Indirect Estimation of Arterial Po2 and pH during General Anesthesia / 대한마취과학회지

Many attempts have been made to device a simple, yet accurate, laboratory method to evaluate the ventilation and acid-base disorders in patients. This study compares the values for Pco2, pH and Po2 of blood samples drawn simultaneously from a radial artery and a vein on the back of the other hand during general anesthesia in 62 cases. The mean arterial and mean venous Pco2 and pH differences were 0. 924 torr and 0. 00013. These differences were too small to be of clinical importance and also varies slightly dependent on the main anesthestics used. Therefore we feel that the use of peripheral venous blood for pH and Pco2 determination during general anesthesia is a reliable indirect method of arterial Pco2 and pH.

Effect of Ketamine on the Isolated Uterus of Guinea Pig / 대한마취과학회지

Postpartum bleeding of the uterus is an important cause of maternal death. It is thought that the inhibitory effect of the majority of potent inhalation anesthetics on uterine contraction is often responsible (Munson, 1970; Lim et al., 1971; Kim, 1972). There have been numerous reports that ketamine stimulates uterine contraction clinically Chodoff and Stella, 1966; Little et al, 1972; Galbert and Gardner, 1973; Corssen, 1974). Jawalekar and associates(1972) reported that ketamine increased resting tension, contractile amplitude and frequency of the uterine strips of pregnant mice. And Kim(1975) reported research on the effects of ketamine on the isolated uterus of rabbits. According to Kim(1975), ketamine exerted .a stimulatory action on the uterus under the influence of progesterone. This progesterone-depenent uterine stimulatory action of ketamine is not concerned with adrenergic and cholinergic mechanisms but appears to have a direct effect on the uterine muscle. The present study was undertaken to determine whether or not ketamine also exerted a stimlatory action on the uterus of the guinea pig and to follow up whether or not stimulatory action of ketamine also depends upon progesterone in the guinea pig. Adult female non-pregnant guinea pigs and rabbits weighing approximately 0, 5 kg and 2. 0 kg respectively were employed in this experiment. At the end of 10 to 14 days following bilateral oophorectomy, non-pregnant guinea pigs and rabbits were injected intramusculary with estradiol benzoate (2,000 I.U./kg) or progesterone (Smg/kg) once a day for four consecutive days, A uterine strip, about 1.5~2,0cm in length, was carefully isolated from the experimental animals and suspended in a muscle chamber containing 50 ml of Lockes solution, maintained at constant temperature of 38C. It was aerated with 100% oxygen bubbling through the bathing fluid by means of a sintered glass plate at the bottom of the muscle chamber. One end of the uterine strip was attached to the bottom of the muscle chamber and the other end to a lever. Motility and tonus were recorded on kymograph paper. After being washed several times with fresh Locke's solution, the uterine strip attained a constant motility and tonus. Ketamine then was added in various concentrations to the chamber. The results are as follows: 1. The uterine mctility of guinea pig shows a higher amplitude and lower frequency compared with that of rabbit. 2. Effects of ketamine on isolated uterine strips of guinea pig pre-treated with estrogen showed no change using 1~20 gamma/ml of ketamine, but with 50 gamma/ml or more, the amplitude of uterine contractions was depressed. 3. On isolated uterine strips of guinea pig pre-treated with progesterone, there was no effect with 1100 gamma/ml of ketamine, depressed amplitude of uterine contractions with 150 gamma/ml and markedly depressed amplitude of uterine contraction with 200 gamma/ml. 4. On isolated uterine strips of rabbit pre-treated with estrogen, there was no effect with 20 gamma/ml of ketamine, but depressed amplitude of uterine contraction using 50 gamma/ml. 5. On isolated uterine strips of rabbit pretreated with progesterone, there was an increase in amplitude and frequency of uterine contractions with up to 150 gamma/ml of ketamine, but depressed amplitude with 200 gamma/ml or more. From the above results it may be concluded that ketamine exerted a stimulatory action on the uterus of rabbit under the influence of progesterone but not on the uterus of guinea pig. The large amount of ketamine depressed the amplitude of uterine contraction in guinea pig and rabbit and this depressing dose is higher in the animals (guinea pig and rabbit) pre-treated with pr ogesterone than with estrogen.

A Statistical Survey of the Patient of Intensive Care Unit in Severance Hospital / 대한마취과학회지

The concept of intensive care has developed from experience in recovery rooms, in anesthetic work, and in early specialized units in different fields of medicine. Between the First and the Second World Wars special units were created in some German hospitals. Intensive care often means a combination of recovery-room service and intensive therapy. Intensive care, especially respiratory care is an important part of the responsibility of the anesthesiologist. So, we have analyzed statistically 3, 072 I.C.U. patients who were admitted during a period of 7 years beginning October 18, 1968 when the I.C.U. at Severance Hospital was opened, The results are as follows: I. Cases admitted to the I.C.U. (March,1970-August, 1975 ) 1) For 5 and a half years, the total number of patients was 2, 479. These patients were 2.7% of 91,400 patients who were admitted into Severance Hospital. 2) The mortality rate was 20.0% . Mortality rate was highest in 1970 (23. 7%) and lowest in 1975 (13. 5%). It has gradually decreased every year. 3) Total occupied bed days were 9,840 days (average 4,0 days). The occupied bed days of the majority of the patients (83.6%) were below 5 days comprising 88.3% of the total expired patients. 4) 50% of the patients were in the 21 to 50 year age group. The highest mortality rate occurred in the 51 to 60 age group (24.3%). 5) The number of patients admitted in the department of internal medicine was 702 cases (28.3%) which was the highest among all departments. The mortality rates of the departments of pediatric and neurosurgery were 40. 3% and 34. 7% respectively and those were relatively high values. 6) All I.C.U. patients have been divided into two categories, operative and non-operative. The operative cases were 1, 264 (51. 0%) and non-operative 1, 215 (49. 0%,). The mortality ,The Journal of The Korean Society of Anesthesiologists VoI. 9, No. 2, 1976 rate of the non-operative cases (22. 5%) was higher than operative (17. 6%). 73 Cardiovascular disease was the commonest cause of death of I.C.U, patients (107 cases) admitted from March, 1974 to August, 1975 (30 cases, 28. 0%). Respiratory support cases (October 18, 1968-August 31, 1975) ;. During the 7 year period, of all I.C.U. admission cases (3,072) 423 cases (13.8%) received respiratory support. These patients gradually increased every year. 2) The mortality rate was 44. 0% which was more than twice the over-all mortality rate of. I.C.U. admission patients. 3) The mortality rate was highest in the 21 30 age group (18. 7%). 4) The department of internal medicine admitted the largest number of cases (153 cases, 36. 2%). 5) Of all conditions, cardiovascular disease was most frequent (126 cases, 29. 8%). Here we have discussed the definition of I.C.U., the responsibility and important role of the anesthesiologist in the I.C.U. by illustrating present situations and presenting problems at the I.C.U. in Severance Hospital.

General Anesthesia for Cardiac Catheterization in Children / 대한마취과학회지

Cardiac catheterization in man was first deseribed by Forasmann in 1929 and introduced as a diagnostic procedure by Caurnand in 1941. The purpose of the catheterization is to evaluate the nature of cardiac abnormalities. The information from the ivnestigation includes pressure and oxygen content of blood in the various chamhers of the heart and the presence of abnormal communications between them. Most of the blood samplings and recordings of pressure at the various sites are not carried out simultaneously but are collected continuously. Therefore, a steady cardiorespiratory state is essential during the procedure in order to allow comparison of pressure and oxygen saturation observed at all stages of the procedure. Inhalation anesthesia used to provide a steady state in children might alter the pressures or oxygen saturatian because of its higher inspired oxygen content. Therefore room air breathing is essential far this investigation. In Yonsei Medical Center, from September 1964 to December 1974 we used thiopental (1964~1970) and ketamine (1971 ~1974) with spontaneous respiration in 170 children with congenital .heart disease, ranging in age from 50 days to 13 years. Thiopental was administered rectally (38 cases) intravenously (10 cases) and both together (10 cases), Ketamine was administered intravenously (13 cases), intramuscularly (8 cases) and both together 119 cases). For premedication, secobarbital was given orally one and a half hours before. Atropine was omitted. The rate of administration, time of operation, anesthesia and. recovery, and alteration in body temperature, blood pressure, pulse rate and respiratory rate were observed statistically. It was concluded that: In the ketamine groups. 1) General anesthesia was obtained satisfactorily without frequent administration and supplementary administration of meperidine or diazepam. Furthermore the drug is stable and requires no prior mixing. 2) Sleep occurs quickly after both intravenous ar intramuscular injection and analgesia is profound. Therefore investigation was begun quickly after injection, and time of operation and anesthesia was shorter. 3) Postoperative increase in body temperature was observed but less than when thiopental was administered. 4) Blood pressure, pulse rate and respiratory rate were increased 5~18% after induction. but returned to previous state after about 15 minutes. 5) Cardiovascular complication was minimal. Profuse salivation was seen in 0.8% of patients, but there were preservation of jaw tone and laryngo-pharyngeal reflexes, so maintenance of the airway was excellent if suction was available. In conclusion, general anesthesia using ketamine was superior to thiopental for cardiac catheterization in children.

Effects of Inhalation Anesthetics on the Myocardial Catecholamines and its Response to Norepinephrine

The data obtained from present experiments demonstrated that among several inhalation anesthetics, ether was the most irritable, resulting in marked irregularity of respiratory movement, and halothane depressed respiratory rate more than the other. The pulse rate and blood pressure were decreased marked1y in ether and the halothane anesthesia. the rate of beat of the isolated atria was not greately altered after anesthesia with ether or trichlore-thylene, while it was reduced after chloroform or halothane inhalation. The response of isolated atria to exogeneous norepinephrine was most prominent in the atria isolated from halothane anesthetized rabbits. Myocardial catecholamine contents were reduced uniformly after anesthesia with each anesthetics and most significantly with the halothane inhalation. From the above results, it may be concluded that the increasing cardiac activity with general inhalation anesthetics is closely related to the quantitative changes of the endogenous myocardial catecholamine contents.

Cardiac Arrest. A Report of Application of External Cardiac Massage on Three Patients

Three patients who were resuscitated with external cardiac massage are reported, who recovered completely without any neurological damage. In all cases, cardiac and respiratory resuscitation was started not later than 2 minutes after arrest-respiration and heart beat returned within 7 minutes. Hypothermia was done in two cases after resuscitation to promote easier recovery. All cases recovered completely without any neurological damage or complications, thus showing a 100% survival rate. Closed cardiac massage proved to be effective in these cases of cardiac arrest.