CT-Guided Celiac Plexus Block with Absolute Alcohol: the Anterior Approach

PURPOSE: To evaluate the safety and efficacy of CT-guided celiac plexus block (CPB) using an anterior approach, and to determine the role of CT in this procedure. MATERIALS AND METHODS: CPB was attempted in 15 patients (10 men and 5 women; mean age, 62.3 years) with intractable upper abdominal pain due to terminal malignancy of the pancreas, liver, bowel, and kidney. To permit an anterior approach, patients lied supine on the CT scan table during the procedure. One or two 21-guage needles were placed just anterior to the diaphragmatic crus at or between the levels of the celiac and superior mesenteric arteries and 10-40 ml of 99.9% alcohol was injected. Pain relief following the procedure was assessed and pain was graded on a visual analogue scale (VAS) from 0 to 10. RESULTS: There were no technical failures and no neurologic or hemorrhagic complications. Abdominal pain during alcohol injection occurred in all patients, and transient hypotension in three. One patient with recurrent cancer of the pancreatic head died of sepsis five days after the procedure; the cause of sepsis was difficult to determine, but there was thought to be a biliary source of infection. Two days after block, 13 of 15 procedures (86.7%) had produced at least partial pain relief ; in 12 patients, relief was good. With CT guidance, more directed positioning of the needle is possible, allowing alcohol to be deposited in specific ganglion areas. CONCLUSION: CT-guided celiac plexus block using an anterior approach was an easy and effective way of reducing intractable upper abdominal pain due to terminal malignancies. CT guidance allowed precise needle placement and a safer procedure.

Effects of InhaIational Anesthetics an Renal Function in Rabbits / 대한마취과학회지

In order to investigate the effects of inhalational anesthetics on renal function, small doses of ether or halothane were administered intravenously to rabbits without anesthesia, or disectly injected into the renal artery of the rabbits under urethane anesthesia. The following results were obtained. 1) 1mg/kg of 8% saturated solution of ether did not influence excretion of urine, creatinine and electrolytes, and osmolarity when intravenously administered over 10 minutes. 2) 1 mg/kg of the above solution markedly reduced urine volume, renal blood flow, glomerular filtration rate and excretion of electrolytes such as sodium, potassium,, chloride when directly injected into the renal artery over 10 minutes. 3) 0.5to 1.0% saturated solution of halothane did not influence renal functions when injected either intravenously or directly into the renal artery. 4) Reduced urine volume and sodium excretion were closely related to the decrease in renal blood flow when ether was injected directly into the renal artery. 5) From the above results it is suggested that halothane did not influence renal function while ether had a direct effect on renal function by hemodynamic change in renal circulation.

Clinical Study of Self-Taming of Succinylcholine / 대한마취과학회지

Administration of succinylcholine for intratracheal intubation may cause untoward reactions such as elevation of intraocular and intrabdominal pressure, increased plasma potassium level, and development of postoperative muscle pain, ets. The fasciculation of muscle fibers caused by nondepolarizing activity of succinylcholine may be responsible for those reactions, although this is not clearly defined. Several attempts ehterfore, have been made to minimize the development of muscle fasciculation following administration of succinylcholine. Of thest, self-taming of succinylcholine, pretreatment wit small doses of non-depolarizing neuromuscular blockers, or the use of hexafluorenium are examples. The authors observed the effects of succinylcholine on intraocular pressure and the degree of muscle fasciculation after self taming of succinylcholine. pretreating the patients with d-tubocurarine and pancuronlum before administration of succinylcholine was also studied. All three techniques showed significant decreases in the degree of muscle fasciculation. And small doses of d-tubocurarine and pancuronium did not seem to affect intraocular pressure, although a taming dose of succinylcholine itself caused significant increases in intraocular pressures.

Cinical Studies of Anesthesia for the Hyprteneive Patient / 대한마취과학회지

Until several years ago it was generally agreed that anihypertensive medication should be stopped a few weeks before anesthesia and surgery in order to regain the compensatory function of cardiovascular system during anesthesia and surgical stress. However the present concept is that the better the hypertension is controled the more the patient's chances of surving anesthesia and it is recommended that antihypertensive medication should be continued to the time of anesthesia. The authors have experienced cases of hypertensive patients undergoing various kinds of operation and have-analyzed these cases according to the degree of hypertension, sex, department, anesthetic agent and technique, previous anesthetic medication, abnormal ECG finding and arterial blood pressure changes after anesthesia, at Jeonbug National University Hospital from January 1977 to June 1979. The results were as follows: 1) The number of hypertensive cases was 326 (12. 3%) out of 2664 total patient who received various surgical operations. 2) Only a few patients(16cases, 0. 5%) received antihypertensive medication before surgery. 3) The degree of hypertension was mostly class 1 or 2(274 patients, 78%) according to the severity index of Elwood 4) Most of the patients (253 cases, 74%) revealed elevated blood pressure after induction of anesthesia.