Closed Lock of the Jaw on Induction of Anesthesia / 대한마취과학회지

The temporomandibular joint (TMJ) is unique among joints in the human body, since it can be dislocated without external force. Manipulation of the upper airway other than laryngoscopy is a risk factor in patients who have a history of habitual dislocation of the TMJ. The case report illustrates that severe limitation of the jaw opening ("closed lock") requiring manipulation for restoration may occur during induction of general anesthesia.

Effects of Propofol and Halothane on Cerebral Metabolism and Brain Histopathologic Change Following Complete Cerebral Ischemia in Diabetic Rabbit / 대한마취과학회지

BACKGROUND: Because propofol has cerebral effects similar to barbiturates, it is postulated that propofol might offer more protection than halothane during cerebral ischemia. But there is no consistent data on the protective difference between these two agents. So this study was done to evaluate the cerebral protective effect of propofol and halothane on the diabetic model which is more susceptible to ischemic insult. METHODS: Twenty diabetic rabbits were anesthetized with 1% halothane in O2 and N2O. In propofol group (n=10), halothane was discontinued and intravenous infusion of 1% propofol was started (loading dose: 1.6 mg/kg/min, maintenance dose: 1.2 mg/kg/min) and the remainder rabbits served as halothane group (n=10). Thirty minutes after propofol infusion (same waiting interval in halothane group) cerebral ischemia was produced by combination of around neck tourniquet inflation and systemic hypotension for 10 minutes. Periischemic vital signs, arterial and internal jugular venous gas analysis, glucose and lactate concentrations were measured. Brain histopathologic examination was done with light microscope after reperfusion. RESULTS: The vital signs, glucose concentrations, arterial blood gas analysis and brain histopathologic examnination were not differed between these two groups in periischemic period. During the reperfusion period, the venous blood pH, PCO2, oxygen contents and lactate concentrations were more rapidly returned to preischemic value in propofol group. Also the arterial blood pH and arteriovenous oxygen content differences were more rapidly returned to preischemic value in propofol group during the reperfusion period. CONCLUSIONS: This results suggest that propofol has more cerebral protective effect from complete cerebral ischemia in diabetic rabbit compared to halothane.

A Comparison of Nalbuphine, Midazolam, and Buprenorphine As Premedication Agents / 대한마취과학회지

BACKGROUND: Premedication traditionally has several goals: reduction of anxiety,pain, and secretions and provision of basal or background sedation. The purpose of this study was to evaluate the efficacy and side effects of nalbuphine, midazolam and buprenorphine as premedication agents. METHODS: Two hundred thirty three patients who were scheduled to have an elective operation were included in this randomized, double-blind study. Nalbuphine 0.2 mg/kg, midazolam 0.05 mg/kg or buprenorphine 0.005 mg/kg was given intramuscularly with atropine(0.01 mg/kg) one hour before arriving at operating room. Sedation, level of anxiety, subjective rating on the effect of premedication and side effects including emesis and etc. were evaluated. RESULTS: The sedation score and the level of anxiety were not significantly different among three groups. The subjective rating on the effect of premedication was significantly higher in midazolam group than other two groups(p<0.05). The frequency of preoperative emesis was not significantly different among three group. The frequency of postoperative emesis was significantly higher in buprenorphine group than other two groups(p<0.05). Buprenorphine group showed dizziness and flushing more frequently than the other two groups(p<0.05). CONCLUSION: The present study demonstrated that, as a premedicant, midazolam increase the patient's satisfaction and decrease lessen the incidence of postoperative emesis and buprenorphine increase the incidence the side effects such as postoerative emesis, dizziness and flushing.

A Clinical Study on Fatal Cases within 30 Days Following Surgery / 대한마취과학회지

BACKGROUND: A retrospective study was performed to evaluate postoperative mortality within 30 days following surgery. METHODS: The records of 31,806 patients who received operation under general anesthesia were reviewed. RESULTS: 1) Postoperative deaths were 184 cases, the ratio of which was comprising 0.57% of all surgical operative cases. 2) The highest ratio of the mortality in age group was 51~60 years group which was 24.5%, and in physical status it was ASA class III which was 36.4%. The highest ratio to the mortality rate in postoperative days was 8~30 days which was 45.1%. 3) The most common causes of death was low cardiac output due to heart failure on operating theater, and hypovolemic shock within postoperative 2 days, and intracranial problem within postoperative 7 days, and pulmonary complication within postoperative 30 days. CONCLUSION: We conclude that fatality rate could be decreased by intensive and multidisciplinary care for postoperaive complications as respiratory and renal failure.

Does Epidural Buprenorphine Really Shorten the Duration of Endotracheal Intubation, Ventilatory Support and Intensive Care Unit (ICU) Stay in Open Heart Surgery Patients? / 대한마취과학회지

BACKGROUND: Epidural buprenorphine has been shown to reduce the anesthetic and analgesic requirements during the perioperative period. The goal of this study is to see whether epidural buprenorprhine reduce the dose of fentanyl infusion for anesthetic management and postoperative pain control and shorten the duration of postoperative ventilatory support and endotracheal intubation in open heart surgery patients. Method: Total 50 patients who underwent the open heart surgery were included for the study. General anesthesia was maintained with a nitrous oxide (2 L/min)-oxygen (2 L/min)-isoflurane (0.5~1.5 %). In control group additional anesthetic requirement is supplemented with intermittent intravenous injection of fentanyl. In buprenorphine group initial loading dose of 0.3 mg of epidural buprenorphine followed by continuous epidural infusion (20 microgram/hr) and additional anesthetic requirement was supplemented with intravenous fentanyl. RESULTS: The total dose of fentanyl requirement was significantly lower in buprenorphine group than in control group. The duration of ventilatory support and endotracheal intubation were significantly shorter in buprenorphine group than in control group. The duration of ICU stay was not different between two groups. CONCLUSIONS: Epidural buprenorphine reduced the anesthetic requirement and postoperative pain and shortened the duration of postoperative ventilatory support and endotracheal intubation. Therefore epidural buprenorphine can be an reasonable alternative for an adjunctive with general anesthesia and postoperative pain control.

A Case Report of Airway Obstruction by Reinforced Endotracheal Tube during Surgery / 대한마취과학회지

A 47-yr old female patient with spinal stenosis was intubated with a 7.0 mm reinforced endotracheal tube (ETT) for inhalation anesthesia. Then she was turned to prone position for operation. As soon as the operation began, signs of partial ETT obstruction were appeared. We examined the ETT and trachea with a fiberoptic bronchoscope and then found that the bevel of the ETT was partially obstructed by the tracheal wall. After the pass of the bronchoscope through the partially obstructed ETT bevel, obstruction signs were relieved and operation was continued. About 6 hours later, the signs of complete ETT obstruction were reappeared. We reevaluated with a bronchoscope, and found that the bevel of the ETT was completely obstructed against the tracheal wall. Advancing the ETT through the trachea to the carina alleviated the airway obstruction.

Evaluation of the Elective Course in Residency Training / 한국의학교육

Up to the present, the existing residency training in Korea, functions only as a factory to produce the heartless and increative medical technician. So, we performed the elective course in residency t raining especially about the basic medicine by the 18 residents for 5 years since since 1990 in college of medicne, Korea University. The residents who paticipate in the elective course, can have enough time to consider the nature, human and doctor and to act as a pioneer to study the basic science. Thus, we concluded that the elective course residency training about the interesting department can enables not only the increment of autonomy but also time to contact with the human nature and basic science.

The Influence of Succinylcholine and Tracheal Tube Lubrication on Postoperative Sore Throat / 대한마취과학회지

BACKGROUND: Sore throat has been reported to occur in 24-90% of intubated patients after general anesthesia. This study was done to evaluate the influence of succinycholine and tracheal tube lubrication on postoperative sore throat. METHODS: Three hundred and two patients requiring orotracheal intubation for surgery were randomly allocated to one of three groups according to kinds of lubricants on endotracheal tube: control group, 2% lidocaine jelly group, K-Y jelly group. All patients were premedicated similarly and anesthesia was induced with thiopental sodium. Patients were paralyzed with succinylcholine or non-depolarizing muscle relaxants and endotracheal intubation was done by one anesthesiologist. All patients were interviewed postoperatively after 24 hour by individals who did not know which lubricants and muscle relaxants were used. RESULTS: The incidence of postoperative sore throat was no statistically significant difference in three groups when non-depolarizing agents were used for endotracheal intubation. And the incidence of postoperative sore throat was increased in control group with succinylcholine compared with control group with non-depolarizing muscle relaxants(p<0.05). But the incidence of postoperative sore throat was decreased in K-Y jelly group and 2% lidocaine jelly group compared to control group when succinylcholine were used for endotracheal intubation(p<0.05). CONCLUSIONS: We suggest that succinylchoine can induce the sore throat, but lubrication of tracheal tubes provide advantage in terms of reducing sore throat when succinylcholine was used for intubation.

Tutorial Systems in Medical Education / 한국의학교육

No abstract available.

The 2nd Workshop on Publication of Korean Journal of Anesthesiology / 대한마취과학회지

No abstract available.

Continuous Intravenous Infusion of Propofol and Succinylcholine Supplemented with Nitrous Oxide in Short Duration of Microlaryngeal Surgery Comparison with Thiopental/Enflurane-N2O and Succinylcholine Infusion / 대한마취과학회지

BACKGROUND: Anesthetic technique for laryngeal microscopic surgery should be focused on rapid recovery of deep anesthesia and full muscle relaxation. This study was taken to evaluate the effect of continuous infusion of propofol and succinylcholine for this kind of anesthetic goal. METHODS: Forty patients scheduled for laryngeal microscopic surgery of short duration(15 min) were randomly allocated into two groups. Anesthesia was induced and maintained with either propofol(2.5 mg/kg followed by a continuous infusion of 0.1 mg/kg/min) in group P or with thiopental (5.0 mg/kg) and inhalation of 1~2 vol % enflurane for maintenance of anesthesia in group T/E. Succinylcholine(1 mg/kg followed by continuous infusion of 0.1 mg/kg/min) was administered to facilitate tracheal intubation and maintain neuromuscular blockade. RESULTS: No significant difference of duration of anesthesia appeared between two groups. Additional doses of succinylcholine were needed in 10% of group P and 30% of group T/E (p<0.05). In group P, time to response to suction catheter(136+/-54 vs 232+/-116 sec), time to eye open spontaneously or to verbal commands (368+/-142 vs 549+/-165 sec) and time to extubation (454+/-117 vs 647+/-181 sec) were significantly shorter comparing to group T/E. The quality of awakening was more favorable in group P(p<0.05). Laryngeal suspension induced bradycardia in 15% of group P and in 5% of group T/E. Both group P and group T/E (10% vs 30%) needed esmolol infusion to control the blood pressure during surgical procedure. CONCLUSIONS: Rapid recovery of anesthesia and muscle relaxation can be expected after continuous infusion of propofol(2.5 mg/kg followed by 0.1mg/kg/min) and succinylcholine(1 mg/kg followed by 0.1 mg/kg/min) supplemented with 50% N2O in 50% O2 for short duration of laryngeal microscopic surgery.

The Relationship between Periadmission Blood Pressure and Periinduction Blood Pressure / 대한마취과학회지

BACKGROUND: There has been a study reporting those cases with elevated blood pressure (BP) above 140/90 mmHg on admission and normotension on ward showed more increase in mean arterial pressure(MAP) and pressure-pulse product than the normotensive or hypertensive patients in both situations. But the mean ages of the groups were different each other. This study was done to see if the same results would come without age differences. METHODS: One hundred and sixty-two patients between the age of 45 and 64 were divided into three groups. The patients with BP below 140/90 mmHg on admission and on ward were included in group 1(N=66) and those with BP above 140/90 mmHg on admission and below 140/90 mmHg on ward, in group 2(N=42) and those with BP above 140/90 mmHg in both situations were included in group 3(N=54). Preiinduction BP, PR, the changes of BP, PR during operation, incidence of hypertension at post-anesthesia room(PAR), and the number of cases who needed the use of inotropics or antihypertensives perioperatively were checked. RESULTS: As for the increase of BP just before induction the group 2 showed the greatest, group 1 was the next, and group 3 showed the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next, and group 3 the least amount increase. As for the increase of preinduction pressure-pulse product(PPP) group 2 showed the greatest, group 3 the next, and group 1 the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next,and group 3 the least amount increase. CONCLUSIONS: Intensive anesthetic care is needed also at periinduction period for the patients who showed hypertensive BP on admission and normotension on ward thereafter.

Comparison of Doses of Doxapram in the Treatment of Postanesthetic Shivering / 대한마취과학회지

Among the pharmacological methods treating postoperative shivering, there were no studies which compare the doses of doxapram. In this study, we have compared the effectiveness of doxapram in a placebo-controlled, double blind method. Sixty patients who shivered after operation under general anesthesia were examined. They were allocated randomly to receive normal saline(n=15), doxapram l mg/Kg(n=15), 1.5 mg/Kg(n=15) or 2 mg/Kg(n=15) from identical syringes intravenously. The investigator who gave the intravenous injection was unaware of the treatment received by the patient, and assessed the shivering. Both doxapram 1.5 mg/Kg and 2 mg/Kg were effective on shivering within 1~2 minutes after intravenous injection. In the saline group, all patients were still shivering 10 minutes after injection. In the doxapram 1 mg/Kg group, only two patients had stopped shivering by 6, 7 minutes after injection. In the doxapram 1.5 mg/Kg group, only three patients were shivering after injection. In the doxapram 2 mg/Kg group, only one patient was shivering after injection. We conclude that doxapram 1.5 mg/kg and 2 mg/kg were effective on postoperative shivering. And the results suggested that doxapram 2 mg/kg may be marginally superior to doxapram 1.5 mg/kg in this respect.

The Effects of Hypothermic Hemodilutional Cardiopulmonary Bypass on the Pseudocholinesterase Level / 대한마취과학회지

Pseudocholinesterase is known to be involved in the metabolism of succinylcholine, mivacurium, procaine, chloroprocaine, tetracaine, cocaine, heroin, and other drugs, although the physiologic function has not been well established. Prolonged neuromuscular block following administration of succinylcholine correlates with very low or genetically variant cholinesterase activity. The determination of pseudocholinesterase activity is of importance to the anesthetist in order to predict the susceptibility of the patient to the muscle relaxant, succinylcholine. The purpose of this study was to investigate the change of pseudocholinesterase level during cardiopulmonary bypass(CPB) for open heart surgery with hemodilution and hypothermia. Seven venous blood samples before induction of anesthesia(control), during CPB, and until the fifth postoperative day in 12 patients who underwent open heart surgery were taken. The pseudocholinesterase level was measured by Wako kit and JASCO UVIDEC 77 clinical spectrophotometer. The results were as follows ; 1) The control hematocrit was 40.32+/-6.21% and decreased to 23.72+/-1.86% immediately after the start of CPB(p<0.01) and to 22.42+/-1.93 % 30 minutes after the start of CPB(p<0.01). 2) The control pseudocholinesterase value of 1296.67+/-251.03 IU/L decreased to 915.67+/-228.16 IU/L immediately after the start of CPB(p<0.01), and to 727.83+/-197.58 IU/L 30 minutes after the start of CPB(p<0.01). 3) The mean values of pseudocholinesterase level immediately posteratively, on the first postoperative, and the third postoperative days were 1488.50+/-333.52 IU/L, 1913. 17+614.50 IU/L and 1620.92+/-458.82 IU/L, respectively, and those were significantly increased from the control value(p<0.05, p<0.01, and p<0.01, respectively). 4) The mean value of pseudocholinesterase level on the fifth postoperative day was 1392.25+/-271.69 IU/L, which was not significantly different from the control valule. 5) Transfused units of whole blood, packed red cells, and fresh frozen plasma were 2.8+/-1.4, 3.2 +/-1.0, 3.4+/-0.9, respectively.

The Analysis of the Questionnaire about the Degree of Satisfaction in Anesthesia Residency Program / 대한마취과학회지

BACKGROUND: Obtaining and utilizing the feed-backs from residents who have finished four year of anesthesia residency could well contribute to improvement in training program. Therefore authors have designed a self questionnaire to analyze the degrees or measures of satisfaction from such training program and data were evaluated to provide,in future,the guideline which would improve the quality of the training program. METHODS: The self-questionnaires were sent to residents(n=148),who have been through the entire four year of residency training courses under anesthesia department. The assessment was conducted to measure the degree of satisfaction based on several variables such as motivation, selection of anesthesiology as a first choice, type of training hospital, and sex. To evaluate the current problems of anesthesia residency program, we made 30 open-ended and close-ended questions. Data analysis was made using Fishers exaet test. RESULTS: There were no statistically significant difference between the degree of satisfaction and their motivation for choosing anesthesia, anesthesia as a major, selection of anesthesiology as a first choice, and types of hospitals. As for the difference in satisfaction of training, male residents showed significantly higher satisfaction rate( n=92, 36.2%) than female residents(n=47, 17%). CONCLUSIONS: These results suggest that degrees of satisfaction was more likely related to the program of each training hospital and sex compared to other variables studied.

Effects of Thoracic Epidural Anesthesia on Pulmonary Hypertension Induced by Acute Diffuse Alveolar Hypoxia and N-nitro-L-arginine in Dogs / 대한마취과학회지

Thoracic epidural anesthesia has been used to manage intraoperative and postoperative pain for thoracic surgical patients with general anesthesia recently, And this combined anesthesia has been associated with less sedation, earlier ambulation, blunting of the stress response and better pain control in the post-operative period. But the effects of thoracic epidural anesthesia on pulmonary shunt, pulmonary vasoactivity and oxygenation are still unknown. The author has investigated the effects of thorarcic epidural anesthesia on pulmonary hypertension induced by acute diffuse alveolar hypoxia and N(W) -nitro-L-arginine(L-NNA) in 12 mongrel dogs. Acute diffuse alveolar hypoxia which is similar to the early stage of acute respiratory failure may induce the pulmonary hypertension. And L-NNA, inhibitor of endothelium derived relaxing factor(EDRF), may also induce pulmonary hypertension under hypoxic state. The measurements were made three times, the first was baseline at room air ventilation. Following baseline recordings, saline 4 ml(group A, n=6) or 2% lidocaine 4 ml(group B, n=6) was injected through the epidural catheter and ventilation was started with hypoxic gas mixture(10% O2, 90% N2). The seeond measurements was made 30 min after the hypoxic ventilation and third was 20 min after infusion of L-NNA(50 mg/kg mixed with distill water 50 ml, infusion rate is 50 ml/20min) under the continuous ventilation with hypoxic gas mixture. The results were as follows: 1) There were significant changes in mean pulmonary arterial pressure, pulmonary vascular resistance in group A(p<0.05) and in arterial and mixed venous oxygen tension, arterial and mixed venous oxygen content, intrapulmonary shunt in both groups(p<0.05) 30 minutes after hypoxia but there were not significant differences between groups. 2) There were significant changes in mean pulmonary arterial pressure, in group B (p<0.05) and pulmonary vascular resistance, systemic vascular resistance and mixed venous oxygen tension and content in both groups (p<0.05) 20 miniutes after infusion of L-NNA under the continuous ventilation with hypoxic gas mixture but there were not significant differences between groups. But there were significant changes in central venous pressure in group B(p<0.05) and significant differences between groups(p<0.05) at 20 miniutes after infusion of L-NNA. These results indicate that thoracic epidura1 anesthesia does not influence the pulmonary hypertension directly and does not praduce any unfavorable hemodynamic events during pulmonary hypertension induced by acute diffuse alveolar hypoxia and N(W)-nitro-L-arginine. Therefore thoracic epidural anesthesia shoud be valuable assistant to the general anesthesia for pulmonary hypertensive patients.

Clinical Observation in 20 Cases with Intubation Granuloma / 대한마취과학회지

Endotracheal intubation has been widely used for general anesthesia and patency of airway. But intubation granuloma may be developed after intubation. From Feb. 1986 to Jun. 1993, the authors encountered 20 cases of intubation granuloma in Korea University Hospital and following results were obtained. 1) The incidence of intubation granuloma was 0.017%. 2) The age range was from 24 to 49 years. 3) The ratio of male to female was 1 to 19. 4) All cases located at posterior one third of vocal cord, 6 cases were bilateral, 14 were unilateral, of them 10 were in the right sides. 5) Eleven cases were occurred after caesarian section, and the ineidence of which was 0.134% . 6) Hoarseness was the main symptom in 18 cases. 7) The duration from intubation to development of symptom was 15 days to 4 months.

A Microbiological Study in the Humidifiers of the Mechanical Ventilators / 대한마취과학회지

Nosocomial infection represent a significant cause of patient morbidity and mortality, especially in the ICU and nosocomial pneumonia that cause high mortality may arise from contaminated respiratory equipments. This study was done to investigate the relationship of micro-organisms in upper respiratory tract and ventilatory equipment, especially humidifier. The total number of cases in this study was 20 and the specimen for bacteriologic culture were taken from the pharynx, the distilled water and the inner wall of humidifier and toilet of trachea at the 0, 4, 8, 12, 24, 48 hours after initiation of mechanical ventilation. The results obtained from the bacteriologic culture were as follows. 1) The most frequently found organism at the pharynx was Pseudomonas aeruginosa and next was Coagulase Negative Staphylococcus, followed by Streptococcus viridans, Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus group D, Enterobacter agglomerans, Acinetobacter spp. 2) The most frequently found organism at the trachea was Pseudomonas aeruginosa and next was Klebsiella pneumoniae followed by Coagulase Negative Staphylococcus, Streptocoecus viridans, Pseudomonas picketti, Staphylococcus aureus and no growth in 5 cases. 3) The most frequently found organism in the fluid of humidifier was Pseudomonas aeruginosa and next was Pseudomonas picketti, Klebsiella pneumoniae, Streptococcus group D and no growth in 2 cases. 4) The most frequently found organism at the pharynx was Pseudomonas aeruginosa and next was Pseudomonas picketti, Klebsiella pneumoniae, Streptococcus group D, Serratia liquefacines, Acinetobacter spp and no growth in 3 cases. 5) The number of isolated organisms in the fluid of humidifier was 3 at 0 hour and 18 after 48 hours and at the wall 2 at 0 hour and 15 after 48 hours. 6) The number of same organism that was isolated between the pharynx and trachea was 13 among 15 cases and between the wall and fluid of humidifier was 15 among 16 cases and between trachea and fluid of humidifier was 10 among 14 cases.

A case report of fiberoptic intubation in neonate with cleft palate lateral synechia syndrome / 대한마취과학회지

An one day old female baby was admitted to the Pediatric department of Korea University Anam Hospital for the evaluation of her facial anomaly. She was born by spontaneous vaginal delivery at term weighing 3.8 kg. On initial examination, she was noted to have congenital trismus and have cleft lip and palate. Bands of fibrous tissue were noted to extend from the superior alveolar part to inferior part at decidual molar tooth region and allowed oral opening of only 5 mm. She was transfered to the Plastic Surgery department under the diagnosis of cleft palate lateral synechia syndrome for resection of her synechial bands. In the operating room ECG, pulse oximeter and precordial stethoscope were applied to the patient and then, anesthesia was induced with , O2, N2O and enflurane. The 60 cm Olympus fiberscope with an external diameter of 2 mm was used and well lubricated 3.0 mm uncuffed endotracheal tube was threaded over the fiberscope through the oral cavity. The fiberscope was advanced into the midtrachea, then the endotracheal tube was passed over the fiberscope into the trachea After securing of the endotracheal tube, two lateral synechial bands were surgically divided. She tolerated oral feedings on postoperative 5 days without difficulty and discharged from the hospital on postoperative 6 days.

A case report of quadriparesis following general anesthesia / 대한마취과학회지

We experienced a case of postoperative quadriparesis secondary to operative position in a patient with pre-existing, asymtomatic,cervical neurilemmoma. The patient was admitted with chronic otitis media for mastoidectomy on right side. There was no specific event throughout operation and anesthesia but developed quadriparesis one hour after arrival on ward. With magnetic resonance imaging, the patient was dignosed to have cervical neurilemmoma. On seventh postoperative day the patient had second operation,cervical laminectomy and tumor removal. Ten days after second operation he was discharged without any complication. Eight months later he had mastoidectomy on the left side and was discharged without any sequale.