The Effect of Inhalation Anesthetics on Platelet Function / 대한마취과학회지

There is some controversy regarding the effect of general inhalation anesthesia on platelet function. In 20 patients undergoing long operations over 3 hours, and anesthetized with either nitrous oxide-oxygen and enflurane (A group) or nitrous oxide-oxygen and halothane (B group), we could not find any clinically significant impairment of coagulation. Platelet functions were consecutively evaluated on the samples collected at preinduction, during anesthesia (3 hours) and at postoperation (24 hours) using an aggregometer and several aggregating agents including ADP, epinephrine, collagen and ristocetin. There were no statistically significant changes between the maximum aggregation rate of preinduction and that duirng anesthesia in either group.

The Usefulness of Radioisotope Angiography in Management of Reflex Sympathetic Dystrophy Syndrome / 대한마취과학회지

Reflex sympathetic dystrophy syndrome is characterized by variable complex of the following symptoms, such as pain, tenderness, vasomotor instability, and trophic changes in distal extremities resulting from injury to either central or peripheral nervous tissue. We measured blood flow using radioisotope angiography with agent containing technecium-99m in one patient with reflex sympathetic dystrophy syndrome. Blood flow were significantly lower in affected side than normal side. After epidural block with 0.5% lidocaine and left lumbar sympathetic block with 100% alcohol, burning pain was disappeared and blood flow was increased to near or above in relation to the normal side. Radioisotope angiography is a noninvasive study and not so expensive. And we thought that radioisotope angiography may be a useful aid not only for diagnosis, but also for evaluating therapeu-tic response.

Clinical Evaluation of Anesthetic Management for CO2 Laser Surgery / 대한마취과학회지

The first laser was developed by Maiman in 1960 using a ruby crystal as an active medium. The word laser is an acronym for Light Amplification by Stimulated Emission of Radiation and this light beam can be focused to a small spot, resulting in precisely controlled coagulation, incision, or vaporization of tissue. The two types of lasers commonly used for airway surgery are the carbon dioxide laser and the neodymium-yttrium-aluminum-garnet (Nd YAG) laser. The light of the former will easily vaporize tissue and can be used to make a precise incision with minimal damage to adjacent tissue and the light of the latter can be conducted through fiberoptic instruments and permits successful endoscopic resection of untreatable recurrent or persistent malignant diseases of the major airways. Airway and endotracheal tube fire are the most feared hazard during laser surgery of the airway. The risk of fire depends on the nature of the tube material, the gaseous milieu, the beam wattage, and its mode of operation. The surgeon should use the laser intermittently at moderate wattage (15W) in a pulsed mode to prevent excessive heat field buildup and tissue dessication. For safe anesthetic management, nitrous oxide should be avoided, and a mixture of oxygen (25%) and air should be used or helium, which is a known flammability quencher may be used during airway laser surgery at a 60 percent He 40 percent 0, mix. Due to the increase in CO2laser treatments, we reviewed the clinical records of 150 patients in whom CO2laser surgery was performed and the anesthetic management was evaluated from April 1987 to December 1988. 1) A total of 150 patients were evaluated, including 81 males and 69 females ranging in age from 10 months to 74 years and averaging 41 years. 2) The operations performed were vocal nodule (26.0%), vocal polyp (16.0%), laryngeal papilloma (16.0%), etc. 3) The methods for keeping the airway open during general anesthesia were orotracheal intubation (67.5%) and intubation through the tracheostomy stoma (32.5%). 4) The main anesthetic agents were halothane, enflurane, and fentanyl. The anesthesia and surgery lasted 60.9+-24.0minutes and 44.5+-28.5 minutes on average respectively. 5) Laryngoscopic laser surgery was carried out in 127 patients (84.7%), bronchoscopic surgery in 14 patients (9.3%) and surgery using a handpiece in only 8 patients (6.0%). 6) Complications were found in 3 cases, including endotracheal cuff ignition and pneumomedias-timum.

Clinical Evaluation of Anesthetic Management for CO2 Laser Surgery / 대한마취과학회지

The first laser was developed by Maiman in 1960 using a ruby crystal as an active medium. The word laser is an acronym for Light Amplification by Stimulated Emission of Radiation and this light beam can be focused to a small spot, resulting in precisely controlled coagulation, incision, or vaporization of tissue. The two types of lasers commonly used for airway surgery are the carbon dioxide laser and the neodymium-yttrium-aluminum-garnet (Nd YAG) laser. The light of the former will easily vaporize tissue and can be used to make a precise incision with minimal damage to adjacent tissue and the light of the latter can be conducted through fiberoptic instruments and permits successful endoscopic resection of untreatable recurrent or persistent malignant diseases of the major airways. Airway and endotracheal tube fire are the most feared hazard during laser surgery of the airway. The risk of fire depends on the nature of the tube material, the gaseous milieu, the beam wattage, and its mode of operation. The surgeon should use the laser intermittently at moderate wattage (15W) in a pulsed mode to prevent excessive heat field buildup and tissue dessication. For safe anesthetic management, nitrous oxide should be avoided, and a mixture of oxygen (25%) and air should be used or helium, which is a known flammability quencher may be used during airway laser surgery at a 60 percent He 40 percent 0, mix. Due to the increase in CO2laser treatments, we reviewed the clinical records of 150 patients in whom CO2laser surgery was performed and the anesthetic management was evaluated from April 1987 to December 1988. 1) A total of 150 patients were evaluated, including 81 males and 69 females ranging in age from 10 months to 74 years and averaging 41 years. 2) The operations performed were vocal nodule (26.0%), vocal polyp (16.0%), laryngeal papilloma (16.0%), etc. 3) The methods for keeping the airway open during general anesthesia were orotracheal intubation (67.5%) and intubation through the tracheostomy stoma (32.5%). 4) The main anesthetic agents were halothane, enflurane, and fentanyl. The anesthesia and surgery lasted 60.9+-24.0minutes and 44.5+-28.5 minutes on average respectively. 5) Laryngoscopic laser surgery was carried out in 127 patients (84.7%), bronchoscopic surgery in 14 patients (9.3%) and surgery using a handpiece in only 8 patients (6.0%). 6) Complications were found in 3 cases, including endotracheal cuff ignition and pneumomedias-timum.

Overdose with Malfunctional Halothane Vaporizer / 대한마취과학회지

A Vaporizer should deliver a constant concentration of anesthetics under the varying conditions of gas flow, liquid volume, and ambient temperature. We had encountered 3 patients with arrhythmia and ST change on EKG monitoring and cardiovascular collapse which occurred immediately after turning on the halothane vaporizer (Drager Halothan Vapor 19.1 No. 24302). Sudden cardiovascular collapse during the induction of anesthesia in an otherwise healthy patient was suggestive of anesthetic overdose. Thus we checked this vaporizer with the Capnomac Datex and Drager Iris. The inspiratory concentration of the vaporizer was found to be much higher than that of the dial setting. Vaporizers are sensitive, accurate, and scientific instruments which are directly involved in critical life support. All vaporizers should be treated and tested with great care for performance after shipment, any major service repair, or equipment modification.

Clinical Evaluation of Ambulatory Surgical Patients / 대한마취과학회지

Ambulstory surgery in a hospital-based setting has been practiced at Yongdong Severance Hospital since August 1983. Several factors favor ambulatory surgery over the inpatient approach, first, hospital costs are decreased, second, it is less disruptive to the patient's personal life and the risk of hospital-acquired infection can be significantly decreased. The charts of 1913 patients who were anesthetized for ambulatory surgery were analyzed retrospectively to obtain better guidance for anesthetic management in ambulatory surgical patients. The results are as follows: 1) The number of patients has been increasing since 1983. 2) A total of 1913 patients were evaluated, including 660 males and 1253 females, ranging in age from 5 months to 80 years and averaging 26 years. 3) The operations performed were grouped into: gynecologic(33.9% of the cases), otolaryngologic(33.7%), orthopaedic(10.4%), etc. The most frequent procedures were diagnostic dilation and curettage(23.7%) and excision(17.6%). 4) General anesthesia was performed for 852 patients(44.5%) and the anesthetic agents administered were intravenous narcotics in 360 cases, halothane-N2O-O2 in 289 cases, enflurane-N2O-O2 in 67 cases, etc. Nongeneral anesthesia was included regional nerve block in 76 cases(4.0%) and local infiltration in 985 cases(51.5%). 5) Anesthesia lasted less than one hour in 79.2% of the cases. Recovery time lasted less than one hour in 88.0% of the cases. 6) Only one patient was admitted for an anesthetic reason which was aspiration pneumonia. Seventeen patients were admitted for surgical reasons such as fever, bleeding, etc. From the above results, we believe that anesthetic care for ambulatory surgical patients can be provided safely and cost saving. Safety is an attitude, and when good practice is followed in selection of patients with careful preanesthetic evaluation and careful anesthetic technique, there is no reason to expect more complication than under the circumstance of hospitalization.