The incidence of Awareness with Recall and Dreams during General Anesthesia / 대한마취과학회지

BACKGROUND: Experience of awareness with recall during general anesthesia can be most distressing for patients. The psychological sequelae of subsequent recall of intraoperative events have been highlighted recently, but the incidence of awareness with recall is uncertain. METHODS: Randomly selected 451 patients, who received elective operation under general anesthesia and were able to communicate with anesthesiologists and follow up for 5 days between December 1995 and February 1996 at Korea Cancer Center Hospital, were interviewed on the 2nd day after their operation. RESULTS: The incidence of explicit memory for events during general anesthesia has been estimated at 0.4% by interviewing patients postoperatively. Auditory perception and the sensation of paralysis were most frequently mentioned. 1.1% of patients had been dreaming during general anesthesia. CONCLUSIONS: Under the influence of anesthetic drugs, the brain is capable of limited processing of information and memory function. Everyone in the operating room must be mindful of conversations during the course of anesthesia and all patients should be given an opportunity to discuss any awareness in detail.

A Report of Unusual Anesthetic Managements of Pheochromocytoma / 대한마취과학회지

It has been emphasized that continuous monitorings of arterial pressure, central venous pressure, electrocardiogram, blood gas analysis, serum electrolytes, body temperature, hematacrit and urinary output are mandatory for the anesthetic management of pheochromocytoma. In addition, it is necessary for the anesthetists to understand pharmacologic effects of drugs which influence the peripheral vascular tone and cardiac excitability. We experienced recently anesthetic management of two cases of pheochromocytoma; one raised problems of ventricular arrhythmias and hypertension that aggravated nature of arrhythrmias by increasing blood pressure and responded favorably to treatment with propranolol and trimetaphan. Tumor of this case originated from abdominal aortic wall. The other was managed by injection of d-tubocurarine which induced narrowing of pulse pressure by depletion of increasing systolic pressure and accompanied tachycardia without cardiac decompensation. We have reported proper anesthetic managements of two cases of pheochromocytoma with N2O O2-halothane anesthesia and reviewed literatures in discussion.

The Effect of Hydroxyethyl Starch (HES) upon Blood CoaguIation in Man / 대한마취과학회지

To determine the effects of hydrcxyethyl starch upon liver, kidney, serm electrolytes and particularly upon blood coagulation, 500 ml of 6% HES in saline solution was administered intravenously to 15 patients during elective minor surgery. In all cases weighted blood loss was less than 600 ml without replacement. The following laboratory tests were performed immediately before infusion and again 1 hour, 24 hours, 48 hours, and 1 week after the infusion: RBC, WBC, hemoglobin, hematocrit, ESR, platelet, bleeding time, coagulation time, prothrombin time, total protein, albumin, total bilirubin, direct bilirubin, SGOT, SGPT, alkaline phosphatase, BUN, sodium, potassium, and chloride. The results are as follows: 1) No anaphylactic shock or bleeding tendency characteristic of colloids was encountered. 2) No functional disturbance of liver or kidney directly attributable to HES was identified. 3) All laboratory parameters except WBC and ESR decreased after infusion. The decrease was, however, within the normal range and believed secondary to dilational effect of infusion. WBC increased somewhat, but returned to the preinfusion level in a week. 4) Exceptionally erythrocyte sedimentation rate increased notably during the 24 hour period following infusion. As with dextran, this was interpreted not due to direct effect of HES, but due to increased adsorption of fibrinogen, alpha-beta-gamma-glcbulin to red cell surface with changes in electric charge between red cells. 5) Clinical applicability, metabolic aspect, degree of subtitution of hydroxyethyl group and safety with multiple infusion of HES must be carefully determined.

An Experimental Study on the Effect of Transfusion and Various Fluid Therapy upon Blood Coagulability in Acute Blood Loss / 대한마취과학회지

Fourty-eight mongrel dogs were bled to half the level of their control aystolic blood pressures and infused with Hartmanns solution, low molecular weight dextran, whole blood, or with Hartmann's solution+low molecular weight dextran (1:1 or 1:3) in the amount equivalent to the blood loss. Bleeding time, coagulation time, platelet count and erythrocyte sedimentation rate were examined 6 hours and 24 hours after the completion of infusion. The results are as follows: 1) No changes in blood coagulability other than due to hemodilution were observed in dogs infused with Hartmann's solution, whole blood, or 1:1 Hartmann's solution+low molecular weight dextran. 2) Significant changes in blood coagulability were noted, however, in dogs infused with low molecular weight dextran alone or 1:3 Hartmann's solution+low molseular weight dextran. These changes seem to be related rather to decreased platelet function than to the decease in platelet number.