Effect of Unilateral Lung Collapse and One-Lung Ventilation on Pulmonary Hemodynamics and Shunt Ratio in Dogs / 대한마취과학회지

One-lung ventilation (anesthesia) has been indicated for certain intrathoracic surgery. However the recommended oxygen concentrations and ventilatory patterns have been variously reported. To clarify this, the author has investigate the effect of left lung collapse and right lung ventilation with relatively large, constant tidal volume of 100% oxygen on pulmonary homodyamic and shunt ratio in 10 mongrel dogs with their left main bronchi ligated and cut following thoracotomy under Pentothal anesthesia. The results are as follows: 1) Heart rate, mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure did not change significantly. 2) Mean pulmonary artery pressure and pulmonary vascular resistance increased significantly during one-lung ventilation. 3) Cardiac output decreased slightly, and alveolar-arterial oxygen tension difference and pulmonary shunt ratio increased significantly. However arterial oxygen and carbon dioxide tensions remained in the normal range. It is concluded that to maintain noramil arterial oxygen and carbon dioxide tensions during one-lung ventilation, it is mandatory to ventilate with relatively large, constant tidal volume of 100% oxygen and all measures and precautions should be exercised to maintain normal cardiac output.

The Effect of Arterial Hypoxemia on Cerebral Blood Flow and Metabolism / 대한마취과학회지

In anesthetized normocapnic and normotensive dogs, the effect of arterial hypoxemia on cerebral blood flow and oxidative carbohydrate metabolism was studied. The results are as follows: 1) The hypoxic vasodilatory effect on cerevral vessels is intact even at profound systemic hypoxemia(Pao2 30 torr) if Paco2 is controlled within normal limits. 2) CMRO2 did not significantly increase above the normal even during profound arterial hopoxemis, indicating that CMRO2 levels are poor indices of hypoxia. 3) A disporportinately high glycolysis at Pao2 of 50 torr suggested early cerebral metabolic changes which became more marked with further decrease in Pao2. 4) One hour after restitution of normoxia, however, carebral blood flow and metabolism manifested complete recovery. 6) It is concluded that a transient(20 minutes) profoun systemic arterial hypoxemia does not produce prolonged disorder of cerebral blood flow and oxidative carbohydrate metabolism provided that the cerebral perfusion pressure is kept normal.

Anesthetic Management of Reconstructive Surgery for the Traumatic Thoracic Aortic Aneurysm / 대한마취과학회지

The management of patient undergoing thoracic aortic surgical procedures represents a major challenge for the anesthesiologists. Aortic cross-clamping and unclamping are particularly hszardous during the- course of the thoracic aortic operation. Proximal hypertension, myocardial ischemia and arrhythmia have been reported to occur after application of the aortic cross-clampmg. Removal of the cross-clamp often results in severe hypotension with subsequent myocardial, cerebral and renal ischemia. In this case, the patient was managed successfully using Regitine drip during the cross-clamp and slow release of clamp during unclamp, combined with slight overhydration just before unclamp.

Anesthetic Management for the Resection of Pheochromocytoma / 대한마취과학회지

Inhalation anesthetics, particularly the hydrocarbons and cyclopropane. lower the threshold to the arrhythmogenic activity of catecholamines. This interaction is of concern during the resection of a pheochromocytoma when the surgically-induced release of large amounts of norepinephrine and epinephrine from tumors sets the stage for ventricular arrhythmia by a direct effect on the myocardium together with an increase in blood pressure. In this communication, anesthesia was performed with N2,O-O2,-halothane. In addition patient was managed successfully, using d-tubocurarine, phentolamine (Regitine) and propranolol (Inderal). For the next same case, enflurane is recommended because of absence of flammability, arrhythmogenic activity and nephrotoxity. etc.

Trends of Anesthetic Managements in 20 Years / 대한마취과학회지

The anesthetic experience in 20 years was evaluated by statistically analyzing the total of 17,595 cases which were performed at S.N.U.H. from 1960 through 1979 according to age, sex, anesthetic agents and methods. To simplify the analysis, the authors selected the anesthetic cases of 1960, 1965, 1970, 1975, and 1978. The results were as follows: 1) General anesthesia has been used with increasing frequencies and local anesthesia with decreasing frequencies during the period. 2) More than half of the totaI cases were performed for the patients in their second or third decades. 3) General surgery cases were the majority of the total. 4) The usage of halothane has been increased ever since its introduction into clinical anesthesia in this hospital. 5) For intravenous induction, thiopental has been used as the main agent, and succinylcholine and pancuronium as the major muscle relaxants since 1975. 6) For anesthetic technique, semiclosed circle absorption system has been employed in almost all cases, and non-rebreathing system has been used recently with increasing frequencies in pediatric anesthesia.

A Comparative Study on the Doses of Epinephrine Causing Arrhythmia during Enflurane and Halothane Anesthesia / 대한마취과학회지

While halothane, cyclopropane, chloroform and trichloroethylene have been clearly implicated to sensitize the myocardum and increase the risk of ventricular fibrillation, newer inhalation anesthetics have shown relatively less arrhythmogenecity. Isoflurane has been suggested to be compatible with epinephrine, while controversial data suggest enflurane, an isomer of isoflurane, may or may not sensitize the myocardium, which is to be clarified by the authors study. By constant intravenous infusion using VIP pump at the rate of 2.5ug/kg/min, the dosage of epinephrine causing premature ventricular contractions was measured in ten male mongrel dogs during halothane and enflurane anesthesia. While premature ventricular contractions were observed in all dogs anesthetized with halothane, the cardiac arrhythythmia was seen in only two dogs anesthetized with enflurane. Epinephrine dosage causing premature ventricular contractions and the resultant increase in mean arterial pressure at which arrhythmias occurred were significantly higher(p< 0. 05) during enflurane anesthesia than durinh halothane anesthesiae. These results suggest that enflurane, in comparison with halothane, is relatively less arrhythmogenic.

A Clinical Study on Haloperidol and Diazepam as Premedieants / 대한마취과학회지

One hundred patients, scheduled to receive operations under spinal anesthesia with tetracaine, were premedicated with haloperidol (Serenace, 0. 08mg/kg I.M.) or diasepam (0.3mg/hg LM.) and evaluated for effects of these premedicants in Seoul National University Hoapital. The results were as follows: 1) Haloperidol was superior to diaxepam in poetoperative antianxiety and analgesic effects. 2) Haloperidol and diasepam were equal in their antiemetic effects. 3) Both haloperidol (0. 04 mg/kg) and diaaepam (0. 1mg/kg) as an intravenous bolus were effective for sedation during operation. Patients given haIoperidol, however, were more cooperative to anesthesiologists and surgeons than were those given diazepam.

The Effect of Tourniquet Release upon PaO2, PaCO2 and pH of Systemic Circulation / 대한마취과학회지

It is well known that undue pressure and prolonged use of tourniquets on an extremity can cause peripheral nerve palsy and vascular damage either from direct pressure or from acid metabolites accumulating in the tissues distal to the tourniquet applied. After release of a tourniquet that has been on for 2 hours, the acidotic changes in the limb take approximately half an hour to recover, and it has been suggested that two hours' ischemia should never be exceeded. The authors have conducted a study to clarify the effect of these acid metabolites on the systemic circulation upon release of tourniquet after 105 minutes (mean) use. In 12 orthopedic patients, 20~32 years of age, who underwent operations below the knee, anesthesia was induced by the intravenous thiopental-succinylcholine-endotracheal intubation sequence and maintained with nitrous oxide-oxygen-halothane in a semiclosed circle absorption system. Respiration was controlled throughout the procedure. Measurements of PO2, PCO2 and pH in the femoral vein and radial artery before inflation of a tourniquet and 15 minutes, 10 minutes, 20 minutes, and again 30 minutes were performed following the release of tourniquet. The results are as follows: 1) Femoral vein pH significantly decreased with concommitant increase in PCO2 reflecting severe metabolic acidcsis during the tourniquet time. 2) Femoral vein PO2 was significantly increased, suggesting the presence of A-V shunt in the extremity. 3) These changes continued to exist for approximately half an hour after release of tourniquet. 4) Analyses of radial arterial blood for PO2, PCO2 and pH revealed no significant changes throughout the study. 5) It is concluded that acid metabolites produced by tourniquet application do not seriously affect when tourniquet is released as long as the buffering capacity and blood volume are kept normal and the patient is kept alkalemic by controlled ventilation.

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.

An Experimental Study on the Mechanism of Respiratory Stimulation by Remeflin® / 대한마취과학회지

To ten male volunteers, 25 to 35 years old and without any known disease, physiological saline solution (placebo) 1 ml, morphine 10mg, and Remeflin 16 mg were administered intramuscularly. Effects of tbese agents upon ventilation at rest and respiratory response to carbon dioxide rebreathing were studied. The results are as follows: 1) Morphine significantly decreased respiratory rate, minute volume, and Pao2 and increased Paco2 without significantly affecting either tidal volume or arterial pH. 2) In morphine-induced respiratory depression, Remeflin improved ventilation by significantly increasing tidal volume and minute volume with resultant increase in Pao2 and decrease in Paco2, Remeflin did not significantly alter respiratory rate and arterial pH 3) Morphine displaced respiratory response curve to carbon dioxide obtained with placebo 7 torr to the right and Remeflin 6 torr to the left. No changes in slope of the curves were observed. 4) It is concluded that Remeflin stimlulatea respiration by directly acting upon the respiratory center.

An Experimental Study of the Effects of Low Molecular Weight Dextran ( Rheomacrodex ) on Blood Oxygen Content / 대한마취과학회지

Arterio-venous oxygen content difference (Ca-vDO2) were measured with IL 213 Blood Gas Analyzer and blood oxygen utilization ratio (percentile of Ca-vDO2 versus arterial oxygen content in 100ml of blood) were calculated in 21 dogs bled until the mean arterial pressure fell to 80~100mmHg. Comparison of blood oxygen utilization ratios among autotransfused dogs, Hartmanns solution-infused dogs, and Rheomacrodex-infused dogs after bleeding through the femoral vein into the ACD bottle revealed that the blood oxygen utilization ratio in the Rheomacrodexinfused dogs was significantly decreased, which might be related to increased cardiac output due to its higher osmolality and blood viscosity-decreasing effect.

A Clinical Study on Respiratory Care for Adult Respiratory Distress Syndrome after Abdominal Surgery / 대한마취과학회지

In recent years applications of artifical ventilation after surgery have broadened with improved diagnostic and therapeutic tools and better understanding of pathophysiology of adult respiratory distress syndrome(ARDS). This report includes 15 cases of ARDS complicated following intraabdominal surgery, whic hcomprise 2. 2% of 681 cases performed in the department of general surgery of this hospital during the period of 6 months from October 1975 through March 1976. The results were as follows: 1) Male to female ratio was 11: 4. 2) Average was 51.4 years with mortality rate of 53. 5% without sexual difference. 3) More frequent incidence and higher mortality rate of ARDS occurred in patients with total serum protein less than 6.0gm% and serum albumin less than 2.9gm%. 4) Average duration of artificial ventilation was 35. 6 hours in the survived group and 44. 5 hours in the expired group. 5) Preoperative ventilatory values(minute volume, frequency and vital capacity) and arterial blood gases revealed no differences between the survived and the expired groups. 6) Six of 15 cases of ARDS were transfused with more than 4,000ml of ACD bank blood. 7) Potential date of onset of ARDS were not predictable.

Enflurane Anesthesia for Pheochromocytoma / 대한마취과학회지

We chose enflurane as the primary anesthetic agent for the surgical removal of a pheochromocytoma (23 year old male) with the satisfactory results. A review of the literature on the anesthetic management of pheochromocytoma discloses no general agreement regarding choice of an anesthetic agent. Almost all agents have at some time been both praised and rejected. It would suggest that selection of an anesthetic agent is not as important as the adequate management of that agent.

A Study on CO2-O2-Halothane Anesthesia / 대한마취과학회지

There are numerous experimental reports on the effects of the inhalation of CO2 in animals but little known in the human being except the accidental inhalations. The authors experienced recently accidental inhalations of CO2 instead of nitrous oxide for the purpose of giving nitrous oxide-oxygen-halothane anesthesia in two cases by changing color of gas cylinder. Although outcomes of above two cases are uneventful, we noted cardiac arrhythmias, oozing in the operative field, cyanotic skin, hypertension, hot canister and .easy restoration of spontaneous respiration. We estimated experimentally FiCO2 by measuring FiO2 with Beckman D-2 paramagnetic oxygen analyzer and reviewed literatures in discussion.

An Experimental Study on the Muscle Relaxation of the Enflurane and Halothane / 대한마취과학회지

The required doses of gallamine (nondepolarizing neuromuscular bloeker) were measured in twelve patients under one MAC anesthesia of nitrous oxide-oxygen(50%)-enflurane with inductions of sodium pentothal (sleeping doses) and succinylcholine(1mg/kg). It was observed that the required dose of gallamine in nitrous oxide-oxygen(50%)-halothane (36. 5+/-3.54mg/hr/M2) is much higher than that in nitrous oxide-oxygen(50%)-enflurane (18.0+/-2.48mg/hr/M2) (p<0.01) and reviewed literaturea on the above result.

The Effects of Propranolol and Lidocaine on CycIopropane-Epinephrine Cardiac Arrhythmias / 대한마취과학회지

Cardiac arrhythmias were produced in the dog by the injection of epinephrine during the inhalation of 26 per cent cyclopropane in oxygen. Cardiac arrhythmias were usually associated with a rise in arterial pressure, but they were also seen with no change or decrease in blood pressure. The beta adrenergic blocking agent propranolol (0.3 mg/kg) caused transient but significant decrease in blood pressure and heart rate, increased the pressor response to epinephrine, abolished or diminished the tachycardia following epinephrine, and ccnsistentiy increased the arrhythmia threshold dose of epinephrine to 12 times that of control. Lidocaine (1.0 mg/kg) did not significantly alter the blood pressure or heart rate, moderate the tachycardia following epinephrine, or consistently increase the arrhythmia threshold dose of epinephrine. From the available evidence together with the authors' it seems reasonable to conclude that the mode of antiarrhythmic action of propranolol differs from that of lidocaine and that the anesthetic-catecholamine cardiac arrhythmias are due to stimulation of beta adrenergic receptors.

Clinical and Laboratory Evaluation of Mechanical Ventilation in Acute Respiratory Insufficiency / 대한마취과학회지

Femoral arterial blood had been analyzed for pCO2 and pH by Astrup technique in 10 comatose patients with respiratory insufficiency due to acute drug intoxication, all of whom eventually recovered. It was found that blood gas analysis did not always surpass clinical judgement as to the efficiency of mechanical ventilation. The readers are reminded of the difference between in vitro and in vivo CO2 titration curves of human blood in acute respiratory acidosis.

Myasthenia Gravis-Anesthetic Experience with - Two Cases / 대한마취과학회지

Anesthetic experience with thymectomies for two patients with myasthenia gravis has been reported. Both of them talerated the surgical procedures under endotracheal nitrous oxide-oxygen-halothane anesthesia well, but one of tbem expired from cholinergic crisis on the 3rd postoperative day. Chemical diagnosis of myasthenia gravis and the salient clinical features including choice of preanesthetic medication, anesthetic agents, techniques and of neuromuscular blocking agents for myasthenic patients have been discussed. Paramount importance of rigid attention to ventilation, the maintenance of a patent airway and the removal of secretions by bronchoscopy or tracheostomy whenever necessary for the patient safety throughout operative and postoperative period has been stressed. Frequent determinations of pulmonary function and the use of edrophonium test in avoiding cholinergic crisis are advocated.

A Clinical Study on Diazepam as Preanesthetic Medication / 대한마취과학회지

It has been well known that successful anesthesia is provided by rendering patients free from apprehension and fear prior to operation. This report is concerned with a new sedative compound which appears to reduce anxiety-tension and relax skeletal muscles. Preanesthetic usefulness of diazepam, which is a derivative of benzodia-zepine and has a high safety index as a preanesthetic medication agent, has been clinically assessed by a standard double blind study on 288 patients in this hospital. They received diazepam(0.3mg/ kg), meperidine hydrochloride (1.0~1.5mg/kg) or saline (1.0ml) via intramuscular route. The following are the results: 1) Diazepam was effective in producing a sound sleep during the preoperative night. 2) Diazepam was effective in reducing apprehension and fear immediately prior to induction of anesthesia. 3) Less nausea and vomiting as well as better sedation were produced by diazepam than by meperidine hydrochloride.