protective pharyngeal and laryngeal reflexes. In addition, ketamine appears to have muscle relaxation properties. This latter clinical finding, however has not been experimentally substantiated since few reports have appeared on the effect of ketamine on muscle relaxation. The present study therefore, was undertaken to determine whether this agent affects the muscle activity during d-tubocurarine block. The experiment was performed on sixteen rabbits weighing 1.8 to 2.5kg and these were divided into two groups; eight rabbits for control and eight for th study group. All animals were intubated through a tracheostomy under general anesthesia with nembutal 40mg/kg given intravenously. Respiration was controlled by means of a Harvard animal respirator. The body temperature was kept at 35 degrees C to 36 degrees C with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and the nerve stimulator was applied to the nerve muscle preparation. The twhitch height of the muscle contraction was recorded on a biophysiograph through the force displacement transducer. The common peroneal nerve was stimulated supramaximally using a single twitch, square wave of 0.2 msec duration at a frequency of 0.1Hz once every 10 seconds. The degree of neuromuscular block following intravenous injection of d-tubocurarine 1mg/kg was measured in the control group. And in the study group ketamine 5mg/kg was administered intravenously when 25% of twitch height of muscle contraction was obtained spontaneously after the intravenous injection of d-tubocurarine 1mg/kg. The changes of the twitch height of muscle contraction and the time of spontaneous recovery in the study group were compared with those of the control group. The results were as follows: 1) The times and degree of maximal single twitch depression were obtained at 194.8sec and 87.3% in the control group and were at 197.5 sec and 87.8% in study group. No significant difference was observed. 2) Recovery index of the control group was 1,560.0 sec and recovery index of the study group was markedly prolonged to 2,387.5 sec(53.0% prolongation). 3) Mean decrease of single twitch height was 8.8% soon after the intravenous ketamine 5mg/kg when 25% of twitch height was obtained after the intravenous d-tubocurarine 1mg/kg in the study group.

Dose Related Neuromuscular Blocking Effect by Succinylcholine Chloride in Cats / 대한마취과학회지

Succinylcholine chloride is the most commonly used muscle relaxant. Its rapid onset of action and relatively brief duration are unique Despite its wide use, certain pharmacologic aspects of auccinylcholine chloride are not as widely appreciated as they should be. There is marked variation in the responses of patients to clinically used doses. Large doses demonstrate that recovery from succinylcholine chloride is slower than is generally appreciated in man. The dose related neuromuscular blocking effect of succinylcholine chloride in cats was investigated using a cat common peroneal nerve anterior tibial muscle preparation. All experimental cats tracheas were intubated through a tracheostomy under general anesthesia with Nembutal 40 mg/kg intravenously. Respiration was controlled by a Harvard animal respirator. The body temperature was kept at 35~37 degrees C by a thermoblanket. The degree of neuromuscular block following intravenous succinylcholine chloride, 0.5 mg/kg and 1 mg/kg, were measured by single twitch response. The common peroneal nerve was stimulated supramaximally by a single stimulus with square waves, 0. 2 msec duration and at a frequency of 0.1 Hz. The ratio of the twitch height was calculated. The results were as follows: 1) The time of neuromuscular blokade to 100% depression was 30.7 sec and to l00% spontaneous recovery was 1,260 sec (21 min.) in the succinylcholine chloride 0.5 mg/kg intravenous group. The recovery index was 258. 5 sec (4. 3 min.). 2) The time of neuromuscular blockade to 100% depression was 30 sec and to 100% spontaneous recovery was 2,004 sec (33. 4 min.) in the succinylcholine chloride I mg/kg intravenous group. No significant time difference was observed in neuromuscular depression in both groups but spontaneous recovery time was markedly prolonged to 744 sec (59% prolongation). The recovery index was also prolonged to 474 sec (83% prolongation).

Evaluation of Cardiac Arrest Cases - Past 10 year experience / 대한마취과학회지

Central to the question of anesthetic risk is the definition of an anesthetic death. This is yet to be defined within any reasonable limits. A number of factusl and philosophical considerations complicate attempts to derive a precise definition. Since anesthesia is usually administered only to permit or facilitate a diagnostic or therapeutic procedure, anesthesia risk is largely confounded with surgical risk and a second set of persons and procedures. For most death, assignment of the relative roles of anesthesia, surgery and patient disease is based on retrospective assumptions, hindsight judgment, bias, and incomplete information. We would like to make a plea for a more widespread use of death reports and more detailed discussion of fatalities occurring in patients who have received anesthesia. Therefore, we have evaluated cardiac arrest during peri-anesthesia this ten-year period (1969~1979) in St. Mary's hospital: 28, 124 anesthetics were administered. On the other hand, recently the developments that led, to widespread organization of hospital based cardiac resuscitation programs in the early sixties were direct mechanical ventilation of the lungs, external cardiac compression, external cardiac electrical defibrillation and conduct a intensive care unit. Obviously, the concept of anesthetic death must contain a judgment of the relative roles of error and toxicity, also. Evaluated results were as follows; 1) Incidence of cardiac arrest was 1: 55. 2) Forty six percent of cardiac arrest was encountered in the thirty to forty age group. 3) Increasing incidence of cardiae arrest was encountered in poor physical status. 4) Etiological factors in cardisc arrest were overdose of anesthetic drags, hypovolemia, electrolyte imbalance and a disease focus in the central nervous system. 5) Cardiac arrest due to the patient's disease itself was 47%, contributed surgical stress was 22% and contributed anesthetic stress was 31%. 6) Highest incidence of cardiac arrest was encountered in hepatobiliary tract diseases.

Evaluation of Cardiac Arrest Cases - Past 10 year experience / 대한마취과학회지

Central to the question of anesthetic risk is the definition of an anesthetic death. This is yet to be defined within any reasonable limits. A number of factusl and philosophical considerations complicate attempts to derive a precise definition. Since anesthesia is usually administered only to permit or facilitate a diagnostic or therapeutic procedure, anesthesia risk is largely confounded with surgical risk and a second set of persons and procedures. For most death, assignment of the relative roles of anesthesia, surgery and patient disease is based on retrospective assumptions, hindsight judgment, bias, and incomplete information. We would like to make a plea for a more widespread use of death reports and more detailed discussion of fatalities occurring in patients who have received anesthesia. Therefore, we have evaluated cardiac arrest during peri-anesthesia this ten-year period (1969~1979) in St. Mary's hospital: 28, 124 anesthetics were administered. On the other hand, recently the developments that led, to widespread organization of hospital based cardiac resuscitation programs in the early sixties were direct mechanical ventilation of the lungs, external cardiac compression, external cardiac electrical defibrillation and conduct a intensive care unit. Obviously, the concept of anesthetic death must contain a judgment of the relative roles of error and toxicity, also. Evaluated results were as follows; 1) Incidence of cardiac arrest was 1: 55. 2) Forty six percent of cardiac arrest was encountered in the thirty to forty age group. 3) Increasing incidence of cardiae arrest was encountered in poor physical status. 4) Etiological factors in cardisc arrest were overdose of anesthetic drags, hypovolemia, electrolyte imbalance and a disease focus in the central nervous system. 5) Cardiac arrest due to the patient's disease itself was 47%, contributed surgical stress was 22% and contributed anesthetic stress was 31%. 6) Highest incidence of cardiac arrest was encountered in hepatobiliary tract diseases.

Clinical Study of Thalamonal-Pentothal-N2O-O2 Anesthesia in Geriatrics / 대한마취과학회지

We have introduced a method of intermittent injections of thalamonal and concomitant use of small doses of pentothal for rapid and smooth loss of consciousness and induction of anesthesia, and maintaining anesthesia with intermittent injections of thalamonal and pancuronium bromide as well as N2O inhalation. From 20 geriatric patients, the following results were obtained. 1) Average dose of thalamonal during induction of anesthesia was 0.75+/-0.28ml/10kg and that of pentothal was l. 77+/-0. 44 ml/kg. The maintenance of anesthesia was achieved by the intermittent injection of thalamonal; the average dose was 0.118+/-. 0.08 ml/10 kg/30 min. 2) During induction, the average decrease of systolic blood pressure was 22. 5 mmHg (P0. 1). 3) During induction, 3 cases among 20 showed moderate chest rigidity and 4 cases showed hypotension. The hypotension may be due to the additive effect of pentothal and droperidol. 4) At the end of operation, after the administration of 510 mg nalorphine, the respiratory rate increased from 13. 8/min to 19. 3/min (P <0. 01). 5) 18 cases among 20 recovered promptly after discontinuation of N2O inhalation with delay in 2 cases. Postoperatively one person complained of nausea and a small dose of narcotic pain control was needed in 3 persons.