The metabolic Effects of Torniquet in the Adult Lower Extremity / 대한마취과학회지

The use of a pneumatic torniquet to obtain a blood less field in the extremities is essential in the precise operations of present-day plastic and orthopedic surgery. There have been studies conducted regarding systemic and metabolic change in response to torniquet ischemia and complication, associated with torniquets have been reported such as injuries to nerves, muscles and blood vessel. The purpose of this investigation was to examine changes in the systemic circulation, blood gases serum potassium and base status on release of torniquet ischemia in adult. The results were as follows: 1) The mean blood pressure and heart rate did not change significantly after torniquet release. 2) The pH decreased significantly after the torniquet release. 3) The PaO2, and PaCO2, did not charge significantly after torniquet release. 4) The HCO3, and BE decreased significantly after torniquet release (P<0.05). 5) The serum potassium levels tended to increase after torniquet release but the changes was not significant. There-fore to minimize the predictable complications, the ventilatory control and rapid volume replacement are needed during the time immediately preceeding and following torniquet release.

A Clinical Study of Complications Following Percutaneous Arterial Connulation / 대한마취과학회지

Cannulation of the arterial system is an invasive monitoring technique that readily is justified by its high information yield and minimal discomfort and risk to the patient and is commonly performed in the ICU and operating room, allowing continuous monitoring and graphic display of the systemic arterial blood pressure, and repeated analysis of arterial blood gases. The major complications subsequent to cannulation are thrombosis and occlusion pain at the puncture site, hematoms and infection. We performed a clinical study on complications following percutaneous arterial cannulation in 378 patients with radial artery cannulation and 172 patients with dorsalis pedis artery cannulation who had undergone surgery at Kyung Hee University Hospital from April to September, 1987. The patients were examined to confirm the patency of the collateral circulation of the hand and foot before cannulation and the frequency of complication was studied by physical examination and the Doppier technique on the 1st, 7th and 10th days after decannulation. The results were as follows: 1) The most common complication of radial artery cannulation was ecchymosis(41.8%) and the next common complications were abnormal blood flow(17.5%), abnormal pulse (13.2%), sensory change(1.3%) and infection(0.3%). 2) The most common complication of dorsalis pedis artery cannulation was ecchymosis(34.9%) and the next common complications were abnormal blood flow(19.8%), abnormal pulse(12.8%), sensory chang(1.7%) and infection(0.6%). 3) The crrelation of sex, duration of cannulation, number of punctures and age to the incidence of abnormal flow was studied in both arteries. Abnormal flow was only significantly related to females(p<0.05) in both arteries. 4) The correlation of both arteries to the incidence of abnormal flow under several circumstances was studied. But neither artery did not revealed a significant difference to the incidence of abnormal flow. 5) No permanent ischemic damage to the hand or foot occurred in any patient in this study. Therefore, we concluded that radial artery cannulation is a low-risk highly beneficial monitoring technique and careful dorsalis pedis artery cannulation provides a relatively safe, reliable and available to the radial artery with caution.

The Effects of Hyperventilation on Acid - Base Changes in Arterial Blood and the Cerebrospinal Fluid during Anesthesia / 대한마취과학회지

The use of controlled hyperventilation during neurosurgical procedures prevents the deleterious effects of hypercarbia on the cerebral blood flow and intracranial pressure. hyperventilation with hypocarbia produces cerebral vasoconstriction, reduced cerebral blood flow and a reduction in brain size in the majority of patients with increased intracranial pressure. But since excessive cerebral vasoconstriction might induce cerebral ischemia, there has been much discussion concerning the optimal level of hypocarbia. Several studies have shown biochemical evidence of a change in cerebral glucose utilization to anaerobic metabolism during hypocarbia. In our investigation, the effect of hyperventilation on 10 neurosurgical patients was evaluated by blood gas analysis and the estimation of lackate and pyruvate in arterial blood and the cerebrospinal fluid. The results were as follows: 1) PaCO2 decreased from a prearesthetic value of 38+/-2.2 mmHg to 22+/-2.1mmHg 1 hour postinduction and 24+/-2.2mmHg at 2 hours due to hyperventilation. pH was 7.58+/-0.047 1 hour postinduction and 7.56+/-0.018 at 2 hours. PaO2 was 251+/-33.0mmHg 1 hour postinduction 1 hour and 215+/-20.9mmHg at 2 hours under a 50% inspired oxygen concentration(FiO2=0.5). 2) The arterial blood lactate value increased statistically significantly from a preanesthetic value of 9.3+/-1.5mg% to 11.8+/-1.47mg% 1 hour postinduction(p<0.01) to 12.5+/-1.53mg% at 2 hours(p<0.005). However all values were within the normal range(4.7+/-15.1mg%), and the lacte/pyruvate ratio did not change. 3) In the cerebrospinal fluid, pH was 7.45+/-0.057, PCO2 was 34+/-3.5mmHg and PO2 was 91+/-6.7mmHg following hyperventilation for 1 hour. The lactate value of the cerebrospinal fluid was 19.2+/-3.14mg%(normal range: 11.0~27.0mg%) and the lactate/pyruvate ration was 14.5+/-2.39. 4) No evidence of an excessive increase in CSF lactate was seen in any case. The above findings suggest that maintenance of an adequate oxygen concentration and a carbon dioxide value over 20mmHg would prevent cerebral ischemia following hypocarbia due to hyperventilation.

The Effect of Extracorporeal Circulation on Serum Angiotensin Converting Enzyme ( SACE ) Levels / 대한마취과학회지

It is well known that the pulmonary capillary endothelium is rich in angiotensin converting enzyme(ACE), which is released in the event of smoking, acute lung injury, or some lung diseases such as Gauchers disease and hypertension. Serum ACE levels may be clinically useful because they are reflections of pulmonary circulation. In order to evaluate the effect of extracorporeal circulation and pulmonary perfusion on serum ACE levels, we measured serum ACE level during prebypass, total bypass(5', 30', 60') and pulmonary perfusion (30', 60', 24 hrs.) in 10 open-heart patients. The results were as follows: 1) The SACE level before the begining of extracorporeal circulation was 10.03+/-1.66u/ml and decreased significantly to 2.79+/-0.63u/ml(p<0.005) 5min. after extracorporeal circulation was initiated. 2) The decreased SACE level seen during extracorporeal circulation returned to a nearly normal (9.33+/-1.8u/ml) 24hrs. after pulmonary perfusion. 3) There were no significant correlations between the SACE level and the variation of age during extracorporeal circulation and pulmonary perfusion. The above results suggest that SACE levels are proportional to the amount of pulmonary blood flow.

Effect of Aminophylilne on the Adenosine-induced Decrease in Sinus Rate / 대한마취과학회지

Since the first report by Drury and Szent-Gyorgyi in 1929, the inhibitory influences of adenosine on the heart have repeatedly been described by many investigators. A lot of investigations on the working mechanisms of adenosine have been focused mainly on the effects on the coronary blood flow. However, the cellular mechanisms underlyiag the inhibitory action of adenosine on the SA node are not well understood yet. Furthe-rmore, the physiological role of adenosine in the regulation of the heart beat remains still to be explored. Thus, this study was undertaken to examine the behavior of the rabbit SA node ander the influence of adenosine, and the interactions between adenosine and aminophylline on the SA node, and then to compare these results with those of acetylcholine. At the same dosage range, adenosine suppressed the sinus rate and atrial contractility even in the reserpinized preparation. The spontaneous firing rate of the SA node at 35degrees C (mean+/-SEM, n=16) was 154+/-3.3 beats/min. The parameters of action potential were: maximum diastolic potential(MDP), -73+/-1,7 mV; overshoot(OS), 9+/-1.4 mV; slope of pacemaker potential(SPP), 94+/-3.0 mV/sec. Adenosine suppressed the firing rate of the SA node in a dose-dependent manner. This inhibitory effect appeared at the concentration of 10(-4)M and was potentiated in parallel with the increase in adenosine concentration. Changes in the action potential by adenosine were dose-dependent as show by the increase of MDP and the decrease of SPP until 10(-4)M. Above this concentration, however, the amplitude of the action potential decreased markedly due to the simultaneous decrease of both MDP and OS. Dipyridamole, which is known to block the adenosine transport aross the cell membrane, definately potentiated the action of adenosine. The effects of adenosine on the SA node were inhibited by aminophylline. However, the similar effects of acetylcholine to those of adenosine were not reversed by aminophylline. These results suggest that adenosine suppressed the pacemaker activity by acting dire-ctly on the membrane of the SA node, and the effects of adenosine on SA node are sele-ctively inhibited by aminophylline.

The Effects of Intrathecal Morphine on Pulmonary Function after Upper Abdominal Surgery / 대한마취과학회지

In order to study the effect of spinal nareotics on postoperative pulmonary function and ventilatory reserve after upper abdominal surgery, small preoperative doses of morphine were administrated into the subarachnoidal space and the changes in FVC, FEVi.e., MMEF and FEVi.e./FVC with the SC-20 spirometric computer wer evaluated. The results were as follows: 1) On the 1st day postoperatively FVC of the control group was 56% of the preperative value, 2.94+/-0.68(1/sec), and that of the morphine group was 66% of the preoperative value, 2.99+/-0.73(1/sec).(p<0.05) On the 2nd and 3rd day postoperatively the control group was 64% and 65% and that of the morphine group was 82% and 87%. (p<0.05) 2) On the 1st and 2nd postoperative day FEVi.e. of the control group was 52% and 57% of the preoperative value, 2.49+/-0.43(1/sec), and that of the morphine group was 61%, and 65% of the preoperative value, 2.42+/-0.68(1/sec). (p<0.05) On the 3rd postoperative day the FEVi.e. of the control group was 65% and that of the morphine group was 80%. (p<0.05) 3) On the 1st and 2nd postoperative day the MMEF of the control group was 56%, and 61% of the preoperative value, 2.45+/-0.77(1/sec). In the 3rd postoperative day the MMEF on the control group was 63% and that of the morphine group was 78%. (p<0.01) 4) The preoperative FEVi.e./FVC of the control group was 84.3% and that of the morphine group was 78.7%. in the postoperative period, there were no significant differences between the control and morphine group.

The Influence of Age on the Sleeping Dosage of Thiopental / 대한마취과학회지

For many years it has been known that the dosage of thiopental required to induce anesthesia depends on the age of the patient, but this information ha resulted from clinical experience with the drugs rather than from planned study. In our study, to elucidate the influence of age on the size of the sleeping dosage of thiopental, 144 patients who underwent minor orthopedic and gynecological operations were studied. This patients had no evidence of a disease other than that scheduled for operation and were within normal values in hematologic examination, liver function and kidney function. Using a simple "yes" or "no" verbal command response, as sleeping response, to a single bolus of thiopental in mg/kg body weight, we have attemted to minimize uncontroliable factors such as cerebral perfusion, circulation time and plasma protein binding which would alter response to thiopental infusions continued to the end points. The results were as follows: 1) There was no statistical difference in verbal command response to thiopental according to age in age groups below 59 years. 2) Compared with age groups below 59 years, 60~79yrs, group failed to respond to the verbal command in 33% by 2.2mg/kg and 100% by above 2.6mg/kg.(p<0.05) 3) The mean time for loss of verbal command response after thiopental injection was 27.4+/-10.3 seconds and 80.4% of theses patients lost lid reflex with a mean time of 41.7+/-9.1 seconds after thiopental injection. 4) All groups showed statistically non-significant alterations of systolic blood pressure and heart rate after injection of thiopental.

An Experimental Study on the Effect of Thiopental on Glutamic Oxaloacetic Transaminase Isozyme in Adult Rabbit Brain / 대한마취과학회지

In order to determine the enzyme activity, as expressed in Reitman-Frankel unit, of GOT isozyme present in whole homogenate, mitochondrial fraction and supernatant fraction were prepared from brain tissues of normal adult rabbit, by a differential centrifugal method. The effect of thiopental on the GOT isozyme activity in each fraction was determined and the following results were obtained. 1) The activity of GOT isozyme in whole homogenate of normal rabbit brain tissues was found to be 545+/-2.608 units/mg of wet weight whereas the corresponding figure for the supernatant GOT isozyme was 512+/-3.081 and the value for the mitochondrial GOT isozyme was found to be 34.9+/-1.224. 2) The supernatant GOT isozyme existing in a floating status within the cytoplasm accounted for 94 percent followed by 6.35 percent of mitochondrial GOT isozyme. 3) The activated-peak of mitochondrial GOT isozyme contained in the whole homogenate of adult rabbit brain tissues was found to be at #15 on the tube of elution in comparison to that of #73 for supernatant GOT isozyme, as analyzed by the DEAE-Cellulose column chromasography. 4) The supernant GOT isozyme from the thiopentaltreated brain was proportionaly distorted while mitochondrial GOT isozyme was not influenced. Fro example, treated with thiopental, the supernatant GOT isozyme was divided to be #63 & #73 on the tube in comparison to #15 for the mitochondrial GOT isozyme. 5) The activity of supernatant isozyme was proportionaly reduced as the concentration of thiopental. 6) Fifty percent inhibition dose(1se) of thiopental on the supernatant GOT isozyme was found to be 0.63mM. 7) The inhibitory effect of thiopental on the supernatant GOT isozyme was very high significantly by the statistics. 8) The mchanism by which thiopental inhibits the supernatant GOT isozyme in the adult rabbit brain was found to bh uncompetitive inhibition as its Michaelis-Menten constant Km=58.07mM demonstrated. In view of the above finding it is suggested that the thiopental inhibited selectively the activity of supernatant GOT isozyme of the adult rabbit brain tissues while it did not inhibitnificantly by the statistics. 8) The mechanism by which thiopental inhibits the supernatant GOT isozyme in the adult rabbit brain was found to bh uncompetitive inhibition as it Michaelis-Menten constant of Km=58.07 mM demonstrated. In view of the above findings it is suggested that the thiopental inhibited selectively the activity of supernatant GOT isozyme of the adult rabbit brain tissues while it did not inhibit that of mitochondrial GOT isozyme. The GOT isozyme of adult rabbit brain tissues was divided into thiopental-sensitive GOT isozyme(supernatant GOT isozyme) and thiopental insensitive GOT isozyme(mitochondrial GOT isozyme) Furthermore, it is suggested that the cellular function of the brain can be somewhat hindered, when thiopental is injected into the brain cell, while mitosis of the brain cell is not influenced.

An Experimental Study on the Pressor Effect of Naloxone-HCI and the Changes of Plasma Beta-Endorphin Level in Shock / 대한마취과학회지

It is known that the cardiovascular system is extremely sensitive to the effect of both exogenous and endogenous opiates. In rabbits, less than 1% of the usual morphine dose necessary to produce antinociception results in significant hypotension and bradycardia. The endozenous opiate, beta-endorphin, is stored along with pitulatary adrenocorticotorphin(ACTH), and the action of stressors seems to result in the release of both peptides. Therefore it seems likely that beta-endorphin is released during stress such as shock and that it might contribute to the hypotension. In order to probe this hypothesis, hypovolemic and endotoxin shock model were produced in rabbits. If these hemorrhage and endotoxin induced hypotension were mediated through the beta-endorphin release, the blockade of beta-endorphin should reverse such hypotension. Using the specific opiate antagonist, Naloxone-HCl, these hypotensions could be reversed and prevented as following results show, 1) As compared with the saline control, the hypovolemic shock experiment had a 36.49+/-14.44% increase in mean arterial pressure(MAP) within 2 to 3 minutes and the endotoxin shock had a 52.43+/-23.66% increase in MAP within 5 to 6 minutes after naloxone treatment (0.4mg/kg). 2) AS compared with the saline control, in both hypovolemic and endotoxin shock naloxone pretreatment(0.4mg/kg) could prevent the decrease of MAP significantly. 3) No significant difference were seen in heart rate between the control and both experimental groups. And plasma bets-endorphin was measured by radioimmunoassay(RIA), using beta-endorphin kit(Immunonucler corportion, Stillwater, Minnesota, USA) and Beckman 8,000 tau-Counter, in these shock model with following results. 1) Hemorrhage and endotoxin induced shock produced a significant increase in plasma beta-endorphin to about 3 times control and reversed by naloxone treatment(0.4mg/kg) significantly as compared with saline control. 2) AS compared with the saline control, in both hypovolemic and endotoxin experiments naloxone pretreatment(0.4mg/kg) could prevent the increase of plasma beta-endorphin significantly.

The Comparative Study of Central Venous Pressure Measurements during Mechanical Ventilation and after Disconnection of Ventilation / 대한마취과학회지

Continuous monitoring of central venous pressure is now considered standard practice in the management of the critically ill patients. Some of these patients require support by mechanical ventilation, often with the concomitant use of PEEP. To determine the existence and amgnitude of systemic differences during mechanical ventilation and after disconnection of ventilation, we studied 120 central venous pressure measurements serially. The results show that mechanical ventilation reading were 11.0 CmH2O (+/-2.53) and ventilation disconnection readings were 8.0CmH2O(+/-2.39) with a mean difference of 3.0 CmH2O. both mechanical ventilation and ventilation disconnection readings were sensitive to hemodynamic changes when taken continuously. We feel that mechanical ventilation readings will more accurately reflect the patient's cariopulmonary status during ventilation support.

Clinical Estimation of L/S rations in the Neonatsl Lung by a Foam Stability Test / 대한마취과학회지

Respiratory distress syndrome(RDS) in the newborn infants is a problem of great importance, not only to the obstetrician and pediatrician but also to the anesthesiologist. RDS is a frequent result of premature birth and occasionally occurs in full term infants. The need for estimation of fetal maturity by amniocentesis is especially indicated when early termination of pregnancy is required in cases of diabetes, Rh sensitization, hypertensive, poor obstetrical history and onset of premature labor, when the decision to attempt to stop labor must be made. A Foam-stability test was performed on 54 samples of amniotic fluid to assess its practical value as a rapid method of confirming adequate surface activity in the neonatal lung. The results of the test were compared with the lecithin-sphingomyelin ratio, gestational age, birth weight and clinical RDS. The results obtained were as follows: 1) Of the 46 cases with the foam test positive, none of the new born infants developed clinical RDS and their mean L/S ration was 3.6+/-0.2. 2) All of the newborn infants with the foam test negative developed clinical RDS and their mean L/S ration was 1.5+/-0.2. 3) In 5 cases with an intermediate test, one who had L/S ration 2.0 showed mild and transient clinical RDS. 4) These results suggest that the foam test is a reliable index of neonatal lung maturity and high predictive value for RDS, when applied to uncontaminated amniotic fluid.

Anesthetic Management for the Patient with Von Gierke`s Diseases / 대한마취과학회지

Glycogen storage disease is a rare metabolic disorder of significant to the anesthesiologist. The term "glycogen storage disease" is applied to a group of congenital and familial disorders characterised by depostion of abnormally large or small quantities of glycogen in the tissues. 13 types of glycogen storage diseases have been described, classified on the basis of enzyme deficiencies. Type l glycogen storage disease (von Gierke's Disease) is the most common of this constellation of syndromes. The basic defect is a deficiency of enzyme, glucose-6-phosphatase. The patient has hepatomegaly, renomegaly, stunted growth, a tend toward severe hypoglycemia and acidoais. The adverse effect of the combined anesthetic and surgical procedure during operation was reflected in a deterioration of the patients's biochemical parameters. A cardiac arrest after tonsillectomy of the patient with Von Gierke's disease was reported and this fact cmphasizes serious anesthetic problems during operation. Anesthetic management of these patients should focus on prevention of hypoglycemia and lactic acidosis. The careful frequent measuring of the acid-base status is highly recommended and is essential prior to and during andy surgical procedure. We report a case of anesthetic management for a patient with Von Gierke's desease ane review anesthetic problems for these patients.

A Case of Segmental Bronchial Obstruction with Mucus Plug during General Anesthesia with Endotracheal Intubation / 대한마취과학회지

It may be the most important problem to keep the patent airway during a general anesthetic procedure or when emergency patient care is necessary. Endotracheal intubation facilitates to keep the airway. But unfortunately, we are confronted with complications of endotracheal intubation, occasionally. The authors experienced a case of segmental bronchial obstruction with mucus plug and successfully remedied by fiberoptic bronchoscopic aspiration through the endotracheal tube.

An Anesthetic Experience of Massive Tumor Embolism during Lung Tumor Surgery / 대한마취과학회지

Sudden operative death due to massive tumor embolism occurred during operation. During the course of anesthesia for pneumonectomy, this 54-year-old male patients showed continuous hypotension, weak or absent pulse of radial, external carotid, femoral and doralis pedis artery of the right side. But those of the other side were within normal range and anesthesia went on uneventfully. As the patient failed to gain consciousness postoperatively, immediate emboleetomy under general anesthesia was performed under the impression of massive tumor embolism. Multiple tumor emboli were removed from the innominate arteries, right common carotid and right brachial artery. After operation of embolectomy, arterial blood pressure and pulse measured on the right side were regained. However, the patient failed to return to his consciousness and died due to unexpected cardiac arrest, 2 days later.

Post Operative Alopecia / 대한마취과학회지

Alopecia has been described as associated with diseases of the endorine glands, various tension state and emotional shock, and as a result of reflex irritation from traumatic injuries. Recently we have observed 3 cases of distinctive type of alopecia after long timed microvascular surgery in which a long-standing pressure to the occiput, seemed to be responsible. All patients noted swelling, exudation and crust formation over the occiput shortly after the operation and usually within the 2 days. Some times there was tenderness. Hair loss occurred from 7 days and regrowth of hair appeared from 30 days with non-specific therapy to hair loss. Histopathologic microscopic findings showed that there were mild chronic perivascular inflammatory reactions.

A Clinical Study of Anesthesia for Emergency Surgery / 대한마취과학회지

We have performed 1,822 anesthetics for emergency surgery at the Kyung Hee University Hospital from Jan 1977 to June, 1978, which were analyzed clinically and statistically according to age, sex, physical status, anesthetic method, duration, peroperative patient state and postoperative mortality. The results were as follows. 1) More than half of the total cases were patients in the second and third decade of age. 2) According to the A.S.A. classification of physical status, patients in emergency class II were 51.4% 3) Emergency surgery was 26.1%, of total surgical cases. 4) The most frequent emergency operations were done by general surgery(42.5%), and orthopedic surgery (25. 0%). 5) Most common diseases, in order, were appendicitis(482 cases), trauma of upper extremities(236 cases), Cesarean section(196 cases), ectopic pregnancy(135 cases), trauma of lower extremities(97 cases), and panperitonitis(80 cases). 6) The most common anesthetic technique for emergency surgery was general anesthesia (84.6%) and next was spinal anesthesia(12.5%). 7) The average duration of the 1, 822 emergency surgical procedure was two hours and twelve minutes. 8) The cases with transfusion during operation were 23.8% (434 cases) of the total cases (1,822 cases), 9) Postoperative mortality rate within 2 days was 1.0%(18 cases).

General Anesthesia for Carolis Disease / 대한마취과학회지

Caroli's disease is associated with the combination of congenital dilation of the intrahepatic bile ducts, polycystic disease of the kidney and congenital hepatic fibrosis. The disease entity was first reported by Caroli and associates(1958) and was extensively reviewed in a monograph by Caroli and Corcos (1964). The original first description of Carolis disease is characterized by congenital saccular dilation of the intrahepatic bile ducts, a high incidence of stone formation and cholangitis, absence of hepatic fibrosis and portal hypertension but associated with renal tubular ectasia or other forms of cystic disease of the kidneys, possibly of the pancreas. However the pure form, as described above, has been uncommon. We have experience with a case of general anesthesia for a 12 year old female patient who had Caroli's disease, which was confirmed preoperatively by computerized tomography in Kyung Hee Medical Center. As the Carolis disease may involve hypofunction of the liver and kidney, anesthetics with less action on the liver and kidney are-preferable. This patient was premedicated with atropine and meperidine. Anesthesia was induced with thiopental and succinylcholine for intubation, then maintained with N2O-O2 pancuronium and meperidine. The anesthetic and immediate postoperative course was uneventful, but the patient expired with expected cardiac arrest one week later.

A Economic Device of Gas Evacuator designed with Angle Stop Valve / 대한마취과학회지

Recent studies suggest possible deleterious effects of chronic exposure to certain common anesthetic agents. A simple and economic gas evacuator was designed with an angle stop valve of a water pipc system which was easily purchased from a hardware store. The device was installed as follows: 1) The pop-off valve assembly of an Ohio Unitrol anesthesia machine was removed and replaced with atail-piece of an angle stop valve with a new screw which was made to fit in place. 2) The disk of the angle stop valve was fixed in place with adhesive cement. 3) The tail nut and tail packing of the angle stop valve were replaced with the same caliver long vinyl hose, which eliminated overflow anesthetic gases from the anesthesia machine air vent system of the operating room. This device is inexpensive and simple to operate and is being used successfully in routine clinical practice.

Clinical Application of ThaIamonaI-Pentothal-N2O-O2 Anesthesia / 대한마취과학회지

The authors have introduced a method of Thalamonai dripping with 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 Pavulon as well as N2O inhnlation. From 21 cases, the following results were obtained: 1) Average dose of fentanyl as a premedicant was l. 143ug/kg (Thalamonal, 0. 023cc/kg). 2) Average dose of fentanyl during induction of anesthesia was 3. 48ug/kg (ThaJamonal, 0, 695 cc/10kg), and concomitant injection of Pentothal (average, l. 83mg/kg) achieved rapid and smooth induction of anesthesia. During induction, changes of blood pressure and pulse rate were insignificant. 3) Intermittent injections of Thalamonal for maintenance of anesthesia were needed at every 30 minute interval, and average dose of fentanyl was 0.64ug/kg/30min. 4) Seventeen cases among 21 recovered promptly after discontinuation of N2O, and the recovery was delayed in the, remainder. Two patients had awareness without pain during operation, Delayed recovery of consciousness seemed related to overdosage of the droperidol component in Thalamonal, but not to total operating time.

A Clinical Study on Hemolysis during Transfusian of Bank Blood / 대한마취과학회지

During massive transfusions especially under pressure, considerable hemolysis has been expected. It had been assumed that hernolysis would increase with increasing age of the bank blood, increasing pressure and with decreasing bore of the needle. Moss and Stauntan, however, found that hemolysis actually increased when blood was forced through larger bore needles. The authors have studied the magnitude of hemolysis according to various needle sizes under ordinary clinical transfusion conditions, and concluded as follows: 1) Hemolysis was maximum when a 18G needle was used and minimum with use of a 22G. needle regardless of the age and temperature of the bank blood, 2) Hemolysis increased with increasing age of the bank blood. 3) When the needle size was constant, hemolysis was not affected by warming of the bank blood.