Clinical Study of the Changes in Arterial Blood Gas and End Tidal CO2 after Release of Tourniquet / 대한마취과학회지

The tourniquet is not only used for facilitation of microaurgery by the bloodless surgical field on the extremities but prepared for the intravenous regional anesthesia and isolation arm test estimated the degree of the neuromuscular transmission in the anesthetic field. On the contrary, there are various complications, such as nerve paralysis and tissue damage from compression, and metabolic and hemodynamic changes from ischemia after application of the tourniquet. Since a sudden increase in PaCO2 immediately following tourniquet deflation is one of the important factors in the hemodynamic changes, we have observed the ehanges of PaCO2 and PCO2, after release of the tourniquet on the upper and the lower extremity under the general anesthesia with enflurane, N2O and respiratory control maintaining PaCO2 level (35 mmHg). The results obtained were as follows; PETCO2, PaCO2 and HCO2- were significantly elevated to peak level within 1 minutue after tourniquet release on the upper and the lawer extremity, except HCO2 on the upper extremity, and there were more severe changes on the lower extremity. pH and base excess were reduced to significantly lowest level 1 minutue and 5 minutes after tourniquet release respectively, and their changes were more reduction on the lower extremity. There were no statistically significant variations in PaO2 on the extremities. In the relationship between tourniquet time and P, it was statistically significant linear on the lower extremity (p<0.05) only. Conlusively, since the sudden changes of PaCO2, pH and base excess after release of tourniquet are closely related with PaCO2, on time and degree, noninvasive monitoring of PaCO2 has rapid interpre- tation to change in PaCO2 after release of tourniquet.

The Effect of H2-receptor Blockers on the Duration of Action of Succinylcholine and Vecuronium / 대한마취과학회지

Cimetidine, and H2-receptor blocker, is associated with a direct inhibition of liver microsomal enzymes and a decrease in liver blood flow which results in a variety of clinically significant drug interactions, but its effects on the action of muscle relaxants have not been established. Recently, Kambam et al(1987) reported that the duraion of action of succinylcholine was prolonged 2~2.5 times by cimetidine. The effects of cimetidine, ranitidine, and famotidine, on duration of action of succinylcholine and vecuronium were studied. Sixty ASA class 1 or 2 patients scheduled for elective exploratory laprotomies were randomly divided into two groups as follows: Succinylcholine Group(n=40, 1mg/kg) control group(n=10), cimetidine group(n=10): 300mg ph hs & 1 hour before induction, ranitidine group(n=10): 150mg po hs & 1 hour before induction, famotidine group(n=10) : 40mg po hs only. Vecuronimu Group(n=20, 0.08mg/kg) control group(n=10), famotidine group(n=10): 40 mg po hs only. All patients were premedicated with hydroxyzine(1.5mg/kg) and Robinul 0.2mg IM, 1 hour before anesthesia. Anesthesia was induced with thiopental sodium 5~6mg/kg and succinylcholine 1mg/kg or vecuronium 0.08mg/kg. Tracheal intubation was performed at 75~!00% block as monitored by train-of-four stimulation of the ulnar nerve at 2Hz, 20 seconds apart(ABM, Datex). Anesthesis was maintained with 50% nitrous oxide, oxygen, and 2% enflurane. The duration of action of the muscle relaxants was measured from injection of muscle relaxant to the time of 25% recovery of first twitch height on train-of-four stimulation. The results were as follows: 1) The duration of succinylcholine was prolonged significantly by the H2-receptor blockers, 8.3+/-1.49 minutes with cimetidine, 9.8+/-1.98 minutes with ranitidine, and 10.3+/-2.48 minutes in the famotidine group as compared to 6.9+/-1.43 minutes in the control(p0.05).

A Case of Atelectasis Resulting in Foreign Body During Anesthesia / 대한마취과학회지

It may be the most important problem to keep the airway during general anesthetic procedure. The authors experienced a case of left segmental bronchial obstruction with foreign body during general anesthesia for right pneumonectomy on the position of left decubitus, which was successfully removed by fiberoptic bronchoscopic aspiration and atelectasis due to segmental bronchial obstrucion was completely cured by active management of I.P.P.B., inhalation of oxygen with humidification, endobronchial suction, and symptomatic medication.