Cardiac Arrest due to High Concentration Epinephrine Soaking on the Nasal Mucosa during Halothane Anesthesia / 대한마취과학회지

There is increasing tendency to use epinephrine injection or topical application to obtain clear operative field and hemostasis under general anesthesia. Even if the surgeons can get the good operative field for surgery, it is well known that the anesthetic problem may be anticipated due to using epinephrine under the halothane anesthesia. We experienced a case of cardiac arrest during halothane anesthesia due to inadvertant soaking with high concentration epinephrine cotton on the nasal cavity. The patient was resuscitated immediately and followed up carefully. Because the nasal cavity is in high vascularity, only soaking of epinephrine can cause cardiac arrest, so it well be preferable to have some attention for using the high concentration of epinephrine on the specific area.

Effects of Furosemide on Perioperative Serum Electrolytes and Osmolality during Transurethral Resection of the Prostate / 대한마취과학회지

The purpose of this study was to prevent the dilutional effect of excessive absorption of irrigating solution by using furosemide intraoperatively during transurethral resection of the prostate. Thirty patients, classified as ASA ps 2 or 3, were selected randomly and divided them into two groups as follows: Group l(N=15); Not-administrated furosemide(control group) Group 2(N=15); Administrated furosemide(Experimental group) All patients were premedicated with hydroxyzine(1 mg/kg, IM) and were performed continuous epidural anesthesia with 2/ lidocaine(1-1.5 mg/segment). 5% D-sorbitols were used for irrigating solution, and Hartmans solutions were given for maintenance fluid. And fixed the irrigating container to 60 cm in height from symphysis pubis. With the starting of operation, 20 mg furosemide was administrated to experimental group. The blood samples for serum Na+, K+, glucose and BUN were obtained at preoperation, 10 min, 20 min, 30 min after the stating of operation and immediate postoperative period, and serum osmolality and effective osmolality were calculated. The results were as follows: l) The values of sodium concentration of control group were decreased significantly at 10 min, 20 min, 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p<0.05). But those of experimental group were not changed significantly. 2) The values of serum osmolality and effective osmolality were decreased significantly at 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p<0.05). But those of experimenta1 group were not changed significantly. These results show that the dilutional effect of excessive absorption of irrigating solution might be prevented by using furosemide intraopertively. So we would like to recommend the use of furosemide during TURP, especially in patients with congestive heart failure or renal failure.

Cardiovascular Effects of Epinephrine Administration for Hemostasis to Pediatric Patients for Tonsillectomy during Halothane Anesthesia / 대한마취과학회지

Epinephrine induced cardiac dysrhythmias and cardiovascular responses during halothane anesthesia for 70 pediatric tonsillectomy cases were observed at Taegu Catholic Medical College from January to July, 1991 We have evaluated the frequencies of cardiac arrhythmia, and the changes of heart rate and blood pressure according to the administration of epinephrine for the purpase of hemostasis on the operating fields. All patients were divided into 3 groups as follows: Group I; Epinephrine used under halothane anesthesia(n=30). Group II; Epinephrine used under halothane anesthesia with fentanyl(n=20). Group III; Epinephrine used under halothane anesthesia with fentanyl, but shut-off the halothane inhalation briefly(n=20). The results were as follows: l) Systolic blood pressure, Increases of systolic blood pressure were observed in all groups compared with pre-injection state and there were statistical significances in group L 2) Heart rate; Decreases of heart rate were observed in group III compared with pre-injection state and there were statistical significances in group III compared with group I. 3) Dysrhythmias; Most childrens electrocardiograms revealed the sinus rhythms except only 4 cases of premature ventricular contraction and 2 cases of nodal rhythm. These benign dysrhythmias were restored to normal sinus rhythms immediately after administration of small doses of lidocaine & 100% oxygen and simultaneously shut-off the inhalation of halothane.

The Effect of Epidural Block Combined with General Anesthesia on Postoperative Liver Function / 대한마취과학회지

The common causes of postoperative liver dysfunction during anesthesia and surgery are due to the decreased cardiac output and/or systemic blood pressure as well as poor regional distribution of hepatic blood flow. It is well known that the surgical manipulation and the kinds of operation, especially around the hepatic area, are more important factors about the hepatic blood flow than anesthetics and anesthesia techniques. We postulated that the activity of sympathetic reflex initiated by surgical manipulation could be abolished by instituting epidural block on the peripheral operative field and consequently hepatic blood flow might be improved. We randomly selected 40 patients for upper abdominal surgery and divided them into 4 groups as follows: Group 1: Halothane anesthesia (10 cases, normal liver function test (LFT); contol) Group 2: Halothane anesthesia with epidural block (10 cases, normal LFT) Group 3: Enflurane anesthesia (10 cases, abnormal LFT; control) Group 4: Enflurane anesthesia with epidural block (10 cases, abnormal LFT) Epidural block was performed just before general anesthesia with 1% lidocaine, 2 ml/segment. Mean arterial pressure (MAP) was measured before anesthesia and at 5, 10, 15, 20, 30 and 60 min during surgery. And serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase, total protein and albumin were measured before anesthesia and on the 1st, 3rd, 5th and 7th postoperative day. The results were as follows: 1) MAP was changed significantly at 20 min in group 2 (p < 0. 01) and at 15 min in group 4(p < 0. 05). 2) The values of postoperative LFT were changed similarly but no statistical difference between group 1 and 2. 3) The values of postoperative LFT were declined significantly (esp. SGOT and SGPT), but no statistical difference between group 3 and 4. 4) Even though the postulation is correct, the effects of epidural block combined with general anesthesia (group 2, 4) on postoperative liver function were not different statistically compared with that of general anesthesia alone (group 1, 3). It might be suggested that the amount of decreased blood flow caused by surgical manipulation would be similar with that by the epidural block. 5) Now we hope that the further evaluation will be expected about the hepatic blood flow such as direct measurement.