Change of Plasma Cortisol concentration during Moderate Hypothermic Cardiopulmonary Bypass / 대한마취과학회지

Cardiopulmonary bypass with moderate hypothermia and hemodilution is an extremely non- physiologic state. The stress responses to cardiopulmonary bypass were evaluated in open heart surgery by measuring the change of plasma cortisol concentration. Patients were anesthetized with fentanyl 20 ug/kg, 50% nitrous oxide in oxygen and a supplementary dose of droperidol and halothane. In each case, at the onset of cardiopulmonary bypass, the hematocrit value was reduced to 25-30% and was maintained around this level during perfusion. Moderate hypothermia was induced to 28-30 degrees C (28.9+/-1.5 degrees C). Blood samples were obtained after sternotomy, at the onset of cardiopulmonary bypass, during moderate hypothermia and after cardiopulmonary bypass. Plasma cortisol concentration was measured by radioimmunoassay technique. Compared with the pre-cardiopulmonary bypass cortisol value (11.12+/-2.19 ug/dl), plasma cortisol concentration at the onset of cardiopulmonary bypass (17.39+/-5.15 ug/dl) was significantly increased (p<0,05). And during cardiopulmonary bypass, especially during the hypothermia period, the plasma cortisol concentration (19.17+/-8.09 ug/dl) was significantly increased (p<0.05). After cardiopulmonary bypass, the plasma cortisol concentration (43.0+/-11.2 ug/dl) was significantly increased when compared with other values (p<0.05). We conclueded that the significant increase of plasma cortisol concentration is secondary to the stress response to cardiopulmonry bypass.

The Effect of Sodium Nitroprusside - Induced Hypotension on Plasma Renin Activity and Serum Aldosterone Level / 대한마취과학회지

The renin-angiotensin system plays an important role in maintaining blood pressure in various pathologic and physiologic states. To investigate the effects of the sodium nitroprusside (SNP)-induced hypotension on plasma renin activity and serum aldosterone level, SNP 2.0 mg/kg/min was infused to seven unanesthetized rabbits. The mean arterial pressure and heart rate were measured three times; at the start of, 15 and 30 minutes after SNP inusion and 30 minutes after the discontinuation of SNP infusion. The measurement of the plasma renin activity and the serum aldosterone levels during SNP infusion were done by means of radioimmunoassay. The results were as follows: 1) The mean arterial pressure was 117.6+/-6.9 mmHg at zero time ans decreased significantly to 84.0+/-19.6mmHg and 72.9+/-21.6mmHg at 15 and 30 minutes after SNP infusion, respectiely(P<0.01). 2) The heart rate was 124.8+/-9.3 beats/min at zero time and increased significantly to 139.7+/-6.4 beats/minute and 155.6+/-7.9 beats at 15 and 30 minutes after SNP infusion, respectively(P<0.05). 3) The plasma renin activity was 2.31+/-0.53 ng/ml/hr at zero time and increased significantly to 5.17+/-1.39 ng/ml/hr and 4.97+/-1.52 ng/ml/hr in 15 and 30 minutes after SNP infusion, respectively. 4) The serum aldosterone level was 28.8+/-13.5ng/dl at zero time and increased to 42.3+/-14.6ng/dl and 39.5+/-13.9ng/dl at 15 and 30 minutes after SNP infusion and it continued to increase up to 30 minutes after discontinuation of SNP infusion. In conclusion, it was postulated that the plasma renin activity and serum aldosterone level were closely related to the change of the mean arterial pressure and heart rate during SNP-induced hypotension.

Case Report of Anesthesia for Insulinoma / 대한마취과학회지

The authors experienced an anesthesia for surgical removal of insulinoma of pancreas in 66 year old woman. The patient showed symptoms of Whipples triad (hypoglycemia, low circulating glucose level and prompt relief of symptoms after glucose administration). On the abdominal CT scanning, round distal pancreatic tumor mass was detected. The patient was premedicated with Robinul 0.2 mg, diazepam 10 mg. On arrival in operating theater, the patients blood glucose level was 38 mg/dl (measured with Glucometer), despite of the low blood glucose level, she was free without any apparent symptoms. But we infused 50% D/W 50 ml rapidly and subsequently dropped 5%D/W solution and the blood gucose level was increased to 162 mg/dl before induction of anesthesia. Anesthesia was induced with thiopental sodium 250 mg IV, followed by succinylcholine 50 mg IV for endotracheal intubation and maintained with enflurane-N2O-O2, pancuronium 4 mg was administered intravenously for muslce relaxant. The blood glucose level was measured with Glucometer every 15 minute. No hypoglycemic episode was observed during anesthesia.

Changes of Blood Gases during Halothane-N2O-O2 Anesthesia / 대한마취과학회지

This study was designed to investigate the ranges of pH, PaO2 PaCO2, and SaO2, before and during halothane-N2O-O2-pancuronium anesthesia under controlled ventilation (Vr: 500-600ml, f: 18-20/min). For the study, 25 surgical patients were selected with physical status ASA class l and ll and age ranging from 20 to 60 years. Samples of arterial and venous blood were collected before and during anesthesia, and sent for immediate gas analysis. The arterial blood gas samples before and during anesthesia revealed values within normal limits. After testing, we were able to control the blood gas patterns by ventilation to produce ideal conditions for patients undergoing anesthesia.

Anesthesia Technic for Simple Operation around the Vocal Cords / 대한마취과학회지

Anestheiologists face the difficulty of mainatining patent airway in performing anesthesia for surgery around vocal cords. Because the simplicity of the above operation, the surgeons and patients tend to avoid the preparatory tracheostomy which is a safe way of maintaining anesthesia. The difficulties and problems occurring during anesthesia without performing tracheotomy were considered. The problems were; 1) Operating field interfering the anesthetic procedures. 2) Possibility of aspiration of blood during operation. 3) Apnea time of surgery limiting to 5 minutes or less. 4) Repeated intubation for anesthesic procedure. Apneic insufflation method was modified by spontaneous respiration. The tehnic was; the endotrachel tube was removed after induction of general anesthesia when patients spontaneous respiration regained Then suction catheter, 12 fr. size, was inserted to above the carina of trachea. Next, for ventilation, oxygen with high flow rate (9~10 L/Min) was insufflated in trachea through the catheter. This insufflation of high flow oxygen brought continuous positive pressure in trachea, also it acted effectively as PEEP (positive end expiratory pressure) effect .and provided protective mechanism from the aspiration. The addition of potent anesthetics such as halothane and ether insufflating oxygen allowed the control of depth of anestheia effectively. With this insufflation technic, two cases of excision of singers nodule were performed uneventfully.

Anesthesia or Kidney Transplantation - report of 5 cases / 대한마취과학회지

This is a report of anesthesia for five cases of renal transplantation which was performed between February 1969 and August 1969 at St. Mary's Hospital, Catholic Medical College, Seoul, Korea. General of renal insufficiency of the operated cases were described. Operative technique were unilateral nephrectomy for three cases and bilateral nechprectomy with splenectomy for 2 cases ; Anesthesia was induced with epontol (propanidid) 250mgs i.v. and 4% halothane-oxygen and maintained with 1% halotbane-oxygen which was supplemented by nitrous oxide occasionally. 6% dextrose and lactated-Ringer's solution were infused. For transfusion, whole blood was given to replace the operative blood loss. Dextran was also used to maintain adequate blood volume. Shortly before anastomosis of renal and femoral vessels, patients were haparinized. Fluids and electrolytes balance were studied pre-and post-operatively. Preoperatively, uremia and hyperpotassemia was corrected by several hemodyalysis. Urinary output after surgery showed a marked degree of diuresis up to 1800 ml/hr until second post-operative day. The special concern of anesthesia for kidney transplantation were: 1. Patients were suffering from severe uremia and metabolic disterbances. 2. Acidosis and hyperpotassemia should be corrected before surgery by hemo-or peritoneal dialysis. 3. Immunosuppressive agents made the patient less resistant to infection. 4. Anemia and hydrops was difficult to be corrected before surgery. 5. Muscle relaxants of choice were depolarizing agents, because of impaired renal excretion.