Two Case Report on Anesthesia for Pheochromocytoma / 대한마취과학회지

The following is a report of the anesthetic experience in the surgical management of two cases of surgery for pheochromocytoma performed at Maryknoll Hospital, Busan, between the dates of June and July, 1982, The report covers the pre-surgical tests and the laboratory results on the two cases, which was similar, and the anesthetic agents halothane and enflurane, was used on the cases, respectively. During surgery using the anesthetic agent halothane, which was chosen because of the high blood pressure of the patient, and our effect to control it, we encountered dangerous arrythmia. In the case where enflurane was the anesthetic agent uaed, it was found that while the blood pressure of the patient was more difficult to control, the incidence of arrythmias was much less frequent. In one of the cases, becsuse of hemorrhage from the operative site during the immediate surgical period, re-exploration was done with adequate replacement of whole blood and catecholamines administered as needed during the anesthetic management. In comparing the two cases, the one case in which alpha-sdrenergic blockers were not administered during the pre-surgical period, when compared with the case in which the the blockers were used, showed, after removal ef the tumor, a decrease in the need for alpha-adrenergic stimulators.

Management of Diskogenic Pain using Epidural Steroids / 대한마취과학회지

Ever since Mixter and Barr demonstrated the relationship between disk protrusion and radicular pain nearly 50 years ago, there has been a swing toward mechanical explanations for all problems of this type. Murphy has proposed that inflammation rather than mechanical pressure is the basis of back pain and sciatica, and that the causal irritant is likely to be a chemical product of disk degeneration. That administration of steroids reduces the inflammatory process is well known. The present study was undertaken to acess our experience in using epidural steroid injection ofr patients suffering from diskogenic low back pain. Ten patients with the clinical diagnosis of sciatica and with post larninectomy sequelae were referred to the anesthesia department of Maryknoll hospital. Our routine epidural injection of the lumbar spine(L3-4) consists of 2ml of 2% xylocaine and 120mg of methylprednisolone(Depo medrol). Following the injection of Depo Medrol patients were encouraged to ambulate actively and were asked to evaluate their subsequent pain relief. Of the 10 patients studied, all patients experience pain relief within 10 minutes of the epidural injection. A follow up study of these patients was done between 5 and 10 months after injection. The results were as follows: 1) 3 patients: Complete relief. 2) 3 patients: moderate relief. 3) 3 patients: no relief. 4) 1 patient: technical failure.

A Clinical Survey of 18,413 Cases of Anesthesia / 대한마취과학회지

A total of 18,413 cases had anesthesia at Maryknoll Hospital in Pusan from January 1970 to December 1979. These data were analyzed statistically and the following results were obtained. 1) The number of general anesthesia cases steadily increased while those of local anesthesia decreased. 2) Of all departments, general surgery had the largest number of cases. 3) Sex ratio was equal when the OB-GYN cases were included. 4) The 20-30yr age group numbered nearly the total number of cases. 5) Geriatric and pediatric cases increased progressively. 6) Among anesthetic agents used, ether was used mostly, but halothane was used with increasing frequency. 7) Of the anesthetic techniques used in general anesthesia, the circle system was mostly used and the non-rebreathing system was used for all pediatric cases, which also have increased in number. 8) For induction of anesthesia, thiopental sodium was mainly used. Since 1975, pancuronium was mainly used in addition to S.C.C. fro muscle relaxation.

Clinical Observation of the Induction of General Anesthesia with Propanidid for Cesarean-Section / 대한마취과학회지

To evaluate the maternal and fetal effects of propanidid, clinical observations were carried out in 160 cases of Cesarean section out of 4, 230 deliveries made during the past three years. Upon having the obstetricians ready for incision, 10ml. of 5 per cent propanidid and 40mg. of succinylcholine chloride were administered intravenously, and surgery was begun almost simultaneously with endotracheal intubabation. Thereafter, anesthesia was maintained with N2O-O2-fluothane, N2O-O2 -ether, or ether-O2 in semiclosed circle absorption system. Umbilical cord was ligated within 3-5 minutes after the commencement of induction. This method of anesthesia did not seriously affect the maternal respiration or circulation, and Apgar scores were good or fair in the majority of cases. No undesirable side effects or complications directly attributable to propanidid were encountered.

Clinical Experience with Acute Pulmonary Edema during Operation and Anesthesia / 대한마취과학회지

The authors have experienced with two cases of acute pulmonary edema; one underwent an intestinal resection under local anesthesia for panperitonitis due to typhoid perforation, and the other under general anesthesia received splenectomy and mesocaval shunt for portal hypertension and splenomegaly. There are many predisposing factors for acute pulmonary edema, namely, left sided heart failure due to cardiac diseases or overloading, pulmonary capillary endothelial damages from bacterial infections, toxins or irritant gases, oxygen poisoning, water (especially salt water) drowning, rarely central nervous system injuries and pulmonary hypersensitivity reactions. For the cases presented, we believe that overloading was the causative factor. There are many preventive measures and treatment for acute pulmonary edema. However in such cases as these, we conclude that prompt recognition and attention by the anesthesiologisis are the most important preventive measure.