The Effect of Midazolam Premedication on Propofol Induction Using a Target Controlled Infusion (TCI) / 대한마취과학회지

BACKGROUND: Many studies indicated that the predictive accuracy of propofol TCI may be compromised by premedication with benzodiazepine which has been shown to reduce markedly the induction dose. This study was designed to examine the influence of midazolam premedication on certain parameters of treatment using the propofol TCI. METHODS: One hundred and sixty ASA I or II patients undergoing elective surgery were randomly allocated to two groups according to premedication: Group 1, glycopyrrolate 0.2 mg; Group 2, glycopyrrolate 0.2 mg and midazolam 0.07 mg/kg IM 1hr before induction. Each group divided to four subgroups (n=20 for each subgroup) according to expected target propofol concentration (4~7 microgram/ml for group 1 and 3~6 microgram/ml for group 2). Anesthesia induction within 3 min was considered as successful. Induction dose and time, success rate of induction, calculated concentration when successful induction, context sensitive decrement time when awakening concentration was 1.2 microgram/ml and side effects were checked. RESULTS: Successful induction rate was higher in group 2 (53.3% vs 77.8% at target concentration of 5 microgram/ml, P<0.05). Mean target concentration of propofol were lower in group 2 (5.18 vs 3.87 microgram/ml, P<0.05). Induction time and dose were decreased 48.4% and 36.8% at target concentration of 4 g/ml, respectively in group 2 (P<0.05). Vital signs, average pain score and incidence of pain showed no differences between groups, but incidence of apnea was significantly increased in group 2 (P<0.05). CONCLUSION: Group 2 showed better quality of propofol induction using a TCI in terms of induction time, induction dose and lower selected target without significant vital sign changes, but showed increased incidence of apnea compared with group 1.

PULMONARY EDEMA INDUCED BY BOSMINE SOAKED GAUZE IN ORTHOGNATHIC SURGER

Central Retinal Artery Occlusion after Cervical Spine Surgery in Prone Position under General Anesthesia: A case report / 대한마취과학회지

Central retinal artery occlusion occurs rarely as a complication of spine surgery under general anesthesia in prone position, but is quite tragic. The suggested causes are hypotension during anesthesia and increased external ocular pressure by headrest, sand bag or others. We experienced a case of left central retinal artery occlusion following cervical spine surgery under general anesthesia using a horseshoe headrest. The patient was 53 years old male whose medical history was non remarkable except dislocation of cervical spine. He was positioned prone after induction. The vital signs were stable during opreration. At the recovery room, he presented left visual field disturbance and investigations revealed that left central retinal artery occlusion occured. This case demonstrates that proper positioning of the head on an adequate head rest and contineous cautious inspection during surgical procedure are important to prevent retinal damage.

Research Output Accuracies of Private Hospital Vaporizers / 대한마취과학회지

BACKGROUND: Vaporizers convert liquid anesthetics into measured amount of vapor that are added to the fresh gas mixture to produce known concentrations of anesthetics. As with anesthesia machines, mordern precision vaporizers require regular checks with respect to technical safety by experts. Some private hospitals in Korea do not have had a anesthesiologist belong exclusively to hospital. Therefore it is difficult to perform a regular checks of anesthesia machine especially vaporizers. We had a question about the accuracy of vaporizer output which used in the private hospitals. METHODS: We investigated outputs of 47 vaporizers which used in 23 private hospitals and 5 general hospitals around Kangdong Gu and Kangnam Gu in Seoul, Korea. Anesthetic agent monitor(Biochem anesthetic agent monitor 8100, Waukesha, Wisc, USA) was used and its analysis value was 0.1 vo1%. 50 vo1% O2 and 50 vol% N2O were used as a carrier gas. The flow rates of the carrier gas were 4 1/min. Dial settings were 0.5, 1, 1.5, 2, 3 vo1%. RESULTS: The result was that vaporizers which had the inaccuracy ranges of concentration less than +/-0.5 vo1% was 76.6% of 47 vaporizers, +/-1 vo1% was 93.6%. And above +/-1 vol% was 6.4% of all. CONCLUSIONS: This research concludes that great care needed when the anesthesiologist strange to the vaporizers in the private hospitals operates the vaporizers.

The Effect of Aging on the Pulmonary Function of the Healthy Adults / 대한마취과학회지

Pulmonary function tests were conducted in 60 male adults and 60 female adults at 20~79 years of age. They showed noevidenee of pulmonary disease on clinical symptoms, X-ray finidngs and past history. We wanted to evaluate the deterioration of pulmonary functional reserve in the aged. The results were as follows: 1) In males, FVC decreased significantly (p <0.01) from 4440+/-271.38 ml in 20~29 year-old subjects to 3090+/-445.75 ml 70~79 year-old subjects. The correlation coefficient with age was-0.6846. 2) In females, FVC decreased significantly (p<0.01) from 2097+/-479.42ml in 20~29 year-old subjects to 2142+/-233.13ml in 70~79 year-old subjects The correlation coefficient woth age was 0.6454. 3) In males, FEV, decreased significantly (p<0.01) from 4005+/-268.26 ml in 20~29 year-old subjects to 2373+/-326.36ml in 10~79 year-old subjects. The correlation coefficient with age was-0.8229. 4) In females, FEV1 decreased significantly (p<0.01) from 2586+/-519.00 ml in 20~29 yrar-old subjects to 1645+/-330.36ml in 70~79 year old subjects The correlation coefficient with age was 0.7013. 5) In males, FEV1/FVC decreased significantly (p<0.01) from 90.17+/-4.90% in 20~29 year-old subjects to 76.72+/-8.13% in 70~79 year-old subjects. The correlation coefficient with age was-0.5595. 6) In females, FEV1/FVC decreased significantly (p<0.01) from 88.66+/-6.58% in 20-29 year-old subjects to 76.80+/-9.32% in 70~79 year-old subjects. The correlation coefficient with age wae-0.4489.

Spinal Anesthesia with Glucose - free 0.5 % Bupivacaine : Effect of Different Volumes / 대한마취과학회지

The effect of glucose-free bupivacaine were compared among thirty patients scheduled for urologic or orthopedic surgery. Different volumes of bupivacaine(2,3 and 4ml) were used for each group of patients. Patients were positioned in the supine position just after spinal tapping. The results are summarized as follows: 1) No statistical significance was found for each group of patients in age, height, and operation time. 2) The maximal height of sensory spread tended to increase as the amount of bupivacaine increased. It was T1-10 for the first group(2ml), T8-6 for the second(3ml), and T6-5 for the third(4ml). 3) The time to maximal cephalad spread of analgesia tended to increase as the amount of bupivacaine increased. It was 14 minutes for the first group, 16 minutes for the second and 19 minutes for the third. 4) The duration of analgesia by bupivacaine is considered to be slightly longer than that by tetracaine. 5) The degree of complete motor blockade at L1-2 was 80% for the first group, and 100% for the second by third group. Therefore, spinal anesthesia with glucose-free bupivacaine is considered to be satisfactory for lengthy operations of perianal or urologic procedures and lower extremity surgery.

A Economic Device of Gas Evacuator designed with Angle Stop Valve / 대한마취과학회지

Recent studies suggest possible deleterious effects of chronic exposure to certain common anesthetic agents. A simple and economic gas evacuator was designed with an angle stop valve of a water pipc system which was easily purchased from a hardware store. The device was installed as follows: 1) The pop-off valve assembly of an Ohio Unitrol anesthesia machine was removed and replaced with atail-piece of an angle stop valve with a new screw which was made to fit in place. 2) The disk of the angle stop valve was fixed in place with adhesive cement. 3) The tail nut and tail packing of the angle stop valve were replaced with the same caliver long vinyl hose, which eliminated overflow anesthetic gases from the anesthesia machine air vent system of the operating room. This device is inexpensive and simple to operate and is being used successfully in routine clinical practice.

Pulmonary Function Studies on Normal Korean Adults / 대한마취과학회지

Since pulmonary function testing was first described by Hutchinson in 1846, this technic has been developed by many physiologists and applied to clinical fields for eviluation of cardiopulmonary status in order to improve diagnosis and treatment of cardiopulmonary diseases. The normal values of the lung volumes and capacities, maximal midexpiratory flow, maximal breathing capacity and forced expiratory volume and time in 120 (male-60, female-60) normal Korean adults by using a Gaensler-Collins bronchospirometer are presented. The results were as follows: 1. The vital capacity of the normal Korean adult was 4191+/-451ml. for males and 2685+/-375 ml. for females. 2. The ratio of inspiratory capacity to vital capacity for males was 66+/- 9% and for females 70+/- 7%, but that of expiratory reserve volume to vital capacity for males was 34+/-9% and for females was 30+/-7%. The ratio of inspiratory capacity to vital capacity of normal Korean adults is slightly lower than that of whites, while that of expiratory reserve volume to vital capacity of normal Korean adults is slightly higher than that of whites. 3. The maximal breathing capacity of males was 95+/- 171/min. and that of females 61+/-141/min. 4. The maxima mid-expiratory flow for males was 266+/- 711/min. and for females 176+/- 421 /min. The maximal mid-expiratory time of males was 0. 497+/- 0.145 second and that of females 0. 479+/- 0. 128 second.