"Precurarization" using d-Tubocurarine , Gallamine and Pancuronium - A Comparative Study / 대한마취과학회지

The depolarizing neuromuscular blocking agent succinylcholine, which was synthesized by Hunt and Taveau in 1906, is still regarded as the drug of choice when speed of onset and good intubating conditions matter most. This agent has several disadvantages, some of which may be unpredictable, serious and immediate, for example, muscle pain, bradycardia, rise in intragastric pressure, increase in intraocular pressure and elevation of serum potassium. These disadvantages may be regarded as the side effects of depolarization and indicate a need for a nondepolarizing neuromuscular blocking agent with rapid onset and good muscle relaxation. Simpson et al. described the neuromuscular blocking properties of the nondepolarizing .neuromuscular blocking agent, Fazadinium (AH 8165) in 1972. This initial work indicated a more rapid onset of action than occurs with succinyleholine and without muscle fasciculation or concomitant rise in plasma potassium concentration. However, Coleman et al., Young, t al., Hartley and Fidler, and Metha et al., concluded that using succinylcholine, a ignificantly greater number of patients had excellent intubating conditions at predetermined times after administration than when using Fazadinium. Several reports have indicated that administration of a small dose of nondepolarizing neuromuscular blocking agents would markedly diminish the fasciculation and muscle pains which so frequently occur, when succinylcholine is given. Many other reports have indicated that administration of a small dose of nondepolarizing neuromuscular blocking agents could attenuate or eliminate the adverse effects of succinylcholine such as increased intra-gastric pressure and intraocular pressure, bradycardia, arrhythmia and hyperkalemia. Several investigators have recommended that when small doses of nondepolarizing neuromuscular blocking aKent are given before succinylcholine administration, larger doses of succinylcholine should be given to achieve satisfactory relaxation. A comparative study using d-tubocurarine, gallamine and pancuronium for precurarization indicates that any of them successfully attenuates fasciculation. They have a little antagonizing effect of vocal cord relaxation after succinylcholine administration, but there was no difficulty during endotracheal intubation.

A Review of Four Cases of Malignant Hyperpyrexia Reported in Korea / 대한마취과학회지

Four cases of malignant hyperpyrexia were reported in Korea since 197I and three of these cases expired. We discuss here the four cases of malignant hyperpyrexia with clinical features and management, and the importance of early recorgnition and aggressive treatment of malignant hyperpyrexia are stressed.

An Experimental Study on the "Loosco" Infant Ventilator / 대한마취과학회지

In the 1st two years (From April 1975 to March 1977), we have had experience with 15 surgical infant patients undergoing general inhalation anesthesia with the "Loasco" Infant Ventilator. The "Locsco" Infant Ventilator is designed for the ventilation of neonates and infants on the lines of an open system with a gas mixture of air-oxygen or oxygen-anesthetics. However we used it with a gas mixture of halothane-N2O-oxygen, This study was undertaken to evaluate the value of ventilatory support with the "Loosco" infant Ventilator during general inha!ation anesthesia for 15 surgical patients whose age was less than 2 years of age. The blood gas analysis showed slight under ventilation combined with metabolic acidosis during the first 15 minutes, in which respiratory frequency was set at 30 times per minute, but the ventilation was gradually improved by increase in respiratory frequency to 35 times per minute during the lost 20 minute. In this study, we considered. the important factors which influenced the value of the blood gas analysis. Not only careful anesthetic management to keep the airway and to convect cardiovascular derangement, but also frequent and repeated blood gas analysis and its accurate interpretation were stressed for using the "Loosco" Infant Ventilator during pediatric general anesthesia.

Ambulatory Anesthesia / 대한마취과학회지

An imaginative innovation to shorten hospital stays as a means to reduce patient charges, is out-patient surgery. This procedure also minimized the inconvenience and disruption of the family unit, reduced the opportunities for cross-infection, and freed hospital beds for the more seriously ill patients Since the concept of out-patient surgical service was organized, managed, and performed in the Hanyang Medical Center, we had experience of 132 ambulatory anesthetics during the last two years (from Jan. 1974. to Dec. 1975 ). The results are summarized as follower 1. Preanesthetic examination should be routinely checked with Hb., Hct., urinalysis and chest x-ray. 2. Premedication should be administered preanesthetically, atropine sulfate intravenously. 3. ASA class 1 patients should be chosen for short (less than 1 hour) procedures. 4. Anesthesia is induced with Epontol+S.C.C. and maintained with Halothane+N2O+O2. 5. We suggest that ambulatory anesthesia should be more carefully planned, organized, and managed.

An Experience with Incompatible Blood Transfusion during General Anesthesia / 대한마취과학회지

We have experienced a case of incompatible blood transfusion during general anesthesia in which 300ml of improperly typed blood were transfused. Upon discovery of the error, the transfusion was discontinued and the patient was immediately, carefully and aggressively treated with proper fresh blood, plasma expander(Rheomacrdex-D), fluids(Hartmanns solution and 10% dextrose in water) and drugs (Solu-Cortef 300 mg, furosemide 400 mg, 20% manitol 500 ml, digoxine 0. 5 mg, morphine 15 mg). The free hemoglobin in the plasma and urine and blood gas of the femoral or radial artery were rnonitorecl throughout the resuscitative procedure. It is felt that accidental incompatible blood transfusion of more than 300 ml should be preventable and that the patients life may be saved without serious complications with immediate and proper management.

A Case Report of the Hypersensitivity Reaction with Urografin / 대한마취과학회지

Since 1929, the iodine compounds were used intravenous pyelogram by the Swick, it was accepted for the use of intravenous pyelogram in the worldwide. Nevertheless, it has several minor and major side reactions, also it has been used to IVP or cholecystography at X-ray room without prepared for side reaction or resuscitation. We have experienced a case of sever hypersensitivity reaction with the urografin during IVP at X-ray room. Here, we review with the several articles including its etiology, symptoms and treatments. Especially, we classified the mild and severe reactionsby David and Frederick from Table 1 Table 6. Furthermore we considered that t is necessary to prepared the resuscitating instruments during IVP with urografin under local or general anesthesia.