Neuromuscular Blocking Effect of Vecuronium in Electric Burned Patients for Endotracheal Intubation / 대한마취과학회지

BACKGROUND: In inducing anesthesia for burn patients, nondepolarizing muscle relaxant (NDMR) is usually used, because succinylcholine, a widely used muscle relaxant may cause hyperkalemia. It is well known that because burn patients show resistance to NDMR, a high dose of NDMR is needed for them. In this study, we wanted to know whether there is significant difference of the relaxation effect between 0.1 mg/Kg and 0.15 mg/Kg dose's of vecuronium, and between burn and unburn patients. METHODS: Subjects are 40 male patients having 1 or 2 ASA physical status (20 are burn patients and the other 20 are unburn patients). We divided them into 4 groups; 1) Group BI (burn patients, vecuronium 0.1 mg/Kg) 2) Group BII (burn Pts, vecuronium 0.15 mg/Kg) 3) Group UBI (unburn Pts, vecuronium 0.1 mg/Kg) 4) Group UBII (unburn Pts, vecuronium 0.15 mg/Kg). Average onset times (time from injection of vecuronium to zero first twitch height (T1)) were measured and intubating condition were scored on 0 to 4 scale. RESULTS: The onset time of vecuronium and distribution of intubation scores didn't show statistical differences among 4 groups. CONCLUSION: The onset time of vecuronium and intubating condition in burn patients dosen't show a difference from unburn patient.

Comparison of Intranasal and Sublingual Midazolam as a Preanesthetic Medication in Pediatric Patients / 대한마취과학회지

BACKGROUND: The perfect preanesthetic medication and its ideal route of administration are still debated. Transmucosal administration of midazolam has been of interest because of the rapid, reliable onset of action, predictable effects and avoidance of injections. Because many medications are well absorbed from the mucosa, we conducted a randomized, prospective, blinded study to compare acceptance and efficacy of intranasal and sublingual administration of midazolam as a preanesthetic medication in children. METHODS: One hundred twenty eight patients aged 0.5-12year were stratified by age: 38 infants and toddlers, 0.5-3yr; 48 preschoolers, 3.1-7yr; and 42 school age, 7.1-12yr. They were randomized to received 0.2 mg/kg of midazolam in the nose or under the tongue. Hemoglobin oxygen saturation by pulse oximetry and sedation score were recorded before drug administration, at 2.5min intervals for 15min, at separation from parents and during induction with enflurane in O2. Retention time of sublingual drug and duration of crying were recorded. RESULTS: The incidence of crying at the time of administration of midazolam was greater following intranasal compared with sublingual administration(60% vs 17%, p<0.05). Within age groups, only infants and toddlers showed a significant difference in the incidence of crying between treatment groups. Significant changes in sedation occured in both groups from 2.5min after administration. CONCLUSIONS: Sublingual midazolam is better accepted than intranasal midazolam as a preanesthetic sedative in children.

The Relation between the Hyponatremia and the Amount of Irrigation Fluid during Transurethral Resection of Prostate / 대한마취과학회지

We know that irrigating fluid used during transurethral resection of prostate (TURP) is rapidly absorbed through open prostatic venous channels in large amount. The TURP syndrome is symptom complex of hypervolemia & hyponatremia (below 130 mEq/1) due to absorption of irrigating fluid. We studied the change of serum sodium, potassium and symptom of hypervolemia during the perioperative period, in 35 patients undergoning TURP. The aim of this clinical study was to examine the possible relation between the irrigating fluid absorption & the development of hyponatremia after TURP. The results were as follow. 1) Though p value was not acceptable, there waa numerical correlation between the weight of resected prostate and the amount of irrigating fluid. 2) TURP syndrome and severe sodium change were not reported in our studiea, 3) We through the cause of above results that operation time & minimal use of irrigating fluid & minimal bleeding due to advanced operative technique, adequate fluid therapy, and intenaive monitoring of vital sign & physiologic change of patients.

The Change of Heart Rate following the mixed injection of Atropine and Neostigmine for Non-Depolarizing Neuromuscular Blocking Agent-Pancuronium / 대한마취과학회지

Around the time of recovery from general anesthesia we usually use atropine and neostigmine to counteract the effect of muscle relaxant that is remaining in the body. We used various kinds of combinations of atropine and neostigmine to see the effect of them on heart rate. The combinations were as follows: I) atropine 0.02mg/kg+neostigmine 0. 02mg/kg. 2) atropine 0. 2mg /kg+neostigmine 0.03mg/kg. 3) atropine 0. 02mg/kg+neostigmine 0.04mg/kg. 4) atropine 0.02mg/kg+neostigmine 0.05mg/kg. 5) atropine 0.02mg/kg+neostigmine 0.06mg/kg. 6) atropine 0.02mg/kg+neostigmine 0.07mg/kg. Ten subjects(ps.I.ASA) were taken for each combination. Thus total sample size of the six combinations were sixty, Each study has been performed in the state of ASA P.S.1, and anesthetized for b but two hours. N2O-O2-Halothane technique was used for anesthesia. The dosage of pancuronium was 0. 08mg/kg. The age distribution of the sample was 2 to 60, and male to female ratio was 4 to 6. We came to the following conclusions from this study. 1) Types of dosage combinations those caused little change in heart rate were; atrop!ne 0.02mg/kg+neostigmine 0.02mg/kg, and atropine 0.02mg/kg+ neostigmine 0.03mg/kg. 2) Just after the simultaneous injection of the drugs, there appeared mild tachycardia, but fifteen minutes after the administration severe bradycardia came on and, after that the heart rate returned to normal. 3) The combinations which included neostigmine, more than 0. 04mg/kg, caused severe braycardia, and the most severe bradycardia was seen with a combination of atropine 0.02mg/kg and neostigmine 0.06mg/kg.

An Experimental Study on the Effects of Operation Sites on Respiratory Functions in the Postoperative Period / 대한마취과학회지

The site of operation is one of the most significant factors affecting the degree of decreased respiratory function and arterial hypoxemia in the postoperative period. To elucidate the relationship between the site of operation and the postoperative hypoxemia, the authors have performed pre-and post-operative arterial blood gas analysises on the 1st POD through the 4th POD on 30 subjects. The experiment was performed on 3 groups, each of which consisted of 10 subjects; an upper abdominal surgery group, lower abdominal surgery group and extremity surgery group. We have selected only those who have had no preoperative cardiopulmonary problems and excluded those who have developed such complications. The results were as follows; 1) In the upper abdominal surgery group, all postoperative PaO2, values were found to be decreased significantly. 2) In the lower abdominal surgery group, only the 2nd POD PaO2 value was found to be significantly decreased. 3) No demonstrable postoperative change of PaO2, was noted in the extremity surgery group.

An Experimental Study on Changes of AaDO2 after Open-Heart Surgery / 대한마취과학회지

Changes of alveolar-arterial oxygen tension differences (AaDO2) after 35 cases of open heart surgery were evaluated with durations of extracorporeal circulation and prognosis. Following results were obtained. 1) AaDO2 values of pre-bypass in fatal open great cases were higher than in survival cases. 2) AaDO2 values of post-bypass were similar and noted no correlation to progonsis. 3) Luration of extracorporeal bypass time in fatal cases were longer than in survival cases. 4) Changes of AaDO2 values after extracorporeal circulation were much correlated to AaDO2 of pre-bypass than those of post-bypass.

A Study on Respiratory Effects of Diuretics ( Furosemide ) during General Anesthesia / 대한마취과학회지

Diuretics have been used as one of therapeutics for acute respiratory failure. We observed the change of arterial blood gases at the same ventilatory level, after intravenous injection of 20 mg of furosemide, in ten of twenty patients without diseases of heart, lung or kidney. The obtained results were: 1) 30 minutes and 1 hour after the injection of furosemide, there were peak increments in arterial PO2. 2) There were no significant changes in pH and PaCO2.