Changes in Renal Blood Flow and Real-time Renal Cortical Perfusion According to Low-dose Nitroglycerin and Dopamine Administration Following the Occlusion and Reperfusion of Liver Blood Flow in Experimental Dogs / 대한마취과학회지

BACKGROUND: Pringle maneuver and nitroglycerin (NTG) administration to reduce hemorrhage during hepatectomy may affect renal blood flow (RBF) and renal cortical perfusion (RCP) by reducing blood pressure (BP), perload and others. However, so far there have been no studies on RBF and RCP changes during and after hepatic vascular maneuver in hepatectomy. The purpose of this study was to evaluate the changes in RBF and RCP along with low dose (2 microgram/kg/min) NTG with or without low dose (3 microgram/kg/min) dopamine after the occlusion and reperfusion of hepatic blood flow. METHODS: Eighteen mongrel dogs were divided into three groups according to drug administration after hepatic reperfusion; control group (group C, n = 6), NTG group (group N, n = 6), and NTG with dopamine group (group N-D, n = 6). After femoral arterial and central venous catheterization, a midline abdominal incision was made, and the hepatic artery (HA) and the portal vein (PV) were exposed for clamping and declamping. Thereafter, the right renal artery was exposed, and a doppler probe for measuring RBF was placed around the right renal artery, and a thermal diffusion microprobe was inserted in the renal outer cortex to measure RCP. Hemodynamics, RBF and RCP, were repeatedly measured before and after HA and PV reperfusion. RESULTS: No significant change in heart rate was observed in any group. The BP decreased in all the groups after HA and PV occlusion. In group C, the BP recovered to the baseline level after hepatic reperfusion but not in groups N and N-D. The RBF and RCP decreased in all groups after HA andPV occlusion. The RBF increased compared to baseline in N-D after hepatic reperfusion, and the RCP increased versus baseline in N-D, 10 minutes after hepatic reperfusion. CONCLUSIONS: In conclusion, it was observed that the RBF and RCP increased compared to baseline by administering dopamine during HA and PV reperfusion. Therefore, the prophylactic administration of low dose dopamine during hepatectomy offers an effective method of protecting renal function.

The Effect of Low Dose Nitroglycerin on Hepatic Blood Flow, Real-time Local Liver Perfusion and Oxygen Extraction Ratio Following the Occlusion and Reperfusion of Hepatic Blood Flow in Experimental Dogs / 대한마취과학회지

BACKGROUND: The Pringle maneuver is traditionally used during the hepatectomy to reduce the blood loss. However, there have been no studies about local liver perfusion (LLP) and oxygen extraction ratio (ERO2) following hepatic ischemia and reperfusion. In this study, the changes in hepatic blood flow (HBF), LLP, ERO2 following hepatic ischemia and reperfusion were observed. And the effects of low dose nitroglycerin (NTG) were observed too. METHODS: A total of 14 mongrel dogs were divided into two groups; control group (C, n = 7), NTG administration group (N, n = 7), NTG administration was started 5 minutes before HBF occlusion. After femoral arterial and central venous catheterization, midline abdominal incision was made. Hepatic artery (HA) and portal vein (PV) were exposed to clamp and declamp. And then doppler flowmeter probes were applied on HA and PV to measure their blood flow and a thermal diffusion microprobe was inserted in the liver parenchyme to measure LLP. RESULTS: The HA and PV blood flow, LLP, and ERO2 were not different between two groups. However, HBF more increased compared to the baseline level in N group after reperfusion. In C group, LLP did not recover after reperfusion. The LLP in N group recovered to the baseline level after reperfusion. CONCLUSIONS: In conclusion, it was observed that the HBF increased and LLP recovered to the baseline level after reperfusion by administration of low dose NTG. The use of low dose NTG is safe and effective for hepatectomy.

A Comparison of Fentanyl, Lidocaine and Esmolol for Blunting the Hemodynamic Response during Rapid-Sequence Induction in the Hemodynamically Unstable Patients / 대한마취과학회지

BACKGROUND: Tracheal intubation is accompanied by varing degrees of sympathetic stimulation as reflected by increases in heart rate, and blood pressure and several clinical trials to reduce the effects on blood pressure and heart rate by pharmacologic agents such as and blockers, calcicum channel blockers, narcotics and lidocaine, have been reported. METHODS: To evaluate the effect of fentanyl, lidocaine, esmolol on the hemodynamic changes induced by intubation, we administered thiopental 5 mg/kg only (group 1, n=12), fentanyl 2 g/kg with thiopental 5 mg/kg (group 2, n=12), lidocaine 1 mg/kg with thiopental 5 mg/kg group 3, n=12) or esmolol 0.5 mg/kg with thiopental 5 mg/kg (group 4, n=12) for induction of anesthesia, and measured heart rate, systolic blood pressure, diastolic blood pressure, mean arteiral pressure, and rate-pressure products (RPP) before induction, after induction, after intubation and at 1, 2, 3, and 5 minutes after intubation. RESULTS: There was a significant increase in heart rate, systolic blood pressure and RPP after intubation and 1 min after intubation in all groups, but in group 2, group 3 and group 4, the cardiovascular responses were more attenuated compared to group 1. CONCLUSION: The preintubation intravenous injection of fentanyl, lidocaine and esmolol may offer important roles in the hemodynamically unstable patients because it attenuate cardiovascular responses with intubation.

Changes in Hemodynamic and Oxygen Availability with Apnea under Halothane Anesthesia / 대한마취과학회지

BACKGROUND: Varying results of hemodynamic and oxygen parameters in response to hypoxia and/or hypercarbia have been reported. In this study, the effects of apnea on the hemodynamic parameters and oxygen availability were evaluated using ten healthy mongrel dogs. METHODS: After full oxygenation, apnea was induced by disconnecting animals from mechanical ventilation. Hemodynamic parameters, oxygen delivery, consumption and extraction ratio were measured at one minute intervals until the cardiac output was undetectable via the thermodilution method. RESULTS: Blood pressure (BP) increased continually following apnea. Cardiac output (CO) increased during the early of apnea (2 and 3 minute) but decreased thereafter. Systemic vascular resistance (SVR) decreased in the early phase of apnea but subsequently declined. The indices of preload increased steadily following apnea. Changes in heart rate (HR) were compared with changes in CO and oxygen delivery, and was found to increase during the early phase of apnea (2~3 minutes) and decrease thereafter. The oxygen extraction ratio did not change significantly and remained steady 6 minutes after apnea but increased and became irregular thereafter. CONCLUSIONS: These data suggest that early reflex responses such as increased BP were primarily due to increased CO, whereas the late increase in BP was due to the increase of SVR. We conclude that BP is not meaningful variables in evaluating critical hypoxic condition such as apnea, and bradycardia might be caused by decreased CO and severe hypoxemia.

Induction of Anesthesia with Low-Dose Midazolam and Thiopental / 대한마취과학회지

BACKGROUND: This study was undertaken to evaluate the hemodynamic response of midazolam-thiopental coinduction technique compared with thiopental or midazolam induction after tracheal intubation. METHODS: 60 patients were divided into 3 groups. Group I thiopental 5 mg/kg induction groups: Group II, midazolam 0.2 mg/kg induction group: Group III 2 mg/kg of thiopental was injected intravenously to each patient 2min after 0.02 mg/kg of midazolam injected. After tracheal intubation, blood pressure and heart rate were measured for 5 minutes at 1 minute interval. Results: There were not significant differences in systolic, diastotic, mean arterial pressure and heart rate in 3 groups. CONCLUSIONS: Low dose midazolam-thiopental coinduction can be a useful method for induction because of same hemodynamic changes as to thiopental or midazolam alone.

Effect of Epidural Steroid Injection in the Low Back Pain

In order to evaluate the effect of the lumbar epidural steroid injection in the low back pain and/or radicular pain. We studied 66 patients who were treated and followed for an average of 8.6 months. In the initial evaluation, main pain sites were as follows: low back pain in 41 patients, buttock pain in 7 patients, and leg pain. In 18 patients. Immediate response and delayed response in the patients were studied. Immediate response within 1 day after injection revealed the following : dramatic improvement in 3.0%;some improvement in 56.1%; no improvement in 27.3%; and more aggravated in 13.6%. Delayed response after 1 month revealed the following : 15.2% continuously maintained improvement; 9.1 showed progressive improvement;36.4% experienced recurring pain; 27.3% had no improvement; and 10.6% had aggravating pain. The effect of the lumbar epidural steroid injection was not affected by the severity of pain in the initial evaluation. Better improvements were noted in patients who suffered radicular pain than those who suffered low back or buttock pain. Good prognostic factors were young age and male. Complications that the patients suffered were transient injection pain(6), edema of the face or extremity(10), transient leg weakness(5) and dural puncture(1). The number of patients who wanted to recommend this procedure to others were 22(33.3%). In conclusion, epidural steroid injection was one of the methods in the management of the patients who suffered low back pain and/or radicular pain and had no effect by any other therapies.

Effect of hypocapnia on extracellular glutamate and glycine concentrations during peri-ischemic period in the rabbit hippocampus

Glutamate (GLU) is a neurotransmitter. Massive release of GLU and glycine (GLY) into the brain's extracellular space may be triggered by ischemia, and may result in acute neuronal lysis or delayed neuronal death. The aim of this study was to evaluate the possible relationship between hyperventilation and the level of GLU and GLY during brain ischemia. Rabbits were anesthetized with halothane and oxygen. Group 1 was allowed to hyperventilate (PaCO2 25-35 mmHg). PaCO2 was maintained throughout the study. Group 2 was a normal control group that maintained normocapnia. Two global cerebral ischemic episodes were produced. Microdialysate was collected during the peri-ischemic and reperfusion periods from the dorsal hippocampus. GLU and GLY concentrations were determined using high-performance liquid chromatography. In the control group, GLU and GLY were significantly elevated during each episode of ischemia; these levels returned to baseline within 10 minutes after reperfusion. In contrast, in the hyperventilation group GLU and GLY concentrations increased during ischemia, but they were not statistically significant. We were able to demonstrate that hypocapnia during periischemic period lowered extracellular GLU and GLY concentrations. These results can explain a part of the protective action of hypocapnia during cerebral ischemia.

The Changes of Percutaneous Oxygen Saturation Following Obstructive Apnea in Infants / 대한마취과학회지

Preoxygenation is a standard anesthetic technique which prevents significant hypoxemia during the induction of anesthesia. Complete oxygenation is especially important in clinical situations of difficult intubation or in patients with decreased FRC, and in siturations where oxygen saturation is critical. During the induction of anesthesia in children, airway obstruction and apnea are associated with rapid development of hypoxemia. The decreasing speed of oxyhemoglobin saturation was faster in smaller infants than bigger infants. The most important factor determining the speed with which hypoxemia develops in healthy children is probably the oxygen reserve contained in the lungs and its relation to the oxygen consumption of the child. With deaeasing age, the arterial oxygen consumption increases and the ratio of FRC to body weight decreases. Due to the anatomical structure of an infant's upper airway, it is more difficult to obtaine patient airway in infants than in children. During repeated atttempts to intubate the trachea or while waiting for recovery from laryngeal spasms hypoxia can occur easily resulting in visible cyanosis in infants. This study was carried out to measure the time permissible for apnea before occurance of hypoxia following full oxygenation. The subjects consisted of 6 randomly selected infants 1-2 month of age, 4.6+/-0.6 Kg of body weight with no abnormalities of cardiorespiratory functions. After the intramuscular injection of atropine, patients were anesthetized through mask using oxygen and halothane. SpO2 and pulse rates were recorded throughout the study. After the patients were intubated, a plug was placed on the distal end of the tube to induce obstructive apnea. As soon as SpO2 decreased to just below 90%, the patients were ventilated again. In 2 of the infants, the time required to obtaine 90% saturation was 60 seconds. Within less than 70 seconds, four out of 6 infants had SpO2 below 90% and SpO2 below 80% were noticed in 3 cases. After the reestablishment of ventilation, SpO2 returned to the preapneic value within 10 second in all subjects. There was no evidence of increasing pulse rate as SpO2 levels decreased. However, pulse rate decreased in all subjects thoughout the study. In summary, maximum time permissible for apnea in neonate and young infant is approximately one minute. Furthermore, tachycardia should not be used as a sign for the onset of hypoxia.

Comparison of d-tubocurarine with vecuronium as the priming drug for vecuronium induced neuromuscular blockade / 대한마취과학회지

Administration of a subparalytic dose of a nondepolarizing muscle relaxant prior to intubating dose hastens the onset time of neuromuscular blockade. This study was designed to investigate the influence of a priming dose of vecuronium (0.015 mg/kg) and d-tubocurarine (0.05 mg/kg) on intubating dose of vecuronium (0.085 mg/kg). The authors measured TOF ratio using neuromuscular monitoring. This monitoring was carried out by stimulation of ulnar nerve at a frequency of 2Hz every 20 seconds using Datex relaxograph to measure the compound evoked electrographic response of hypothenar muscle. The patients were randomly divided into two groups as priming dose ; vecuronium and dtubocurarine (DTC) group respectively. Mixture of two different nondepolarizing muscle relaxant may produce synergism, although the reason for this synergism is unknown. It may be the results of the action of the drugs at different sites. In our study, we found the results as follows ;1) The rapid onset was occured with d-tubocurarine(0.05 mg/kg) as priming drug than vecuronium (0.015 mg/kg) 2) The duration was longer when d-tubocurarine was used (P<0.05) The authors conclude that the onset is more rapid and the duration is longer when other species of nondepolarizing muscle relaxant is used than same agent is used as priming drug.

Cardiovascular Effects of Verapamil during Nalbuphine - Nitrous Oxide Anesthesia / 대한마취과학회지

Cardiovascualar effects of a verapamil infusion were investigated in six dogs given nalbuphine-nitrous anesthesia. Verapamil 0.2 mg/kg was given followed by an infusion of 3 and 6 mcg/kg per minute. Verapamil significantly reduced the systemic vascular resistanee index and mean arterial pressure. The decrease in afterload led to an increase in cardiac index, since was little change in myocardial contractility(LV dp/dt). Administration of calcium chloride, 20 mg/kg, did not reverse tbe hemodynamic effects of verapamil. The data indicate that in dogs verapamil be even in high concentrations, during nalbuphine-nitrous oxide anesthesia without serious adverse hemodynamic sequences.

Measurement of Pulmonary Capillary Pressure and Hemodynamics in a Canine Model of Endotoxin - induced ARDS / 대한마취과학회지

Gram-negative sepsis is the most common setting in which the constellation of abnormalities in lung function, is clinically called the adult respiratory distress syndrome(ARDS). There is a considerable clinical interest in measuring pulmonary microvascular filtration pressure in patients with acute respiratory failure. Pulmonary capillary pressure(Pc) influences the rate of edema formation in the injured lung, and an understanding of how Pc is altered by the disease is important to improve our treatment of acute respiratory failure, We infuesd E. Coli endotox-in, 3 mg/kg, intravenously into anesthetized dogs and measured the hemodynamics and pulmonary capillary pressure, which was derived from the pressure transient recorded while the pulmonary artery catheter was rapidly wedged. Dogs were given fluids to restore cardiac filling pressure to baseline levels. This resulted in a low resistance shock in all animals. 3 hours after the endotxin infusion experimental ARDS developed. The data report that mean pulomanary artery pressure, pulmonary capillary pressure, and pulmonary vascular resistance(PVR) are increased in experimental ARDS(P<0.1), and there is uneuqal, variable partitoning of the PVR. The Gaar estimation of Pc and measured Pc were highly correlated(r=0.915). These data suggest that measuring Pc will alow the clinician to learn if vasoactive agents infused in the management of acute respiratory failure can reduce the microvascular filtration pressure. In this manner, clinicians may directly reduce the rate of edema formation in the acutely injured lung.

Measurement of Pulmonary Capillary Pressure and Hemodynamics in a Canine Model of Endotoxin - induced ARDS / 대한마취과학회지

Gram-negative sepsis is the most common setting in which the constellation of abnormalities in lung function, is clinically called the adult respiratory distress syndrome(ARDS). There is a considerable clinical interest in measuring pulmonary microvascular filtration pressure in patients with acute respiratory failure. Pulmonary capillary pressure(Pc) influences the rate of edema formation in the injured lung, and an understanding of how Pc is altered by the disease is important to improve our treatment of acute respiratory failure, We infuesd E. Coli endotox-in, 3 mg/kg, intravenously into anesthetized dogs and measured the hemodynamics and pulmonary capillary pressure, which was derived from the pressure transient recorded while the pulmonary artery catheter was rapidly wedged. Dogs were given fluids to restore cardiac filling pressure to baseline levels. This resulted in a low resistance shock in all animals. 3 hours after the endotxin infusion experimental ARDS developed. The data report that mean pulomanary artery pressure, pulmonary capillary pressure, and pulmonary vascular resistance(PVR) are increased in experimental ARDS(P<0.1), and there is uneuqal, variable partitoning of the PVR. The Gaar estimation of Pc and measured Pc were highly correlated(r=0.915). These data suggest that measuring Pc will alow the clinician to learn if vasoactive agents infused in the management of acute respiratory failure can reduce the microvascular filtration pressure. In this manner, clinicians may directly reduce the rate of edema formation in the acutely injured lung.

Effects of Esmolol on Hemodynamic Responses to Laryngoscopy and Tracheal Intubation in Normotensive Patients / 대한마취과학회지

Laryngoscopy and endotracheal intubation undergoing general anesthesia cause hypertension and tachycardia with concomitant increases in plasma catecholamine concentration. These transient stress responses are greatly exaggerated in patients with hypertension and cardiovascular diseases and can lead to cardiac arrhythmia, pulmonary edema, cardiac failure and cerebral hemorrhage. Therefore, several attempts have been made to attenuate the hypertensive and tachycardiac responses, but none has been satisfactory. This study was made to alleviate the hemodynamic responses to tracheal intubation using ultra-short acting cardioselective beta-blocker, Esmolol. Following get informed consent in ASA physical status 1 and 2, 28 patients were randomly divided into two groups. Group 1(n=16), control group, and group 2(n=12), esmolol treatment group. Patients on alpha or beta-blockers or agonists were excluded from the study. 12 patients received an infusion of 500 mcg/kg/min esmolol loading dose for 3 min before induction with thiopental and 300 mcg/kg/min for maintenance for 6 additional minutes during the endotra- cheal intubation. The control patients, group 1(n=16), received 5% D/W infusion in place of esmolol with infusion pump. The patients received hydroxyzine 1 mg/kg, nalbuphine 0.1 mg/kg, and glycopyrroate 0.2 mg i. m. 60 minutes before anesthesia. Patients were induced with sodium thiopental 4-5 mg/kg until the disappearance of lid-refex. Succinylcholine 1.0 mg/kg i. v. was used to facilitate endotracheal intubation. As soon as relaxation was complete, laryngoscopy was initiated. After the completion of intubation, nitrous oxide/oxygen=2: 2 L/min with 0.5-1.5 % halothane or enflurane was administered. The blood pressure and heart rate were measured using noninvasive automatic blood pressure manometer Accutorr 1A (Datascope) for 30 minutes per l minute. Blood pressure and heart rate were evaluated at 6 key points; 1) baseline, 2) anesthetic induction, 3) tracheal intubation, 4) I minute postintubation, 5) 2 minutes postintu- bation, and 6) 3 minutes postintubation, Data were analyzed with paired t-tests within the groups. P<0.05 was considered significant. Esmolol infusion significantly prevented the increases in heart rate and rate pressure product caused by laryngoscopy and endotracheal intubation. Esmolol also moderated the increases in pressures. Esmolol infusion may offer an important role in patients in whom an increase in heart rate, blood pressure and/or rate pressure product should be avoided during the endotracheal intubation.

Changes in Blood Sugar , Insulin , Osmolarity and Electrolytes with Intraoperative Infusion of Various Solutions / 대한마취과학회지

Rapid administration of solution containing dextroae results in marked hyperglycemia and osmotic diuresis hut a balanced electrolyte solution containing maltese does not increase blood sugar. 30 patients were chosen at random and divided into 3 groups j.e, one group received 5% dextrose in water, the second group received Hartmann solution and the third group, 5% maltose in a balanced electrolyte solution. The Patient's blood was collected in the operating room prior to the start l.V. infusion, for the measurement of blood sugar, insulin, osmolarity and electrolrtes in various conditions of N.P.O. Intravenous fluid was administered at a rate of 10 m1/kg/hour while anesthesia was induced and maintained with an endotracheal tube in place. Blood samples were taken one hour. 2 hours and 3 7ours f:on the time 1,V. infusion started, In the of 5% dextrose in water groups, the value of blood sugar and insulin was 88.5+/-12.1 mg% and 14.60+/-7.67 un/ml at NPO, 257.7+/-60.8mg% and 70.75+/-37.55 un/m1 at 1 hour, 298.8+/-84.4mg%: and 143.19+/-50.32 un/ml at 2 hours and 228.6+/-75.8% and 127.71+/-56.98 un/m1 at 3 hours. Although the b1ood sugar and insulin values increased markedly. but potassium and chloride were 4.74+/-0.55 mEq/l and 101.1+/-2.9 mEq/l and 4.11+/-0.31 mEq/l, 107.4+/-2.3 mEq/l and 3.75+/-0.41 mEq/l, 176.4+/-2.7mEq/l and 3.89+/-0.50mEq/l, 106.3+/-2.2 mEq/l and shoewed mild decrease, by the way, osmolarity and serum sodium did not changed. In contrast to the 5% dextrose in water groups, there are no changes in the blood glucose. insulin levels, osmolarity or and electrolrtes in the either Hartmann or Elitol (Elitol=5% maltose contained in a balanced electrolyte solution) groups. There was a slight increase in osmolarity with maltose but it was not significant. Accordingly it is concluded that rapid infusion of harmann or 5% maltose contained ina balanced electrolyte solution affects the blood sugar and insulin levels insignificantly compared to the dextrose cont5aining solution which increase the blood sugar and indulin levels markedly.

Allergic Reactions and the Intraoperative use of Foreign Substances / 대한마취과학회지

No abstract available.

A Treatment for Intractable Pain / 대한마취과학회지

Recently, epidural tunnelling was introduced for the convenience of keeping a catheter inserted for a long period of time. We had 15 cases in which used epidural tunnelling for the tratment of intractable pain mainly in terminal cancer patients. Epidural puncture with cannulation was carried out in the same technique as used for epidural anesthesia. After the subcutaneous epidural tunnelling was done from the site of the epidural entry to the anterior chest, just under the skin using a tunnelling device, the catheter was threaded through the tunnelling needle at the sit of the outlet, was fixed and the tip of the catheter was connected to a filter. Five ml(2mg) of saline diluted morphine can be given at home as needed when intractable pain occurs. This long-term treatment of intractable pain by morphine injections through the epidural cannula place by subcutaneous tunnelling, is very convenient for the patient's daily routine and a better alternative in such a situation. Our technique, its advantages and problems were described in this paper.

Pitfalls and Problems in Anesthesia for Transurethral Resection / 대한마취과학회지

The anesthetist plays an important role in recognizing and managing the problems during surgery as well as postoperatively in patients having transurethral resection. As the number of transurethral resctions increase in Korea, we are facing more cardiovascular and respiratory problems as well as other problems. During the 5year period from 1974 to 1979, 230 cases of T.U.R.'s which were performed under various anesthesia, were recorded at the Dongsan Medical Center. We have observed the problems and the pitfalls according to the following classification in table l and ll. Underlying diseases in patients of T.U.R. , operation time, destribution of patients according to ASA classification, age and sex distribution, preoperative prolbems, classification of anesthesia and anesthetica, sedatives used during regional anesthesia and post T.U.R. complications were listed in tables lll through Xl. 1) The age of these cases ranged from 20 to 80 years old and the sixth decade was most common. 2) The preoperative problems are listed in table Vll. i.e., cardiovascular abnormalities(35.7%), pulmonary problems (10%), metabolic and endocrinenutritional disordera in that order. 3) Major underlying diseases are listed in table ll. i.e., bladder tumor, BPH and prostate carcinoma in that order of incidence. 4) Postoperative complications are listed in tabel Vll. i.e., bleeding, infection, extravasation, fluid absorption toxicity in that order of incidence. 5) The sedatives(pentothal, nembutal, valium) were used in 35.9% of the total cases during the regional analgesia for T.U.R. 6) The low spinal anesthesia is considered to be the best technique for anesthesia in T.U.R. procedures after reviewing the problems, pitfalls and complications.

Post-Spinal Complications Observed in Koreans / 대한마취과학회지

Various post-spinal complications have been well reported for a century since spinal anesthesis first started in 1885. However, we have no statistics on postspinal complications observed in Koreans. During the five year period from 1974 to 1979, 5318 cases of spinal analgesia, mainly using a premixed 5 percent lidocaine solution with 5% dextrose, were recorded at Dong Sam Medical Center. This study was primarily undertaken to observe various postspinal complications in Koreans. AS a result of this, we can summarize as follows: 1) The mean age of these cases was 43 years. 2) The main aensthetic was the premixed 5 percent lidocaine solution with 5 percent dextrose. 3) The needles for the lumbar puncture were mainly 22 gange Whitacre pencil point needel. 4) The overall incidence of headache was 3.4 percent. The details as to postspinal headache and treatment were published previously. 5) Backache was subdivided into three different groups: localized pain(3.88%), diffuse pain (2.47%) and radiating pain(0.17%). The overall incidence was 2.7 percent. 6) The incidence of voiding difficulty was 2.7%. 7) The Rare neurological sequelae were not observed in our series and the other complications are noted in table 5. 8) The results are compared with the Dripps and Phillips series in table 2.