Severe Hypercapnia Occurred by Anesthetized Child with Treated Bronchitis during an Operation for Bilateral Hutch's Diverticulum of Bladder: A case report / 대한마취과학회지

A 23-month-old male patient with treated bronchitis underwent a surgery for the repair of bilateral Hutch's diverticulum of bladder under general anesthesia. He treated bronchitis during 2 weeks since 3 weeks before operation. Arriving operating room, he had mild coughing with sputum. During anesthesia, he was well ventilated but endotracheal secretion was profuse. At ABGA of 2 hours after starting anesthesia, severe hypercapnea(PaCO2: 190.2 mmHg) and severe acidosis(PH: 6.746) were checked. Active treatment was done by suction of endotracheal secretion, hyperventilation, PEEP(5~10 cmH2O), increasing fresh gas flow rate(3.6 L/min --> 7 L/min), and administration of sodium bicarbonate, orciprenaline sulfate and methyl- prednisolone. After 3 hours of treatment, ABGA was normalized and symptoms including wheezing were relieved.

Anesthetic Management of the Hypothermic Patient with Intracranial Hemorrhage / 대한마취과학회지

Hypothermia is defined as a core temperature of less than 35 degrees C. Hypothermia changes homeostasis of human body. It includes neurologic, cardiovascular, and metabolic abnormalities. we have anesthetized a woman patient who had intracranial hemorrhage with accidental hypothermia of 27.8 degrees C. We managed for elevation of body temperature with elevation of room temperature (30 degrees C), bladder irrigation with warm saline, application of warming pad and infusion of warming fluid during 4 hours and 20 minutes. At the end of anesthesia, her body temperature was 34.3 degrees C.

Comparison of Postoperative Analgesia and Side Effects of Continuous Epidural Morphine Infusion and Continuous Intravenous Morphine Infusion following Cesarean Section / 대한마취과학회지

BACKGROUND: Continuous epidural morphine infusion is a good and popular method to control postoperative pain. But intravenous morphine infusion after general anesthesia can avoid anxiety during operation and also control postoperative pain. We compared analgesia and side effects between continuous epidural infusion and continuous intravenous infusion of morphine sulfate to control of postoperative pain after cesarean section. METHODS: Forty women who received cesarean section were randomly divided into epidural and IV groups. Morphine 0.08 mg/kg was administered intravenously as an initial loading dosage for both groups. Morphine 0.08 mg/kg for epidural group or morphine 0.8 mg/kg for IV group was diluted into 96ml of normal saline. A mixture was injected into Two-day Infusor which is continuously infused 2 ml/hr. The patients received morphine solution into epidural or intravenous route with Two-day Infusor according to their allocated group. The assessments for pain score with VAS, VRS, patient's satisfaction score and side effects were made at recovery room, 0.5, 3, 12, 24, 36, 48 and 60 hours after operation. RESULTS: The VAS in IV group was significantly higher than that in epidural group at 3, 12, 24 and 36 hours after the operation (P<0.05). The VRS in IV group was significantly higher than in epidural group at recovery room and 3 hours of postoperative period (p<0.05). The frequency of pruritus, nausea, vomiting, back pain and urinary retention were less in IV group than in epidural group. The patient's satisfaction scores were similar in both groups. CONCLUSIONS: The management of postoperative pain in epidural group was more effective than the continuous intravenous morphine infusion. But the incidence of complications was more frequent in the epidural group while patient's satisfaction scores were similar in both groups. Therefore, the continuous intravenous morphine infusion can be used effectively as a postoperative pain management.

Effects of Lidocaine and Airway Epithelium on Tension in the Rat Tracheal Smooth Muscle / 대한마취과학회지

BACKGROUND: Lidocaine is often administered intravenously to suppress airway reflexes associated with tracheal intubation or tracheal suction. In addition, lidocaine is known to have airway relaxant effects through a direct relaxant mechanism on the smooth muscle. The presence of airway epithelium has been reported to reduce the sensitivity and maximum contractile response to histamine or acetylcholine(ACh). The purpose of this study was to determine whether the cumulative application of lidocaine may cause a concentration-dependent relaxation of the rat tracheal smooth muscle strips with intact or rubbed epithelium. METHODS: Using the rat tracheal smooth muscle strips, the effects of 10 6~3 10 3M of lidocaine pretreatment on isometric tension induced by 40 mM of K+ or 10 5M of ACh in presence or absence of adherent epithelium, and the influences of 10 6M of propranolol, 10 4M of L-NAME and 10 6M of atropine on relaxing response of lidocaine were studied. RESULTS: The tracheal smooth muscle concentration induced by K+ and ACh was similar magnitude both in presence or absence of adherent epithelium. The removal of epithelium did not affect the relaxant effect of lidocaine on the K+ and ACh-induced tracheal smooth muscle contraction. Lidocaine pretreatment reduced Ca2+-dependent contraction of the rat tracheal smooth muscle. Following pretreatment of the tracheal smooth muscle preparations respectively with propranolol, L-NAME and atropine the relaxing responses to lidocaine of tracheal smooth muscle were not depressed. CONCLUSIONS: These results suggest that the effect of the epithelium on lidocaine-induced relaxation of the tracheal smooth muscle is not significant and lidocaine may directly relax tracheal smooth muscle by the influences on the Ca2+ mobilization.

The in Vivo Effects of Ethrane Anesthesia and Single Intravenous Injection of Hydrocortisone 250 mg on T-cell Subsets / 대한마취과학회지

The in vivo effects of ethrane and single intravenous injection of hydrocortisone 250 mg on T-cell subsets (T3, T4 and T8), s-cortisol, s-Na+ and K+, polymorphonuclear leukocytes, lymphocytes and HSR (T-helpers to T-suppressors ratio) has been studied. Six healthy volunteers and 16 patients was selected and observed. Sixteen patients has been done surgery under ethrane anesthesia, and single dose of hydrocortisone 250 mg was injected intravenously to eight patients among them. The result is as follows; 1) Serum cortisol level was increased after surgery under ethrane anesthesia and was decreased bellow control value at 24 hours after injection of hydrocortisone 250 mg. 2) After surgery under ethrane anesthesia, PMN's counts and monocyte counts in peripheral blood were increased, but absolute number of lymphocytes and T-cell subsets were decreased. 3) After surgery under ethrane anesthesia with hydrocortisone 250 mg, there was the most elevation of PMN's counts and the most redution of absolute number of T-cell subsets at 5 hours and was somewhat tended to return to control values, but remained changed at 24 hours, and monocyte counts was unchanged. 4) Adding hydrocortisone 250 mg compared with ethrane anesthesia alone, the increasing rate of PMN's counts and the decreasing rate of lymphocytes and absolute number of T-cell subsets were higher at 5 hours, and were lower at 24 hours. 5) Relative percentage of T-cell subsete and HSR were unchanged after surgery under ethrane anesthesia alone and adding hydrocortisone 250 mg.

Intrathecal Block with 15 % Phenol in Glycerine for Pain of Rectal Cancer / 대한마취과학회지

This patient who was a 42-year-old female had suffered from bearing down sensation and pain on anal region due to metastatic rectal cancer. She was done intrathecal block with 15% phenol in glycerine. The result was exellent to bearing down sensation and pain on anal area. Because lower back pain, pain on lower extremity and generalized painful sensation was not improved, we has done pharmacologic assistance. Urination difficulty became slightly aggrevated but was improved at post-block day 4th. This pain clinic report that intrathecal block with 15% phenol in glycerine was effective to treatment of cancer pain without major complications.

Clinical Evaluation of Patients who Received a Blood Transfusion During Operation / 대한마취과학회지

Of a total of 11690 operative cases, 2111 patients who received a transfusion during operation were analyzed statistically at the Department of Anesthesiology, Chung-Nam University Hospital from January 1985 to December 1987 according to department, sex, preoperative hemoglobin, blood type, operation time and blood component therapy. The results as follows: 1) The percentage of transfused patients among all operative cases was 18.05 percent. 2) Of all the transfused patients, 477 cases(22.95%) were general surgery cases. 3) Of all the transfused patients, 1187 cases(56.2%) were male. 4) The mean value of hemoglobin measured preoperatively was 10~15g/dl (72.19%). 5) The most frequent cases of transfusion were done in operations requiring 2~3 hours. 6) Blood component therapy was preformed 11 percent in 1985, 26.73 percent in 1986, and 80.72 percent in 1987. The number of cases receiving blood component therapy has tended to increase year by year.