The Effect of Surgical Stress under General Anesthesia on Serum Gonadotropin in Male and Female Patients / 대한마취과학회지

The neuroendocrine responses to surgical stress in man include release of ACTH, GH and prolactin in the serum(Cooper and NElson, 1962: Ney et al., 1963: Ross et al., 1966: Schlach, 1967: Gordon et al., 1972: Jeffrey et al., 1977). Data on serum LH and FSH during operation under general anesthesia have been conflictiong. Evidence has also been accumulated that serum LH levels are increased significantly in male patients during operation under general anesthesia in comparison of serum LH in males might be different from that in postmenopausal females with a very high basal level of LH and from menstrating females. Effects of surgical stress under general anesthesia with halothane-N2O on serum LH and FSH levels were studied in 12 menstruating female patients, 8 postmenopausal female patients, and in 8 male patients with no endocrine disorders, liver or kidney function impairment as judged by routine tests. Control serum samples were taken immediately before anesthesia and subsequent samples were obtained from the patients 30 minutes, 1hour and 5~6hours after the onset of anesthesia and on the second and seventh postoperative day. The concentrations of serum LH and FSH were measured by a specific and sensitive radioimmunoassay method. The results are as follows; 1) Preanesthetic levels of serum LH and FSH served as controls and were within range of normal values for male and female subjects in our laboratory. 2) In male patients, serum LH levels 1 hour after onset of anesthesia increased significantly over those of preanesthesia, while no significant intraoperative increase in LH levels was found in female patinets. 3) No significant change in serum LH levels was demonstrated on the second and seventh postoperative day except female patients, who showed significant decrease in the serum LH level on the second postoperative day. 4) No significant intracperative and postoperative changes in serum FSH levels were observed in male or female patients. From the above results, it may be concluded that significant intraopertive increase in serum LH levels occurs in male patients but not in female patients.

Endotracheal Anesthesisl with Thslamonal , Ketamine Infnsion , N2O and Relaxant / 대한마취과학회지

The dangers of explosion hazards and operation theater contamination by inhalation anesthetics have led to a renewed interest in intravenous anesthesia. without intubation. We have reported clinical studies of Thalamonal-ketamine anesthesia under room air breathing in non-abdominal surgery in a previous paper that discussed advantages, disadvantages and usefulness. Now, we report Thalamonal-N2O-Ketamine anesthesia with a microdrip technique and intubation in 63 patients undergoing various operations. These patients were divided into three groups by operation site: Group 1-upper abdominal, Group 2-lower abdominal and Group 3-non-aMominal surgery. These groups were subdivided, by muscle relaxants used, into pancuronium, d-tubocurarine and no relaxant groups. To minimize potential cardiovascular stimulation and postoperative sequelae, ThalamonaI was used at the beginning of anesthesia. The results were as follows: 1) The average duration of anesthesia was 153.9 minutes. The duration of anesthesia was 217.9 minutes in Group I, 121.9 minutes in Group 2 and 152.1 minutes in Group 3. 2) The average dose of ketamine-during induction was 1mg/kg/19 minutes. The average maintenance dose of ketamine was 1.8mg/kg/hr, 2.3mg/kg/hr in Group 1, 1.6mg/kg/hr in Group 2 and 1.8mg/kg/hr in Group 3. 3) The order of frequency of administration and total dose of pancuronium and d-tubocurarine was Group 1, Group 2 and Group 3. 4) The changes in vital signs after intubation and during anesthesia were insignificant clinically. 5) The average duration required from the end of operation to extubation was 10 minutes. 6) Arterial blood gas study performed preoperatively, during operation and in the recovery room in 11 patients revealed no significant changes. 7) The postanesthetic complications were pleasant dreams 18% (11), unpleasant dreams 6% (4), emergence delirium 3% (2), vomiting 6% (4) and shivering 3% (2).

Sympathetic Nerve Block for Herpes Zoster / 대한마취과학회지

Since May 1976, 16 cases of herpes zoster were treated, mainly by repeated stellate ganglion or epidural block with 1% lidocaine. These cases were divided into two groups depending on the duration of herpes zoster, within 2 weeks (group 1) and 2 weeks to 2 months (group 2). The results were as follows: 1) No significant differences of sex and age distribution in the two groups were observed. The youngest case was 12 years old, the oldest 80 years and 87. 5% of cases were above the age of 50. 2) The left side was slightly more often involved. The highest incidence was observed in the thoracic region (62.5%) and in 1 or 2 segments (75%). 3) Blocks, repeated more than four times, were needed for the complete relief of pain in group 1. 4) The effect of repeated blocks was excellent in early cases. The above results indicate that repeated sympathetic blocks, more than 5 times, were effective for early cases of herpes zoster.

Anesthetic Management of Pheochromocytoma employing Methoxyflurane as a Primary Anesthetic Agent / 대한마취과학회지

Various anesthetic agents have successfully used for patients undergoing surgery for pheochromocytoma removal. A review of the literature on the anenthetic marnagement of pheochromocytoma discloses no general agreement regarding choice of an anesthetic agent. It would appear that the selection of the anesthetic agent is not as important as the proper management of the patient Previously the anesthetic experience of a case of pheochromocythma removal managed under methoxyflurane anesthesis has been reported by us. Thereafter we have had another five eases of pheochromocytoma removal operation under general anesthesia, employing methoxyflmrane as a primary anesthetic, with relatively satisfactory results.