Effect of Nasal Insufflation of Oxygen on Arterial Oxygen and Carbon Dioxide Tension during Apnea in Anesthetized Humans / 대한마취과학회지

During induction of anesthesia, apnea may persist in the case of difficult intubation or fiberoptic guide intubation. In that situation hypoxemia and hypercarbia may occur even though preoxygenation and hyperventilation has performed before apnea start. Sometimes anesthesiologist perform preoxygenation with mixed oxygen and nitrous oxide gas to facilitate and smooth induction. The aim of this study was to know the apnenic time that arterial oxygen saturation drop below 9%o in the patients who was preoxygenated with 100% oxygen or mixed gas (oxygen-nitrous oxide 1:1 ratio) before apnea begin and to know whether nasal oxygen insufflation during apnea affect arterial oxygen tension. Study was conducted in three groups. Each group has 13 patients, After induction of anesthesia with thiopental, pancuronium and isoflurane 1 vol%, Group 1 (Air group) and Group 2 (O2 group) were ventilated with facemask with 100% oxygen for 5 minutes and then remained apneic state in air (Group 1) or nasal insufflation of oxygen (1 L/10 kg/min) (Group 2) with patent airway. Group 3 (N group) was ventilated with O2 and N2O in 1: 1 ratio for 5 minutes and remained apneic state in air. Apnea continued until either SaO2 dropped to 93%, or 8 min had elapsed. At this time, duration of apnea and minimum SaO2 were recorded. During apnea period PaC2, PaCO2, SaO2, MAP, HR were measured 1 min interval. Duration of apnea and mean minimum saturation for Group 1, 2 and 3 were 7+/-1, 8, 3.0+/-0.9 min and 96.6+/-2.4%, 99.1+/-1.5%, 95.7+/-2.5% (mean+/-SD) respectively. In Group 2, SaO2 never fell below 95% during the entire 8 min apnea in any subject. PaCO2 were increased by 5.8 mmHg (Group 1), 7.4 mmHg (Group 2), 7.8 mmHg (Group 3) at first 1 min and then linealy increased by 2.9 mmHg/min for Group 1 and 2 and by 3.2 mmHg/min in Group 3 during apnea period. There was no difference in MAP among three groups during apneic period but HR of Group 3 showed significant increase after 2 min compared to Group 2. In conclusion, preoxygenation followed by insufflation of oxygen via nasal oxygen cannula provides at least 8 min of adequate oxygenation in healthy apneic patients whose airways are unobstructed in whom the trachea is not intubated. It is safe method not to use preoxygenation with mixed gas of N2O before apnea if there is any possibilty of difficult intubation or difficulty in establishing patent airway.

A case of esophageal perforation during endotracheal intubation in ankylosing cervical rheumatoid patient / 대한마취과학회지

Adverse respiratory events during endotracheal intubation for general anesthesia are variable. These events frequently occur to difficult airway patients. Traumatic endotracheal intubation with poor glottic exposure and blind thrust can perforate the hypopharynx or cervical esophagus. We experienced a case of esophageal perforation during endotracheal intubation for general anesthesia of total hip replacement in a 50 year old female patient. Neck extension was almost impossible due to longstanding ankylosing rheumatoid cervical arthritis. We tried several times of endotracheal intubation but failed. Post-operative esophago-graphy after we found subcutaneous emphysema confirmed esophageal perforation. Emergency tube drainage and general supportive care were done. Fortunately she recovered uneventfully and discharged on post-op. 30th days.

The Change of Platelet Function during Pediatric Open Heart Surgery / 대한마취과학회지

To evaluate the change of platelet function during pediatric open heart surgery, authors measured CBC(hemoglobin, hematocrit, platelet count), bleeding time, activated clotting time (ACT), and the degree of platelet aggregation immediately after induction(Tl), after arrival at intensive eare unit (ICU)(T2) and 24 hours after operation(T3) separately. The patients were devided into two groups; one group (7 patients, DHCA(-) group) was not undergone deep hypothermic circulatory arrest(DHCA) and the other group (7 patients, DHCA(+) group) was undergone DHCA. Authors analized the differences between two groups(intergroup) and between pre-CPB and post-CPB values(intragroup). The correlations between the degree of platelet aggregation and platelet count, body temperatue, period of cardiopulmonary bypass (CPB), and hleeding time were also analized respectively. The results were as follows, 1) The age, weight, body surface, and the nadir of body temperature during CPB, except the period of CPB, were significantly different between two groups. The average period of DHCA was 53.7+/-7.5 minutes. The average nadir of rectal and esophageal temperature were 17.2+/-1.1 degrees C and 14.0+/-0.9 degrees C in DHCA(+) group. 2) Intergroup and intragroup differences were not significant in hemoglobin and hematocrit. 3) Intragroup differences in platelet count were significant but intergroup difference were not significant. 4) The percent changes of platelet aggregation at T2 and T3 compared to the value at Tl were 70-80%, and 80-90% respectively. 5) The correlations between the degree of p1atelet aggregation and temperature, period of CPB, platelet count and bleeding time were poor, but bleeding time correlated with platelet count(r=0.6, P< 0.05).

Comparison of Hemodynamic Effect between Laryngeal Mask and Conventional Endotracheal Intubation to Maintain Airway during Induction of General Anesthesia / 대한마취과학회지

The adverse cardiovascular effects of laryngoscopy and endotracheal intubation are well known. We compared the cardiovascular response of conventiomal tracheal intubation with that of newly developed Laryngeal Mask insertion in twenty-four ASA class I patients. Anesthesia was induced with injection of fentanyl 2 ug/kg, thiopental sodium 4 mg/kg and vecuronium 0.15 mg/kg intravenously. Ventilation was controlled for 5 minutes with inhalation of 50% nitrous oxide and 1 vo1% of isoflurane or 1.5 vol 8% of enflurane before tracheal intubation or laryngeal mask insertion in all patients. The patients are random1y assigned to either tracheal intubation group(ET group) or Laryngeal Mask group(LM group). After tracheal intubation or insertion of laryngeal mask, blood pressure(systolic, diastolic and mean) and heart rate were measured for 5 minutes at 1 minute interval. In all the parameter, cardiovascular response in ET group was significantly higher than that of LM group for 5 minutes after intubation. It is concluded that insertion of Larynaeal Mask is beneficial to a certain patients than use of laryngoscopy and tracheal intubation to avoid harmful cardiovascular respones in the management of airway during general anesthesia.

A Study on the Priming Effects of Nondepolarizing Neuromuscular Blockers / 대한마취과학회지

The authors studied the priming effects of the nondepolarizing neuromuscular blockers on the frequency of discomfort, intubation condition and the time interval between the administration of nondepolarizing neuromuscular blockers and endotracheal intubation. Thirty two patients were divided randomly into four groups: the patients administered vecuronium priming dose, 0.02mg/kg and intubating dose, 0.06mg/kg (Group I), vecuronium customary single dose, 0.1 mg/kg (Group II), pancuronium priming dose, 0.02 mg/kg and intubation dose, 0.06mg/kg (group III) and pancurnium customary single dose, 0.1 mg/kg (group IV). The results were as follows. 1) Seven patients complained discomfort after administration of priming dose in the priming groups. (Group I and III) 2) There was better intubating condition in the priming groups than the customary single dose groups. 3) The time intervals between the administration of intubating dose and the maximum depression of single twitch response were revealed 57.9+/-14.6 seconds, 115.5+/-27.2 seconds, 74.5+/-30.0 seconds and 101.4+/-13. 7 seconds in I, II, III and IV group respectively. The time interval in group I was significantly shorter than group II (p< 0.05). And the interval in group III was also significantly shorter than group IV (p<0.05). With the above results we conclude that the priming groups provide smooth and rapid intubation condition than the customary single dose group, in spite of small total intubating dose.

Hemodynamic Effects of Propranolol on Canine Cardiovascular System under Variable Concentration of Insoflurane Anesthesia / 대한마취과학회지

To determine the beta-sympatheitc activity of isoflurane and interaction between isoflurane and propranolol the study on cardiovascular effects in 8 dogs under various concentration of isoflurane anesthesia after intravenous injection of propranolol was undertaken. Heart rate, mean arterial pressure, central venous pressure, pumonary artery pressure, pulmonary capillary wedge pressure, and cardiac output were monitored and recorded under N2O-O2. N2O-O2-1 MAC of isoflurane, and N2O-O2-2 MCA of isofiurane, respectively and than at 20 minutes after wash;out with N2O-O2,and at 20 minutes after propranolol injection, and at 20 minute after the same conditioned anesthesia, above parameters were rechecked, respectively. Using above paramethers the cardiac index, stroke volume index, left ventricular stroke work index, systemic vascular resistance and pulmonry vascular resistance were calculated. Following results were obtained by comparing each data, and between isoflurane alone and isoflur- ane with propranolol injection.1) The heart rate, mean arterial pressure, cardiac output, cardiac index, left ventricular stroke index, systemic vascular resistance decreased significantly according to increment of isoflurane concentration. 2) The heart rate, mean arterial pressure, cardiac output, cardiac index and left ventricular stroke work index decreased significantly after injection of propranolol comparing with the data before injection and under same concentraion of isoflurane decreased significantly in the dogs pretreated with propranolol. 3) The stroke volume index did not change significantly with injection of propranolol but as adding isoflurane decreased significantly according to the concentration of isoflurane. 4) The pulmonary artery pressure did not change significantly with injection of propranolol but as adding isoflurane increased significantly comparing with that under the same concentration of isoflur-ane without propranolol. 5) The central venous pressure did not change significantly according to injection of propranolol or adding isoflurane. 6) The systemic vascular resistance and pulmonary vascular resistance increased significantly with injection of propranolol and adding isoflurane.

The Effect of Component Transfusion on Perioperative Change of Hemoglobin , Hematocrit and Platelet Count / 대한마취과학회지

The progress of anesthetic and surgical techniques has resulted in an increase in the number of operations requiring transfusions over the past 10 years. Thus, the incidence of complications from shortage transfusions increases daily and a blood supply shortage occurred recently. blood component therapy is now believed to be an answer to these problems. To assess the effect of blood component therapy, especially packed RBC transfusion compared with routine whole blood transfusion, the author compared the preoperative and postoperative hemoglobin, hematocrit and platelet count values. The conclusions are as follows: 1) There were no significant changes in hemoglobin and hematocrit values of the whole population studied, from preoprative values of 12.6+/-0.2g% and 37.6+/-0.6% to postoperative values of 12.7+/-0.1g% and 38.2+/-0.4%, respectively. The platelet count significantly decreased (p<0.05) from 305200+/-9500/mm(3) preoperatively to 249600+/-8800/mm(3) postoperatively in the whole population studied. 2) There were no significant changes in hemoglobin and hematocrit levels according to age distribution, type of transfusion, amount of transfusion, surgical department and operative site, except in the Department of General Surgery, in abdominal surgery, and tumor group surgery in which preoperative hemoglobin and hematocrit values were slightly increased postoperatively. 3) The platelet count significantly decreased postoperatively in the whole population studied except in transfusion amounts under 1 unit, in the age distributions of 20~29, 60~69 and above 70 years, in the Departments of Neurosurgery, Urology, Plastic Surgery, Dental Surgery, ENT, and in head and neck surgery. However, it did not decrease to the level of abnormal bleeding(50.000/mm(3). From the above results, blood component therapy, especially packed RBC transfusion, made no difference in maintaining postoperative hemoglobin and hematocrit levels compared with routine whole blood transfusion.

The Effects of Prostaglandin E1 and Hydralazine on Hemodynamics and Gas Exchange in Oleic acid induced Acute lung Injury / 대한마취과학회지

Prostaglandin E1(PGE1) is a potent vasodillator of the systemic and coronary circulatory system, and when used in adult respiratory distress syndrome, PGE1 produces a decrease in pulmonary arterial pressure(PAP) and pulmonary vascular resistance(PVR), and increases cardiac output(CO) and arterial oxygen tension(PaO2). Another vasodilator hydralazine in patients with pulmonary hyertension and heart failure produces a decrease in PVR, and an increase in CO and inspite of an increase in CO, hydralazine maintains or increases the PaO2. The authors made a comparative studies on the effects of PGE1 and hydralarine on hemodynamics and gas exchange in experimentally induced acute lung injury. Oleic acid was infused in 8 dogs in order to induce acute lung injury and the effects on hemodynamics and gas exchange were measured every 30 minutes for 2hrs. After measuring Pre-PGE1 and Pre-hydralazine values, PGE1 and hydralazine were administered intravenously in order to evaluate and compare their effects. Doses for PGE1 and hydralazine were titrated until CO increased by 25%, heart rate(HR) increased by 15%, or mean arterial pressure(MAP) decreased by more than 20% from Pre-PGE1 and prehydralazine values. In PGE1 group, CO increased by 21%(p<0.01). MAP decreased by 14%(p<0.01). PVR decreased by 19%(p<0.01) and systemic vascular resistance(SVR) decreased by 29%(p<0.01). As CO increased with PGE1, intrapulmonary shunt(Qs/Qt) increased from 37% to 49%(p<0.01) and PaO2 fell from 109mmHg to 88mmHg(p<0.01). In hydralazine group, MAP, PVR, SVR and pulmonary capillary wedge pressure(PCWP) all decreased by 9%(p<0.01), 10%(p<0.05), 30%(p<0.0), 28%(p<0.01), respectively. CO increased by 41%(p<0.01) but the increase in Qs/Qt was only 5% inspite of a remarkable increase in CO, consequently PaO2 increased by 10% rising from 86mmHg to 94mmHg(p<0.01). Comparing the two groups, hydralazine resulted in a minor increase in Qs/Qt while there was a remarkable increase in CO. Moreover, it caused an increase in PaO2 and decrease in PCWP. The above results suggest that the effects of hydralazine are superior to those of PGE1 on the effects of hemodynamics and gas exchange in acute lung injury in dogs.

The Cardiovascular Effects of Isoflurane with Increment of Minimum Alveolar Concentration in Dogs / 대한마취과학회지

To investigate the cardioyascular effects of 1 MAC-and 2 MAC-isoflurane anesthesia, eight Mongrel dogs were anesthetized with intravenous thiopental sodium and maintained with endotracheal nitrous oxide (2 l/min) -oxygen(2 l/min) -isoflurane-pancuronium. Dogs were kept normothermic by the use of Aqua-Therm and normocapneic with controlled ven-tilation employing Airshield Ventimeter with frequent measurements of PaCO2. An 18G Medicut was inserted in the left femoral artery, a Swan Ganz catheter was passed into the pulmonary artery through the right femoral vein, and cardiovascular parameters were measured during control, 1 MAC-and 2 MAC isoflurane administration. The results are as follows : 1) Heart rate, mean arterial pressure, cardiac output, cardiac index, stroke volume, left ventricular stroke work index and left ventricular dp/dt max decreased during both MAC isoflurane anesthesia. These decreases were more prominent during 2 MAC-isoflurane administration. 2) Pulmonary capillary wedge pressure and pulmonary vascular resistance did not change significantly during the 1 MAC phase, but did during the 2 MAC phase. 3) Mean pulmonary arterial pressue decreased slighter during both phases. 4) Central venous pressure and srstemic vascular resistance did not change significantly throught the experiment. The above findings indicate that isoflurane does directly depress the myocardium and the hemodynamic function, and it is important to decrease isoflurane concentration acccordingly with the use of nitrous oxide.

A Clinical Study on the Determination of Expected F1o2 / 대한마취과학회지

On the 25 open heart patients with mechanical ventilatory support, we compared the stabilities of oxygen derived variable for predicting Pao2 after F1o2 modification. With arterial blood gas values in F1o2 1.0, F1o2 was reset succeesively by using AaDO2, a/A Po2 and Pao2/F1o2 to obtain the desired Pao2(100 torr). A total of 100 data were used to compare the Qs/Qt and varying F1o2 with AaDO2, a/A Po2 and PaO2/FlO2 respectively. 1) PaO2 obtained by a/A PO2 or PaO2/F1O2 was much closer to the expected PaO2(100 torr) than that by AaDO2. 2) The calculated values of F1o2 were decreased successively in order of equations used by AaDO2, a/A Po2 and PaO2/F1O2. 3) a/A Po2 anfl Pao2/Flo2 were constant mathematically with varying Flo2. 4) Qs/Qt was higher in F1o2 1.0 than in Flo2 below 1.0. In varying F1o2, it was difficult to find statistical correlations between a/A Po2, Pao2/F1o2 and Qs/Qr, but AaDO2 was relative Qs/Qt due to the used equation. 5) We found high Statistical Correlations (R>0.99) among AaDO2, a/A Po2 and Pao2/F1o2 in Flo2 1.0 which were decreased after F1o2 changes. AaDO2 ranged from 213 torr to 452 torr in Flo2 1.0 and it was decreased Progressivelr in Flo2 below 0.8. The Flo2 modified by AaDO2 in Flo2 1.0 must be changed to the lower level to keep the Pao2 100 torr. a/A Po2 could not be discarded due to its stability in spite of its complexity to calculate. But Pao2/F1o2 was also stable and had the advantage of a/A Po2 in point of simplicity to calculate.

A Study upon the Changes of Hemoglobin and Hematocrit between Preoperative and Postoperative Values / 대한마취과학회지

Because of the increasing numbers of the operations requiring transfusions day by day, there is increase in transfusion reaction, and recently the shortage of blddd supply and the requirements for component transfusion are enhanced. In order to overcome the shortage of blood supply and to prepare the standard for com-ponent transfusion, the author compared the preoperative heraoglebin and hematocrit with postperative ones, and the conclusions are as followings. 1) There were no significant changes in hemoglobin and hematocrit of both male and female groups, as from preoperative values of 17.4+/-1.87g% and 42+/-5.0% to postoperative values of 14,2+/-1.79g% and 42+/-5.0% in male group, and from preoperative values of 12.8 +/-1.15 g% and 77+/-3.2% to postoperative values of 12.6+/-1.43g%, 37+/-4.0% in female group respectively. 2) There were no significant changes of hemoglobin and hematocrit according to the distributions of age and operating trite and the amount of b1ood transfusion. 3) There was significant decrease in hemoglobin of the transfusion group, but nut of the non-transfusion group, from 13.5+/-1. 59% to l3.3+/-1,73g%(P<0.05), but the practical sig- nificance of the change below 1.5% was considered negligible. 4) In the distribution of departments, there were significant changes in hemoglobin and hematocrit of obstetric gynecologic surgery from 12,8+/-1.24g%,37+/-3.3% to 12.3+/-1.44g%, 36+/-3.9% and hemoglobin of orthopedic surgery from 13.9+/-1.65g% to 13.2+/-1.88 g% respectively, but their practical significance of the changes in the range of 2 to 5% was also considered negligible. 5) There was significant change in hemoglobin of non cancer group, but not of cancer group from 13.6+/-1,65 g% to 13.4+/-1.75 g% (P<0.05) But the practical significance of the change under 1.5% was also considered negligible. From the about results, it is suggested that there are rooms for saving blood from curt-ailing transfusion of patients who were given one pint of blood only and even with multiple pints of blood, and also there are a great possibility for component transfusion after-wards but with slight limitation.

Anesthetic Experiences Using the F-flow Circuit / 대한마취과학회지

In order to evaluate the ventilatory efficiency of the F-type breathing circuit, the authors compared the conventional anesthetic circuit using a 2-corrugated tube with the F-type breathing circuit through arterial blood gas analysis in 20 adult patients. There were no statistical differences between the two groups in arteral blood pH, PCO2 and PO2 and so the authors concluded that the F-type breathing circute could be substituted for the conventional anesthetic circuit using a 2-corrugated tube and even is superior in the case of head and neck surgery.

A Clinical Survey on Pediatric Respiratory Intensive Cares - The third report / 대한마취과학회지

The clinical analysis was performed on 730 critically ill patients under 15 years old who had been admitted in respiratory intensive care unit(RICU) from January, 1983 to December 1984. 1) The mortality rates in 1983 and 1984 were 8.7% and 5.9% and the number of patients was increased but the mortality rate was decreased than before 1983. 2) the mortality was significantly high in neonates and infants but gradually decreased with age. 3) Of 730 patients, 30 of 437 male and 24 of 393 female patients were dead. 4) Of 730 patients, 667 were the patients of chest surgery and 56 were the patients of pediatric surgery but 7 were the patients in the departments other than in chest surgery or pediatric surgery. The Mortalities in chest surgery, pediatric surgery and other surgical departments were 5.4%(36 patients) 26.8%(15 patients) and 37.5%(3 patients). 5) Of 667 patients in department of chest surgery, 640 were the patients with the congenital heart disease and the mortality was 5.2%(33 patients) but 12 were the patients with acquired heart disease and the mortality was 16.7%(2 patients). Of 667 patients, 15 were the patients with noncardiac disease and mortality was 0.1%(1 patients). 6) The duration of the mechanical ventilation in RIDU patients, was 54.5 hours on the average and in the patients of mechanical ventilation more than 72 hours, the mortality was significantly increased compared with the patients of mechanical ventilation less than 72 hours. 7) The major causes of the death in RICU patients under 15 yearts old were LCOS(low cardiac output syndrome) and sepsis.

A Clinical Study upon Oxygen Inhaler "O2-Pack" / 대한마취과학회지

It is considered that a portable oxygen source easy to tranport and manipulste is very useful in any emergency situation. The effect of a portable inhaler "O2-Pack" were studied by comparing the arterial blood gas analysis before and after transportation of patients in dividing two groups of each 20 patients from respiratory intensive care unit to surgical intensive care unit or ward. One group of 20 patients were not given the "O2-Pack" and another group of 20 patients was administered oxygen with the "O2-Pack" . The results were as follows: 1) There were no significant changes in arterial pH, PCO2 and HCO2(-) regardless of the use of the inhaler "O2-Pack" during transportation. 2) There were no significant differences in PaO2 before transportation between both groups. PaO2 of the after-transportation without "O2-Pack" compared with the before-transportation of the two groups and the aftertransportation using the "O2-Pack" during transportation. Considering the above results the authors conclude that the application of portable inhaler "O2-Pack" during transportation of critically ill patients is very useful in maintaining the adequate oxygen level in the arterial blood.

A Clinical Study on Intensive Reapiratory Care in Critieally Ill Patients - The fourth report / 대한마취과학회지

A clinical study was performed on the respiratory cares of 1,654 critically ill patient who were admitted to the respiratory intensive care unit(RICU) from 1976 to 1980. This was 5.5% of the 25,191 patients in post-operative recovery room of Seoul National University Hospital. 1) The patients who needed respiratory care increased annually: 76 in 1979, 115 in 1977, 289 in 1978, 439 in 1979 and 735 in 1980 and their overall mortality was 14.5%. 2) Mortality in the respiratory intensive care unit(RICU) decreased annually and became 10.4% in 1980. 3) The duration of ventilatory assistance was the longest(11.1 days) for pediatric patients and 1.2 days for opend heart surgery patients. 4) Major causes of death (77cases) in respiratory care patients in the respiratory intensive care units were low cardiac output syndrome(33 cases), sepsis(14) and brain damage(7). 5) Types of airway in ventilatory assistance were orotracheal (508 cases) and tracheostomy (22 cases). 6) Importance of the monitorings including Swan-Ganz catheterizations, blood gases, measurements of colloid oncotic pressure and percutaneous gas measurements for critically ill patients in the respiratory cars unit were literarily discussed.

Clinical Study of a Simplified Method in the Measurement of VD / VT / 대한마취과학회지

Bed-side measurement of Vd/Vt has not been used clinically, because the measurement of Pico2 in using the Bohr equation is complicated and a time-consuming test. A new, simplified and time-saving, bed-side calculation of Vd/Vt by using the Radford nomogram has been developed. In order to verify the method of calculated Vd/Vt, we compared the two methods(measured versus calculated Vd/Vt) in 20 open heart patients. Two methods had direct correlationship(y=0.95X+0.04) with r=0.864, and so the authors considered that the calculating method in the measurement of Vd/Vt is advantageous in clinical use.

A Clinical Experience upon Acute Renal Failure due to Mismatched Blood Transfusion / 대한마취과학회지

Among the transfusion reaction, the hemolytic reaction due to mismatched blood transfusion is a fatal complication. After immediate fatal disaster, the renal complication is still life threatening and so its prevention and management are very important. We experienced five cases of acute renal failure and, two of five patients were developed at the SNU hospital and the remainders were transfered to the SNU hospital from local hospital. Two of five patients were showed oliguric renal failures and the remamders were showed non-o-liguric renal failures. All five patients were discharged without complication. We summerize the labaratory data of the five patients during hospitalization and together reviewed with the literatures.

Clinical Application of ThaIamonaI-Pentothal-N2O-O2 Anesthesia / 대한마취과학회지

The authors have introduced a method of Thalamonai dripping with concomitant use of small doses of Pentothal for rapid and smooth loss of consciousness and induction of anesthesia, and maintaining anesthesia with intermittent injections of Thalamonal and Pavulon as well as N2O inhnlation. From 21 cases, the following results were obtained: 1) Average dose of fentanyl as a premedicant was l. 143ug/kg (Thalamonal, 0. 023cc/kg). 2) Average dose of fentanyl during induction of anesthesia was 3. 48ug/kg (ThaJamonal, 0, 695 cc/10kg), and concomitant injection of Pentothal (average, l. 83mg/kg) achieved rapid and smooth induction of anesthesia. During induction, changes of blood pressure and pulse rate were insignificant. 3) Intermittent injections of Thalamonal for maintenance of anesthesia were needed at every 30 minute interval, and average dose of fentanyl was 0.64ug/kg/30min. 4) Seventeen cases among 21 recovered promptly after discontinuation of N2O, and the recovery was delayed in the, remainder. Two patients had awareness without pain during operation, Delayed recovery of consciousness seemed related to overdosage of the droperidol component in Thalamonal, but not to total operating time.

A Clinical Study on Hemolysis during Transfusian of Bank Blood / 대한마취과학회지

During massive transfusions especially under pressure, considerable hemolysis has been expected. It had been assumed that hernolysis would increase with increasing age of the bank blood, increasing pressure and with decreasing bore of the needle. Moss and Stauntan, however, found that hemolysis actually increased when blood was forced through larger bore needles. The authors have studied the magnitude of hemolysis according to various needle sizes under ordinary clinical transfusion conditions, and concluded as follows: 1) Hemolysis was maximum when a 18G needle was used and minimum with use of a 22G. needle regardless of the age and temperature of the bank blood, 2) Hemolysis increased with increasing age of the bank blood. 3) When the needle size was constant, hemolysis was not affected by warming of the bank blood.

An Experimental Study of the Effects of Muscle Relaxants on the Intraocular Pressure / 대한마취과학회지

Since succinyl choline was introduced, into clinical anesthesia, it has been used as main muscle relaxant because of its rare side effects and short duration of action. Our interest in the effects of this drug on extraocular muscles and intraocular pressure began in 1957 following reports of vitreous expulsion in patients who received succinylcholine during ocular surgery. The effects of muscle relaxants on the intraocular pressure were studied in 60 healthy human subjects. When succinylcholine was given alone, 20 human subjects had a mean increase in intraocular pressure of 10. 5 mmHg. When gallamine 2. 5 mg/kg or pancuronium 80 ug/kg was used, 20 subjects showed a mean decrease of 3. 1 mm Hg from control. Giving gallamine (20 mg) or dtubo curarine(3 mg) 2-3 minutes prior to the administration of succinylcholine, 20 human subjects had no significant change in intraocular pressure. This simple method prevents the increase in intraocular pressure associated with the use of succinylcholine.