Anesthetic Management for Pheochromocytoma with Enflurane ; 2 Cases / 대한마취과학회지

Pheochromocytoma is a functioning tumor occurring in the chromaffin tissue and catecholamines from the tumor cell lead to the symptoms such as hypertension, palpitation and headache. Among the problems arising in the anesthetic management, the excessive secretion of catecholamines by the induction of anesthesia and the tumor mass manipulation causes a hypertensive crisis and the arrhythmia. Also, after the removal of the tumor mass, it must be remembered that a profound hyptension may follow due to abrupt lowering of catecholamine level. We experienced two cases of anesthetic management of pheochromcytoma using enflurane. In one case of sufficient preoperative management, it was performed uneventfully without symptoms such as hypertensive crisis and arrhythmia during the anesthetic management. But, in the other case with insufficient preoperative management, the patient was unstable due to hypertnesive crisis, premature contractions of the ventricle and tachyarrhythmia during the anesthetic management.

The Effects of Propranolol and MJ 1999 against Ventricular Fibrillation during Piofound Hypothermia in Dogs / 대한마취과학회지

Profound hypothermia (15 degrees C) was induced in 36 mogrel dogs anesthetized with nitrous oxide-oxygen-d-tubocurarine. Prcpranolol (0.3 mg/kg) or MJ 1999(0.8 mg/kg) was administered intravenously 10 minutes prior to the start of cooling. Significant protection against ventricular fibrillation was provided by MJ 1999, but not by propranolol. With available evidence that hypothermia causes increased catecholamine release and that MJ 1999 is more specific in its beta-adrenergic blocking prcperties than propranolol, the authors findings suggest that ventricular fibrillation during hypothermia is due to beta-adrenergic hyperactivity.

The Effect of Hydroxyethyl Starch (HES) upon Blood CoaguIation in Man / 대한마취과학회지

To determine the effects of hydrcxyethyl starch upon liver, kidney, serm electrolytes and particularly upon blood coagulation, 500 ml of 6% HES in saline solution was administered intravenously to 15 patients during elective minor surgery. In all cases weighted blood loss was less than 600 ml without replacement. The following laboratory tests were performed immediately before infusion and again 1 hour, 24 hours, 48 hours, and 1 week after the infusion: RBC, WBC, hemoglobin, hematocrit, ESR, platelet, bleeding time, coagulation time, prothrombin time, total protein, albumin, total bilirubin, direct bilirubin, SGOT, SGPT, alkaline phosphatase, BUN, sodium, potassium, and chloride. The results are as follows: 1) No anaphylactic shock or bleeding tendency characteristic of colloids was encountered. 2) No functional disturbance of liver or kidney directly attributable to HES was identified. 3) All laboratory parameters except WBC and ESR decreased after infusion. The decrease was, however, within the normal range and believed secondary to dilational effect of infusion. WBC increased somewhat, but returned to the preinfusion level in a week. 4) Exceptionally erythrocyte sedimentation rate increased notably during the 24 hour period following infusion. As with dextran, this was interpreted not due to direct effect of HES, but due to increased adsorption of fibrinogen, alpha-beta-gamma-glcbulin to red cell surface with changes in electric charge between red cells. 5) Clinical applicability, metabolic aspect, degree of subtitution of hydroxyethyl group and safety with multiple infusion of HES must be carefully determined.

An Experimental Study on the Vasopressor Effects of Various Sympathomimetic Amines in Reserpinized Dogs during N₂O-O₂-Halothane Anesthesia / 대한마취과학회지

Vasopressor effects of epinephrine, norepinephrine, ephedrine, phenylephrine, methoxamine and of mephentermine were compared in resrpinized dogs with or without nitrous oxide-oxygen-halothane anesthesia. The results are as follows: (1) Epinephrine and norepinephrine were shown to have the most potent pressor effect in reserpinized and nitrous oxide-oxygen-halothane-anesthetized dogs. Phenylephrine, methoxamine, mephen-termine and ephedrine were less potent in decreasing order. (2) Decrease in mean arterial pressure was less marked in dogs reserpinized and anesthetized with nitrous oxide-oxygen-halothane than in reserpinized but unanesthetized dogs. (3) It revealed that nitrous oxide-oxygen-halothane anesthesia potentiated the vasopressor effects of the sympathomimetic amines studied. Nitrous oxide-oxygen-halothane anesthesia is implicated to exert an sympathomimetic effect.

A Clinical Study on Diazepam as Preanesthetic Medication / 대한마취과학회지

It has been well known that successful anesthesia is provided by rendering patients free from apprehension and fear prior to operation. This report is concerned with a new sedative compound which appears to reduce anxiety-tension and relax skeletal muscles. Preanesthetic usefulness of diazepam, which is a derivative of benzodia-zepine and has a high safety index as a preanesthetic medication agent, has been clinically assessed by a standard double blind study on 288 patients in this hospital. They received diazepam(0.3mg/ kg), meperidine hydrochloride (1.0~1.5mg/kg) or saline (1.0ml) via intramuscular route. The following are the results: 1) Diazepam was effective in producing a sound sleep during the preoperative night. 2) Diazepam was effective in reducing apprehension and fear immediately prior to induction of anesthesia. 3) Less nausea and vomiting as well as better sedation were produced by diazepam than by meperidine hydrochloride.

Effect of Small Dose Atropine on Cardiac Rate in Rabbits / 대한마취과학회지

In rabbits: (1) Intravenous atropine in the dose of 0.002-0.004 mg/kg caused bradycardia, whereas in that exceeding 0.02 mg/kg tachycardia. Transient but alarming degrees of tachycardia could be observed when 2 mg/kg dose was employed. (2) While Arfonad was being infused, the heart rate changed little regardless of the doses of atropine used. (3) During Arfonad drip, changes in heart rate seemed fairly well correlated with the degree of hypotension, i.e., magnitude of ganglionic blookade. (4) The above findings suggest that, at least in rabbits, small dose atropine-induced cardiac slowing is due to the inhibitory action of atropine on the sympathetic ganglia. This cannot, however, be directly applied to human physiology because of the possible species difference in the regulatory mechanisms of heart rate.