Effects of Soy Protein, its Hydrolysate and Peptide Fraction on Lipid Metabolism and Appetite-Related Hormones in Rats

This study was aimed to investigate whether soy protein hydrolysates had beneficial effects on serum and tissue lipid contents and appetite-related hormones as compared with intact soy protein. Four-week-old male Sprague-Dawley rats were fed AIN-93M diet containing high fat (18% w/w) with low protein (10% w/w). After four weeks, the rats were divided into four groups (n = 8/group) and fed experimental diets with different nitrogen sources and levels, respectively; 10% soy protein isolate (10SPI), 25% soy protein isolate (25SPI), 25% soy protein hydrolysates (25SPH) and 25% soy macro-peptide fractions (25SPP, MW > or = 10,000) for six weeks. Weight gain was significantly higher in 25% nitrogen sources-fed groups than in 10% group (10SPI). In 25SPP, perirenal fat mass and serum total lipid were significantly lower than in other groups. As for appetite-related hormones, serum ghrelin concentration was not shown to be different among groups but leptin concentration was significantly decreased in 25SPP. It can be concluded that soy macro-peptide fractions as compared with intact soy protein may have beneficial effects on reducing fat mass and serum lipid.

The Effect of Old Age on the Development of Postoperative Complication in Surgery for Gastric Carcinoma

PURPOSE: Despite the fact that the number of elderly in the population has increased due to the improvement in medical skills and equipment and an increased interest in health, there is a view common among patients, guardians, and even the surgeons that the prognosis after surgery in the elderly is not optimistic. We examined the effect of old age on the prognosis after surgery in patients who were to undergo surgery after being diagnosed with gastric cancer. The effect of old age on the development of postoperative complications was evaluated. METHOD: Five hundred and seventy three patients, who underwent surgery for gastric cancer from January 1994 to December 1998 at Wonju Christian Hospital under Yonsei University Wonju College of Medicine, were analyzed retrospectively. The patients were divided into those older and younger 70 years of age. The presence of an underlying disease, the physical condition according to ASA(American Society of Anesthesiologist) classification, the extent of the resection, the TNM stage according to the AJCC (American Joint Committee on Cancer), and the operation time were examined. The effects of age on the postoperative complications in the study and control groups were also evaluated. RESULTS: Among the 573 patients, 515 were under 70 years and 58 were older than 70. Those older than 70 years, showed significant differences with physical condition (P<0.001), the presence of an underlying disease (P=0.043), M stage of TNM staging (P=0.001), hospital days (P<0.001), and operation time (P=0.026). CONCLUSION: Age itself did not correlate with the development of postoperative complications (P=0.193). The presence of an underlying disease affected the development of postoperative complications regardless of age or gender. Therefore, surgery can be performed safely when the patient's condition is evaluated thoroughly before surgery and the operation is carried out as scheduled.

Effects of Halothane and Enflurane on Heart Rate Changes during Reversal of Neuromuscular Block with Glycopyrrolate and Pyridostigmine / 대한마취과학회지

Changes in heart rate during reversal of neuromuscular block have been a subject of clinical investigation for manly years. A number of studios have compared the effect used anticholinergica and anticholineaterase. In most studies, the druga were administered separately or simultaneously. Furthermore these studios have ignored any possible affects that the general inhalation aneathetics used during surgery might have had during reversal of neuromusclar Block. Recently, the volatile anesthetics which mar hove a significant role in heart rate during administration of atropine and neostigmine were reported. This study was undertaken to investigate those effects of halothane and enflurane on heart rate chances during reversal of neuromuscular b1ock with glycopyrrolate (0.7 ug/kg) and pyridoatigmine (0.2 mg/kg) which was given either separately or simultaneously have been used on 40 cartes at Depatment of Anesthesiology, Hanyang University Hospital from October 1985 to June 1786. The results were as follows : 1) There were not a significant differences on age, height and weight in compare with subgroups. 2) The changes of systolic and diastolic blood pressure were not a significant statistica-llr in compare with subgroups. 3) The changes of heart rate were showed that Initial increasing and decreasing of base-line level at 10 minutes were statistically significant in compare with subgroups. (p P>E:G +P>H : G+P > H : G --> P and bradycardia were as following sequence; H : G --> P>H : G+P>E : G --> P=E : G+P.

The Comparative Study of Diazepam, Lorazepam and Meperidine as Premedicants / 대한마취과학회지

Among the elective Surgeries performed at Hanyang University Hospital from March to July 1986, 150 cases were studied. Each 50 cases were given diazepam, lorazepam and mep-eridine as prefnedicants. In the diazepam and lorageparm group, each 25 cases were given by intramuscvlary and intravenously. 40 minutes after injection, scoring the degree of sedation was performed. Scoring the degree of sedation was adopted by "Simple Scoring System" (Nisbet and Norria, 1963). The results were as follows : 1) Comparison of diazepam, lorazepam and meperidine intramusclar administration, sign-ificantly lower souring wan defined in meperidine. (p0.05 by ridit analrsis in both groups) 3) Environmental factors (sex, grade of education, religion and sits of operation) were not influenced on scoring significantly. (p>0.05 by Chi-square test)

The Comparative Study of Epidural and General Anesthesia in Total Hip Replacement / 대한마취과학회지

Twenty six casea of general anesthesia and eighteen cases of epidural anesthesia for total hip replacement which were performed at department of anestheaiolow, Hanrang University Hospital from Jan. 1984 to fun. 1986 were measured blood toss, operation time, volume of whole blood tranafusion and mean arterial blood pressure perioperatively. The result were as follws : 1) Both groups were statistically comparable with regard to sect, height and weight but age of patients were statistically greater in epidural group(p<0.75). The oldest case was 85 years Old in epidural group. 2) The mean operativeblood loss of patients who had their operations under epidural anesthesia was significantly less that that of patients under general anesthesia, being 1,444+/-769 ml for the epldural group and 2,081+/-1,051 ml for the general group(p<0.75). 3) The mean bleeding rate of the patients under epidural anesthesia wart significantly less that of patients under general Anesthesia, being 9.2+/-3.0 ml/min for th? epidural group and 12.6+/-5.5 ml/min for the general group(P<0.725). 4) The mean volume of whole blood transfusion of patients under epidural anesthesia was significantly less than that of patients under general aneathesia, being 1,178+/-854 ml for the epidural group and 1,763+/-937 ml for the general group(7<0.05). 5) There was no case of deep vein thrombosis both groups.

Effect of Neuromuscular Blockers with Neostigmine Pretreatment in Rabbit / 대한마취과학회지

The history of muscle relaxant is fascinating, and their use in clinical anesthesia has been accepted. Depolarizing muscle relaxant may produce prolonged apnes with dual block and has no antidote. But non-depolarizing muscle relaxant has an antidots so whenever it is able to get reversal of muscle relaxation. Obviously, return of normal muscle function following muscle relaxant administration is of prime importance to the restoration of adequate spontaneous ventilation because it is clinically very important. By the way, there is no report on the effect of neuromuscular blocker with neostigmine pretreatment. The experiment was performed on forty rabbits weighing 1.8 to 2.4 kg and these were divided into two groups: eighteen rabbits for the control and twenty two rabbits for the study group. All animals were intubated through a tracheostomy under the general anesthesia with urethane and thiopental. Respiration was controlled by shinano animal respirator. The body temperature was kept at 35 to 36 degrees C with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and the peripheral nerve simulator was applied to the nerve muscle preparation. The twitch height of the muscle contraction was recorded on a biophysiograph through the force displacement transducer. The common peroneal nerve was stimulated supramaximally using a single twitch, square wave of 0.2msec duration at a frequency of 1 Hz. The degree of neuromuscular block and recovery following intravenous injection of succinylcholine 0.2mg/kg and pancuronium 0.02mg/kg were measured in the control group. And in the study group, succinylcholine 0.2mg/kg and pancuronium 0.02mg/kg were administered intravenously five minutes after the intravenous neostigmine then neuromuscular block and recovery were measured. The change of the twitch height on the muscle contraction and the time of spontaneous recovery in the study group were compared with those of the control group. The results were as follows: 1) Neostigmine pretreated succinylcholine effect was markedly prolonged muscle relaxation(about 7 times) and twitch height was diminished to 61.4% of the control level. 2) Neostigmine pretreated pancuronium effect was not afected significantly compare to the control group.

The Clinical Investigation of Supine Hypotensive Syndrome in Korean Parturients / 대한마취과학회지

The supine hypotensive syndrome occurs when the parturients near term in supine, enlarged uterus compresses the inferior vena cava and partially obstructs the lower aorta and venous return to the heart and arterial blood flow to the pelvic organs and lower extremities are decreased. Major supine hypotensive syndrome was defined as a fall greater than 30% or a value less than 80mmHg in systolic blood pressure. Many studies in Western countries have reported that up to 50% of parturients near term develop signs of shock including fainting, nausea, vomiting, loss of consciousness or sudden death when they assume supine position. The haxards of obstruction the aorta by the gravid uterus in pregnancy are well documented. Compression of the aorta is not associated with maternal symptoms but does cause arterial hypotension in the lower extremities and uterine arteries, so it can cause fetal distress and asphyxia. Most parturients are able to compensate for mild to moderate dupine hypotensive syndrome by increase in collateral circulation via azygos venous system and vertabral venous system and peripheral resistance or heart rate. But the anesthesiologists must recognize the importance of the supine hypotensive syndrome and the potential hazard of anesthesia in augmenting its effects. We have investigates the incidence of supine hypotensive syndrome in 171 parturients were Cesarean sectioned. We have investigated the correlating factors such as fetal body weight and parturient's physical status, body weight and age among the 36 cases of decreased blood pressure in supine position and also we have investigated the relationship between blood pressure changes and parturient's associated diseases. We have measured the arterial blood pressure indiredctly by the Rira-Rocci method when they are lying on the operating table in supine and compared it with arterial blood pressure in their comfortable position in ward. The results are as follows: 1) Among the 171 parturenits, the incidence of decreased arterial blood pressure in supine position was 21%(36casese). However the incidence of increased arterial blood pressure in supine position was 79%(135 caese). No case of severe blood pressure changes defined as a fall greater than 30% was notice but there was one case with less than 80 mmHg in systolic blood pressure which would be a rate of 0.6%. 2) The realationship between decreased blood pressure in supine posction and fetal body weight and parturient's physical status, body weight and age was not statistically significant(p>0.05). 2) The relationship between decreased blood pressure in supine position and parturient's associated diseases especially preechlampsia or eclampsia was statistically significant (p<0.05).

Epidural Morphine / 대한마취과학회지

No abstract available.

Effects of Intrathecal Morphine, Injected with Bupivacaine, on Pain after Orthopedic Surgery / 대한마취과학회지

To assess the postoperative analgesic effect of intrathecal morphine, it was given with 0.5% isobaric bupivacaine intrathecally after orthopedic surgery. The patients were divided into three groups. In group l(control group) 0.5% bupivacaine 3ml was administered with normal saline 0.2ml to 10 patients. In group ll (experimental group) 0.5% bupivacaine 3ml was administered with morphine hydrochloride 0.5mg to 10 patients and in group lll (experimental group) morphine hydrochloride 1.0mg to 10 patients. The duration of the postoperative analgesic effect, fequency of analgetic jection and incidence of side effects were checked and compared. The results of this study were as follows: 1) The mean time of duration of analgesia was prolonged significantly in group ll compared to group l (p<0.05) and very significantly in gorup lll(p<0.005) and also significant sifference getween group ll and group lll(p<0.01). 2) The frequency of analgetic injection in the postoperative period was lower in group ll than in group l and no patien was injected in group lll. 3) The mean time to maximal analgesic block was 19.5 minutes and the mean time to maximal motor block was 17.7 minutes. There was no difference among the three groups. 4) The mean time of recovery from the sensory blockade and motor blockade was 6.1 hours and 4.2 hours. There was no difference among the three groups. 5) Among the three groups there was little change in a the cardiovascular system due to suppression of the autonomic nervous system after induction of spinal anesthesia. 6) In all groups the systemic complications occurred such as nauses, vomiting, micturition difficulty, itching, constipation, headache and backache. This complications did not appear to be dose dependent and not occurred in patients not receiving morphine. Severe delayed respiratory depression was noted 2 cases in group lll.

Clinical Study of Subarachnoid Blockade with Bupivaeaine / 대한마취과학회지

The effects of subarachnoid administration of 0.5% bupivacaine in 5% and 10% glucosesolution were investigated in a randomized 30 cases undergoing a low limb and low abdominal surgery in the Department of Anesthesiology at the Hanyang University Hospital from October 1st, 1984 to March 31st, 1985. The results are as follows: 1) These were no significant differences between the patients of the three groups in relation to sex, age, weight, height and operation time. 2) The oneset time of the maximum segmental spread of analygesia in the control group was 5 to 10 minutes and 10 to 15 minutes in the experimental groups. 3) The spread of sensory blockade in the experimental groups was lowered 2~3 segment compared with control group. 4) The onset time of complete motor blockade in the control group was 5 minutes and 5~10 minutes in the experimental group. 5) Duration of complete motor blockade in experimental groups was shorter than the control group. 6) The cardiovascular changes were investigated with no significant differences between the patients of the three groups. 7) The minimal complications such as mild hypotension in three cases, micturition difficulty in one case, mild translent headache in one case were investigated in the three groups. According to our investigation of subarachnoid blockade with 0.5% bupivacain 2ml in 5% and 10% glocose solution, it considered that the spread was limited and produced intense sensory and motor block of long duration which was suitable of the low limbs and low abdominal surgery.

Clinical Study of the Postperative Pain Management with Silver Spike Point Electro-therapy / 대한마취과학회지

Silver Spike PintElectro-Therapy(SSPET) means passing electric current through the skin surface with the triangle spike silver coated metal electrode. Transcutaneous Electrical Nerve Stimulation(TENS) for chronic pain management was first reported by Shealy in 1972. Since 1975, Vanderark and Mograth reported that TENS has had a analgesic effect for the relief of acute postoperative pain. SSPET was reported by Hyoto and Kitade at Edinburg, Scotland. 3rd World Congress on Pain in 1981; It has a number of advantages over traditional narootic medication in postoperative pain management. It does not depress the cardiovascular, respiratory of metabolic system and has no apparent effect on the sensorium. Furthermore it is noninvasive, nontoxic, simple in its application and can be used continuously or intermittently. This study was undertaken to investigate recent reports concerning the use of Silver Spike Point Electro-therapy for the relief of postoperative pain. Sisyt patients undergoing elective Cesarean section were subjected to a standard perianesthetic proctocol by the Department of Anesthesiology at Hanyang University Hospital from March, 1st to August, 31, 1984. The patients were divided into three groups of twenty, designed control, SSP and sham SSP. Postoperative analgesic requirements for each group were compared. The results are as follows; 1) The age distribution ranged from 21 years to 36 yearts. Mean age was 25 years and the body weight ranged from 45kg to 68kg. The mean body weight was 52kg. 2) The incisional area of the Cesarean section was 23 cases (38.3%) of low midline incision and 37 cases(81.7%) of Pfannenstiel incision. 3) There were no remarkable changes in the blood pressure, pulse rate or respiratory rate during before and after SSP administration. 4) The total number of intramuscular doses of Demerol given to the patients in the ward was: control group 94 doses, SSP group 31 doses and sham SSP group 89 doses. The SSP group was statistical different from the other 3 groups when compared by the Student's T-test. 5) In the subjective assessment of each group, their statements were markedly varied. Nevertherless SSP has shown that the analgesic requirement was considerably less than that of the other group. This result means that SSP can be used for the relief of acute postoperative pain. Despite a number of diffidulties encountered during this study, we were primarily concerned with the action mechanism, subjective measurement of pain and standards in the requirment of Demerol. We considered that further investigation should be done in the use of SSP for postoperative analgesia and pain. SSP for postoperative pain management is a useful method that is simple, non-invasive, non-toxic and obtains safe analgesia.

Aneathetic Management in Pregnant Myaethenics for Elective Cesariaa-section / 대한마취과학회지

Myasthenia gravis is relatively common in young women and therefore sometimes associated with pregnancy. Since pregnancy influences the course of the myasthenia gravis, and the drugs used for its treatment may influence gestation, the obstetrical management of myas-thenic patient merits special consideration. In myasthenia gravis, it is generally thought that the anesthesia of chice is regional anesthesia during vaginal delivery and general anesthesia during Cesarian section. But in Cesarina section for a pregnant myasthenic with pulmonary disease, epidural or subarachnoid block may be preferable to avoid postoperative hazards. We performed epidural anesthesia with lidocaine in a 39-year-old elderly primigravida myasthenic with COPD and obtained good intra and postoperative results.

The Clinical Comparative Stndy on Liver Function with Enflurane and Halothane Anesthetics / 대한마취과학회지

Halothane was introduced in 1956. It has been used worldwidely as a relatively safe inhalation anesthetic but it is generally accepted that it can cause decrease of liver function. But the causative factor has not yet been pinpointed. Enflurane also seems to decrease liver function but the exact cause is not yet known. In order to study the effects of enflurane and halothane on liver function, we used 10 cases of spinal anesthesia as a control group, and 20 cases each of enflurane and halothane anesthesia respectively as experimental group. We then checked serum GOT, GPT, total bilirubin, alkaline phosphatase, and eosinophil count in peripheral venous blood before oeration and 6 days after operation and looked for the existence of high fever of more than 39 degrees C 3 days postoperatively. The results are as follows: 1) We found statistical significant change of serum GOT, GPT, total billirubin alkaline phosphatase and eosinophil count in spinal, enflurane, or halothane anesthesia beofre and after operation. There was no statistically significance between the control and experimental groups. 2) No patient developed high fever of more than 39 degrees C until 3 days after anesthesia in any group. 3) No significant change of mean arterial blood pressure was observed before and during anesthesia in each group. In this study no definite conclusion that enflurane and halothane might have affected the liver function.

Clinical Observation of the Patient who recieved Blood Transfusion / 대한마취과학회지

It is a well known fact that the best method of determinign need ofr transfusion is the accurate measurement of blood loss related to the patient's status and surgical maneuvers during operation. There are many complications of blood transfusion and their pathophysiologic mechanism, and theprevention and management has been discussed. Among the complications of blood transfusion, urticaria is the most common symptom. The pathophysiologic mechanism of urticaria is understood in some degree at the present time but there are many different opinions as to its prevention and management. Furthermore antihistamine has been widely used for the prevention of urticaria but there are many debatable events about the use of antihistamine. This study was undertaken to investigate the recent reports concerning the use of antihistamine for the prevent in and management of urticaria. Two hundred eighty eight transfused patients among the total of six thousand four hundred forty eight surgical cases done at the Hanyang University hospital from January 1st to December 31th 1983. were reviewed. The result are as follows: 1) The incidence of urticaria was 28 cases (9.72%) among the 288 transfused cases and there was no sex difference. 2) The age distribution was 10 cases (12%) in the 2nd decade and 9 cases(11.3%) in the 4th decade. 3) The lowest incidence of urticaria was 5 cases (5.3%) with A blood type and high of incidence with B, O and AB blood type. 4) The physical status of class 3 was seem in 10 cases(43.5%) as the most common occurrence of urticaria. 5) The highest incidence of urticaria was observed in 9(45%) of 20 obstetric cases. 6) There was no significant differnece of urticaria incidence between the groups which did and did not use antihistamine. Also in the group which received histamine 10 minutes before treansfusion there was a significant decreases 6 cases (3.41%) among the 178 transfused cases. 7) There was no significant statistical difference between blood loss and transfused blood volumes. 8) There was no significant statistical change in the mean values of hemoglobin and hematocrit which were measured preoperatively, in recovery room and 24 hours after operation. 9) In the patient's who were tranfused with more than 10 oints of whole blood, urticaria developed in 9 cases (50%) among 18. From the results of this study, I consider the most effective method for the prevention of urticaria to be the administration of histamine 10 minutes before transfusion. Further investigation of this method will be carried out.

Anesthetic Management in Patient with Myasthenia Gravis / 대한마취과학회지

Myasthenia gravis is a disease characterized by muscle weakness upon exertion of an involved muscle group and partial return of function eithe with rest or the administration of anticholinesterase. It is generally thought that myasthenia gravis is caused by an autoimmune response associated with the thymus gland and thymectomy is considered to be the treatment of choice for countering this autoimmune process. It is a well known fact that perioerative nticholinesterase therapy, muscle relaxant administration during operation and postoperative respiratory management are in dispute. We described a case of a 42 year old male myasthenic patient with mild symptoms who needed 4 days of artificial ventilatory support following thymectomy.

Clinical Study of Electrical Stimulation of the Peripheral Nerve / 대한마취과학회지

Recent studies in western countries have reported that the mechanism pf pain are concorded with gate control opiage receptor binding sites and the release of intrinsic morphine like substances, sodium glutamate and also with bradykinin, seroconin, histamine and prostaglandin E. Otherwise the mechanism of the stimulstion producing analgesia has been reported to involve a neurophysiologic and neurohumoral inhibitory effect at the level of spinal cord, brain stem, thalamus and cortex. This has been clarified but further study should improve the chance of understanding the mechanism of pain. From the standpoint of pain management, medications used to manage pain have some unfortunate side effects. nerve blocks cause anesthesia toxicity, major neurosurgical procedures have many complications. Subarachnoidal and epidural analgesics have unknown irritation pneumonia and drug toxicity, and plexus or pituitary gland block with phenol or alcohol has uneventful complication. From January 1980 to December 1982, electrical acupuncture stimulation has been used on 210 cases at HANYANG university hospital in the pain clinic. I found it useful in relieving pain which has not responded to various conventional methods which included medications, nerve blocks, neurosurgical intervantion and neuropolytics. The results are as follows: 1) There are two kinds of treated patients: One is consultation case-12 from internal medicine, 16 from orthopedic surgery, 10 from neurosurgical and 2 from psychiatry. Another 170 cases were patients who directly to the clinic. And the age distribution shows the highset number of patients in the 3rd decade(21%) and in the 4th decade(24.8%). 2) The region of pain was 21% lumbar, 13.8% shoulder, 10% lower leg and head or face with 9.5%. 3) The duration of the pain showed 10 days 25.7%, 1~2 month 18.6%, one year 11.4% and the longest up to 20 years. 4) Patients who were able to walk into the clinic were 19.5%, moderate cases who to be accompanied were 58.6% and bedridden cases were 21.9%. 5) Treatment was conducted mainly on low frequency stimulation with various waves that included the general dynamic activity point plus reactive electro permeable point (REPP) 81.9% and REER plus head in situ needle 18.1%. 6) In 16.7% only one treatment was administered, in 46.1% 2~5 treatments were given, in 28.6% 6~10 treatments were given and in 3 cases more than 100 treatments were administered. 7) Of the 210 cases, 43.3% showed marked improvement, 41.4% were improved, 13.8% showed translent improvement and there were 3 cases of no improvement. The total confidence was 84.7%. 8) There are no serious complications except hypertensive shock case, submucosal hemorrhagic petechia 7 cases and generalized fatigue 18 cases. In conclusion, electrical acupuncture stimulation of the peripheral nervous system can be used to relieve pain replacing such conventional means as medications, nerve blocks, major neurosurgical procedures, neuroytics and physiopsychic therapy which are generally less effective.

The Clinical Investigation of Geriatric Anesthesia / 대한마취과학회지

In contrast to younger patients, old peoples frequently mainfest more than one pathologic process, mainly degenerative diseases and neoplasia. Nearly all have some degree of arteriosclerosis, even if this is not clinically diagnosed, and many have associated chronic cardiac, renal, hepatic, or pulmonary disease. The surgeon and the anesthesiologist must see theat their clinical decisions are tied to a physiologic understanding based on exact quantification of the specific hemodynamic, respiratiory, renal, and metabolic factors which may play a decisive role in influencing the final outcome to a major operative procedure. From May 1972 to Dec 1980, the Department of Anesthesiology, Hanyang University, College of Medicine had 517 geriatric patients(above 65 years) who received anesthesia and these were analyzed clinically according to age, sex, department, physical status, anesthetic technique and agent, anesthesia time, length of admission, laboratory studies(chest X-ray, EKG, arterial blood gas), and postoperative complications(mortality and causes of deathe). The results are as follows. 1) Out of 25,857 anesthetized patients 517(2.0%) were over 64 years of age and 290 were males(56.1%) and 227 females(43.9%). 2) In the surgical group, 246 cases (47.6%) were from general sugery: 81 cases(15.7%), orthopedic surgery: 78 cases (15.1%), urology: and 67 cases (12.9%), neurosurgery respectively. 3) In the classification of physical status, 33 cases(6.4%) were class 1, 269 cases(52.0%) class 2, 181 cases (35.0%) class 3, 28 cases (5.4%) class 4, and 6 cases (1.2%) class 5. Emergency cases were 137 cases(26.5%) and 380 cases (73.5%) were elective. 4) Concerning premedication-150cases(29.0%) were premedicated with atropine sulfate plus valium and 93 cases had no premedication. 5) There were 425 cases of general anesthesia (82.2%) and 92 cases of regional anesthesia (17.8%). The major anesthetic was halothane, 362 cases (70.0%). The technic in 419 cases( 81.0%) was circle type with endotracheal intubation. Anesthesia duration was within 1hour for 70 cases(13.5%), within 2 hours for 158 cases(30.0%), and within 3hours in 144 cases(27.9%). 6) Preoperative laboratory findings were as follows: The chest X-ray suggested that 199 cases (45.9%) were within normal limits, 56 cases (12.9%) had hypertensive heart disease, 56 cases (12.9%) had pulmonary tuberculosis, and 38 cases (5.1%) had senile lung fibrosis. The EKG which was done on 85% of the patients, ravealed that 193 cases (44.0%) were within normal limits, 61 cases(13.9%) showed left ventricular hypertrophy, and 38 cases(8.7%) had myocardial ischemia. In the preoperative arterial blood gas studies of 56 cases the results were almost all within normal limits. 7) Postoperative complications were as follows: 52 cases showed wound infection or bleeding, 20 cases had pneumonia, and 18 cases atelectasis. There were a number of miscellaneous complications. 8) The overall mortality rate was 5.8%. The difference of mortality rate related to the age was not statistically significant,(p>0.1) and the mortality rate related to physical status was statistically significant(p<0.005). 9) As the cause of death-11 cases (36.7%) had transtentorial herniation, 2 cases (6.7%) sepsis, 2 cases (6.7%) hypovolemia, and 1 case (3.3%) had pulmonary edema.

The Effect of d-Tubocurarine and Lidocaine on Elevated Serum Potassium Level with Succinylcholine / 대한마취과학회지

Succinylcholine has been used extensively for endotracheal intubation as a short-acting muscle relaxant. Intravenous administration of succinylcholine may be associated with adverse effects including elevated serum potassium and creatine phosphokinase, postoperative myalgia, changes in cardiac rate and rhythm, elevated intraocular pressure and intragastric pressure. Although elevated serum potassium is usually slight in normal person, it can be greater in disease states such as burn, massive trauma, uremia, neuromuscular disorders, CNS injury and tetanus. In the present study, the influence of d-Tubocurarine and lidocaine on the serum potassium level was observed in 80 patients undergoing elective surgery and without electrolyte. abnormality. The patients were divided into four groups of 20 cases. control group: serving as control. dTc group: receiving 3 mg of d-Tubocurarine as pretreatment prior to succinylcholine administration lidocaine group: receiving 1 mg/kg of lidocaine as pretreatment prior to succinylcholine administration dTc with lidocaine group: receiving d-Tubocurarine with lidocaine as pretreatment prior to succinylcholine administration Blood samples for electrolyte measurement were drawn before induction and 3, 5 and 10 minutes after the administration of succinylcholine. The following results were obtained; 1) Serum potassium levels were significantly increased in the control group(p<0.05) and lidocaine group(p<0.001). 2) Serum potassium level were slightly incerased, but not significantly in the dTc group and dTc with lidocaine group. 3) Serum sodium levels were slightly decreased in all groups, but not significantly. 4) Serum chloride levels were slightly increased in all groups, but not significantly.

Influence of Midazolam on Serum Potassium and Creatine Phosphokinase Levels / 대한마취과학회지

Succinylcholine is used most widely for tracheal intubation during induction for general anesthesia. However adverse effects following the administration of succinylcholine which include an increase of serum potassium, creatine phosphokinase, abdominal pressure and the presence of fasciculation are well known to anesthesiologists. Many investigators have studied the influence of pretreatment with d-tuhocurarine and diazepam to prevent the adverse effects following administration of succinylcholine. We studied the effects of serum potassium and creatine phophokinase with midazolam(0.25 mg/kg) the most newly introduced benzodiazepine derivatives and thiopental sodium(4-5mg/kg) the most widely used induction agent for anesthesia in 33 adult healthy surgical patients. We also observed the onset of loss of eyelash reflex and fasciculation, the degree of fasciculation and the adequacy of relaxation for intubation comparing the two agents. The results are as follows: 1) There were no significant increases in serum potassium and creatine phosphokinase levels before succinylcholine and after 10 minutes administration in both agents groups. 2) Loss of eyelash reflex occurred immediately with thiopental and at 63+/-43 seconds with midazolam one minute after administration. 3) Fasciculation appeared at 14.4+/-4.9 seconds with thiopental and at 21.3+/-11.9 seconds with midazolam and continued 66.3+/-20.1 seconds with thiopental and 43.5+/-l8.5 seconds with midazolam. 4) The adequacies of relaxation for intubation were good enough in both agents groups but midazolam seems to be better. Midazolam seems to be a good induction agent for general anesthesia and prevents an increase of serum potassium level after administration of succinylcholine without pretreatment of non-depolarizing muscle relaxants or diazepam.

Clinical Evaluation of the Patients who Received Blood Transfusion During Operation / 대한마취과학회지

This study chose 530 patients among the total of 5214 operative cases except open heart and pediatric surgery who received more than 2 pints of blood who were performed general, spinal and epidural anesthesia. This study lated for a year in an operating room. We measured and compared the value of hemoglobin and hematocrit, preoperatively, in recovery room and 24 hours after operation. We also compared the volume of blood transfused with the volume of blood loss during the operation. The results are as follows. 1) According to the operative Department of the transfusion cases, the distributions were 129 cases(Obstetic & Cynecology), 114 cases(Orthopedic Surgery). 2) The mean values of hemoglobin measured preoperatively, in recovery room and 24 hours after operation were 11.9gm/dl, 11.5gm/dl and 11.6gm/dl, respectively. 3) In the comparison and observation about the difference of the hemoglobin value and hematocrit value preoperatively and in recovery room the cases which showed the difference of 10% were 229 cases which was the most frequent cases. The cases which showed the differences of 40% were 24 cases and it was the less frequent cases. 4) In the volume of blood loss on the operative department, maximum volum of blood loss was 4,130ml in hepatic primary closure. 5) In the comparison and observation of the volume of the blood transfusion, the cases whose volume of transfusion was 2~5pint were 430 cases. The cases in which more than 10 pints transfused were 25 cases. 6) In the operation where the patients transfused more than 10 pints of whole blood, vertebral interbody fusion was the most cases. 7) In the patients who transfused more than 10 point of whole blood, urticarias was whon 16 cases among 25 cases. 8) Recording the values of hemoglobin and hematocrit, preoperatively, in recovery room and 24 hours after operation on the blood trasfusion makes anesthesiologist precise to determine the volume of blood transfusion and blood loss. The results from all the cases were considered satisfactory except one case which showed the complication of pulmonary edema.