The Effect of Small Dose of Nondepolarizing Muscle Relaxant Administered Prior to Succinylcholine on Intubating Condition / 대한마취과학회지

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.

The Effect of Small Dose of Nondepolarizing Muscle Relaxant Administered Prior to Succinylcholine on Intubating Condition / 대한마취과학회지

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.

The Effect of Small Dose of Hydrocortisone to the Recovery Index from Neuromuscular Blockade Induced with Vecuronium / 대한마취과학회지

Several investigators have described an interaction between muscle relaxants and hydrocortisones which have showed different results. The exact mechanism of this action is not clear and ther conflicting results have further confusion. The experimental methods were two ways. In the one of method, a group that vecuronium 0.1mg/kg was given intravenously is control and a group that hydrocortisones of various doses(0.3, 0.5 and 1 mg/kg) were administered into vein when T1 was appeared is compared. In the another of method, a control group was anticholinesterase(pyridostigmine 0.12 mg/kg, robinul 0.004mg/kg) were given at the time when T1 reached 25% and a group treated with hydrocortisone 0.5 mg/kg when T1 was appeared is compared. Neuromuscular blockade was measured by recording the twitch response following ulnar nerve stimulation by EMG(ABM, Datex Co. 2Hz 30mA supramaximal voltage). The recovery time from 25% to 75% recovery of twitch height was measured according to recovery index(RI). The results obtained were as follows: `) The RI of control group treated with vecuronium 0.1mg/kg alone was 40.32+/-20.24 minutes and the group which hydrocortisone 0.5mg/kg was combined, was shorten to 18.79+/-5.17 minutes, but in the group combined with hydrocortisone 1.0mg/kg and 0.3mg/kg, the RI was also tended to short, but not significant. 2) In the RI of vecuronium 0.1mg/kg, anticholinesterases were given, was 8.46+/-5.06 minutes and the group combined with hydrocortisone 0.5mg/kg was shorten to 4.77+/-1.82 minutes significantly. Conclusively, in the small doses of hydrocortisone, there is a effect of antagonism to the vecuronium induced blockade and a potentiated effect to the anticholinesterase activity to the vecuronium.

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.

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.

Influence of Flunitrazepam on the Adverse Effects of Succinylcholine Chloride / 대한마취과학회지

Intravenous succinylcholine is often associated with adverse effects, including muscle fasciculation, postoperative myalgia, increased intraocular and intragastric pressure, along with potassium and creatinine phosphokinase, myoglobinuria, and disturbances in cardiac rate and rhythm. Several methods have been used to modify these side effects, the most popular of which has been the of subparalyzing doses of nondepolarizining relaxants prior to injection of succinylcholine. With such pretreatment however satisfactory muscular relaxation is often not achieve, necessitaing use of larger doses of succinylcholine becauses pretreatment renders the endplateless sensitive to succinylcholine; hence large doses of succinylcholine are necessary to ensure adquate degress of relaxation. The present investigation was undertaken to determine the effects of flunitrazepam on the adverse effects of succinylcholine. This paper covers the period from March, 1981 to March, 1982 in the Department of Anesthesiology, Hanyang University Hospital. The 45 subjects were divided into 3 groups: 1) propanidid (8mg/kg) with succinylcholine 2) flunitrazepam(0.03mg/kg) with succinylcholine 3) flunitrazepam(0.06mg/kg) with succinylcholine. None had existing neuromuscular disease nor were any patients receiving diazepam or any drug known to influence myoneural blocking agent. Patients with burns, muscle injury of muscle atrophy were excluded. In each group, the plasma concentration of potassium and creatinie phosphokinase was observed before and 10 minutes after use of succinylcholine. Also succinylcholine in duced myalgia, fasciculation, onset of loss of eyelid reflex and relaxation were observed and compared. The conclusions are as follows: 1) There were no significant changes of plasma concentration of potassium and creatinine phosphokinase in presuccinylcholine and 10 minutes postsuccinylcholine. Also any statistically significant changes were not observed in the comparison of the propanidid group and the flunitrazepam groups. 2) Flunitrazepam significantly diminished the incidence of postoperative muscle pain and it was shown that the degree of fasciculation has no relationship with succinylcholine induced muscle pain. 3) In the propanidid group, the onset of loss of eyelid reflex was most rapid(22+/-13 second). In the flunitrasepam 0.03mg/kg group, the onset of loss of eyelid reflex was statistically significant (p<0.05), as compared with the 0.06mg/kg group(42+/-27 second). 4) In all groups, excellent conditions of intubation were observed. Propanidid and flunitrazepam did not affect the magnitude nor duration of the succinylcholine neuromuscular block.

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.

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.