Effect of the separated airway on the Intubating condition in fiberoptic bronchoscope-guided intubation fiberoptic intubation using separated airway

BACKGROUND: Fiberoptic bronchoscope guided intubation is an important method of difficult airway management. The use of specific airways has been devised to assist the fiberoptic intubation. The authours compared effectiveness of separated airway with fiberoptic bronchoscope guided intubation and the hemodynamic responses. METHODS: 104 adult patients of American Society of Anesthesiologists grading (ASA) I-II who scheduled for surgery under general anesthesia were randomly divided into the Laryngoscope group (L group, n = 30) or the Fiberoptic bronchoscope group (F group, n = 36) or the Fiberoptic bronchoscope with separated airway (MF group, n = 38). A Fiberoptic bronchoscope guided intubation and a fiberoptic bronchoscope with separated airway and a direct laryngoscope was performed after inducing anesthesia. Intubation time, Jaw thrust incidence, mean blood pressure and heart rate after anaesthesia induction, at intubation and every two minute for a further 7 min were recorded. RESULTS: The intubation time was significantly shorter in the MF group (58.3 +/- 13.7 sec) than F group (71.9 +/- 22.1 sec). Jaw thrust incidence was lower in the MF group (60.5%) than F group (100%). The changes of MAPs and HRs during the observation were not significantly different in three group. CONCLUSIONS: Fiberoptic intubation using separated airway reduced intubation time and the incidence of jaw thrust.

The proper effect site concentration of remifentanil for prevention of myoclonus after etomidate injection / 대한마취과학회지

BACKGROUND: Etomidate frequently induces myoclonus when administered intravenously with bolus injection during anesthetic induction. This can be bothersome for the anesthesiologist. The dose of remifentanil appropriate for preventing myoclonus without side effects was investigated. METHODS: All patients with American Society of Anesthesiologists (ASA) physical status I-III were divided into three groups (n = 33 per group) according to the pretreatment effect site concentration of remifentanil (Ultiva, Glaxo-Wellcome, Munchen, Germany) of 0, 2 or 4 ng/ml (Group N: 0 ng/ml, Group R: 2 ng/ml, Group Q: 4 ng/ml) by a target controlled infusion (TCI) system. After a 0.3 mg/kg dose of etomidate was injected intravenously for over 1 minute for anesthetic induction, myoclonus was observed. Before the etomidate injection, the patients were pretreated with remifentanil and their side effects were monitored. RESULTS: The number of patients showing myoclonus was significantly different among the groups. The incidence of myoclonus was 81%, 12% and 0% (groups N, R, and Q, respectively, P < 0.01). Side effects including bradycardia and hypotension did not occur in either Group R or Q. Chest wall rigidity occured in 45% of patients in Group Q. CONCLUSIONS: Administration with a 2 ng/ml effect site concentration of remifentanil could reduce the incidence of myoclonus caused by etomidate bolus injection without chest wall rigidity.

Airway Management of a Pediatric Patient with Interarytenoid Adhesion : A case report

Interarytenoid adhesion is a rare complication associated with endotracheal intubation. The vocal cord is fixed to arytenoid cartilage and the movement of vocal cord is limited. Its clinical symptoms are dyspnea and hoarseness, so sometimes it is mistaken for bilateral vocal cord palsy because of its clinical features. We have experienced unanticipated failed intubation followed by hypoxia in interarytenoid adhesion who was scheduled for emergency tracheotomy due to bilateral vocal cord palsy. After failure of cricothyroidotomy, patient was successfully ventilated with jet injector and tracheotomy was done without complication.

The Effects of Doxapram on the Pulmonary Function during Total Intravenous Anesthesia with Propofol According to Nalbuphine Pretreatment / 대한마취과학회지

BACKGROUND: Total intravenous anesthesia with propofol can cause respiratory depression and apnea especially during induction of anesthesia. To study the possibility of reversal of respiratory depression during anesthesia with propofol, pretreated with nabuphine or not, the respiratory effects of doxapram to spontaneously ventilating patients were investigated. METHODS: Patients were divided into 4 groups - saline-propofol-saline group (SPS), saline-propofol- doxapram group (SPD), nalbuphine-propofol-saline group (NPS), and nalbuphine-propofol-doxapram group (NPD). After saline or nalbuphine pretreatment, anesthesia was induced with propofol and then doxapram or saline was intravenously injected. Apneic time interval, blood pressure, heart rate, respiratory rate, minute ventilation, end tidal CO2 partial pressure and oxygen saturation were measured in every minutes during induction of anesthesia. Percent changes of each values were compared. RESULTS: There is no differences in apneic time intervals in each groups. The percent change of first minute ventilation in SPD group after doxapram injection unchanged significantly compared with those depressions of SPS, NPS and NPD group (p<0.05). Respiratory rates increased in SPD and SPS groups after laryngeal mask insertion. There is no differences in minute ventilation, respiratory rate and end-tidal CO2 concentration between nalbuphine pretreated groups regardless of doxapram injection. CONCLUSIONS: Doxapram has effect in increasing minute ventilation after propofol induction within first few minutes, but it cannot reverse respiratory depression during propofol induction pretreated with nalbuphine.

Cardiovascular Effects of Verapamil during Isoflurane Anesthesia / 대한마취과학회지

12 mongrel dogs were divided into two groups and anesthetized with 100% O and isoflurane in different concentrations (1MAC and 2MAC). Blood pressures and heart rates were monitored and cardiac outputs were measured during all experiments. Cardiovascular effects of isoflurane in different concentrations were investigated. And then, intra-venous verapamil was injected slowly in bolus (0.2mg/kg) in each group and its cardiovascular effects were also investigated. The results were as follows: 1) Heart rate was decreased when the concentration of isoflurane was increased (p<0.05) but there was no significant change after administration of verapamil. 2) Mean arterial pressure was decreased when the concentration of isoflurane was increased (p<0. 01), and after verapamil was injected intravenously in each group (p<0.01). 3) Cardiac index and stroke volume were decreased when the concentration of isoflurane was increased (p<0.05). 4) Left ventricular stroke work index was decreased when the concentration of isofiurane was increased (p<0.01) and it was also decreased significantly after administration of verapamil in high concentration of isoflurane (2 MAC) (p< 0.01), and the degree which was decreased by the administra- tion of verapamil was much more in high concentration of isoflurane than that of low concentration (p< 0.05). 5) There were no statistically significant changes in central venous pressure, pulmonary arterial pressure, pulmonary capillary pressure, vascular resistances, and right ventricular stroke work index.

The Clinical Evaluation to Recovery Time of Blood Glucose Level after Anesthesia and Operation / 대한마취과학회지

The recovery time of the blood glucose level after anesthetic and surgical stress in 30 surgical pediatric patients with A.S,A. physical status class 1 or 2 was evaluated Although they had fasted from 4 to ll hours, none of the patients exhibited hypoglycemia, dehydration or hypotension; This showed that the duration of fasting, age, body weight, and sex did not influence hypoglycemia, dehydration. and hypotension. All patients were anesthetized with Halothane(0.5~1.5 Vol. %)-N2O(1.5L/min) under endotracheal intubation. Just after surgical stimulus, the blood glucose concentration increased about 27mg%, and then returned to pre-operative values within 30 minutes. The author concluded that the hormonal effects arising from the strong stimuli disappeared within 30 minutes. Also, the increase in blood glucoee concentration during intraabdominal surgery was more notable than in surgery to the skin, head or neck. Changes in blood glucose concentration in the recovery room are poasibly related to postoperative pain control.

A Clinical Study of Changes in INtracranial Pressure on Neurosurgical Patients under General Anesthesia with Nitrous Oxide, Thiopental Sodium and Lidocatine Hydrochloride / 대한마취과학회지

In patients undergoing intracranial surgery, the drugs used for anesthesia and the opera-tive procedure can effect an increase in intracranial pressure. Especially in patients whose intracranial pressure has already increased significantly, if the pressure is further increased br these factors, then the patient's neurological condition may be aggravated and the post-operative prognosis may be affected. Thus it is desirable to use drugs which reduce intrac-ranial pressure during this type of surgery. In this study, the spinal subarachnoidal pressures of two groups were compared. One group received a combination of thiopental sodium and lidocaine which are known to relatively reduce intracranial pressure, white the other group was given halothane which is known to increase intracranial pressure. The summary of this study is as follows : 1) The spinal subarachnoidal pressure began to increase 1~4 minutes after the administra-tion of halothane, and the duration of increament was 15-38 minutes with a maximal pressure change from 346+/-63 mmHaO to 417+/-90 mmH2O. Thereafter the pressure returned to the pre-induction level spoataneously. 2) The spinal subarachnoidal pressure began to decrease 2~4 minutes after the admini-stration of thiopental sodium and lidocaine. The greatest decrease in pressure occurred within 10~15 minutes level as the Preseure fell form 324+/-41 mmH2O to 210+/-73 mmH2O, thereafter the pressure remained decreased.

A Clinical Study on Pruritus Due to Intrathecal Morphine / 대한마취과학회지

Herein is a review of eigthy six surgical cases from March to August, 1986 with recieved tetracaine hrdrochloride spinal anesthesia. In an attempt to relieve postoperative pain, 0.5 mg morphine sulfate was administrated into the lumbar Subarachnoid space. Pruritus, a side effect of intraSpinal morphine, was explored in detail. The results were as follows : 1) The incidence of Pruritus was 67.4%, 65.5% in man find 71.0% in Woman. 2) The time of onset of pruritus was between 30 and 120 minutes with an average of 79.1 minutes. 3) Pruritus primary occurred on the face(87.9%). especially on the nasal, perinasal and periocular areas. Other sites included the scalp, neck, chest, abdomen, shoulder, hip, thigh, flank, and whole body. 4) The severity of pruritus was classified as mild and moderate, but 4 cases(6.9%) were regarded as severe and were treated with naloxone. 5) The duratiun of pruritus was from 15 minutes to 19 hours with an average of 4.7 hours. 6) There was no significant difference in the prevention of pruritus between the group recieving diphenhydramine and the one which received normal saline.

Anesthetic Management for Bilateral Pheochromocytoma / 대한마취과학회지

Pheochromocytoma is the cause of hypertension in 0.1% of the hypertencive patits, and in 10% of these cases, the tumor is bilateral. Therefore bilateral pheochromocytoma is very rare. The following is a report of the anesthetic methods employed in the surgical management of a case of bilateral pheochromocytoma which was performed in stages at PNUH, between June 4th and June 12, 1986. The staged operation reduced the instability of the vital signs caused by concurrent manipulation of the bilateral pheochromoytoma and facilitated tumor removal.

Anesthetic Management for Bilateral Pheochromocytoma / 대한마취과학회지

Pheochromocytoma is the cause of hypertension in 0.1% of the hypertencive patits, and in 10% of these cases, the tumor is bilateral. Therefore bilateral pheochromocytoma is very rare. The following is a report of the anesthetic methods employed in the surgical management of a case of bilateral pheochromocytoma which was performed in stages at PNUH, between June 4th and June 12, 1986. The staged operation reduced the instability of the vital signs caused by concurrent manipulation of the bilateral pheochromoytoma and facilitated tumor removal.