Comparison of Interpleural Block and Paravertebral Block with Bupivacaine for Pain Relief after Cholecystectomy / 대한마취과학회지

The adverse effects of pain in post-surgery or trauma patients are well documented. A reliable, safe approach to achieving unilateral analgesia in multiple contiguous thoracic dermatomes would be of great benefit to anesthesiologists in acute pain setting following thoracic or upper abdominal surgery. The aim of this study of post-cholecystectomy pain was to compare two methods of postoperative analgesia with interpleural block and paravertebral block with bupivacaine. Thirty otherwise healthy patients who had undergone elective cholecystectomy through a subcostal incision were randomly allocated to two groups of fifteen patients each and given either interpleural block(group 1) or paravertebral block(group 2) with 20 ml 0.5% bupivacaine mixed with 1:200,000 epinephrine through a single catheter. The degree of analgesia was assessed by a verbal rating scale, Prince Henry pain score and a visual analogue scale(VAS 1-10 cm ; O=no pain, 10=worst pain). These pain scores and vital signs were assessed just before and 10, 20, 30, 60 and 120 minutes after injection of bupivacaine. The onset time of analgesia was similar in both groups(6.6+/-3.74 minutes in group 1 and 5.5+/-2.88 minutes in group 2), but the duration of analgesia was significantly longer in group 1(6.5+/-1.92 hours) than group 2(4.5+/-2.17 hours)(p<0.05). In both groups Prince Henry pain scores significantly decreased 10 minutes after injection of bupivacaine and VAS also significantly decreased 10 and 20 minutes after injection(p<0.05), but there was no significant difference between two groups. The systolic blood pressure decreased 10 minutes after the injection of bupivacaine in both groups(Group 1-3.7%, Group 2-6.5%) and the diastolic blood pressure decreased 10 minutes after the injection of bupivacaine only in group 1(2.5%), (p<0.05), however, these changes in arterial blood pressure were of minimal clinical significance. There is no complication in group 1, but 2 out of 15 patients in group 2 showed bilateral blockade without any serious hemodynamic derangement clinically. In conclusion, both techniques showed similarity in the onset and the degree of analgesia except the duration of analgesia, and presented only a few minor complications. Therefore, we feel that paravertebral block can be used in case that coexisting pulmonary or pleural pathology limits the use of interpleural block for post-cholecystectomy pain management. Furthermore, either of the two techniques may be used alternatively in management of thoracic or upper abdominal pain according to technical skill and preference of anesthesiologists.

Clinical Study of the Changes in End tidal PCO2 Arterial Blood Gas and Vital Signs by Increased Minute Ventilation After Deflation of Tourniquet / 대한마취과학회지

Tourniquets are often used for surgery on the extremities to provide a bloodless surgical field. However, tourniquets may cause nerve and other tissue injuries.While the tourniquet is inflated, metabolic changes occur in the ischemic limb, chages that include increased PaCO2, lactic acid and pottasium, and decreased levels of PaO2 and pH. Deflation of the tourniquet results in the release of these products of ischemia into the general circulation. The resultant decreases in arterial pH and PaO2 and increased in arterial lactic acid, potassium, PaCO2 and P(ET)CO2 are associated with significant decrease in mean arterial and central venous pressure and increase in heart rate. Since Pa is one of the important factor to control the cerebral blood flow and intracranial pressure, a sudden increase in PaCO2 immediately after toumiquet deflation may cause detrimental effects in head injured patients with elevated intracranial pressure. The purpose of this study was investigate the effect of the degree of hyperventilation by means of increased minute ventilation by 25%, 50% and 75% respectively, after deflation of toumiquets to keep P(ET)CO2 at former levels, for twenty minutes period, with arterial blood gas analysis, endtidal PaCO2 and vital signs was monitored serially. We compared normal minute ventilation group I with increased minute ventilation groups(II, III and IV) before and after deflation of tourniquet. In summary, we calculated from our data that increasing minute ventilation by more than 50% for 5 minutes following tourniquet deflation could prevent P(ET)CO2 from increasing more than 1.5-6.5 mmHg in all patients.

Effect of Propranolol on Changes in Sereum K+ Induced by brachial Plexus Block / 대한마취과학회지

When we perform the regional blockade, we usually addit epinephrine to the local anesthetics for the purpose of lengthening anesthesia time and preventing the systemic reaction of local anesthetics. In that situation, epinephrine produces decrease in serum potassium concentration and changes in electrocardiogram. We investigated the influence of propranolol on changes in serum potassium and ECG induced by brachial plexus block with 30ml of mixture of local anesthetic (2% lidocaine +0.5% bupivacaine) which contains 1:200,000 epinephrine. The subjects classified as following two groups: Group l : Brachial plexus block with mixture of local anesthetic and 1:200,000 epinephrine(n=20). Group ll : Pretreated with 2 mg of propranolol(slow intravenous injection for 5 min. before block) and performed as Group l. The results were as follows: 1) Group l showed statistically significant decrease of serum potassium after 10, 20, 30 min. of block(p<0.05). Group ll did not show any significant change. 2) Group l showed progressive flattening of T wave and appearance of U wave (25% of pts) in ECG as the serum-potassium decreased progressively, but Group ll did not sho any significant change. 3) The epinephrine mediated beta-adrenergic stimulation may be considered as the cause of epinephrine induced hypokalemia during brachial plexus block.

The Anesthetic Experiences of 200 Cases of Brachial Plexus Block by Parascalene Technique / 대한마취과학회지

Two-hundred cases of brachial plexus block by parascalene technique for the surgery of upper extremity, shoulder and/or neck were evaluated for the period from November, 1989 to October, 1990 at the Department of Anesthesiology, Hallym University, Kangdong Sacred Heart Hosipital in Seoul, Korea. Local anesthetics we used in this technique were mixture of equal amount of 2% lidocaine and 0.5% bupivacaine with 1: 200,000 epinephrine. Total amount of local anesthetics injected were varies from 20 to 40 ml for each block. The results were as follows: 1) Of the 200 Patietns, 153(76,5%) were male and 47(23.5%) were female. Their ages ranged from 5 to 83 years. One hundred twenty-one or 60.5% of this total group's ages fell between 20 to 39 years. 2) The most common site of operation was the hand; ll6 cases of the 200 blocks(55.3%). 3) Paresthesia was most often elicited at the superior nerve trunk; 80 cases of the 200 blocks (40%). 4) The average depth of needle from the skin to eliciting the parethesia is 1.954 cm. 5) The onset of anesthesia was within 5 minutes in 166.cases(84,4%). 6) The duration of anesthesia ranged from 180 to 1,800 minutes, and average was 657+/-113 minutes. 7) The extent of anesthesia by sensory dermatomes were average from cervical 2.3+/-1.0 to thoracic 2.90+/-5. 8) Shoulder surgery(e.g. clavicle fracture) and neck biopsy were performed successfully by this technique. 9) Parascalene approach to the brachial plexus has proven both safe and reliable. It provide satisfactory anesthesia of the upper extremity, shoulder and neck in 98.5%(l97 cases) of the 200 patients. 10) Complications of parascalene brachial plexus block were 2 cases of Horners syndrom, 1 cases of recurrent laryngeal nerve paralysis and 2 cases of subclavian artery puncture. We presumed that the complications other than Horners syndrome were due to technical error.

The Anesthetic Experiences of 200 Cases of Brachial Plexus Block by Parascalene Technique / 대한마취과학회지

Two-hundred cases of brachial plexus block by parascalene technique for the surgery of upper extremity, shoulder and/or neck were evaluated for the period from November, 1989 to October, 1990 at the Department of Anesthesiology, Hallym University, Kangdong Sacred Heart Hosipital in Seoul, Korea. Local anesthetics we used in this technique were mixture of equal amount of 2% lidocaine and 0.5% bupivacaine with 1: 200,000 epinephrine. Total amount of local anesthetics injected were varies from 20 to 40 ml for each block. The results were as follows: 1) Of the 200 Patietns, 153(76,5%) were male and 47(23.5%) were female. Their ages ranged from 5 to 83 years. One hundred twenty-one or 60.5% of this total group's ages fell between 20 to 39 years. 2) The most common site of operation was the hand; ll6 cases of the 200 blocks(55.3%). 3) Paresthesia was most often elicited at the superior nerve trunk; 80 cases of the 200 blocks (40%). 4) The average depth of needle from the skin to eliciting the parethesia is 1.954 cm. 5) The onset of anesthesia was within 5 minutes in 166.cases(84,4%). 6) The duration of anesthesia ranged from 180 to 1,800 minutes, and average was 657+/-113 minutes. 7) The extent of anesthesia by sensory dermatomes were average from cervical 2.3+/-1.0 to thoracic 2.90+/-5. 8) Shoulder surgery(e.g. clavicle fracture) and neck biopsy were performed successfully by this technique. 9) Parascalene approach to the brachial plexus has proven both safe and reliable. It provide satisfactory anesthesia of the upper extremity, shoulder and neck in 98.5%(l97 cases) of the 200 patients. 10) Complications of parascalene brachial plexus block were 2 cases of Horners syndrom, 1 cases of recurrent laryngeal nerve paralysis and 2 cases of subclavian artery puncture. We presumed that the complications other than Horners syndrome were due to technical error.

Comparison of the End-Tidal PCO2 Measurements Sampled at the Distal and Proximal Ends of the Endotracheal Tube in Adults / 대한마취과학회지

To determine whether the site of gas sampling affects end-tidal gas measurements in adult patients during anesthesia, end-tidal pCO2(PetCO2) was measuredcontinuously from the distal and proximal ends of the endotracheal tube(SHERIDAN) in 33 adults ventilated with Drager anesthesia ventilator. These data were compared with simultaneous arterial PCO2 (PaCO2) measurements. The study was commenced after each patients was ventilated no less than 15 minutes at the desired ventilator settings. Gas was continuously aspirated at 230 ml/min. for measurement of the PetCO2 using SARA Cap.A.G,Capnometer'sampled from the distal and proximal ends of the endotracheal tube for 3-minutes of each sampling port, alternativiely measured at 5 minutes interval. And each measurement was repeated twice and calculated mean values. The results were as follows: The mean PetCO2 sampling from the distal end was 31.6+/-2.4 mmHg. and the proximal end was 31.0+/-2.3mmHg. The difference between two results was statistically not significant(p> 0.05). The correlation coefficients of PetCO2 vslues for the distal end and the proximal end samplings to the PaCO2 values were r =0.48 and r=0.45 respectively, and statistically significant(p< 0.05) We concluded that the measured PetCO2 sampled from the distal end of the ETCO cuffed endotracheal tube' does not show any statistically significance to the proximal one. However, distally sampled PetCO2 measurements were more approximate PaCO2 measurements than proximally sampled one.

The Effect of Sedation with Diazepam on Arterial Oxygen Saturation During Spinal Anesthesia / 대한마취과학회지

We have studied the effect of sedation with diazepam on arterial oxygen saturation during spinal anestheia in two groups of patients: Group I: Received diazepam (0.2 mg/kg i.v.) after the level of spinal anesthesia was determined, and breathed the room air. The level of sedation was controlled such that the patient was drowsy but aroused easily and capable of communication. An additional dose of diazepam was given when required. (n=15) Group II: Received diazepam (0.2 mg/kg i.v.) in the same manner as Group I but with supplementary oxygen inhalation (3l/min) through the nasal catheter. (n = 15) The results were as follows: Two of 15 patients of Group I who were given sedation during spinal anesthesia and who breathed room air developed moderate hypoxemia, with a SaO2 of 88-89%. There were no episodes of hypoxemia in Group II patients who received supplementary oxygen inhalation. We concluded that oxygen should be administered routinely to patients receving diazepam as a sedative during spinal anesthesia for the prevention of hypoxemia, unless a pulse oximeter is available to monitor SaO2.

Anesthetic Management of a Patient with Pheochromocytoma - A case report / 대한마취과학회지

The anesthetic management of patients with pheochromocytoma presents many difficult problems, such as hypertension, cardiac arrhythmias, and hypotension. A 21 year-old male underwent resection of pheochromocytoma under general anesthesia with isoflurane and fentanyl. Hypertensive crisis during induction of anesthesia and surgical manipulation of the tumor were managed with phentolamine and sodium nitroprusside drips. Anesthesia was maintained wtih nitrous oxide : oxygen, 50% : 50%, isoflurane, 0.5-2% and supplemented with fractional doses of fentanyl and vecuronium for muscular relaxation. We also used propranolol for the cardiac arrhythmia. An endotracheal semi-closed circle absorption technique with controlled ventilation was employed. Fentanyl does not release histamine, and has stable hemodynamics. Isoflurane has also advocated on the grounds that arrhythmias are less esaily provocated by circulating catecholamines than with other volatile agents, and has been shown to be a satisfactory agent. Vecuronium does not provoke catecholamine release, does not release histamine, has no autonomic effects at clinical plasma concentrations, and is clearly the neuromuscular blocking agent of choice in this case. Optimal pre-operative preparation, smooth induction of anesthesia, adequate alveolar ventilation, proper cardiovascular control, and good communication between surgeon and anesthesiologist are most important for the anesthetic management of pheochromocytoma.

The Hemodynamic Effects of Metocurine during Enflurane Anesthesia / 대한마취과학회지

This study was undertaken to determine the hemodynamic effects of metocurine in 40 adult patients (ASA class I-II) scheduled for elective operation. Anesthesia was induced with thiopental sodium 3-5 mg/kg IV and maintained with enflurane at a constant inspired concentration of 1.5-2.5 vo1%. After 30-minutes of hemodynamic stabilization and when operative stimulus was judged to be unchanged, each patient was randomly assigned to one of following three groups. Group I: Bolus injection of metocurine(0. 28 mg/kg, ED95) within 5 seconds. Group II: Slow injection of metocurine(0.28mg/kg, ED95) within 3 minutes. Group III: Metocurine injection as group I with prophylactic use of H(1)-H(2)-receptor blocker(Cimetidine 300 mg PO, 1 hour before induction and chlorpheniramine 1. 0 mg/kg IV, 10 min. before metocurine injection). There were no significant changes in mean arterial pressure and heart rate throughout the study (p< 0.05), but only one case of group I revealed the evidence of systemic histamine release. Group II and Group III showed no evidence of systemic histamine release. Therefore, we felt that metocurine might be used safely with slow injection or prophylactic use of H(1) and H(2) receptor blocker with rapid bolus injection for any surgical operation, including cardiovascular operations.

The Effects of Halothane, Enflurane, and Regional Anesthesia on SGOT and SGPT / 대한마취과학회지

When halothane was first introduced into the clinical anesthesia in 1956, it was acclaimed as the ideal anesthetic agent. Soon after its clinical introduction, reports were published regarding jaundice and hepatic necrosis following its use. Stock and Strunin group the etiologic factors as biotransformation, hypersensitivity (immune-related), hypoxia and pharmacogenetic. In contrast, Calahan and Mangano list as possible causes hypoxia, trauma, viral hepatitis and toxic injury. A few cases of hepatitis following enflurane anesthesia have been described and a diagnosis of enflurane hepatitis was made. However, it is much rare than halothane hepatitis and the case remains unproven. Regional anesthesia with local anesthetic agent (lidocaine or bupivacaine) does not cause hepatic injury, even patients with moderate hepatocellular disease may well be able to metabolize durgs normally. Decrease in hepatic blood flow in healthy individuals will cause no problems with regional anesthesia, as the blood flow and cardiac output can be reestablished with the use of fluids or appropriate vasoconstrictors. This study was undertaken to evaluate the effects of halothane, enflurane, and regional anesthesia with lidocaine or bupivacaine on liver function, particularly with serum glutamic oxaloacetic and pyruvic transaminases (SGOT and SGPT) values which are the most frequently determined indicators of possible liver disease. Whereas SGOT is present in a variety of tissues, SGPT appears to be the liver-specific transaminase. We studied randomly-selected 219 patients, ASA class I or II, aged 15-68 yr, scheduled for elective surgery. They had no history of liver disease, and preoperative liver function tests were within normal limit. And we excluded blood transfused cases in this study. They were divided into three groups according to the anesthetic agent used; Group I: Halothane anesthesia (116 cases). Group II: Regional anesthesia (50 cases). Group III: Enflurane anesthesia (53 cases). We also divided subgroups according to the duration of anesthesia in each group; Subgroup A (Subg-A): under 2 hours of anesthesia. Subgroup B (Subg-B): more than 2 hours of anesthesia. SGOT and SGPT were measured before surgery, and on 1st, 3rd and 5th postoperatine days. The results we as follows: 1) The values of SGOT and SGPT were increased (p<0.01) in both Subg-A and B of Group I. However, on the 1st post-operative day they were more prominently elevated than the other postoperative days (P<0.05), but clinically the change of values was all within normal limits. 2) The values of SGOT were increased (P<0.05) in Subg-B of Group II on the 3rd postoperatine day hut clinically were within normal limits. The values of SGPT in Group II were slightly increased within normal ranges. 3) The values of SGOT were increased in Subg-A (P<0.05) and Subg-B (P<0.01) of Group III on the 1st postoperatine day, but clinically were within normal limits. The values of SGPT in Group III were slightly increased within normal ranges. 4) In comparing Group I and Group II, the value of SGOT in Group I was significantly increased than Group II (P<0.05), but clinically was within normal limits, and the change in that of SGPT was not significant. 5) In comparing Group II and Group III, the value of SGOT in Group II was significantly increased (P<0.01) on the 5th postoperatine day than Group III, but clinically was within normal limits, and changes of SGPT were not significant. 6) In comparing Group II and Group III, the values of SGOT and SGPT were not significantly different. 7) The results show that the effect of halothane on liver function (SGOT, SGPT) is not significantly different from those of enflurane and regional anesthesia with local anesthetics.

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.

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 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.

Cushing's Syndrome due to Adrenocortical Carcinoma: Anesthetic Experience with Two Cases / 대한마취과학회지

Anesthetic experience with unilateral adrenalectomy for two patients (ll-year-old and 19- year-old female) with Cushings syndrome due to adrenocortical carcinoma has been reported. Anesthesia was induced with intravenous thiopental followed by nitrous oxide-oxygen-halothane and Pancuronium (Mioblock) for muscular relaxation. An endotracheal semi-closed circle absorption techniqne with controlled respiration was employed. The Patient tolerated well the anesthesia and surgery with appropriate cardiovascular control using hydrocortisone, whole blood and fluid replacement under continuous monitoring of B.P., E.C.G., C.V.P., and urine output. Importance of optimal preparation of the patient with Cushings syndrome, sufficient sedation, smooth induction, complete analgesia, good mucular relaxation, adequate alveolar ventilation and of proper cardiovascular control has been stressed and discussed together with the hazards of postoperative adrenal insufficiency.

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.

A Clinical Study of Anesthesia for Cesarean Section / 대한마취과학회지

Anesthesia for cesarean section involves consideration of Loth maternal and fetal welfare. The choice of anesthesia for cesarean section is controversial. Regional analgesic techniques may be least harmful to the fetus, but suffer definite drawbacks; they are time-consuming, and therefore not always applicable when urgent surgery is indicated; are associated with a definite failure rate even in skilled hands, and require considerable technical ability and practice. Recently there has been progressive increase in the use of balanced anesthesia for cesarean section, it produces little or no hemodynamic and acid-base disturbance in the mother and infant if administered skillfully. The value of muscle relaxants to facilitate endotracheal intubation and pulmonary ventilation and to permit the use of light general anesthesia. From November, 1971 to October, 1973 there were 1,432 deliveries, of which 1,284 were delivered vaginally and 148 (10.3%) by cesarean section. Of the cesarean section group, 139 were performed under general anesthesia and 9 were performed under regional anesthesia. The characteristic difference for our series was that most of all cases were emergency cesarean section (71.6%). The major indication for surgery was that of a previous cesarean section (45.3%), the second most common cause was dystocia (42.9%), and the others are as following order; Hemorrhage (5.4%), toxemia (3.4%), and others (3.4%). In our study, we adopted two different general anesthetic techniques for cesarean section. Patients were randomly assigned to two groups: Group I: 112 patients, thiopental-succinylcholine-nitrous oxide-oxygen (67:33) anesthesia. Group II: 25 patients, thiopental-succinylcholine-nitrous oxide-oxygen (50:50) supplemented with 0.5~1.0% of halothane anesthesia. All patients were pre-oxygenated for 3 5 minutes and anesthesia was then induced with thiopental sodium 125~250mg, followed by succinylcholine 40~50 mg to facilitate intubation. Pressure was maintained on the cricoid cartilage to prevent regurgitation following loss of consciousness. After the affects of succinylcholine showed signs of wearing off, relaxation was maintained with 0.1% succinylcholine drip or 40~80 mg of gallamine. Anesthesia was maintained with nitrous oxide 4 l/min. and oxygen 2 l/min. and/or nitrous oxide 2 l/min. and oxygen 2 l/min. supplemented with 0.5~1.0% of halothane. Respiration was carefully controlled by manually so as not to producing hyperventilation. The clinical condition of newbron infant in general anesthesia series of 135 cases, mean minute apgar score were good (7~10) in 91.8 percent, fair (4~6) in 6.7 per cent, and poor (1~3) in 1.5 per cent. And 90.4 per cent of babies born within 10 minutes of induction to delivery time interval (IDI) had mean apgar score of 8. 8, 5.8 per cent were delivered after 11 to 15 minutes of IDI with decreased mean apgar score of 7.6, and 3.7 per cent were delivered after over 15 minutes of IDI had mean apgar score of 7. 6. A short IDI appears to be advantageous from the standpoint of the newborn. Of the 144 infants, 6. 9 per cent of newbron infants(10) received intermittent positive pressure breathing by face mask and 3.5 per cent(5) received oxygen through an endotracheal tube for the resuscitation. Neonatal death occurred only 1(0.69%) case out of 144 infants, which caused by severe fetal. distres associated with toxemia of pregnancy. There were no maternal death or anesthetic complication.. At the conclusion, the technique of general anesthesia with thiopental-succinylcholine-nitrous oxide-oxygen and/or supplemented with 0.5~1.0% of halothane was proved to be safe for mother and child, and showing a wide acceptance of general anesthesia for cesarean section(94%) at the Kyung Hee University Hospital.

Effect of Doxapram Hydrochloride on Respiration after General Anesthesia / 대한마취과학회지

The effect of a new analeptic, doxapram hydrochloride, on respiration has been studied in ten subjects anesthetized with thiopental or with nitrous oxide-oxygen-halothane. The results are as follows: 1) Respiratory stimulation was more pronounced in the group anesthetized with thiopental than that with nitrous oxide-oxygen-halothane. 2) The stimulatory effect lasted for four minutes. Subjects who received multiple doses of the drug, however, showed a cumulative effect. 3) Most cases showed moderate hypertensive effect and brief electrocardiographic change was observed in one of the ten.

Electrocardiographic Monitoring during General Anesthesia / 대한마취과학회지

At the Kyung Hee Medical Center all patients receiving general anesthesia in the operating room are monitored continuously with electrocardioscope, Burdick CS-515 Monitor, and recorded by EK4S ECG. Among 50 patients 18 cases (36%) developed a variety of arrhythmias. Seven (14%) were considered serious in nature, such as ventricular extrasystoles. There was an increased incidence of arrhythmias during induction of anesthesia, in old age group and in poor risk patients. Continuous cardiac monitoring is valuable, easy, and practical in virtually all instances during anesthesia and surgery.