A Clinical Studies on Changes of Various Constitutions in the Blood after Massive Blood Transfusion / 대한마취과학회지

It was obtained following results on changes of various constitutions in the blood of eleven patient who had massive blood transfusion ( average 14. 6 pints of ACD stored blood) in Seoul Natioeal University Hospital. I. It revealed no definite change of hemoglobin and hematocrit value in two days after massive blood transfusion. 2. Counts in platelets in two days after transfusion decreased from normal value to about I00, 000/mm3 except one case who had transfused 35 pints of bleod. 3. No hypearpotasaemia obser ved in two days after massive transfusion with usage of the blood warmer. 4. Temporary increase of blood glueose revealed with tendency of decrease to normal values in two days after massive transfusion. 5. The pattern of respiratory alkalosis revealed in two days after massive blood transfusion. It implies that the alkalizing agent is not recommended to inject routinely for the transfused patients without checking acid-base status. 6. It is highly recommended to check body temperature, hematocrit, hemoglobin, platelets and values in arterial blood gas and apply the blood warmer for cares in massive transfused patients.

A Clinical Study Anesthesia for Renal Transplantation / 대한마취과학회지

This report is 5 anesthetic experiences of renal transplantation performed from October 1972 to May 1973 at Central Operating Theater, Seoul National University Hospital. The major considerations about renal transplantation are the states of anemia, uremia, acidosis, electrlytes imbalance with hyperpatassemia, hypertension and immunological problems. In anesthetic management, the following must be considered: 1) Operative method. 1. Concomitant transplantation with nephrectomy 2. Transplantation followed by nephrectomy 2) Duration of operation 3) Degree of hypertension 4) Degree of anemia 5) Degree of pulmonary function 6) Intraoperative arterial blood analysis.

A Comparative Study of Flunitrazepam ( Ro 5-4200 ) and Meperidine HCI as Preanesthetic Medicant / 대한마취과학회지

It has recently been reported that chemical evaluations of a new benzodiazepine derivative, flunitrazepam (Ro 5-4200) revealed promising effects as premedicant. We studied on effects of premedication by double blind technique comparing flunitrazepam (Ro 5-4200) 0.03mg/kg I.M. and meperidine HCI 1mg/kg I.M. in 300 cases of preoperative patient by random selection. The questionaire on drowsiness, sleepiness and awareness during transport to the operation theatre, as well as nausea and vomiting were checked by anesthetists who were ignorant of the given premedicant. Following results were obtained; 1) Flunitrazepam has excellent calming effects in preanesthetic period, inducing drowsiness and adequate rest. 2) Flunitrazepam produces good sleep the night before operation. 3) Flunitrazepam has lower incidence of nausea and vomiting than that cf meperidine HCI.

Anesthetic Management of Corrective Operation of Tracheal Stenosis / 대한마취과학회지

A 34 year old male patient underwent emergency operation of tracheal resection and primary end-to-end anastomosis to correct of tracheal stenosis following tracheostomy. On admission, a No. 3 Magill plastic Portex tracheostomy tube had been placed in the previous tracheostomy opening. Stenotic narrowing was noted 4 cm above carina. Despite of severe narrowing of the lesion, anesthetic course was uneventful with nitrous oxide, oxygen and halothane by controlled respiration and serial blood gas analyses. Postoperative courses were also favorable with adequate respiratory cares. It is mandatory to perform serial blood gas analyses for the management of corrective operation on tracheal stenosis.

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.

Clinical Evaluation of Flunitrazepam as a Preanesthetic Medicant / 대한마취과학회지

No abstract available in English.

A Clinical Study on Haemaccel / 대한마취과학회지

To determine the effects of Haemaccel upon liver, kidney, serum electrolytos and hemostatic functions, 500 ml. of 3.5% Haemaccel solution was administered intravenously to 20 patients during elective surgery. In all cases estimated blood loss was less than 600 ml. without replacement. RBC, WBC, hemoglobin; hematocrit, ESR, platelet, bleeding time, coagulation time and prothrombin time were determined immediately before, and again 30 minutes and 5 hours after infusion; and total protein, albumin, total bilirubin, direct bilirubin, SGOT, SGPT, alkaline phosphatase, BUN, sodium and potassium were ehecked immediately before, and again 5 hours and 24 hours after the end of infusion. The results are as follows: 1) No anaphylactic shock or bleeding tendency characteristic of colloids was encountered. 2) No functional disturbances of liver or kidney directly attributable to Haemaccel were identified. 3) No pathological changes were noted in general laboratpry parameters except for elevated ESR, probably due to decreased blood viscosity, dilution of blood and to pseudoagglutination of red cells.

Comparative Evaluation of Cyclopropane and Fluothane Anesthesia During Hemorrhagie Shock in Dogs / 대한마취과학회지

In order to comparatively evaluate the effects of cyclopropane and fluothane upon mean arterial pressure. cardiac output and splanchnic blood flow during hemorrhagic shock a Iaboratory investigation was conducted in the following three successive phases in two groups: Group I (cyclopropane):1l. Observation 60 minutes following Nembutal I .V. injection 2. Observation 30 minutes following acute hemorrhage 3. Observation 30 minutes following cyclopropane anesthesia Group II (fluothane): 1. Observation 60 minutes following Nembutal I .V. injection 2. Observation 30 minutes following acute hemorrhage 3. Observation 30 minutes following fluothane anesthesia Nine mongrel dogs weighing 11.2±1. 2kg composed each group. Immediately following induction of anesthesia with intravenous pentobarbital (Nembutal), all dogs were endotracheally intubated with the aid of intravenous succinylcholine chloride. Spontaneous respiration was allowed during pentobarbital anesthesia, but ventilation was controlled with Ohio Anesthesia Ventilator during cyclopropane or fluothane anesthesia. In order to insure the adepuacy of ventilation, arterial blood samples were drawn at appropriate intervals for analysis of pH and Pco2 by Beckman Blood Gas Measurement System. Ventilation was adjusted so that the pH and Pco were maintained in the range of 7.30~7.35 and 30~35 mmHg. A heating pad was used to maintain the esophageal temperature at the normal leveal (±0.5 ℃). The internal carotid artery and femoral vein were cannulated. Carotid arterial pressure was measured by sensing with a Statham transducer. Lead II of the electrocardiograph and arterial presaure were continuously monitored end recorded on the Beckman RM 4-Channel Monitor/Recorder. The abdomen was opened and the portal vein and common hepatic artery were cannulated with IVM FT-P Blood Flow Transducer and the blood flow was recorded on EMF-120 Electromagnetic Blood Flowmeter. Bleeding amounted to approximately 2per cent of the body weight. Cardiac output was measured by the direct Fick method. Cyclopropane was administered in the concentration of 10 per cent(100cc/min cyclopropane-900cc/min oxygen) and fluothane-was administered in 1 per cent concentration from Mark II Fluotec vaporizer. Both anesthetics were delivered in semiclosed circle carbon dioxide absorption system. The results are summarized in Tables 1~2. In brief both cyclopropane and fluothane caused a further reduction in splanchnic blood flow by 14 per cent and 21 per cent respectively during hemorrhagic hypotension. Mean arterial pressure rose 24 per cent and cardiac output increased 17 per cent by cyclopropane, whereas mean arterial pressure fell 25 per eent and cardiac output decreased 24 per eent by fluothane. Furthermore, five out of nine dogs inhaled fluothane did not survive despite retransfusion after the experiment. All changes were conaistent and atatistically significant (P<0. 001). The reults suggest that for patients with hypovolemie hypotension without blood replacement cyclo- propane would be the inhalation anesthetic of choice, fluothane might be detrimental in such circum-stances, and that the choice of fluothane ahould be reserved for normovolemic vasnconatrictive states.

An Experimental Study on Cardiovascular Responses and Hepatie Functions by the Intravenous Anesthetic Agent-a Home Product Thiopental Sodium (Thiotal) / 대한마취과학회지

Blood pressures and heart rates were recorded with Twin-Viso (Sanborn, USA) for comparative estimations of cardiovascular responses by injection of intravenous anesthetic agents-2.5% solution of Pentothal Sodium (Abbott Laboratory, USA) and Thiotal (Samsung Pharmaceutical Co., ROK) mongrel dogs. Dogs were evaluated the hepatic function by biochemical studies of blood such as total protein, albumin, total bilirubin, direct bilirubin, thymol turbidity test, alkaline phosphatase, serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGOT). Liver biopsies were performed in dogs for identifications of hepatic darnages by injection of the above barbiturates, The following results were observed: 1) It was observed the remarkable negative inotropic effect in myocardium of the mongrel dogs intravenously injected with 20 mg/kg of the above barbiturates for three minutes (Table 7, Fig. 8) 2) It was noted slight negative inotropic effect in mongrel dogs intravenously injected with 10 mg/ kg of the above barbiturates for thirty seconds (Table 8, Fig. 8). 3) It was more shorter recovery time from negative inotropic effects in mongrel dogs injected with Thiotal than in the dogs injected with Pentothal Sodium. 4) It was noted no significant changes in pathological studies of Hematoxylin-Eosin stained liver specimen and liver function studies of the blood by biochemical analysis in mongrel dogs intravenously injected everyday with 10 mg/kg of the above barbiturates. 5) It was noted slight changes in mongrel dogs injected with 20 mg/kg of the above barbiturates on TTT, Alkaline Phosphatase, SGOT and SGPT as biochemical analysis in comparing with controI values. These values, however, were not concided with the pathological findings of HematoxyIin-Eosin stained liver biopsy specimen. The facts explain to be inquired into further investigations in the pathological and biochemical aspect.

An Experimental Study on the Vasopressor Effects of Various Sympathomimetic Amines in Reserpinized Dogs during N₂O-O₂-Halothane Anesthesia / 대한마취과학회지

Vasopressor effects of epinephrine, norepinephrine, ephedrine, phenylephrine, methoxamine and of mephentermine were compared in resrpinized dogs with or without nitrous oxide-oxygen-halothane anesthesia. The results are as follows: (1) Epinephrine and norepinephrine were shown to have the most potent pressor effect in reserpinized and nitrous oxide-oxygen-halothane-anesthetized dogs. Phenylephrine, methoxamine, mephen-termine and ephedrine were less potent in decreasing order. (2) Decrease in mean arterial pressure was less marked in dogs reserpinized and anesthetized with nitrous oxide-oxygen-halothane than in reserpinized but unanesthetized dogs. (3) It revealed that nitrous oxide-oxygen-halothane anesthesia potentiated the vasopressor effects of the sympathomimetic amines studied. Nitrous oxide-oxygen-halothane anesthesia is implicated to exert an sympathomimetic effect.

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.

An Experimental Study on the Antiarrhythmie Effect of Propanidid upon Catecholamine-Cardiac Arrhythmias / 대한마취과학회지

Cardiac arrhythmias were produced in the dog by injections of epinephrine or isoproterenol during intravenous thiopental or propanidid anesthesia. Propanidid did not increase the pressor response to epinephrine, reduce the depressor response to isoproterenol, or diminish the tachycardia following epinephrine or isoproterenol. Propanidid, however, consistently increased the arrhythmia threshold doses of epinephrine and isoproterenol four times those during thiopental anesthesia. It is concluded, therefore, that the antiarrhythmic effect of propanidid is not related to beta adremergic blockade but to its local anesthetic or quinidine-like action and that propanidid is an excellent intravenous anesthetic in view of its antiarrhythmic action on the heart.