Necrotizing Fasciitis of the Low Extremity / 대한정형외과학회잡지

PURPOSE: To describe the clinical presentation and course of necrotizing fasciitis of low extremity and to analyze the factors affecting the clinical result of necrotizing fasciitis. MATERIALS AND METHODS: The medical records and MRI of 26 patient who had suffered from necrotizing fasciitis were reviewed retrospectively. RESULTS: There were 18 men and 8 women with a mean age of 43.8 years. Twenty two of 26 patients had a medical disease and the most common comorbidity was diabetes mellitus. Exquisite pain, erythema, warm skin were the most consistent clinical feature at the time of admission. Only six patients had a diagnosis of necrotizing fasciitis initially. The interval between onset of symptom and operative treatment was average 5.4 days in 20 patients who didn't have a diagnosis of necrotizing fasciitis initially, and among them, 2 patients died. There were limited range motion of knee joint in 3 cases, sacral osteomyelitis in 1 case, and sciatic nerve palsy in 1 case as a complication. CONCLUSION: We think that the diagnosis of necrotizing fasciitis should be considered with a high index of suspicion in patients who present with unexplained limb pain, and delay in operative treatment and wide involvement of the necrosis is associated with poor results of necrotizing fasciits.

Hemoglobinuria during General Anesthesia / 대한마취과학회지

There are many disease entities which are associated with hemoglobinuria but the report of which is very rare during anesthesia except in the case of incompatible transfusion. The authors experienced a case of severe hemoglobinuria during general anesthesia with halothane, nitroud oxide, and thiopental sodium. The patient had no transfusion perioparatively, and no history of hemoltic problems except for prolonged oozing after ethrane anesthesia for tympanoplasty five monthes ago previously. The hemogiobinuria disappeared after two days of corticosteroid therapy, but afterwards the patient suffered from mild hepatitis which seemed to be due to repeated halothane anesthesia.

The Effect of Anesthesia ( Balanced anesthesia ) and Surgery on Thyroxine and Triiodothyronine Levels in Plasma / 대한마취과학회지

This study was undertaken to investigate the effect of anesthesia(balanced anesthesia) and surgery on plasma thyroxine and triiodothyronine levels in ten surgical patients by means of the radioimmunoassay method which provides a quantitative measure of thyroid function. The sex ratio between male and female patients was 1:1, mean age was 30.1+/-12.26 and the average body weight was 57.38+/-15.81kg. The plasma triiodothyronine level before anesthesia and surgery was 138.1+/-32.64(ug/dl) but at 90 minutes and 120 minutes after anesthesia and surgery they were 100+/-19.64(ug/dl) and 92.4+/-7.49(ug/dl) respectively. The plasma thyroxine level remained unchanged during anesthesia and surgery. Consequently there was a statistically significant decreased level in plasma triiodothyronine but there was no change in plasma thyroxine level during anesthesia and surgery.

The Effect of Intravenous Anesthesia with Ketamine on Respitatory System / 대한마취과학회지

An increasing interest in intravenous anesthetic techniques has resulted from the availability of more efficacious intravenous agents, possible discomfor of the patient on endotracheal intubation and the concern over anesthetic pollution in the operating room. This study was done to investigate the effect of intravenous anesthesia with ketamine on the respiratory system by comparing arterial blood gas analysis before and after the procedure. Analysis of arterial blood for PCO2, PO2, pH, and excess were carried out. Heart rate and blood pressure were monitored on 15 patients in ASA class l for diagnostic or short procedures. Each patient was premedicated with atropine 0.01mg/kg and valium 0.2mg/kg intramuscularly 30 minutes before the procedure. ketamine was administered intravenously 1.0~1.5 mg/kg or intramuscularly 3~5mg/kg for induction of anesthesia. The anesthesia was maintained with ketamine 0.5~1.0mg/kg and valium 0.1mg/kg ever 5 to 10 minutes. The results of this study showed that ketmine anesthesia seemed not to cause any untoward effect on respiratory function. In other words, ketamine seems to be a safe and good intravenous anesthetic agent for diagnostic or short surgical procedures.

Comparison of Pre- and Post-Operative Liver Function after Halothane and Enflurane Anesthesia / 대한마취과학회지

The problem of hepatotoxicity of clinically employed halogenated inhalation anesthetics has major implications for the practice of anesthesiology. Because of emerging disadvantages with all the available anesthetics, chemists continue to search for better compounds. In 1963 Terrel synthesized enflurane and many anesthesiologist used it, hoping to avoid the disadvantage of halothane. This study was undertaken to investigate the advantage of enflurane as compared to the disadvantege of halothane, by comparing of pre- and post- operative liver functions of 16 cases of halothane use and 16 cases of enflurane use. in this study, all cases physical status were all ASA class 1, and excluded patients who had any liver disease, jaundice, previous experience of halothane or enflurane anesthesis, and who had not been transfused during this study. The result of this study which compared pre-operative and post-operative liver function tests disclosed statistically significant change in SGOT(p<0.02). On table lll the comparison of liver function tests between halothane and enflurane disclosed significant difference and that enflurane in less hepatotoxic than halothane. Considering the allergic or the intermediate by-product theory of the mechanism of halethane hepatoxicity, it is desirable to avoid repeating the use of halothane in the near future. Thus, it seems to be safer to use enflurane instead of halothane.

A Case of Prolonged Recovery from Balanced Anesthesia for Liver Cirrhosis / 대한마취과학회지

This is taecase report of a 64 year old male patient with the chief complaint of esophagial vahix bjeeding, who has been scheduled for emergency sever hypoalbuminemia, and abnormal liver function test. Anesthesia was induced with nitrous oxide, Innovar, morphine sulfate, pancuronium bromide and Valium. The long operation of 3 hours required transfusions of 5 pints banked bloods without any and difficulty. Anesthesia was reversed with Nsrcan, neostigmain and Atropine. In the recovery room, the patient's ventilation was satisfactory but he did not recover from deep coma until 5 hours after surgery. After repeated injection of Narcan intramuscularly the patient awoke from his deep asleep at midnight without any delayed sequelae.

Clinilcal Study of IPPB Therapy for Pre- and Post-operative Chronic Respiratory Diseases / 대한마취과학회지

Chronic obstructive pulmonary diseases are being increased every year by many factors. But there are two important factors. First of all the atmospheric contamination is due to modern civilization, secondarily, the increase of old age population which is the result of prolonged life span by contribution of modern medicine. For these reasons increasing chronic obstructive pulmonary disease, anesthesiologists have had increased problems to administer anesthesia, because these patients are most difficult to manage for anesthesia. Author have studied for if it could be diminished these problems by comparing of the complications during period of anesthesia induction, maintenance, recovery and 5 postoperative days, with IPPB therapy and other physical therapy. The results of the study are as follows: 1) Pre and postoperative IPPB therapy is more useful to diminish anesthesia problems compared with other physical therapy. 2) Other physical therapy is useful when compared with controlled group. 3) IPPB therapy is the choice of treatment for postoperative atelectasis. Statistical significance was assessed by using student t test.