Effect of Positive End-Expiratory Pressure on the Concentration of Sodium and Potassium in Plasma and Urine, Plasma Creatinine and Urine Output in Mechanically Ventilated Patients / 대한구급학회지

BACKGOUND: It has been suggested that the addition of positive end-expiratory pressure (PEEP) to the patients with ventilator support leads to an impairment on renal hemodynamics and water- and sodium-retaining hormonal systems, such as plasma renin activity (PRA), plasma aldosterone, urinary antidiuretic hormone (ADH). METHODS: To evaluate the effects of 5 cmH2O and 10 cmH2O PEEP on renal function, we measured the plasma concentration of sodium (Na+), potassium (K+) and creatinine, urinary excretion of Na+, K+ and urine output in eight normovolemic male patients requiring ventilator support. Also changes in mean arterial pressure, pulse rate, arterial oxygen tension (PaO2) and carbon dioxide tension (PaCO2) during the experimental period were measured in these patients. RESULTS: Both 5 and 10 cmH2O PEEP showed no significant effect on the mean arterial pressure, heart rate, PaO2, and PaCO2. Both 5 and 10 cmH2O PEEP showed no significant effect on the plasma concentration of sodium, potassium and creatinine. 5 cmH2O PEEP showed no significant effect on the urinary excretion of sodium, potassium and urine output, but 10 cmH2O PEEP showed significant effect on the urinary excretion of sodium (19% decrease, p<0.05), and urine output (12.5% decrease, p<0.05) respectively. CONCLUSIONS: 10 cmH2O PEEP was revealed to decrease urinary sodium excretion along with urinary output and this phenomenon was likely to relate with water- and sodium-retaining hormonal systems. These results suggested that it was preferable to apply high PEEP cautiously in patients with impaired renal function.

Clinical Study of Ten Cases of Continuous Spinal Anesthesia for Total Hip Replacement / 대한마취과학회지

This study was primarily undertaken to assess the value of continuous spinal anesthesia for total hip replacements (Charnley's low friction arthroplasty), which had been done under the Filtered Air Flow System for the prevention of wound contamination due to long term exposure. The results were as follows: 1. Preoperative diagnosis was in 4 cases hip joint tuberculosis,in 2 cases avascular necreosis, in 2 cases femur fracture, and in 2 cases osteoarthritis of the hip joint. 2. Average blood loss was 2, 800 ml for a one side operation and 5, 000 ml for a bilateral one. Overall average blood loss with continuous spinal anesthesia was 2, 600 ml and with general anesthesia was 1, 725 ml, and with amount of difference being 1. 175 ml more in the spinal anesthesia group (p<0. 025). 3. In 4 eases (40%) the hypotensive range was over 30% of the preoperative level, but recovery occurred soon after administration of Effortil. 4. Practically management of a patient with continuous spinal anesthesia is easier' thai with general anesthesia for total hip replacement, with fieeing of the anesthesio1ogist'a hands for better care of the patient during anesthesia.

A Clinical Study of Cardiac Arrhythmias during General Anesthesia in Patients with Preexisting ECG Abnormalities / 대한마취과학회지

The incidence of cardiac arrhythmias has been studied in 50 unselected surgical patients with preexisting ECG abnormailties preoperatively, by means of continuous monitoring, utilixingan eIectrocardioscope, Burdick CS-515 Monitor, and was recorded by EK-4S ECG, at the Kyung Hee University Hospital, Seoul, Korea. The results are as follows: 1) Among 50 patients, 32 cases (64%) developed a variety of arrhythmias during general anesthesia and operation. It also showed arrhythmias excluding sinus tachycardia in 14 cases. The 28 per cent incidence of arrhythmias was rather high compared with the patient groups without preexisting heart disease or arrhythmias, such as in our previous report in 1972 of 20%, Dodds 19, 9% and Vaniks 16. 3%. 2) The most common arrhythmia seen was sinus tachycardia (26 cases, 65% of the total arrhythmias) and the next one was premature ventrieular contraction. 3) Nine cases (22. 5%) were considered serious in nature, such as premature ventricular contractions. 4) There was an increased incidence of new arrhythmias in the patients in poor general condition. 5) The vast majority of arrhythmias seen during anesthesia, except for 3 cases did not require drug treatment. It is usual to eliminate the cause of the arrhythmia by lowering anesthetic depth, eliminating excess carbon dioxide by hyperventilation and proper oxygenation of the lungs. 6) Constant electrocardiographic monitoring of patients under anesthesia has proven to be valuable adjunct to the administration of clinical anesthesia.

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.

Pulmonary Function Studies on Normal Korean Adults / 대한마취과학회지

Since pulmonary function testing was first described by Hutchinson in 1846, this technic has been developed by many physiologists and applied to clinical fields for eviluation of cardiopulmonary status in order to improve diagnosis and treatment of cardiopulmonary diseases. The normal values of the lung volumes and capacities, maximal midexpiratory flow, maximal breathing capacity and forced expiratory volume and time in 120 (male-60, female-60) normal Korean adults by using a Gaensler-Collins bronchospirometer are presented. The results were as follows: 1. The vital capacity of the normal Korean adult was 4191+/-451ml. for males and 2685+/-375 ml. for females. 2. The ratio of inspiratory capacity to vital capacity for males was 66+/- 9% and for females 70+/- 7%, but that of expiratory reserve volume to vital capacity for males was 34+/-9% and for females was 30+/-7%. The ratio of inspiratory capacity to vital capacity of normal Korean adults is slightly lower than that of whites, while that of expiratory reserve volume to vital capacity of normal Korean adults is slightly higher than that of whites. 3. The maximal breathing capacity of males was 95+/- 171/min. and that of females 61+/-141/min. 4. The maxima mid-expiratory flow for males was 266+/- 711/min. and for females 176+/- 421 /min. The maximal mid-expiratory time of males was 0. 497+/- 0.145 second and that of females 0. 479+/- 0. 128 second.

Clinical Study for 20 Cases of Anesthesia for Total Replacement / 대한마취과학회지

We have experienced 20 cases of anesthesia for Total Hip Replacement(Charnleys Lov Frictinn Arthroplasty), which had been done under the Filtered Air Flow System for the prevention of wound contamination due to long term exposure. Preoperative diagnosis was, 7 cases of Hip Joint Tuberculosis, 6 cases of Femur Neck Fracture, 5 cases, of Osteoarthritis of Hip Joint, and 2 cases, of Avascular Necrosis. Average blood loss has 1500 ml for one side operation, and 2400 ml for bilateral one. In 12 cases, hypotensive response was occurred during the application of Acrylic bone cement to the medullary canal of femur, however in 4 cases, hypotensive responses was more prominentafter the application of Acrylic bone cement to the Acetabulum fossa and the rest of cases were no changes in blood pressure and pulse rate whatsoever. In two cases, hypotensive range was over 30%(in compare with preoperative one), but recovery was soon after administration of Effortil corticosteroids, volume expanders etc. There was no mortality.