Acid-Base Balance according to Intravenous Fluid during Continuous Hyperthermic Peritoneal Perfusion / 대한마취과학회지

BACKGROUND: Continuous hyperthermic peritoneal perfusion (CHPP) has been introduced to improve the survival of cancer patients. However CHPP induced acute change of body temperature and intra- abdominal pressure could produce various abnormal physiologic responses, especially acid-base and electrolyte imbalance. The purpose of this study was to evaluate the effects of intravenous fluids, plasma solution and Hartmann's solution on acid-base status and electrolyte concentrations during CHPP and to determine strategies for safer fluid management. METHODS: Thirty five patients with ovarian cancer were divided into two groups; Group 1 (16 patients) was supplied with plasma solution and Group 2 (19 patients) was supplied with a Hartman solution as the intravenous fluid. Closed peritoneal irrigation was done with perfusate at a temperature of 47oC for 90 min under general anesthesia. Body temperature, hemodynamic parameters (mean arterial pressure MAP, heart rate HR), blood gas tensions (PaO2, PaCO2), acid-base parameters (pH, base deficit BD) and electrolytes (sodium, potassium, calcium) were measured at 10 min before CHPP, 30, 60, 90 min after the initiation of CHPP, and 30 min after the end of CHPP. RESULTS: There were no significant changes in body temperature, MAP, HR, PaO2, PaCO2 during CHPP in both groups. pH measured at postCHPP in group 2 was significantly lower than that measured in group 1. Base deficits measured at 30, 60, 90 min after the initiation of CHPP and 30 min after the end of CHPP in group 2 were significantly lower than those measured in group 1. Potassium and calcium ion concentations did not show statistical significance during CHPP in both groups. 7 patients in group 1 whose calcium ion level dropped by more than 20% of the initial value needed a calcium injection but only 1 patient in group 2 needed a calcium injection. CONCLUSION: It appears that hemodynamic stability was maintained well during CHPP between the two group. A plasma solution may be more ideal in reducing acidic tendencies and base deficits thana Hartmann's solution but a plasma solution supplied group requires frequent evaluation and a supply of calcium for adequate serum calcium levels.

Fos Expression in the Brain of Neuropathic Pain Rats / 대한마취과학회지

BACKGROUND: There have been some investigations regarding expression of c-fos, as a marker of altered neuronal expression in the spinal cord of neuropathic rats. However, the expression of c-fos in the brain of a neuropathic pain model has not yet been investigated. The purpose of this study was to evaluate the time course of c-fos expression in the brain of neuropathic pain rats. METHODS: The experimental rats were divided into two group; neuropathic pain (n = 16) and control (n = 16) groups. The left L5 L6 spinal nerves of the neuropathic pain group were ligated but those of the control group not ligated (sham operation). Two hours, 1st day, 3rd day and 7th day after the operation, we examined the expression of Fos in the cerebral cortex, the amygdala, the thalamus and the hypothalamus of the coronary sectioned brains of the rats. RESULTS: C-fos expressions in the cerebral cortex and the amygdala of the neuropathic pain group were greater at 2 hours, the 3rd and the 7th day than the control group, but those of the thalamus and hypothalamus of the neuropathic pain group were greater on the 3rd and 7th day than the control group (P< 0.05). In the neuropathic pain group, c-fos expressions of four brain regions were greater on the 3rd and 7th day than those at 2 hours and day 1, but there was no difference between the 3rd and 7th day's (P< 0.05). CONCLUSIONS: There were significant expressions of Fos protein in the brain of the neuropathic pain group at 2 hours, the 3rd day and 7th day of the operation, but the meaning of each expression was different. The expression of Fos at postoperative 2 hours resulted from acute pain but that at the 3rd and 7th day of the operation resulted from neuropathic pain.

Effect of Duration of Lower Motor Neuron Injury on Mivacurium-induced Muscluar Relaxation in Rabbits / 대한마취과학회지

BACKGROUND: The purpose of this study was to investigate whether the effects of mivacurium on muscular relaxation were similar by the duration of more than 2 weeks after the injury of lower motor neurons in rabbits. METHODS: The animals were divided into five groups. The control group was without lower motor neuron injury. In the experimental groups, the lower motor neuron injury was made by denervating with 75 - 80% lesion on the common peroneal nerve to the right anterior tibialis muscle. The experimental groups were subdivided as 1, 2, 3 and 4 week groups (referred to ad the 1 wk, 2, 3 and 4 wks group) according to the durations of the denervation of common peroneal nerve, respectively. The dose-response relationship of mivacurium on the muscle twitches induced by TOF (train of four) stimulation (supramaximal stimulus of 0.2 ms duration, square-wave pulses, 2 Hz rate, repeated every 10 seconds) was studied by calculating ED50 and ED95 in the anterior tibialis muscles and compared between all groups. After recording the muscle twitches, microscopic findings were observed. RESULTS: The effective dose for 95% twitch depression (ED95) of mivacurium at 1week after denervation was significantly higher than that of the control group (P <0.05), but the ED95 of 2, 3 and 4wks groups were not significantly different from that of the control group. However, the ED95 of 3 and 4wks group were inclined to be lower than that of the control and significantly lower than 1wk group (P < 0.05). There was no significant difference in the effective dose for 50% twitch depression (ED50) of mivacurium in all groups. The size of the anterior tibialis muscle was significantly decreased at 4weeks after the lower motor neuron injury (P <0.05), but the number of its sarcoplasmic nuclei was increased, according to the duration after the denervation. CONCLUSIONS: Our results therefore suggest that neuromuscular response of denervated anterior tibial muscle was resistant to intravenous mivacurium in early periods of 1 or 2 weeks but sensitive 4 weeks after the lower motor neuron injury.

The Effect of Mivacurium on Onset and Recovery According to the Durations of Lower Motor Neuron Injury / 대한마취과학회지

BACKGROUND: The purpose of this study was to investigate whether the effects of mivacurium on onset and recovery were affected by the duration of more than 2 weeks after injury of the lower motor neuron in rabbits. METHODS: The animals were divided into five groups. The control group was without lower motor neuron injury. In the experimental groups, the lower motor neuron injury was made by denervating with a 75 - 80% lesion on the common peroneal nerve to the right anterior tibialis muscle. The experimental groups were subdivided as 1, 2, 3 and 4 week groups (named group 1 wk, 2, 3 and 4 wks) according to the duration of the denervation of the common peroneal nerve. The response relationship of mivacurium on the muscle twitches induced by TOF (train of four) stimulation (supramaximal stimulus of 0.2 ms duration, square-wave pulses, 2 Hz rate and 10 mA, repeated every 10 seconds) was studied in the anterior tibialis muscles and compared between all groups. Neuromuscular responses (onset, recovery time to T1(1), T1(25), T1(75), T1(95) and recovery index) of muscle twitches to intravenous mivacurium (0.18 mg/kg) were studied. After recording the muscle twitches, macroscopic findings were observed. RESULTS: The recovery time, T1(1) of group 4 wks was significantly longer than those of group 1, 2 and 3 wks (P < 0.05), but not different from the control group. The recovery time, T1(25), T1(75) and T1(95) of group 4 wks was significantly longer than those of all other groups (P < 0.05), but the onset times of all groups were not significantly different. The recovery index of group 4 wks was significantly higher than that of the control group (P < 0.05), but those of groups 1, 2 and 3 wks were not significantly different from that of the control group. The mass of the anterior tibialis muscle was significantly decreased at 4 weeks after the lower motor neuron injury (P < 0.05). CONCLUSIONS: Our results therefore suggest that the neuromuscular response to intravenous mivacurium on recovery in rabbits becomes prolonged according to the durations of the denervation and represents sensitivity at 4 weeks after the lower motor neuron injury.

Effect of Cervical Sympathectomy on Ischemic Brain Damage Induced by Focal Cerebral Infarction in Rats / 대한마취과학회지

BACKGROUND: Recently Umeyama et al. reported that cerebral blood flow is definitely increased on the ipsilateral side after the blockade of stellate ganglion. Considering that the most obvious solution to the problem of poor cerebral blood flow is to augment the flow, cervical sympathectomy may reduce the volume and extent of the brain damage by increasing the cerebral blood flow. We studied the effects of cervical sympathectomy on ischemic brain damage in a middle cerebral artery occlusion model in rats. METHOD: The experimental animals were divided into three groups. In the sham-operated control group (n=7), middle cerebral artery was occluded without cervical sympathectomy. In the experimental group I (n=7), cervical sympathectomy was performed 5 minutes before middle cerebral artery occlusion. In the experimental group II (n=7), cervical sympathectomy was performed 5 minutes after middle cerebral artery occlusion. The neurological grade of each experimental animal was evaluated at 24 hours post occlusion and then the animals were sacrificed. The brain was cut into coronal sections. The volume of infarct was computed and the edema volume was calculated. RESULTS: 1. There were no differences in the physiological variables in all groups. 2. Cervical sympathectomy, compared with the controls, significantly reduced the volume of infarct (P<0.05). 3. There was no significant difference in ischemic brain edema between each group. 4. The neurologic deficit was less severe in sympathectomized groups compared with the control group (P<0.05). And neurological grades were significantly correlated with the volume of infarction (P<0.05). CONCLUSION: These results suggest that cervical sympathectomy may improve the neurologocal deficit and reduce the infarct volume measured 24 hours following induction of focal cerebral infarction.

Effects of Cervical Sympathectomy on Mechanical Allodynia and Cold Allodynia in a Rat Model of Neuropathic Pain / 대한마취과학회지

BACKGROUND: The pathophysiologic mechanism of the neuropathic pain is still unclear. We designed this study to evaluate the effect of bilateral cervical sympathectomy on allodynia and the relationship of neuropathic pain with sympathetic nerve system of supraspinal level in rats experiencing neuropathic pain. METHODS: Neuropathic pain was produced by tight ligating the left 5th and 6th lumbar spinal nerves of male Sprague-Dawley rats. Mechanical allodynia was quantified by measuring the foot withdrawal frequency to stimuli with two von Frey filaments of 14.5 mN and 53.9 mN applied to the affected left hind paw, and cold allodynia was quantified with the same manner using 100% acetone. We divided the neuropathic pain models into experimental group (bilateral cervical sympathectomy) and control group (sham operation), and then measured the foot withdrawal frequency 1, 3, 5, 7, 14, 21 and 28 days postoperatively. RESULTS: In experimental group, the foot withdrawal frequency to mechanical stimuli with 14.5 and 53.9 mN of von Frey filament and cold stimuli with 100% acetone was significantly lower than that of control group for all postoperative observation points. Also, the experimental group showed decrease in foot withdrawal frequency compared with preoprative value over the course of the study. CONCLUSIONS: Bilateral cervical sympathectomy reduced mechanical allodynia and cold allodynia in the rat model of neuropathic pain suggesting that neuropathic pain, although the lesions are localized in low extremities, may be correlated with functional disturbance of sympathetic nerve fibers of supraspinal or brain level and help explain the mechanism of neuropathic pain.

The Effects of Stomach Cancer Surgery on Immunomodulation and Neuroendocrine Response: Comparison of Anesthesia and Analgesia Methods / 대한마취과학회지

BACKGROUND: Authors have undertaken this study to see if the choice of anesthesia can directly or indirectly provide immunomodulation for cytokines, to determine the relationship of cytokines and hypothalamo-pituitary-adrenal axis in stomach cancer surgery patients, and also to see whether the amount of morphine administration and choice of analgesia can influence cytokine release, and possibly immunity. METHODS: Total 19 gastric cancer surgery patients were randomly assigned in double-blind fashion into two groups. Group-G (n=9) was provided with general anesthesia plus morphine intravenous patient controlled analgesia (IV-PCA), whereas group-GE (n=10) with preemptive epidural and general anesthesia plus continuous epidural analgesia for control of postoperative pain. At predetermined time interval, proinflammatory cytokines and stress hormones were evaluated with visual analog pain scale. Simultaneous assessments of operating and anesthesia time, total morphine doses, the time to recovery of gastrointestinal function and incidences of complications were also made. RESULTS: Demographic data, the durations of operation and anesthesia and recovery of gastrointestinal function were similar in both groups. Total morphine doses were approximately four times greater in group-G. Secretions of interleukin-1 beta , TNF and epinephrine were blocked by preemptive epidural anesthesia, meanwhile, interleukin-6 as well as ACTH and cortisol were not. After 24 hours after skin incision, the differences of cytokines, ACTH and cortisol between two groups were dissipated. In spite of these hormonal findings, visual analog pain scale could not disclose any differences. Incidences of complications were statistically insignificant except that of itching in group-GE. CONCLUSION: Preemptive epidural anesthesia and analgesia can partially block only some of cytokines and stress hormones, and these effects do not have clinically relevant long term influences. The amounts and means of morphine administered by continuous epidural analgesia block or IV-PCA demonstrated no evidence of immunosuppression at clinical dose range.

Anesthestic Experience for Hepatic Retransplantation: A case report / 대한마취과학회지

Orthotopic liver transplantation has been an established medical therapy for almost any end-stage liver disease. In spite of improved survival rates following transplantation, acute or chronic allograft failure requiring hepatic retransplantation still occurs with an incidence of 9% to 22%. We experienced one case of anesthesia for liver retransplantation in 30-year-old male patient with posttransplantation hepatic arterial thrombosis. He had taken primary liver transplantation due to hepatocelluar carcinoma 15days before retransplantation. The operation was finished successfully after 10hours of anesthesia with anhepatic time of 65 minutes. Careful attention was paid to eletrolyte balance, blood coagulation function as well as cardiovascular and respiratory function. Hemodynamic value was relatively stable throughout the operation and postoperative mechanical ventilatory support was required for about 15 hours.

The Last Fifty Years of Western Medicine in Korea: Korean Soceity of Anesthesiologists

No abstract available.

Effects of Exposure to Nitrous Oxide After Fertilization on Embryo in Vitro and in Vivo Development in Mice / 대한마취과학회지

BACKGROUND: Nitrous oxide exposure for long periods during gestation causes the increased fetal wastage, growth retardation, morphological abnormalities in rodents. Most studies have explained deleterious effects of nitrous oxide on postimplantation embryo development. The aim of this study was to evaluate the effects of nitrous oxide on embryo after the fertilization in superovulated BALB/c mice. METHODS: Pregnant mice were exposed to 70% nitrous oxide in oxygen for 6, 12 and 24 hours on the day of gestation, and 2-cell stage embryos were cultured to blastocyst. Reproductive data were determined at cesarean section on 16th day of gestation based on embryonic developmental failure in vitro by 24 hours nitrous oxide. The protective effects of folinic acid or methionine against inhibition of 2-cell embryo development were also evaluated. RESULTS: Blastocyst development was significantly lower in 12 and 24 hours nitrous oxide group than in the control and 6 hours nitrous oxide group. The pregnancy rate and the mean number of implantations were significantly lower in 24 hours nitrous oxide group than in the control. No significant differences in percentage of the living fetus, the dead fetus, the resorption per implantation, the mean fetal weight and the crown-rump length were observed between nitrous oxide group and control group. There was no significant difference between the nitrous oxide group and the nitrous exposed group receiving methionine and folinic acid. CONCLUSIONS: The exposure to high concentration of nitrous oxide for a long time after the fertilization in mice may be possibility of the early abortion of embryos, whereas there is not any influence on fetus after the implantation.

Clinical Study of the Onset Time of Rocuronium / 대한마취과학회지

BACKGROUND: Rocuronium, a new nondepolarizing muscle relaxant, has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence induction of anesthesia. Therefore we have compared rocuronium with pancuronium and vecuronium about the onset time, intubation time, and tracheal intubating conditions. METHOD: Thirty patients were divided into three groups, who were receiving intravenously pancuronium 0.14 mg/kg, vecuronium 0.1 mg/kg and rocuronium 0.6 mg/kg respectively for tracheal intubation during induction of anesthesia. The onset time(Time from drug administration to zero count of PTC) and intubation time were checked using train of four responses of the adductor pollicis muscle after ulnar nerve stimulation(2 Hz, 40mA) every 10 seconds. The intubation conditions were recorded by a "blinded" assessor as excellent, good, fair or not possible. RESULT: The onset time of pancuronium, vecuronium and rocuronium was, 125.0+/-10.0, 256.0+/-18.4 and 90.0+/-22.1 sec. respectivly. The time of intubation was 94.0+/-12.6, 95.3+/-7.9, and 77.0+/-10.6sec.(pancuronium,vecuronium & rocuronium respectively). The onset time of rocuronium was significantly faster than the other two nondepolarizing muscle relaxants. The tracheal intubation with rocuronium was possible earlier than pancuronium or vecuronium but no statistical significance was observed and the condition of intubation was excellent compare to others in all ten patients. CONCLUSION: Rocuronium may have advantages over existing non-depolarizing neuromuscular blocking agents with faster rate of development of neuromuscular block with excellent intubation condition after administraction of a dose 0.6 mg/kg(ED 95 x 2).

Clinical Study of the Onset Time of Rocuronium / 대한마취과학회지

BACKGROUND: Rocuronium, a new nondepolarizing muscle relaxant, has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence induction of anesthesia. Therefore we have compared rocuronium with pancuronium and vecuronium about the onset time, intubation time, and tracheal intubating conditions. METHOD: Thirty patients were divided into three groups, who were receiving intravenously pancuronium 0.14 mg/kg, vecuronium 0.1 mg/kg and rocuronium 0.6 mg/kg respectively for tracheal intubation during induction of anesthesia. The onset time(Time from drug administration to zero count of PTC) and intubation time were checked using train of four responses of the adductor pollicis muscle after ulnar nerve stimulation(2 Hz, 40mA) every 10 seconds. The intubation conditions were recorded by a "blinded" assessor as excellent, good, fair or not possible. RESULT: The onset time of pancuronium, vecuronium and rocuronium was, 125.0+/-10.0, 256.0+/-18.4 and 90.0+/-22.1 sec. respectivly. The time of intubation was 94.0+/-12.6, 95.3+/-7.9, and 77.0+/-10.6sec.(pancuronium,vecuronium & rocuronium respectively). The onset time of rocuronium was significantly faster than the other two nondepolarizing muscle relaxants. The tracheal intubation with rocuronium was possible earlier than pancuronium or vecuronium but no statistical significance was observed and the condition of intubation was excellent compare to others in all ten patients. CONCLUSION: Rocuronium may have advantages over existing non-depolarizing neuromuscular blocking agents with faster rate of development of neuromuscular block with excellent intubation condition after administraction of a dose 0.6 mg/kg(ED 95 x 2).

A Comparison of the Postanesthetic Recovery of Cognitive and Psychomotor Function between Propofol Anesthesia and Enflurane Anesthesia / 대한마취과학회지

BACKGROUND: For out-patient anesthesia a safe and rapid postoperative recovery, especially, the full recovery of psychological function for "street fitness" has become increasingly important. Up to the present, the scoring system - Steward postanesthesia recovery score - has been frequently used for the decision of discharge. But this system focuses on recovery of vital signs, other objective tests are needed to investigate cognitive and psychomotor function which is suitable for estimation of "street fitness". METHODS: The propofol group(n=70) received fentanyl 0.8 ug/kg followed by propofol I mg/kg for anesthesia induction. Continuous propofol infusion was initiated upon induction. Ventilation was supported with N2 O-O2 mixture. The enflurane group(n=70) was induced with sodium thiopental 4 mg/kg. 2.0 vo1% of enflurane with N2 O-O2 mixture was initiated immediately upon induction. Both group received vecuronium 0.08 mg/kg as muscle relaxants. We measured Steward postanesthesia recovery score as scoring system and seven kinds of parameters as cognitive and psychomotor function test. The tests were performed at three measurement points; the day before the operation and 30, 60 minutes after extubation. RESULTS: By the scoring system, no difference in recovery score at postop. 60 min. could be found between two groups. But by the cognitive and psychomotor function test, propofol group showed significantly better recovery than enflurane group at all tests, reaching control values at postop. 60 min. CONCLUSIONS: The scoring system is not suitable method for decision of discharge, thus cognitive and psychomotor function test should be performed for "street fitness" after outpatient anesthesia. Propofol was associated with less impairment in cognitive and psychomotor function than enflurane.

The Anatomy of the Lumbar Epidural Space using Magnetic Resonance Imaging / 대한마취과학회지

MRI(Magnetic Resonance Imaging) have provided for greater image resolution, detailed tissue contrast without use of contrast media and images acquired in any plane. The purpose of this study was to examine the anatomy and dimension of the epidural space using MRI(Magnetic Resonance Imaging) and to compare the information obtained with that from other investigative technique. The anatomy of the lumbar epidural space was studied retrospectively using lumbar MRI scans of 90 patients. The epidural width(E.W.) is divided into three distance between the anterior surface of the ligamentum flavum and the dura at the caudal end of the lumbar segment(A), at the mid point of the ligamentum flavum(B) and at the cranial end of the lumbar segment(C). The distance from skin to supraspinous ligament(S-L) and from supraspinous ligament to epidural space(L-E) were measured. And then with adding both the distance, We measured the distance from skin to epidural space(S-E). Results were as follows; I) Posterior to the dural sac, epidural fat which is of high signal(white) on Tlw(T1 weighted) image is demonstrated at levels Tl I-T12 to L5-Sl giving 'Saw toothed' pattem to the epidural space. The fat is divided into segments by the interposing laminar, and the epidural space is deeper at cranial end than caudal end. 2) It was the relatively wide epidural space in L2-3 and L3-4 level, and the narrowest epidural space in L5-Sl level. 3) The distance from skin to supraspinous ligament was noted marked variation(2-40mm) according to the individual disparity. And the distance from supraspinous ligament to epidural space is 17-43mm. In distance from skin to epidural space, the most narrow place is Ll-21evel (37.95+/-7.65mm). The most deep place is IA-5 level(46.35+/-7.20mm). As the age increase, epidural width is decreased at L3-4 level (p<0.05).

The Effect of Transdermal Scopolamine Patch on Nausea and Vomiting after Epidural Injection of Morphine / 대한마취과학회지

Sixty patients, undergoing major gynecologic surgery with lumbar epidural anesthesia, were randomly selected 32 patients to apply a transdermal scopolamine patch (Kimite MyoungMoon, Korea) on the skin behind one ear. We were divided into 2 groups. Control group; epidural morphine 4mg were given and not applied scopolamine patch. Experimental group; epidural morphine 4mg were given and applied transdermal scopolamine patch on the skin behind her ear at the night before surgery. They were followed up for 3 days postoperatively and statistical analysis was done. There was a significant (p<0.05) reduction in nausea and vomiting between experimental group and control group. There was no significant incresed incidence in scopolamine side effects. However, despite receiving transderrnal scopolamine patch there was still a high incidence (43.8%) of nausea and vomiting.

The Changes of Metabolic and Acid - base Status and Respiratory Gases Elicited by Pneumatic Tourniquet for Lower Extremity Surgery / 대한마취과학회지

For extremity surgery, tourniquet is placed routinely. With deflation of the tourniquet, the metabolic product is flushed into the systemic circulation and theoretically poses a potential for toxic reactions. In actual fact, these are rare events with this technique. Vigilant monitoring will detect cardiovascular depression at this time. By the tourniquet application, lactic acidemia, abnormal coagulopathy, hypotention, hyperkalemia, increased PaCO2, and production of noxious oxygen free radicals were reported following the release of the tourniquet. But the serial changes of metabolic derangement, degree of lactic acidemia following the use of the tourniquet were not exactly known. To confirm the safety of the pneumatic tourniquet use for two hours, the serial changes of lactic acid levels, acid-base status, potassium concentration, concentration of respiratory gaaes (arterial and end-tidal CO2,) and also hypotension, dysrhythmias and respiratory pattern following release of the tourniquet were studied. Patients were anesthetized with 1% halothane, 50% nitrous oxide and 50% oxygen. Ventilation was maintained by the ventilator to keep the end-tidal CO2, to 4.0% just before the release, and then respiratory parameters (respiratory rate, tidal volume) were constantly maintained through the study. The data were measured from arterial samples or monitors with the following interval; just before tourniquet apply (BTA), before tourniquet release (BTR), at 1, 3, 5, 15 and 30 minutes after the tourniquet release (ATR 1 m, 3m, 5 m, 15 m 30 m). Data measured before the tourniquet apply were used as control values. All data were analyzed by the paired t-test with control. Changes of mean values of each time in one parameter were analyzed by one-way ANOVA. Correlationships between the parameters and duration of ischemia induced by the tourniquet were analyzed by simple regression. The results of this study were as follows; 1) The arterial concentration of lactic acid was maximally increased at 3 minutes after tourniquet release and not returned to control value until 30 minutes after tourniquet release. 2) End-tidal CO, was reached to maximal values of 5.3% at 5 minutes after release of tourniquet. Accompanying theses changes, spontaneous respiration was recovered from the controlled ventilation in 11 patients out of 13 and fought with mechanical ventilator due to asynchronism of respiratory cycles. 3) Mild metabolic acidosis showing the decreased arterial pH and increased PaCO2, in arterial blood gas analysis was maintained in 30 minutes following the release of tourniquet. 4) There were no significant changes of concentrations of potassium. 5) Three episodes of mild hypotension were observed out of 13 patients, but dysrhythmias and other significant clinical changes not observed through the study. The above results showed the possibility of lactic acidemia and changes of respiratory pattern by increased PaCO2, after release of the tourniquet may occur. More intent monitoring is needed to the patients who have had the metabolic derangement in acid-base balance and increased intracranial pressure in application of tourniquet on limbs.

A Clinical Study of Geriatric Anesthesia / 대한마취과학회지

It is widely believed that, compared with younger patients, elderly having surgery have a significantly high incidence of complications or death. So, we reviewed clinical records of 2094 patients aged over 65 out of 41,129 surgical cases performed at Catholic University Kang-Nam St. Mary Hospital from May 1980 to December 1989. The case were analysed statistically according to age, sex, department, preoperative physical status, operation site, anesthetic techniques and agents, duration of anesthesia, intraoperative transfusion, intraoperative complication, asaociated disease, postoperative complication and mor- tality. The results were as follows: 1) Of the total 41, 129 cases, 2,094 cases (5.1%) were over 65 years of age consisting of 1,039 male (49.6%) and 1,055 female (50.4%). 2) The most common age group for geriatric anesthesia (1, 164 cases) was 65~70 years of age (55.6%). 3) The rate of elective and emergency surgery was 90.2% (1,889 cases) and 9.8% (205 caaes). 4) Among the 2,094 cases, 1.029 cases were general surgry (49.1%), 373 cases were orthopedic surgery (20.7%) 5) The number of upper abdominal surgery cases were 643 cases (30.7%) and the number of lower abdominal surgery cases 433 cases (20. 7%). 6) The duration of anesthesia was within 1 hour in 286 case (13.1%), 1~2 hours in 755 cases (36.1%), 2~3 hours in 516 cases (24.6%). 7) The technique of anesthesia was done under the general anesthesia for 1,445 cases (69.0%) and epidural anesthesia for 433 cases (20.7%). 8) The anesthetics were halothane for 631 cases (30.1%), enflurane for 435 cases (20.8%) and fentanyl for 364 eases (17.8%), lidocaine and bupivacaine mixture for 254 cases (12.1%). 9) Among the 2.094 cases, 1,471 cases had preoperative disease (70.3%), which of the most common disease (24.1%) was the chronic obstructive pulmonary disease (545 cases). 10) The numbers of postoperative death were 40 cases (1.9%).

Clinical Evaluation of the Neruomuscular Blocking Effect of Isoflurane / 대한마취과학회지

Isoflurane, which has only recently been introduced into clinical practice, is a nonflammable halogenated ether used as an inhalation anesthetic. It has pharmacological, physical, and clinical properties similar to those of halothane and enflurane: however, it differs from botn in several important aspecs. The potent neuromuscular blocking action of sioflurane in desirable, because it reduces the requirement for muscle relaxants and allows lower doses of anesthesis. To quantitatively clarify the neuromuscular blocking effect of isoflurane, neuromuscular function was monitored by "Train of Four" stimulus with and without administration of muscle relaxants under halothane and isoflurane anesthesis, respectively, in 60 patients. The patients were divided into 4 groups(halothane anesthesia without muscle relaxants, halothane anesthesis with muscle relaxants, isoflurane anesthesia without muscle relaxants and isoflurane anesthesia with muscle relaxants). Twich responses of thenar muscle were monitored and analysed for the value of maximaum twich depression by halothane and isoflurane anesthesia, respectively, and the onset time, degree of maximal neuromuscular blockade, duration of action and recovery index of pnscuronium bromide under halothane and isoflurane anesthesia, respectively. The results were as follows: 1) Isoflurane exhibited a neuromuscular blocking effect 2,3 times more potent than halothane. 2) Neuromuscular depression by halothane and isoflurane was not accompanied by "fade". 3) The recovery time from nuromuscular blockade by succinylcholine in isoflurane anesthesia was increased significantly compared with halothane anesthesia. 4) The duration of action and the recovery index were increased significantly in isoflurane anesthesia compared with halothane anesthesia.

The Neuromuscular Responses of Atracurium in Myasthenia Patieats / 대한마취과학회지

Myasthenia gravis is now considered as one of autoimmune disease eintities and characterized by progressive muscle weakness upon exertion and high sensitivity to the motor end plate. Special considerations are required in the anesthetic management of the myasthenic patient undergoing surgery under general anesthesia. The myasthenic patient is generally highly sensitve to non-depolarising agents and resistant to depolarizing agents. it is advisable to avoid the non-depolarzing agents or use only small dose during anesthesia, if neccessary. Atractrium is an intermediate acting bisquatenary ammonium compound and it's effects are well dissipated by hofmann elimination and ester hydrolysis. We have had myasthenic patient undergo thymectomy. Muscle relaxation was obtained by using a small dose of atracurium during anesthesia. Patient's perianesthetic course was not remarkable except slow spontaneous recovery, but it was well reversed by anticholinesterase.

Preoperative Anesthetic Management of the Patient with Hypoprothrombinemia / 대한마취과학회지

Disorders of coagulation and uncontrollable bleeding are major problems during a major surgical operation. The correct diagnosis, appropriate treatment and preparation for abnormal coagulation and bleeding conditions with specific factors and blood products are procedure of utmost importance. Detailed history, physical examination and performance of appropriate laboratory tests including specific factor assay are essential for the diagnosis of an abnormal coagulation and bleeding problem. We have experienced a case of factor ll deficient patient who had surgery for a glioma of the forebrain. He had a past history of two episodes of massive bleeding during operation and showed a bleeding tendency after angiography for this last admission, but he didn't show any abnormal blood coagulation tests except for a factor ll deficiency. He had received Vitamine K 20 mg/day for 7days preoperatively. All laboratory coagulstion tests became normal and he had a surgical removal of a forebrain glioma uneventfully under general anesthesia. He received only 1 unit of fresh frozen plasma during operation and had an uneventful postoperative course.