Genotoxicity of Enflurane in Human Peripheral Blood Lymphocytes Studied in vivo by Single Cell Gel Electrophoresis / 대한마취과학회지

BACKGROUND: The alkaline single cell gel electrophoresis comet assay was applied to study the genotoxic properties of enflurane on the human peripheral blood lymphocytes (PBL) of cancer patients before and during anesthesia as compared to an non-cancer control group. Method: The cancer group consisted of 24 patients (aged 15-77 years), while the control group consisted of 14 trauma individuals (aged 20-81 years). After anesthesia induction (thiopental 4 mg/kg and vecuronium 0.1 mg/kg), it was maintained by enflurane inhalation; 1-2 minimal alveolar concentration in oxygen - nitrous oxide mixture. Venous blood samples were obtained before the induction of anesthesia, and after 60 and 120 min of anesthesia. The comet assay detects DNA damage, such as strand breaks and alkaline labile sites induced directly by genotoxic agents, and DNA degradation due to cell death. Fifty cells from each sample were examined and Olive tail moments (OTM) were calculated using Komet 4TM software. RESULTS: OTM values were no different between controls and patients before anesthesia. However, the OTMs of blood sampled from cancer patients at 60 (7.97 +/- 1.83) and 120 min (7.86 +/- 2.05), and from trauma patients at 120 min (8.04 +/- 1.32) of anesthesia were significantly increased. CONCLUSIONS: In immunocompromised cancer patients, we suggest the existence of a higher risk of an association DNA damage and enflurane exposure.

Anesthetic Management of a Patient with Hemophilia B / 대한마취과학회지

A 22 year old male with hemophilia B was scheduled for the correction of a right subtrochanteric femur fracture. Plasma concentration of coagulation factor IX in this patient was 50% of the normal level and the partial thromboplastin time was 57 seconds on the first day of hospital administration. We started the intravenous administration of facnyne injection (factor IX) 11 days before the operation when his plasma concentration was 20%. His plasma concentration was 40% on the operation day. The operation and general anesthesia were accomplished safely without severe hemorrhage or major complication. He received facnyne injection continuously until the 5th postoperative day: 25-43% of his plasma concentrations of factor IX was maintained. He had no problem with postoperative care.

The Effects of Peripheral mu and kappa Opioid Receptor Agonists on the Thermal Injury Induced Hyperalgesia in the Rat / 대한마취과학회지

BACKGROUND: Previous reports have described that the local administration of opioid receptor agonist can attenuate the nociceptive responses induced by a variety of inflammatory states. This study evaluated the effects of mu or kappa opioid receptor agonists peripherally administered at a site of injury on the state of thermal hyperalgesia induced by mild burn injury. METHODS: Thermal injury was induced after briefly anesthetizing with halothane, by applying the left hindpaw to a hot plate (52.5 degree C) for 45 seconds. Paw withdrawal latency of the hindpaw was determined using an underglass thermal stimulus, which allowed the response latency of the injured paw to be obtained. In this work, the mu receptor agonist, morphine (10, 30, 100 microgram), or the kappa receptor agonist, U50,488H (10, 30, 100 microgram), was administered respectively at the injured site on the right hindpaw in rats. To compare the systemic effects of the drug, the same drug was administered at the normal left hindpaw site with mild burn injury. Naloxone (40 microgram/kg) was administered at the injured site or at the normal site to determine the reversibility of the opioid used. RESULTS: Mild burn injury produced thermal hyperalgesia manifested as reduced paw withdrawal latency. Administration of either morphine (10, 30, 100 microgram) or U50,488H (10, 30, 100 microgram) at the injured site attenuated hyperalgesia in a dose-dependent manner. But the administration of drugs at the normal site had no effect on hyperalgesia at the injured site. In addition, naloxone had the effect of morphine and U50,488H reversed significantly. CONCLUSIONS: These results suggest that peripheral mu or kappa opioid receptor administration at an injured site may play an important role in the hyperalgesia induced by mild burn injury.

Reconsideration of Hypoxic Chamber Flight Training through a Pulse Oximetry Monitoring Study in ROKAF

Hypoxia is a serious aviation problem and can always be a source of dangerous aerospace accidents. Hypoxic chamber flight training used to evaluate hypoxia tolerance via TUC (time of useful consciousness) and to become aware of hypoxic symptoms. Because TUC depends on subjective symptoms and lacks strict objectivity, pulse oximetry monitoring has become useful in the aviation environment. In this study, we monitored arterial oxygen saturation (SaO2) by pulse oximetry in the ROKAF subjects (n=33) experiencing hypoxia at the simulated altitude of 25,000 ft. The duration from mask-off to mask-on (TUC), the duration from mask-off to the time of SaO2 of 90% (T90), the duration from 90% to 70% of SaO2(T70), and the SaO2 value at mask-on (bottom SaO2) were examined. The mean bottom SaO2 and TUC were 64.5% and 180 sec, respectively. The subjective hypoxic symptoms were facial flushing, thinking impairment, dyspnea, sweating, anxiety, and so on, in descending order. The majority of the subjects put on their mask before 70% of SaO2 was reached or before they felt any severe symptoms. In comparison with the data of JASDF (Yoneda, 2000), TUC, T90, and T70 were longer in JASDF, but bottom SaO2 and pulse increasing rate during hypoxia (PR/TUC) were higher in ROKAF. Also, TUC in the subjects of this study was much shorter than those of 10 years ago. These may be due to different training protocols, but not enough data exists to explain such difference. The need for the reconsideration of the hypoxic training from the various viewpoints is raised.

Analysis of Body Mass Index in 4,966 Patients Undergoing Operations / 대한마취과학회지

BACKGROUND: Obesity is defined as an excess accumulation of body fat. To measure body fat accurately is difficult, but body mass index (BMI, kg/m2) is easily available for routine clinical use. METHODS: A total of 4,966 (male; 2,580, female; 2,386) patients from January to September in 1997 and aged up to 90 years old were studied for BMI. Among these subjects, obstetric patients were excluded in our study. We calculated the BMI as weight (kg) per height squared (m2). The heights and weights of study subjects were obtained from anesthesia records. The BMI was analyzed by 4 different age groups: group 1 (less than 3 years), group 2 (between 3 to 7 years), group 3 (between 8 to 17 years), and group 4 (18 years or more), decade of age, 4 obesity categories according to BMI levels: underweight (less than 18 kg/m2), normal weight (19-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (30 kg/m2 or more), and surgical departments. RESULTS: Mean BMI values of group 1, 2, 3, and 4 were 16.1+/-2.9 kg/m2, 16.2+/-2.4 kg/m2, 19.2+/-3.7 kg/m2 and 23.3+/-4.6 kg/m2 in males and 15.7+/-3.9 kg/m2, 15.8+/-2.7 kg/m2, 19.4+/-3.5 kg/m2 and 23.6+/-3.7 kg/m2 in females, respectively. According to generations, the BMI under teen-age was 16.3+/-2.7 kg/m2 and 14.3+/-2.9 kg/m2 in males and females respectively while it was between 20.4+/-3.3 kg/m2 to 25.0+/-3.6 kg/m2 from 1st to 7th decade patients in both sex. The prevalence of overweight and obesity were nearly zero in group 1 and 2, but males in group 3 had them of 4.6% and 1.4% while 6.9% and 0.8% in females, respectively. In group 4 they were 25.3% and 2.2% in males and 28.8% and 4.8% in females, respectively. Obese patients increased in the order of neurosurgery, gynecology, orthopedic surgery, urology, and general surgery departments. CONCLUSIONS: This study revealed the guidelines of BMI of operating patients. We recognized that the prevalence of overweight and obesity of preschool aged and adolescent patients were nearly zero. Adult patients were the highest at 4th decade in males and 6th decade in females and the obesity rates were 27.4% and 33.6% in males and females, respectively.

Anesthetic Experience of Extrathoracic Surgery in Rendu-Osler-Weber Syndrome / 대한마취과학회지

The Rendu-Osler-Weber syndrome (hereditary hemorrhagic telangiectasia) is an autosomal dominant disorder of blood vessels associated with mucocutaneous telangiectasis and arterivenous malformations in several organs. A pulmonary arteriovenous fistulae can cause hypoxemia, hemoptysis, polycythemia and clubbing. However the condition is often not recognized until the 3rd decade of life. The authors report a case of a 28-year-old male patient who had been suffering from telangiectasis of the upper lip and upper portion of the chin and unexpedly became undersaturated of hemoglobin through general anesthesia during an operation of the upper lip lesion.

Changes Induced by the Infusion of Normal Saline in Arterial Blood Gas Analysis, Serum Electrolytes and Central Venous Pressure during Renal Transplantation / 대한마취과학회지

BACKGROUND: The changes in acid-base balance and serum electrolytes after infusion of 0.9% normal saline during renal transplantation are poorly characterized. In this study, the relationships between the infusion of fluids and the changes in arterial blood gas analysis, serum electrolytes and central venous pressure during renal transplantation were determined. METHODS: Sixty-seven patients undergoing elective renal transplantation were divided into two groups: group I (n = 33) was made up of patients who received a living related renal transplantation, while group II (n = 34) was made up of those who received a living unrelated renal transplantation. Blood gas analysis, central venous pressure and serum electrolytes were evaluated just after the beginning of the operation, just before reperfusion (unclamping of the renal artery and vein), just after reperfusion and 20 minutes after arriving in the recovery room. RESULTS: pH, base excess, HCO3 and Na+ concentration were decreased, but PaCO2 was not changed during the operation. Central venous pressure and K+ concentrations were elevated during the operation. CONCLUSIONS: The results of this study suggest that 0.9% normal saline and mannitol leads to dilutional acidosis. If a lot of fluids are required during transplantation, we need to consider that 0.9% normal saline can aggravate acidosis in a renal transplantation patient.

Clinical Study of the Duration of CO2 Absorption of ROK and USA-produced Soda Lime and Their Re-use Time after Being Exhausted / 대한마취과학회지

BACKGROUND: In a circle system, gas that is to be reused is cleared of carbon dioxide by passing through a canister containing a chemical CO2 absorbent. In anesthesia textbooks the utilization time of carbon dioxide is nearly always specified to last about 5 hours. The soda lime used was noted to regenerate its efficiency for CO2 absorption after being exhausted. Two different types of soda lime (a ROK product and USA product) were analyzed in patients for their duration of carbon dioxide absorption from the anesthetic closed circle system and re-use time after being exhausted. METHODS: General inhalation anesthesia was performed using a PhysioFlex anesthesia machine. To determine the duration of carbon dioxide absorption by soda lime and the re-use time after being exhausted, twenty seven (ROK; 20 and USA; 7) and fifty (ROK; 22 and USA; 28) adult patients were studied. Duration of CO2 absorption was determined as the time for the inspired CO2 concentration to reach 0.5%. The color change of ethyl violet in soda lime was observed throughout the study. Duration of CO2 absorption was compared by unpaired t-test. Re-use time of each group was analysed by simple regression; p less than 0.05 was considered significant. RESULTS: Duration of CO2 absorption was 2.67 +/- 2.12 hrs for the ROK product and 9.52 +/- 0.68 hrs of USA product, and they were different significantly (P < 0.05). Regression equations of ROK- and USA-products werey (min) = 5.761x + 45.701 (r2 = 0.0438, P = 0.3496, x means day after being exhausted) and y = 0.6x + 33.179 (r2 = 0.0158, P = 0.5233) respectively. A color change of ethyl violet in ROK soda lime was not observed throughout the chemical reaction. CONCLUSIONS: From the above results we suggest that ROK soda lime is not effective yet to use for CO2 absorption in clinical anesthesia. It is marked shorter than that of the USA soda lime. A color change of ethyl violet was not observed throughout the chemical absorption reaction in ROK soda lime. Re-use time of both soda limes were not related with the duration after being exhausted.

Lumbar Nerve Root Sleeve Injections in Painful Disorders of the Lumbar Spine: Short Term Results / 대한마취과학회지

BACKGROUND: Nerve root sleeve injection has become popular in the treatment of lumbar radicular complaints. However reported data on nerve root sleeve injection is more of a technical nature. The present study was designed to evaluate the therapeutic success of a fluoroscope guided nerve root sleeve injection of local anesthetics and corticosteroids. METHODS: Fifty seven patients who had persistent radicular pain and/or low back pain that is resistant to conservative treatment were treated with fluoroscope guided injection therapy. 0.125% bupivacaine 2.5 ml and triamcinolone 40 mg were injected at intervals of 2 - 4 weeks. Before and after treatment and at follow up, a visual analogue scale (VAS) was measured. Treatment success was evaluated on a ratio based on the visual analogue scale (post-treatment VAS/pre-treatment VAS) and categorized as following (good improvement = > 70%, moderate improvement = 70 50%, no improvement = < 50%). RESULTS: Short-term good and moderate improvement was observed in 46% of the patients with radiating pain and/or lower back pain, and in 43% of patients with lower back pain only. CONCLUSIONS: Results indicated that nerve root sleeve injections of corticosteroids done under fluoroscopic guidance as an outpatient procedure was effective and safe in our study and may deserve to be used as part of the conservative management of lumbar radiculopathy before resorting to more invasive methods.

The Effects of Transection Injury and Local Infiltration of Phenol at the Sciatic Nerve on c-fos Expression in the Spinal Cords of Rats / 대한마취과학회지

BACKGROUND: Phenol has effects like surgical neurectomy, but may evoke pain after local infiltration in nerves. Transection of peripheral nerves may induce neuropathic pain through increased spontaneous discharge and other mechanisms. Proto-oncogene, c-fos, is an indicator of neuronal activity, and its expression in the spinal cord may be related to pain development, because inhibition of c-fos expression has corresponding effects like analgesia. We evaluated the effects of local infiltration of phenol and transection injury at the sciatic nerve on c-fos expression in the spinal cords of rats. METHODS: Sixteen male Sprague-Dawley rats were divided into 2 groups; transection of the sciatic nerve was performed for group 1; phenol was infiltrated into the sciatic nerve in group 2. Three hours, 1 week, 2 weeks, and 3 weeks after the experiment, the corresponding spinal cord was stained immunohistochemically for c-fos. RESULTS: c-fos was expressed from 3 hours to 2 weeks over the laminae of the dorsal horn in each group. Phenol increased the expression of c-fos initially, but decreased 1 week later. Transection injury did not increase it initially, but showed the peak expression at 1 week, and maintained it for 2 weeks. Therefore, it seems that phenol, rather than the transection injury, stimulates c-fos expression early, but decreases later. CONCLUSIONS: Phenol treatment, caused by chemical block due to protein denaturation and nonspecific inflammation, may induce less neuropathic pain than the transection of a nerve.

Clinical Experience of PhysioFlex Anesthesia Machine / 대한마취과학회지

BACKGROUND: The anesthesia machine PhysioFlex was especially constructed to deliver anesthetics in a closed circuit system. In this anesthesia machine the concentrations of the respiratory gases and the gas volume in the circle system are automatically controlled by a feedback mechanism. The aim of this study is to introduce 1,132 patients who have received general anesthesia in a closed circuit system using PhysioFlex, and to calculate the real consumed amount of oxygen and nitrous oxide, and to describe the advantages and disadvantages of PhysioFlex for clinical uses. METHOD: The author used a PhysioFlex in cases of 1,132 various surgical interventions. After induction with thiopentone and suxamethonium, general anesthesia was maintained with nitrous oxide in 50% oxygen and enflurane (or isoflurane, halothane) and supplemented with nalbuphine and pancuronium. These cases were analyzed by their sex, age, height, weight, method of airway maintenance during general anesthesia, operation position, anesthesia time, and arterial blood gases by review of anesthesia records. Average minute-consumed amount of oxygen and nitrous oxide was calculated by recording every 30 seconds throughout the anesthesia procedures except preoxygenation and flush periods. The advantages and disadvantages of PhysioFlex were described on the base of the author's clinical experience. RESULTS: The anesthetic technique of the closed circuit system by PhysioFlex could be used adequately for any surgical procedures. In this system consumed amounts of oxygen and nitrous oxide were 179.72+/-2.48 ml/min and 88.49+/-2.78 ml/min respectively. The author found out several advantages and few disadvantages of PhysioFlex for its clinical uses. CONCLUSIONS: Closed circuit system of PhysioFlex anesthesia machine offer numerous advantages such as reduction of gas consumption, low cost, less pollution in both the operating theater and the environment, increase in inspired gas humidity, easy handling of machine, and excellent respiratory alarm systems.

The Factor that Determines Mechanical Ventilation during Cesarean Section under General Anesthesia: Weight before pregnancy vs. weight during delivery / 대한마취과학회지

BACKGROUND: During general anesthesia the adult patient's tidal volume is determined by patient's weight. Therefore patients with severe ascites, huge abdominal mass or pregnancy have considerable ventilatory change during the operation because the great change in their body weight, that might cause unwanted respiratory alkalosis or acidosis. The purpose of this study is to identify the effects of such changes in ventilation between pre-delivery and post-delivery periods during the cesarean section. METHODS: Eighteen 36weeks or older pregnant patients (ASA 1), scheduled for elective cesarean section under general anesthesia, are selected for the study. PhysioFlex was used for ventilation. Pre-induction maternal gas analysis were performed in all cases. They were randomly divided into two groups according to the ventilator setting for minute ventilation, one set by pre-pregnant weight (Group 1) and the other by pregnant (term) weight (Group 2). Blood gas analysis were performed 5 minutes after induction and 20 minutes after delivery. End-tidal CO2 and inspiratory airway pressure were also measured. RESULTS: All patients show mild hyperventilation with normal acid-base status at pre-induction period. There were no significant differences in arterial PCO2 value between two groups. Group 1 shows mild metabolic acidosis compared with group 2 (by pH at 20 minutes after delivery). CONCLUSION: Term(just prior to operation) body weight rather than pre-pregnant weight is preferable for ventilator setting in the case of cesarean section under general anesthesia.

Humidity of Inspired Gases in Partial Rebreathing Anesthesia Method with and without Bird Humidifier / 대한마취과학회지

BACKGROUND: Adequate humidification of anesthetic gases has been recommended both for the prevention of pulmonary damage during endotracheal anesthesia and for the maintenance of body temperature, especially in long-duration operated patients. Partial rebreathing anesthesia technique frequently lacks adequate humidity. So, this study was designed to compare inspired humidities in partial rebreathing anesthesia method with and without humidifier in the system. METHODS: The author examined inspired humidity using a controlled partial rebreathing anesthesia method with and without Bird humidifier in 10 and 22 healthy adult patients respectively. The patients were divided into two groups (1 and 2). All patients were anesthetized with pancuronium, halothane or enflurane, nitrous oxide-oxygen, 50-50 per cent, and their lungs were mechanically ventilated. Inspired humidity was measured for three hours at 30-min intervals in both groups. RESULTS: Significant differences were found among group 1- and 2-inspired humidities for 3 hours. While group 2-inspired humidity remained constant between 13 and 16 mgH2O/L during entire anesthesia procedure group 1-inspired humidity remained under 9 mgH2O/L. CONCLUSIONS: The humidities in all partial rebreathing anesthesia method with Bird humidifier not only exceeded those of method without humidifier but also seemed to be high enough to prevent dysfunction of tracheobronchial ciliated epithelium, while the standard partial rebreathing anesthesia method does not provide adequate inspired humidity.

The Effects of the Levering Laryngoscope on the Laryngoscopic View / 대한마취과학회지

BACKGROUND: The effects of the levering laryngoscope (McCoy laryngoscope) on the laryngoscopic view classified by the Cormack and Lehane were investigated in this study. METHODS: The laryngoscopic view with the levering laryngoscope blade in neutral and best position were recorded respectively and analysed statistically. RESULTS: 109 laryngoscopic views were grade 1 or 2 and 12 were grade 3 or 4 in the neutral position with the McCoy blade. Only three patients were grade 3 or 4 in its best position and the others grade 1 or 2. The reduction in the incidence of difficult laryngoscopic view (grade 3 or 4) using the levering laryngoscope in its best position was statistically significant (p<0.01). CONCLUSIONS: Levering laryngoscope improves laryngoscopic view and also reduces the incidence of difficult intubation. So, we suggest that it is an useful instrument for the anesthesiologists in the difficult tracheal intubation.

Comparision of Consumed Amount of Volatile Anesthetics between the Closed with PhysioFlex Anesthesia Machine and Semiclosed Anesthesia Systems / 대한마취과학회지

BACKGROUND: A circle system can be closed or semiclosed depending on the amount of fresh gas flow. A closed system is one in which the inflow gas exactly matches that being taken up or consumed by the patient. A semiclosed system is associated with partial rebreathing of gases and is the most commonly used system today. The purpose of this study is to examine the actual consumed amount of volatile anesthetic by closed and semiclosed anesthesia systems. METHODS: Forty-seven patients undergoing general inhalation anesthesia with enflurane and thirty-six patients with isoflurane were examined. Each group was divided into two subgroups by the circle system; enflurane-closed (33 patients), enflurane-semiclosed (14 patients), isoflurane-closed (23 patients), and isoflurane-semiclosed groups (13 patients). Closed system was performed by using PhysioFlex anesthesia machine. The difference of initial (just before anesthesia) and remained (just after anesthesia) enflurane or isoflurane volumes measured by 30 ml-syringe was obtained as consumed amount of anesthetics. This amount was calculated on the base of 1% enflurane or isoflurane for 1 hour anesthesia with a given fresh gas flow (4 to 5 L/min). RESULTS: Consumed amount of liquid enflurane and isoflurane when using closed system was 6.99 +/- 0.26 ml/hr and 4.84 +/- 0.27 ml/hr respectively while 15.99 +/- 1.48 ml/hr and 14.01 +/- 0.92 ml/hr respectively when using semiclosed system. Consumption of liquid anesthetics was significantly lower in closed anesthesia and significantly higher in both systems than those of predicted values. CONCLUSIONS: In closed system by using PhsioFlex anesthesia machine consumed amount of liquid anesthetic for 1 hour anesthesia with 1% of endtidal anesthetic concentration at 25 degrees C, 1 atm and 4 to 5 L/min of fresh gas flow was within 35 to 44% of that in semiclosed system.

Current Status of Outpatient Anesthesia in University Hospitals in Korea / 대한마취과학회지

BACKGROUND: Outpatient procedures account for more than half the operations performed in the United States, but the status of outpatient anesthesia in Korea has not been documented yet. The present study was designed to evaluate the current status of outpatient anesthesia in university hospitals in Korea. METHODS: Thirty-nine university hospitals were surveyed by questionnaire in February 1997. Objects were patients underwent outpatient operations under general, intravenous or regional anesthesia except local anesthesia by surgeon from January 1996 to December 1996. RESULTS: One university hospital started outpatient anesthesia in 1980 and now ten of 39 universities (25.6 %) provide the procedures. In 1995 one of 10 university hospitals has opened day- surgery center having 7 operating rooms and the capability of 24 hours overnight stays. The other 9 hospitals use one of in-patient operating rooms for outpatient procedures. The utility rate per year was 3.06 +/- 1.59 % and 11.49 % in 9 university hospitals and day-surgery center respectively during 1996. Outpatients were mainly classified as physical status 1 and 2 by American Society of Anesthesiologists, and 54.0 38.3 % to 70 % of patients were distributed under 15 years of age. Surgical procedures were relatively simple and 10 surgical departments were participated into the field of outpatient anesthesia. Inhalation techniques and intravenous anesthesia were used predominantly. Complications were sore throat, nausea and vomiting, delayed recovery of consciousness, bleeding at the operative site, fever and so on. CONCLUSIONS: I think that outpatient anesthesia in Korea has grown at very slow rate over the last 4 decades and that it is very low utility rate per year compared to United States. So we have to try to get more interests and supports about the outpatient anesthesia setting.

Management of Anesthesia for Ischiopagus Tetrapus Conjoined Twins / 대한마취과학회지

Only 6% of conjoined twins are of the ischiopagus type in which the twins are joined symmetrically at the pelvis and fusion begins at the level of the common umbilicus. Two sets of female ischiopagus tetrapus conjoined twins were born in August, 1994. The longitudinal axis extended in a straight line in opposite directions and the heart, large vessels, musculo-skeletal system and genitourinary tracts were shared. Tetrapus is a subtype in which all 4 extremities are present. At 20 hours of age, separation was successfully performed under general anesthesia, requiring 185 minutes for twin A and 225 minutes for twin B at the Hanyang University Hospital. We describe the associated anomalies, surgical operation and anesthesia management of these 2 sets of ischiopagus tetrapus twins and now, l year after the operation, the two continue to live.

The Analysis of Anesthetic Management of 156 Infants with Congenital Hypertrophic Pyloric Stenosis / 대한마취과학회지

Congenital hypertrophic pyloric stenosis is one of the most common gasttointestinal abnonnalities occurring in the first six months of life. Although the primary therapy for pyloric stenosis is surgical, it is essential to realize that pyloric stenosis is medical and not a surgical emergency. Preoperative preparation is the primary factor contributing to the low perioperative complication rates and the necessity to recognize fluid and electrolyte imbalance is the key to successful anesthetic management. The anesthetic records of 156 infants with congenital hypertrophic pyloric stenosis were reviewed. Seventy-six per cent of the infants were male(i.e., 3:1 male to female ratio). Surgical correction was undertaken between age of 2 and 3 weeks, and the average weight of the infants at the time of surgery was 3.74+/-0.68 kg. All the infants received general anesthesia for the surgical procedure and assist respiration through the laryngeal mask airway was applied increasingly from 1992. There were no perioperative deaths.

Anesthetic analysis of 428 neonatal cases / 대한마취과학회지

Neonates requiring anesthesia present unique challenges for anesthesiologists. They are very different from children and adults in the point of anatomy, cardiovascular response, respiratory system, central and autonomic nervous system, renal system and fluid balance, metabolism and thermal homeostasis, and pharmacology. In addition, they are frequently associated with congenital anomalies. The object of this study is to analyze the neonates' operation and anesthesia and to improve the outcome. We analyzed the 428 neonates who had received operation from 1979 to 1992 retrospectively. We devided them into four groups by age ; 0-1, 1-2, 2-3, and 3-4 weeks old group, and 0-1 week group is subdivided into preterm and full term one. The results were as follows ; 1. The rate of male versus female was 2.2: 1 (68.7: 31.3%) and 54.2% of them had been operated under 1 week old age. 2. The incidence of operated diseases is in order of congenital megacolon (15.9%), imperforate anus (15.9%) and pyloric stenosis (10.5%). 3. Operating time was within 2 hours in almost cases (95.7%) except tracheo-esophageal fistula (141.82+/-43.49 minutes). And the disease having operated in the shortest duration was inguinal hernia (19.29+/-16.15 minutes). 4. Patients with duodenal atresia, gastroschisis, omphalocele, diaphragmatic hemia, and tracheo -esophageal fistula were somewhat associated with congenital anomalies and the mortality was 10.5 to 33.3%. 5. Endotracheal intubation was achieved by mask inhalation in 76.4% and remains by using intravenous drugs. 6. There was not used any neuromuscular blocking agents thorough the operation procedure in 133 cases (48.4%). 7. Breathing circuit for anesthesia was Mapleson F system in all and the airway was kept with endotracheal tube (91.3%), mask (5.1%), and laryngeal mask airway (3.6%). 8. There were about 40% of patients with tracheo-esophageal fistula, sacrococcygeal anomalies, diaphragmatic hernia, omphalocele, and gastroschisis requiring special respiratory care, that is, keeping endotracheal intubation and ventilator for certain postoperative period. 9. Overall rate of emergency operation was 61%, but it was 73% in 0-1 week old neonates. 10. Mortality of operation for neonates was 7.7% and it occurred mainly in the pateints with gastroschisis, omphalocele, duodenal atresia, diaphragmatic hernia, imperforate anus, and tracheo- esophageal fistula. But there was only 1.6% mortality during 24 hours after operation. With the above results I suggested that shortening of operation time and skilled anesthesia could markedly improved the outcome of operation for neonates. And to achieve the goal all neonatal surgeons and anesthesiologists will have to get many experiences and knowledge about the neonate pathophysiologic conditions and pharmacologic responses.

Factors Influencing the Immediate Neonatal Outcome Following Cesarean Section / 대한마취과학회지

Various factors ; i.e., maternal and fetal conditions, method of ansthesia, induction delivery time (IDT), induction uterine incision time (1UT), uterine incision - delivery time (UDT), surgical experience (specialists vs. residents), and gestational age ; which might intluence neonatal outcome follwing cesarean section were investigated in sixty-one patients who underwent cesarean section at Han Yang University Hospital between August 1992 and March 1993. Neonatal outcome was assessed by 1-and 5-minute Apgar scores, and umbilical vein blood gas analysis (UVBGA) taken immediately after birth. The results were as follows. 1) Preoperative maternal conditions did not affect neonatal outcome. For the neonates of normal and abnormal maternal conditions, the 1-minute Apgar score were 7.2+/-1.0 and 6.8+/-1.0, respectively. In the same groups of neonates, The UVBGA showed pHa 7.33+/-0.04 and 7.33+/-0.05; PaCO2 44.7+/-5.1 and 44.4+/-7.4 mmHg; PaO2 30.5+/-7.1 and 27.9+/-6.3 mmHg; and BE -2.7+/-3.5 and -3.8+/-3.5 mEq/L, respectively. 2) Method of anesthesia did not change neonatal outcome. In the general and epidural anestheia groups, the 1- minute Apgar scores were 7.1+/-1.0 and 7.3+/-0.8, respectively. The UVBGA in the same groups showed pHa 7.33+/-0.05, 7.34+/-0.03; PaCO2 44.6+/-6.1, 41.0+/-6.1 mmHg ; PaO2 29.5+/-6.8, 28.7+/-6.6 mmHg; and BE -3.2+/-3.5, -4.0+/-3.6 mEq/L, respectively. 3) IDT did not influence neonatal outcome. In the groups with IDT exceeding or equal to 10 ininutes and less than 10 minutes, the 1-minute Apgar scores were 7.2+/-1.0 and 7.0+/-1.0 with IDT, respectively. In the same groups, the UVBGA revealed pHa 7.33+/-0.04, 7.33+/-0.05; PaCO2 40.0+/-6.2, 44.9+/-6.1 mmHg; PaO2 28.8+/-7.1, 29.9+/-6.7 mmHg; and BE -2.8+/-3.5, -3.8+/-3.5 mEq/L, respectively. IDT was more than 10 minutes in all epidural anesthesia cases. 4) In the groups with UDT more than or equal to 3 minutes and less than 3 minutes, the 1- minute Apgar scores were 7.0+/-1.1 and 6.7+/-1.6, respectively. In the same groups, the UVBGA revealed pHa 7.32+/-0.05, 7.33+/-0.05; PaCO2 41.8+/-5.1, 44.4+/-6.4 mmHg; PaO2 28.3+/-6.2, 29.5+/-6.9 mmHg; and BE -3.9+/-3.6, -5.0+/-2.8 mEq/L, respectively. 5) Surgical experience did not contribute to the neonatal outcome. The 1-minute Apgar scores were 7.2+/-1.0 and 7.0+/-1.1 in the groups where cesarean section were performed by specialists and residents, respectively. UVBGA showed PHa 7.33+/-0.04, 7.32+/-0.06; PaCO2 44.8+/-6.5, 44.3+/-5.8 mmHg; PaO2 30.2+/-6.9, 28.5+/-6.9 mmHg; and BE -2.6+/-3.4, -3.9+/-3.6 mEq/L, respectively in the same groups. 6) Gestational age, determined as fullterm or preterm did not influence neonatal outcome. In the fullterm and preterm neonates, the 1-minute Apgar scores were 7.1+/-1.0 and 6.6+/-1.1, respectively. UVBGA showed pHa 7.33+/-0.05, 7.32+/-0.05; PaCO2 44.5+/-6.3, 45.0+/-4.9 mmHg ; PaO2 29.4+/-6.9, 30.0+/-6.6 mmHg ; and BE -3.2+3.6, -2.7+2.1 mEq/L respectivly. It appears that maternal and fetal conditions, method of anesthesia, IDT and UDT, experience of surgery, and gestational age do not influence post-cesarean neonatal outcome.