Neurogenic Pulmonary Edema following Cerebral Aneurysmal Rupture: A case report / 대한마취과학회지

Neurogenic pulmonary edema (NPE) occurs in association with CNS lesions and in the absence of underlying cardiopulmonary disease. The dramatic increase in intracranial pressure (ICP) that follows aneurysmal rupture appears to trigger a massive autonomic discharge which causes virtually instantaneous circulatory adjustments i.e. NPE. When we anesthetize a cerebral aneurysmal patient combined with NPE, not only is there the risk of hypoxemia due to NPE, but also we have difficulty in managing to control hemodynamics and hypervolemia. As we experienced a cerebral aneurysmal patient combined with NPE, we report this case with a review of the literature.

The Cardiovascular Effects of Epinephrine Used for Hemostasis under Enflurane-N2O Anesthesia during Tonsillectomy / 대한마취과학회지

BACKGROUND: Exogenously administered epinephrine under enflurane anesthesia was known to have mild myocardial sensitizing effect. And N2O activates the sympathetic nervous system mildly. We planed this study to confirm cadiovascular effects of clinically administered epinephrine for hemostasis under the enflurane-N2O anesthesia during tonsillectomy. METHODS: Eighty children scheduled to have tonsillectomy were selected randomly and divided into 2 groups as follows; Group E: 1:100,000 epinephrine 2ug/kg and Group EL: 1:100,000 epinephrine containing 1% lidocaine 2 g/kg. Blood pressure, heart rate, and the occurrence of arrhythmia were evaluated before injection, at injection, 1 min, 2 min, 3 min, 5 min and 10 min after injection and 1 min after operation start. RESULTS: In both groups, systolic and diastolic blood pressure and heart rate are increased. But there are no significant statistical differences in each group and between groups. One min after operation, there are significant increases in systolic and diastolic blood pressure and heart rate in both groups (p<0.05), but there is no significant difference between groups. CONCLUSION: Under the enflurane-N2O anesthesia of children, 1:100,000 epinephrine 2ug/kg used for hemostasis could be used comparatively safe without any significant hemodynamic changes. But because there is always the possibility of myocardial sensitization, careful observation is necessary during epinephrine injection under the enflurane-N2O anesthesia.

A Comparison of the Analgesic and Side Effects of Continuous Epidural Morphine and Nalbuphine for Postoperative Pain / 대한마취과학회지

BACKGROUND: A number of recent reports have described the usefulness of the epidural injection of narcotics for the relief of postoperative pain. Morphine, a u-receptor agonist, produce strong analgesic effect with some side effects. Nalbuphine, is a u-antagonist and k-agonist, has an analgesic effect comparable to morphine with little side effects. METHOD: We divided 60 patients into 3 groups utilizing the five-day Baxter Infusor in 0.125% bupivacaine at 0.5 ml/hr: 1) Group M (n=20) received initial 2 mg of bolus + 2 mg/day of maintenance morphine 2) Group N(n=20); initial 4 mg of bolus + maintenance 8 mg/day nalbuphine 3) Group M+N(n=20); initial 2 mg morphine of bolus + maintenance 8 mg/day nalbuphine. Analgesic effect was evaluated by visual analogue scale(0-10) at 6, 12, 18, 24 and 48 hour postoperatively. Changes in blood pressure, heart rate, and incidence of side effects were observed. RESULTS: No significant hemodynamic changes were seen in any of the groups. The patients of group M and M+N get less pain than group N but side-effects of group M were significantly more than group N, M+N. CONCLUSIONS: Nalbuphine hydrochloride could be better agent than morphine in terms of complication and the dose of group M+N (initial morphine 2mg of bolus + maintenance 8 mg/day nalbuphine) may be recommended for postoperative analgesia.

Acute Attack of Asthma and Pulmonary Collapse Induced by Tracheal Intubation / 대한마취과학회지

Identification of the presence of chronic obstructive pulmonary disease in the elderly patient who was scheduled for surgery is vitally important. If appropriate therapeutic and preventive measures should not be instituted, tracheal intubation of the patient should be associated with a number of complications. We experienced a case of acute attack of asthma and pulmonary collapse during endotracheal intubation. A 54-year-old male who was scheduled for an emergency of primary corneo-scleral suture have had history of bronchial asthma. On the preoperative physical examination, there was no specific finding except expiratory wheezing. After endotracheal intubation with the aid of ketamine 2 mg/kg, pancuronium bromide 0.1 mg/kg and lidocaine 2 mg/kg, iv, acute asthmatic attack was appeared. Breathing sounds on the both lung fields can not be audible during manual ventilation and SpO(2) was dropped to 70% at F(1)O(2) 1.0. To relieve asthmatic attack, epinephrine(1: 1.000) 0.5 ml, sc, aminophylline 4 mg/kg, iv and methyprednisolone 1 mg/kg, iv were injected. Erosion of tracheal mucosa, blood clots and mucous plugs were found by the fibroptic bronchoscopy. After removal of blood clots and mucus, lung compliance and SpO2 were improved. The patient was discharged 7 days later without any complications or sequelae.

Anesthetic management for repair of Tracheoesophageal fistula with proximal esophageal atresia / 대한마취과학회지

A two days old female baby was transferred to our hospital from local clinic due to respiratory difficulty. The baby was born at 38 weeks gestation through cesarian section in the clinic. At birth, the body weight of the baby was 2280 grams and the Apgar score at 1 minute and 5 minute were 5 and 7. The child had frothing about the nose and mouth, and regurgitated the first feeding almost immediately. Coughing and mild cyanosis were associated with regurgitation. She was diagnosed as distal tracheo-esophageal fistula with proximal esophageal atresia and transferred to our hospital for further evaluation and corrective surgery. She had no other congenital anomaly. The most common defect consists of a blind upper esophageal pouch and a fistula between the lower esophagus and trachea. The preferred surgical approach for treatment of the newborn with this disease is ligation of the defect and primary anastomosis of the esophageal segments by an extra-pleural approach. Proper placement of the tracheal tube is critical. It should be above the carina but below the tracheoesophageal fistula. Nitrous Oxide should be used with caution in a neonate without a gastrostomy, as diffusion of this gas into the distended stomach would be undesirable. The emergency operation was done under general anesthesia. She was tolerable anesthesia and operation. Special respiratory care and continuous antibiotic administration were done. She discharged 18 days later without significant pulmonary complication or sequelae.

A Comparison of The Induction Characteristics of Propofol and Thiopental on The Hypertensive Patients / 대한마취과학회지

We have compared the cardiovascular effects during intravenous induction and endotracheal intubation with propofol or thiopental sodium on the forty hypertensive patients. Propofol was given 2 mg/kg or thiopental sodium was given 5 mg/kg intravenously for induction of general anesthesia, and endotracheal intubation. The patients were allocated in two groups according to the intravenous anesthetic sgents that were administered (Group I; 20 patients Propofol group and Group II; 20 patients Thiopental group), Arterial blood pressure and heart rate was recorded by automatic noninvasive blood pressure cuff (ESCORT 100/200 Medical Data Electronics. Arleta Ca. U.S.A.). Systolic, diastolic arterial blood pressure, and heart rates were recorded 1 minute before administration of intravenous anesthetic agents, 1 minute and 5 minutes after endotracheal intubation. Reduction of systolic and diastolic arterial blood pressure were significantly greater after propofol(30%) than thiopental sodium administration and intubation. The change of the heart rate after propofol induction and intubation was not significant. However, the heart rate was increased about 23% after thiopental sodium induction and intubation. The results of this study indicate that propofol 2 mg/kg intravenous induction and intubation for hypertensive surgical patient should be contribute to patients prognosis.

Clinical Consideration of Anesthetic Management for Otolaryngeal Laser Surgery / 대한마취과학회지

The laser provides the surgeons with several advantages and are capable of providing very high intensity output that can be collimated, resulting in spots sized on the order of the wave length of light, having extremely high energy density, therefore pathological tissues can be removed without blood loss or surrounding tissue edema. There are some problems related to anesthetic management for otolaryngeal laser sugery. One such problem is flamibility of endotracheal tube by the laser light and the difficulties of keeping airway open during the surgery. The anesthesiologist should understasnd the character and the hasards of laser light for both the patients and the others in the operating room. We have clinically analyzed 282 cases of otolaryngeal laser surgery to study their hasards and the anesthetic problems, from January 4th 1988 to December 31,1990. in Wallace Memorial Hospital, Pusan, Korea. The results were as follows 1) Endotracheal tube cuff perforation has occured during otolaryngeal laser sugery in 10.6 percent by the biginner surgeons, and 1.8 percent by expert surgeons. 2) Endotracheal tube firing did not occured by using the endotracheal tube, that was wrapped with aluminum foil tape. 3) Kinking of the endotracheal tube occured frequently by using these tubes during otolaryngeal laser surgery in 5.7 percent by biginner surgeons and 1.4 percent by expert surgeons.

Hemoglobinuria during General Anesthesia / 대한마취과학회지

There are many disease entities which are associated with hemoglobinuria but the report of which is very rare during anesthesia except in the case of incompatible transfusion. The authors experienced a case of severe hemoglobinuria during general anesthesia with halothane, nitroud oxide, and thiopental sodium. The patient had no transfusion perioparatively, and no history of hemoltic problems except for prolonged oozing after ethrane anesthesia for tympanoplasty five monthes ago previously. The hemogiobinuria disappeared after two days of corticosteroid therapy, but afterwards the patient suffered from mild hepatitis which seemed to be due to repeated halothane anesthesia.

Comparison of Pre- and Post-Operative Liver Function after Halothane and Enflurane Anesthesia / 대한마취과학회지

The problem of hepatotoxicity of clinically employed halogenated inhalation anesthetics has major implications for the practice of anesthesiology. Because of emerging disadvantages with all the available anesthetics, chemists continue to search for better compounds. In 1963 Terrel synthesized enflurane and many anesthesiologist used it, hoping to avoid the disadvantage of halothane. This study was undertaken to investigate the advantage of enflurane as compared to the disadvantege of halothane, by comparing of pre- and post- operative liver functions of 16 cases of halothane use and 16 cases of enflurane use. in this study, all cases physical status were all ASA class 1, and excluded patients who had any liver disease, jaundice, previous experience of halothane or enflurane anesthesis, and who had not been transfused during this study. The result of this study which compared pre-operative and post-operative liver function tests disclosed statistically significant change in SGOT(p<0.02). On table lll the comparison of liver function tests between halothane and enflurane disclosed significant difference and that enflurane in less hepatotoxic than halothane. Considering the allergic or the intermediate by-product theory of the mechanism of halethane hepatoxicity, it is desirable to avoid repeating the use of halothane in the near future. Thus, it seems to be safer to use enflurane instead of halothane.

Clinilcal Study of IPPB Therapy for Pre- and Post-operative Chronic Respiratory Diseases / 대한마취과학회지

Chronic obstructive pulmonary diseases are being increased every year by many factors. But there are two important factors. First of all the atmospheric contamination is due to modern civilization, secondarily, the increase of old age population which is the result of prolonged life span by contribution of modern medicine. For these reasons increasing chronic obstructive pulmonary disease, anesthesiologists have had increased problems to administer anesthesia, because these patients are most difficult to manage for anesthesia. Author have studied for if it could be diminished these problems by comparing of the complications during period of anesthesia induction, maintenance, recovery and 5 postoperative days, with IPPB therapy and other physical therapy. The results of the study are as follows: 1) Pre and postoperative IPPB therapy is more useful to diminish anesthesia problems compared with other physical therapy. 2) Other physical therapy is useful when compared with controlled group. 3) IPPB therapy is the choice of treatment for postoperative atelectasis. Statistical significance was assessed by using student t test.

Clinical Evaluation of Hypotensive Anesthesia for Total Hip Replacement Therapy / 대한마취과학회지

Induced hypotension is a well established adjunct to anesthesia which provides improved operating conditions for a wide variety of surgical procedures without significantly increasing the risk to the patient. Since introduction of hypotensive anesthesia in 1964 by Gardner, there has been a wide choice of methods for inducing hypotension during anesthesia, most of which are based on the concept of arteriolar dilatation. Hypotensive anesthesia was attempted on ten patients for total hip replacements which were done at Gospel Hospital, from Feb. to Oct. in 1979. The patients selected did not have a liver problem, and this was determined by SGOT and SGPT, and without a limit of age or sex. The hypotension was induced with 2~3% halothane, 50% N2O and 50%, O2and the blood pressure averaged for systolic pressure 71. 22 mmHg and for diastolic pressure 50. 09 mmHg, The average duration of the induced hypotension was 57. 0 minutes and the blood loss during operation was 300 ml on average. During the hypotensive anesthesia, the urine output decreased by 27. 0% and during the recovery period from hypotension urine output increased by 20%. On our experience, we can conclude that hypotensive anesthesia provides good operative conditions and can be performed without damage to vital organs and can reduce blood loss during operation.

Cardiopulmonary Resuscitation for Tension Pneumothorax during General Anesthesia - A Case Report / 대한마취과학회지

A 67 year old male patients was anesthetized with halothane for a open reduction of the fractured right femur shaft. The patient was admitted to the emergency room after he had cerebra1 contusion and fracture of the femoral shaft by a traffic, accident. Anesthesia was continued for one and a, half hours without any problem. At around one and a half hours of anesthesia, the patient developed cardiac arrest and resuscitation was performed immediately. The patient's life was saved by resuscitation and the operation was completed without any further problem. At the time of the resuscitation, a tension pneumothorax was recognized but anesthesia was continued with immediate, proper management. Closed thoracotomy was performed at the recovery room after anesthesia and the patient recovered from anesthesia without any other problem.

A Complication of Intraveaous Regional Anesthesia: A Case Report / 대한마취과학회지

Intravenous regional anesthesia is a convenient anesthetic technique of for some cases of surgery to the legs, fingers, or forearms, especially with a full stomach. However as in other anesthesia, we must watch closely and check the equipment for intravenous regional anesthesia carefully. The author had experience with a case of complication of intravenous regional anesthesia with a defective touraiguet which allowed local anesthetic to leak into the general circulation, and the patient developed convulsions, unconciousness, tachycardia, tachypnea, and hypertention about 40 seconds after injection of lidocaine 200 mg (0.5%) into a regional vein just above the wound. The patient was intubated after induction with thiopental sodium 250 mg and succinylcholine 80 mg intravenously. Fortunately the convulsion disappeared and vital signs became stable after injection of thiopeewil sodium. The patient tolerated the surgery well and was discharged in a healthy state on the 6th postoperative day.

Ketamine Anesthesia for Hypotensive Patient / 대한마취과학회지

This is a report of ketamine anesthesia with exploratory laparatmy for ruptured ectopic pregnancy. The Patients preoperative state was as the following: Hb; 4. 0m%, Ht; 12%, BP; undetectable Mentolity; semicomatous In the emergency room, she received 2 pints of whole blood, 1,000 ml of Hartmanns solution and 500 ml of Rheomacrodex via two intravenoues routes. In the operating room, blood pressure was 70/60 mmHg. Intrbatien was perfamed after ketamine induction with d-tubocurarine 3mg (to prevent fascicul- ations) and succinykholine 50 mg intravenously. Anesthesia was maintained with ketamine and d-tubocurarine without trouble. During surgery blood pressure was 110/80 mmg Hg after transfusion of 2 more pints of whole blood. She tolerated the surgery well, and was discharged on the 8th postoperative day in a healthy state.