Clinical Statistical Analysis of Pediatric Anesthesia / 대한마취과학회지

Within the past decade it has been said that progress it pediatric anesthesia is especially the result of clinical application of developments in baic medicine, added to the anesthetist's technical improvements and experience in the use of apparatus and the knowledge of respiratory control. And so anesthetists sholud perform good pediatric anesthesia after understanding pediatric anatomy, physiology and the phamacology of all the drugs used in pediatric anesthesia. 803 cases (under 15years) of pediatric anesthesia were analyzed statistically according to sex, age, disease, department, physical status, premedication, anesthetic technic, anesthetic agents, length of anesthesia duration of Hospitalization, re-operation incidence, complications and mortality in the Department of Anesthesiology, Hanyang University, College of Medicine from August of 1979 to December 1980. The conclusions are as follows: 1) Sex and Age: 91 cases(11.33%) under 1year and 95 cases(11.83%) under 7years are of interest. The comparison of male (542 cases) to female (261 cases) is 2:1. 2) Departmente: 257 cases(32.00%) from ENT, and 217 cases(27.02% from general surgery were noted ont of the total. 3) Disease: It divided into two groups. 204 cases(25.40%) were congenital disease which comprised mainly of 70 cases of inguinal hernia and 45 cases of eleft lip and palate. 599 cases (74.60%) were acquired disease comprised mainly of 237 cases of tonsillitis and 43 cases of appendicitis. 4) Physical status: The time of operation divided into two groups. One group contained 657 cases of elective surgery and the other 146 cases of emergency surgery. According to the ASA classification of physical status, 741 cases(92.28%) were class 1 and 2, and 52 cases (64.8%) were class 3, and 10 cases(1.24%) were in class 4. 5) Premedication: 400 cases(49.81%) were premedicated with atropine sulfate and valium 161 cases(20.05%) were not premedicated because the patients had fever, dehydration, or tachycadia. 6) Anesthetic method and agents: they were divided into three groups. In the frist group using general inhalation, 206 cases(2565%) ont of 761, had non-rebreathing anesthesia and 555 cases(69.12%) had semiclosed circle technique anesthesia. In the second group 41 cases(5.10%) had intramuscular and intravenous anesthesia. Thirty 1 case(0.12%) was given spinal anesthesia. 711 cases(88.54%) received halothane + nitrone oxide _ oxygen. 7) Incidence of reoperation: 32 cases(3.98%) were reoperated and included colostomy repari, abdominal flap detachment, pin removal, skin graft, post operative bleeding control, remove of laryngeal papilloms, and urethral dilatation. 8) Complications: 20 cases which were made up of 8 cases of pneumonia, 5 cases of wound infection, 3 cases of post operative bleeding control, 2 cases of fistula formation, 1 case of gastroenteritis, 1 case of intestinal obstruction. The relationship between length of anesthesia and complications is statistically in significant(p<0.01). 9) Motality: 10 cases died 3 from respiratory insufficiency, 3 cases of sepsis, 1 case of intestinal obstruction and 3 cases of high intracranial pressure. There is statistical significance in the relationship between the anesthetic time, physical status, and mortality.(p<0.01).

Anesthetic Management for Carinal Resection - A case report / 대한마취과학회지

A 36 years old man was scheduled for carinal resction, left pneumonectomy, and tracheobronchial anastomosis under the diagncais of malignant tumor in the carina and left main bronchus. During the procedure of carinal resection, anesthesia had been maintained with a right bronchial tube which was intubated through operating thoracic cavity. The E.K.G. was monitored continuously and a radial artery canula was inserted for disect arterial pressure monitoring and blood gas analysis sampling. Anesthetic course was uneventful with nitrous oxide, ahlothane and pancuronium under controlled respiration. Postoperative course had minor problem with right upper lobe atelectasis which disappeared soon after tracheal suction.

The Pain Control with Epidural Morphine / 대한마취과학회지

The patients receiving epidural morphine were divided into two groups. One group(A group): epidural injection of 2 mg morphine mix with physiologic saline 10 ml were given to 13 patients with acute pain after surgery under epidural or light general anesthesia and chronic pain of chronic disease. The other group): epidural or caudal injection of 2 mg morphine mix with 2% lidocaine 400 mg were given to 5 patients. In A group, assesed single or continuous epidural injection. In B group, assessed epidural or caudal injection. All cases had considerable amelioration of pain which commenced with 2 to 15 minutes and was effectiveness 2 to 59 hours. Epidural morphine injection did not cause sympathetic depression or bladder dysfunction and it's analgesia was segmental.

The Clinical Investigation of the Neonatal Gastric Acidity / 대한마취과학회지

It is well known that increasing tendency of emergency surgery of congenital snomalies such as tracheoesophageal fistu1a, esophageal atresia, esophageal hiatal hernia, hypertrophic pyloric stenosis,intestinal obstruction, imperforated anus, omphalocele, and meconium ileus by virtue of improvement of pediatric surgical procedure, anesthetic agent, and anesthetic method. The possibility of a low gastric pH and the resultant pulmonary damage if aspirated must be considered in the initial care of the newborn with poor muscle tone or reflex activity as well as in the anesthetic management of neonates. We became interested in the factors determining neonatal gastric pH in this point of view, and have measured gastric pH in 75 unselected neonates, 55 of whom were born vaginally and 20 by cesarean section. In premature infants, pH was high regardless of mode of delivery. In mature infants, pH was 1) significantly lower after vaginal delivery than after cesarean section; 2) tended to be lower after section preceded by labor than after elective section; and 3) was lowest after precipitate delivery. There was no correlation between neonatal gastric pH and duration of rupture of membranes, birth weight, or Apgar score. It was concluded that the mature human fetus produces gastric acidity in response to stresses associated with labor and vaginal delivery.

Blood Pressure and Pulse Rate Responses to Extubation with and without Topical Tracheal Anesthesia / 대한마취과학회지

Usually, blood pressure and pulse rate are increased in the light planes of anesthesia at the end of operation especially just prior to extubation. The increasing of heart rate and blood pressure produce an elevation in cardiac work and oxygen demand and can lead to mycardial ischemia in patients with coronary artery disease. Tracheal anesthesia with 2 or 4% lidocaine (jelly and liquid) was done as a method which permits patients to be extubated during light planes of anesthesia. The results were as follows: 1) Each groups had similar blood pressure and pulse rate five or ten miriutes before extubation. 2) Lidocaine group did not have a significant elevation in systolic or diastolic blood pressure and pulse rate at or after extubation or in the recovery room. 3) The control group had significantly increases in both pressure and pulse rate(p<0.01). The data suggest that maneuver should be of advantage to patients with coronary artery disease who may not be able to tolerate the increased cardiac dynamics during extubation period.