Influence of Flunitrazepam on the Adverse Effects of Succinylcholine Chloride / 대한마취과학회지

Intravenous succinylcholine is often associated with adverse effects, including muscle fasciculation, postoperative myalgia, increased intraocular and intragastric pressure, along with potassium and creatinine phosphokinase, myoglobinuria, and disturbances in cardiac rate and rhythm. Several methods have been used to modify these side effects, the most popular of which has been the of subparalyzing doses of nondepolarizining relaxants prior to injection of succinylcholine. With such pretreatment however satisfactory muscular relaxation is often not achieve, necessitaing use of larger doses of succinylcholine becauses pretreatment renders the endplateless sensitive to succinylcholine; hence large doses of succinylcholine are necessary to ensure adquate degress of relaxation. The present investigation was undertaken to determine the effects of flunitrazepam on the adverse effects of succinylcholine. This paper covers the period from March, 1981 to March, 1982 in the Department of Anesthesiology, Hanyang University Hospital. The 45 subjects were divided into 3 groups: 1) propanidid (8mg/kg) with succinylcholine 2) flunitrazepam(0.03mg/kg) with succinylcholine 3) flunitrazepam(0.06mg/kg) with succinylcholine. None had existing neuromuscular disease nor were any patients receiving diazepam or any drug known to influence myoneural blocking agent. Patients with burns, muscle injury of muscle atrophy were excluded. In each group, the plasma concentration of potassium and creatinie phosphokinase was observed before and 10 minutes after use of succinylcholine. Also succinylcholine in duced myalgia, fasciculation, onset of loss of eyelid reflex and relaxation were observed and compared. The conclusions are as follows: 1) There were no significant changes of plasma concentration of potassium and creatinine phosphokinase in presuccinylcholine and 10 minutes postsuccinylcholine. Also any statistically significant changes were not observed in the comparison of the propanidid group and the flunitrazepam groups. 2) Flunitrazepam significantly diminished the incidence of postoperative muscle pain and it was shown that the degree of fasciculation has no relationship with succinylcholine induced muscle pain. 3) In the propanidid group, the onset of loss of eyelid reflex was most rapid(22+/-13 second). In the flunitrasepam 0.03mg/kg group, the onset of loss of eyelid reflex was statistically significant (p<0.05), as compared with the 0.06mg/kg group(42+/-27 second). 4) In all groups, excellent conditions of intubation were observed. Propanidid and flunitrazepam did not affect the magnitude nor duration of the succinylcholine neuromuscular block.

Change in Total Serum Potasium, Sodium and Calcium by the Administration of Induction Agents with Succinylcholine / 대한마취과학회지

It is important that the clinical anesthetist pay attention to the interaction of anesthetic induction agents and succinylcholine chloride(S,C,C) on the elctrolyte level especially the plasma potassium ion concentration. For instance succinylcholine chloride has a marked effect upon specific conditions such as severe burns, multiple injury, deabetes insipidus and myopathy. Also secondary plasma changes may bring about non synchronous depolarizing action on the muscle and cause cardiac arrhythmai and even cardiac arrest by the increase of potassium concentration in the plasma. With this in mind the author has randomly selected 30 patients who belong to class l physical status by the classification of the American Society of Anesthesiologist had no abnormal symptoms in respiration, circulation or endocrine and metabolism defects. This paper covers the period from the 10th of April 1979 to the 10th of May 1980 in the Department of Anesthesiology, Hanyang University Hospital. The 30 subjects were divided into 3 groups: a) propanidid with S.C.C. b) thiopental sodium with S.C.C. c) diazepam with S.C.C. The plasma concentration of potassium, sodium and calcium were observed and compared in the pre-induction (control group) and two minute post-induction(study group). The results are follows: 1) The plasma potassium ion concentration showed no any significant changes in the whole group. 2) The plasma sodium and calcium ion concentration also showed no any significant changes in the whole group.

Clinical Investigation of Twenty Living Renal Transplants / 대한마취과학회지

This is a report of anesthesia experiences for twenty cases of living renal transplantation at the Hanyang University Hospital from April 11th, 1978 to June 5 th, 1979. The living or cadavar renal transplantation has become a form of treatment for the terminal stage of kidney disease in the last ten years. Since last 1970, several authors in Korea have reported on the anesthetic management of the recipients of living renal transplantation, briefly mentioning the technics used and statistics of the morbidity and mortality of the recipient patients. We have reviewed the preanesthetic preparations, anesthetic agents and technics as well as the surgical procedures and recipients mortalities. The results are as follows: 1) All kidney grafts were performed from living donors. 2) In the sex distribution of the donors, females were the great majority. and on the other hand, of the recipients, males were the great mayority. 3) All patients were anesthetized with endotracheal general anesthesia using propanidid 300~500mg, pancuronium 2~4mg for induction and halothane 0.5~1.0%, and nitrous oxide plus oxygen proportionally 2: 2 L/m for maintenace. 4) The amount of whole blood transfusion during anesthesia ranged from 300 to 800 ml and fluid infusion was 940 ml of normal saline solution. 5) After living renal transplantation, diuresis started immediately and the majority of patients showed marked diuresis in which the urine volume in 24 hours was 4,202ml. 6) The following study of the patients mortality showed that 5 cases died out of 20 cases after surgery. The survival rate is 75% at the present time.

Cardiac Arrest during Epontol Intravenous Anesthesia / 대한마취과학회지

Epontol is well known as an ultra-short-acting intravenous anesthetic which can be used for minor surgery. This case report is to present the possibility of cardiac arrest while using Epontol in a patient with heart disease because its pharmacological action causes acute hypotension due to myocardial depression and histamine release. This 30 year old female who had a history of rheumatic fever with incomplete RBBB manifested by ECG, was admitted with vaginal bleeding and 500 mg of 5% Epontol was .administered for D % C. The patient appeared to have acute cyanosis immediately after Epontol administeration, followed by cardiac arrest. Despite cardiac resuscitation was performed adequately, the patient remained comatose for 1 year and 4 months and died of respiratory failure with sepsis.

The Effects of Propanidid-Ketamine Anesthesia on Cardiovascular and Respiratory Systems of Rabbits / 대한마취과학회지

There is a definite need for safe and potent intravenously administered anesthetics of .short duration which combine analgesic and sleep-producing effects without significant cardiovascular and respiratory depression. There are many intravenous drugs to choose from and there have been many types of balanced anesthesia, but no one is satisfactory yet. This experimental study was carried out to seek the possibility of some improved features of cardiovascular and respiratory systems, with the combination of propanidid and ketamine, using rabbits as experimental animals. The following results were obtained. 1) Propanidid is freely miscible with ketamine without significant change of pH, colour or any sediment, so it seems that the effects of both drugs may be preserved well. 2) The propanidid-ketamine mixture group shows that ketamine compensates for the depressive effect of propanidid on blood pressure and pulse rate. 3) The propanidid-ketamine mixture group shows that ketamine compensates for the respiratory depression of propanidid to some extent and propanidid alleviates increased muscle tone by ketamine. Taking together the present results, ketamine compensates well the for depressive effects of propanidid on the cardiovascular and respiratory systems. Thus propanidid-ketamine mixture seems to be a suitable anesthetic.

The Observation of Complications after General Anesthesia / 대한마취과학회지

Recently, with the remarkable theoretical progress made in anesthesiology these years, reports are being made on the results of the study on the complications, minor or major, caused by previous general anesthesia. However, .the reports on incidence vary according to the reporters. According to Riding, the recent development of anesthesiology, anesthetic inatruments, knowledge of physiology, anesthetics, induction agents and muscle relaxants are said to have reduced the incidence of complications to a great extent. Riding, Gold and Dyrberg report that the factors capable of influencing the incidence of complication, in the post-operative period include age, sex, premedicants for anesthetics, inhalation method of anesthetics, time of anesthesia, muscle relaxant, use of induction agent, acid-base imbalance and developed knowledge of physioloy, operation site, mental state of patients before operation, general condition, anesthetic technique, and. adequate selection of medicine. Working for Department of Anesthesiology, Hanyang University, from October 1976 to August 1977, we selected, out of the patients who received general anesthesia, 523 males and 372 females, totalling 895, who showed no abnormal symptoms in their respiratory systems, circulatory systems and metabolic systems and observed the incidence of complication in the light of sex, age and operation site, the factors supposed to affect the incidence. An hour prior to the general anesthesia, the patients were given intramuscular injection with premedicants atropine 0. 01 mg per kg, Valium 0. 2 mg or Demerol 1 mg per kg of body weight. For induction of anesthesia, Epontol 10 mg per kg and succinylcholine 1 mg per kg of body weight were injected in the veins, then ventilation was made for a minute with mask and then endotracheal tubes were inserted. and then a minimum amount of air was injected. into the cuff of the endotracheal tube, and the ventilation was done in a semi-closed system. During the period of maintenance, anesthesia was administered in a semi-closed system with 0. 5~l. 0% halothane, 3 L/min of nitrous oxide, 2 L/min of oxygen; and if need be, muscle relaxant was injected into the vein. In case a nondenolarizing agent was used in the course of maintenance, atropine 0. 5~1. 0 mg and neostigmine 2.0 ~ 4.0 mg were injected into the vein for reversion at the recovery time. After the patient was completely recovered, the endotracheal tube was cautiously removed, so as not to give trauma to the throat. As for method of observations, 24 hours after the patient had recovered, we visited the patient in the ward, first observing the existence or nonexistence of incidence of minor complications, and then calculating the incidence by the distribution of sex, age and operation site. The outcome of the observation of the above results by statistics and by chi square test is as follows; 1) the incidence of complications after general anesthesia was high in females. 2) Age has not affected the incidence of complications. 3) The incidence of nausea was highest in the patients with abdominal operation. 4) The incidence of sore throat was highest in the head and neck patients. 5) The incidence of fever was highest in the abdomen patients. 6) The incidence of headache was highest in the head and neck patients.

Anesthesia for Renal Transplantation - Report of 24 Cases / 대한마취과학회지

This is a report of anesthesia done for 24 cases of renal transplantation performed at St. Mary's Hospital, Catholic Medical college, Seoul, Korea, between 25 March 1969 and 19 August 1976. The recipient of renal transplantation show many critical conditions which require special considerations in performing anesthesia. The patients preoperative condition should be evaluated more carefully than most other kinds of surgical patients and anesthesia technic also must be selected specially. All kidney grafts were obtained from living donors. The family linkage of 24 donors was: 7 cases(29.1%) were from parents, 3 cases(12.5%) from children, 9 cases (37.5%) from siblings, 3 cases(12. 5%) from other relatives and 2 cases (8. 3%) were from nonrelated prsons. In the sex distribution of the donors, each sex was equally distributed.: All donors were anesthetized by means of endotracheal anesthesia using halothane, nitrous oxide and oxygen. As to complications during the nephrectomy of donors, a case of hiccup and two cases of pleural tear were encountered. The removed kidney was perfused with Hartmanns solution before transplantation and the choice of anesthetic agents caused no problems in the function of transplanted kidneys. The recipients had histories of chronic glomerulozephritis or pyelonephritis from 6 months to 32 years and showed uremic conditions. Their mean age was 38 years, ranging from 18 years to 59 years. The most frequent age group of the recipients was the 30 and 40 year group. Most recipients were males; among 24 cases, only 3 were females. Most of the recipients had decreased function of heart and lungs, severe anemia difficult to correct by blood transfusion(Hb, 7. 3 gm%, Hct. 24, 2%), increased BUN(70. 36+/-31. 34 mg/dl), hyperkalemia (4. 67+/-0. 63 mEq/L), poor and fragile veins, bleeding tendency and decreased kidney function(serum creatinine 10. 48 edmea, +/-2. 99 mg/dl). Prolonged medication to the recipient was another hazard to anesthesia. To lessen the risk during the anesthesia maintenance, preoperative preperation of the recipient The Journal of The Korean Society of Anesthesiologists Vol. 10, No. 1, 1977 Premedication of the recipients was perfor med by valium(515 mg) and atropine(0. 4 0. 5 mg) one hour before anestl esia. For tlie anesthetic technic, endotracheal anesthesia was applied to aI1 cases. Induction was done with intravenous pentothal soium, l00~ 200 mg or Epontol 250~500mg. As to the muscle relaxant to facilitate intubation, succinylchline for ll cases of the initial period of the transplantation, later gallamine for one case and pancuronium for the recent 12 cases. All anesthesia was maintained with halothane, nitrous oxide and oxygen. Muscle relaxants were used in al) cases during the surgery: succinylcholine drip for the initial 7 cases, d-Tubocurarine for 2 cases, gallamine for 2 cases and pancuronium for the recent 12 cases. Galllamine seems to be not contraindicated, as far as the active diuresis could be anticipated after the transplantation. Amount of blood transfused during operation was 2, 041 ml in average, ranging from 800 ml to 5000 ml and fluid infused was 1, 242 m] of Hartmann's sol. and/or other solutions. Respiration was controlled manually or mechanically. During the anesthesia, 16 cases of hypertension, 7 cases of arterial hypotension, 3 cases of arrhythmia, one cas of tight chest and one case of tachycardia, were encountered. Emergence of anesthesia was within 15 minutes. After the transplantation, diuresis started in 33 minutes on the average and most patients showed marked diuresis in which urine volume of 24 hours was 10, 164 ml on the average. The total surgical procedure lasted 4 hours and 50 minutes on the average, ranging from 3 hours 50 minutes to 7 hours. The ischemic tine of the removed kidney was 32 minutes in average. Followup of the patients showed that 10 cases died out of 24 cases between 4 months and 4 years after the surgery Patients surviving more than 1 year were 11 cases out of 15 cases(73. 3%), two cases out of 8 cases(25%) survived more than 2 years and two cases out of 8 cases(25%) more than 3 years. One case had the longest survival of 7 1/3 years.

Changes in Serum Potassium after Induction with Propanidid-Succinylcholine / 대한마취과학회지

Three groups of healthy adults were premedicated with diaxepam or secobarbital and anesthetized with propanidid or thiopental. The concentration of serum potassium wes measured before induction and after succinylchaline iodide administration. The increases of potassium in diazepam-thiopental, diaxepam-propanidid and secobarbital propanidid groups were 0. 14, 0. 06, and 0. llmEq/L (3. 29, l. 38 and 2. 58%) respectively. Serum potassium changes were least in diazepam-propanidid group, but there were no significant differences among the 3 groups. The choice of induction agent is of importance for the changes in serum potassium which follow the subsequent injection of succinylcholine iodide. For instance, intravenous induction by barbiturate is followed by a lesser increase in serum potassium after succinylcholine injection than induction by halothane. As barbiturates are so commonly used as intravenous induction agents, we chose thiopental and succinylcholine iodide as standard with which to compare the other induction agents, propanidid and succinylcholine iodode. And also, we wanted compare two premedicants, secobarbital and diaepam. The results were as follows: (1) The thiopental-succinylcholine iodide group and the propaaidid-succinylcholine iodide group revealed no significant differences in serum potassium level. (2) There was a lesser increase in serum potoassium level after premedication with diazepam than premedicstion with secobarbital in the propanidid-succinylcholine iodide group. (3) Induction by propanidid succinylcholine iodide and premedication by diazepam are recommendable for least increasing the serum potassium level.

Postanesthetic Unusual Excitement due to Atropine Overdose / 대한마취과학회지

Postanesthetic unusual excitement and prolonged postauesthetic recovery time were experienced after general anesthesia. The cause was discovered later due to accidentally administered atropine overdoses. Atropine vials supplied by the hospital pharmacy were labeled no containing quantity. After survey, the content of atropine was notified as 5 mg/ml instead of 0.5 mg/ml. It was ten times stronger content of the usual dose. General anesthesia were performed under halothane-N2O or methoxyflurane-N2O with semi- closed circle absorber system. Pentothal sodium or epontol intravenously was used as induction agent. For premedication, valium and atropine or valium, demerol and atropine was given intramuscularly. Additional atropine was given before reversing the muscle relaxation with neostigmine. 20 cases of acute atropine toxicity after general anesthesia were analysed for incidence of excitement, prolonged recovery time, total doses of atropine, change of the pulse rate, scarlet and tremor. The results were as follows; 1. Postanesthetic unusual excitement was observed but there were no mortality. 2. Doses of accidentally administered atropine were 9.53+/-4.75 mg (Mean+/-S.D.) 3 Postanesthetic recovery time was unusually prolonged, Mean recovery time was 146.1+/-24.4 minutes. 4. Among the patients, the following rate of complications were found; unusual excitement was 75%, scarlet was 50% and tremor was 10%, respectively 5. Law of the pharmacist should be strictly observed to prevent the accidental overdoses.

Clinical Observation of the Induction of General Anesthesia with Propanidid for Cesarean-Section / 대한마취과학회지

To evaluate the maternal and fetal effects of propanidid, clinical observations were carried out in 160 cases of Cesarean section out of 4, 230 deliveries made during the past three years. Upon having the obstetricians ready for incision, 10ml. of 5 per cent propanidid and 40mg. of succinylcholine chloride were administered intravenously, and surgery was begun almost simultaneously with endotracheal intubabation. Thereafter, anesthesia was maintained with N2O-O2-fluothane, N2O-O2 -ether, or ether-O2 in semiclosed circle absorption system. Umbilical cord was ligated within 3-5 minutes after the commencement of induction. This method of anesthesia did not seriously affect the maternal respiration or circulation, and Apgar scores were good or fair in the majority of cases. No undesirable side effects or complications directly attributable to propanidid were encountered.

An Experimental Study on the Antiarrhythmie Effect of Propanidid upon Catecholamine-Cardiac Arrhythmias / 대한마취과학회지

Cardiac arrhythmias were produced in the dog by injections of epinephrine or isoproterenol during intravenous thiopental or propanidid anesthesia. Propanidid did not increase the pressor response to epinephrine, reduce the depressor response to isoproterenol, or diminish the tachycardia following epinephrine or isoproterenol. Propanidid, however, consistently increased the arrhythmia threshold doses of epinephrine and isoproterenol four times those during thiopental anesthesia. It is concluded, therefore, that the antiarrhythmic effect of propanidid is not related to beta adremergic blockade but to its local anesthetic or quinidine-like action and that propanidid is an excellent intravenous anesthetic in view of its antiarrhythmic action on the heart.

Clinical Study of Propanidid as an Induction Agent ( Part III ) / 대한마취과학회지

Since 1966, Propanidid has been used not only for minor operative procedures but also as an induction agent. The present study was undertaken on 28 unselected cases from the daily operating schedule and blood gas analsis done before anesthesia and immediately after intubation with the aid of deporalizing muscle relaxants. Endotracheal intubation was performed intentionally preceding artificial oxygenation. The results of the blood gas study showed a mean PaO2 of 120. 2 mmHg, PaCO2-mean 41. 2 mmHg and pH-mean 7, 388 during respiratory depression following hyperpnea. As an induction agent, propanidid not only has no local complications but also gives smooth induction without excitatory phenomen and a rapid recovery. Further study on the interaction with nondeporalizing muscle relaxants is suggested.

Anesthesia or Kidney Transplantation - report of 5 cases / 대한마취과학회지

This is a report of anesthesia for five cases of renal transplantation which was performed between February 1969 and August 1969 at St. Mary's Hospital, Catholic Medical College, Seoul, Korea. General of renal insufficiency of the operated cases were described. Operative technique were unilateral nephrectomy for three cases and bilateral nechprectomy with splenectomy for 2 cases ; Anesthesia was induced with epontol (propanidid) 250mgs i.v. and 4% halothane-oxygen and maintained with 1% halotbane-oxygen which was supplemented by nitrous oxide occasionally. 6% dextrose and lactated-Ringer's solution were infused. For transfusion, whole blood was given to replace the operative blood loss. Dextran was also used to maintain adequate blood volume. Shortly before anastomosis of renal and femoral vessels, patients were haparinized. Fluids and electrolytes balance were studied pre-and post-operatively. Preoperatively, uremia and hyperpotassemia was corrected by several hemodyalysis. Urinary output after surgery showed a marked degree of diuresis up to 1800 ml/hr until second post-operative day. The special concern of anesthesia for kidney transplantation were: 1. Patients were suffering from severe uremia and metabolic disterbances. 2. Acidosis and hyperpotassemia should be corrected before surgery by hemo-or peritoneal dialysis. 3. Immunosuppressive agents made the patient less resistant to infection. 4. Anemia and hydrops was difficult to be corrected before surgery. 5. Muscle relaxants of choice were depolarizing agents, because of impaired renal excretion.

Clinical Evaluation of Electro-convulsive Therapy under the General Anesthesia / 대한마취과학회지

In 1938 Cerletti described a method of producing convulsions by eleetricity and began its use in the treatment of schizophrenias. In avoider to avoid fractures or dislocation and to diminish the risk, convulsion may be modified by means of drugs which inhibit the action of acetylcholine at neuro-muscular junctions and often the muscular contractions combining ultra short acting barbiturate especially thiopental sodium. Since ultra short acting barbiturat, like thiopental, require postanesthesia supervision of the patient for up to an hour, the recentlyintroduced ultrashort-acting nonbarbiturate anesthetic agent, propanidid, was investigated for comparison with thiopental sodium. One hundred psychiatric patients under the diognosis of involutional melancholia, manic depressive psychosis, schizophrenia and neurotic depression, divided into two equal groups, were subjected to electroconvulsive therapy by thiopental-succinylcholine (Group 1) and propanidid-succinyl choline (Group 2). In our study, there were no definite change in blood pressure and heart rate after electroconvulsive therapy in both group. Duration of apnea in Group 2 averaged 63 seconds longer than in Group 1, but awakening and ambulation averaged 5 minutes and 40 minutes shorter than in Group 1. Complications after E.C.T. were minimal and not significant different between two groups.

Clinical Studies of a New Intravenous Anesthetic Agent-Propanidid / 대한마취과학회지

Propanidid was administered to 50 surgical patients, and the following results were obtained 1) Propanidid seemed effective as an induction agent. 2) Propanidid could be used alone or in combination with muscle relaxants. 3) Propanidid had little influence on the cardiovascular system, and caused no significant change in blood pressure. 4) Recovery was more rapid with propanidid than with other barbiturates. 5) Hiccough and involuntary movement were noted in the majority of patients. Vomiting, nausea, headache, shivering, and rash occurred in a few patients.