The Effect of Physostigmine on Arousal and Respiration after General Anesthesia with Enflurane / 대한마취과학회지

Physostigmine has been used to counteract somnolence or coma induced by different types of pharmacological agent, such as anticholinergics, opioids, ketamine, tricyclic antidepressants and inhalational anesthetics. In this study, we have assessed the effect of physostigmine on arousal and respiration after 50% N2O-50% O2-enflurane general anesthesia under controlled condition such as no premedication, no neuromuscular blockade, same operative procedure and duration. Fifty healthy gynecologic patients scheduled for dilatation & curettage and cervical cone biopsy were divided randomly into two groups such as control group and physostigmine group. In physostigmine group, 0.02 mg/kg of physostigmine was administered intravenously at the end of operation. We evaluated the recovery time of pain response, eye opening on verbal command and orientation after the end of operation. We also checked the end-tidal enflurane concentration with SARACAP spectrometry. Blood pressure, pulse rate, respiration rate and tidal volume were checked at the end of operation and at the time of each recovery parameters returned. The results were as follows; first, pain response time was 5.1+/-2.4 min in control group compared with 3.5+/-2.1 min in physostigmine group. Second, on simple order to patients, eye opening time was 8.5+/-2.3 min in control group compared with 6.5+/-2.1 min in physostigmine group. Third, recovery of orientation to time, place and person was 9.7+/-2.8 min in control group compared with 7.5+/-2.1 min in physostigmine group. Fourth, there was no significant difference in respiratory parameters between the two groups. But there was no significant difference in end-tidal enflurane concentration between the two groups inspite of rapid recovery time in physostigmine group. In conclusion, 0.02mg/kg of physostigmine has the effect of early arousal after enflurane anesthesia without specific problems.

Anesthetic Management with Magnesium Sulfate for the Resection of Pheochromocytoma / 대한마취과학회지

A 66 year-old male patient underwent resection of a pheochromocytoma under general anesthesia. The patient was treated with phenoxybenzamine and propranolol for 7 days preoperatively. Follwing an induction of anesthesia with intravenous fentanly 100 ug, thiopental sodium 250 mg, vecuronium 12 mg, and magnesium sulfate 3.0 gm, endotracheal intubation was performed. Aneathesia was maintained with nitrous oxide, oxygen and isoflurane. For the management of blood pressure during surgical manipulation, magnesium sulfate was infused at the rate of 0.75-1.0 mg/kg/min. After the removal of the tumor mass, the blood pressure dropped to 80/40 mmHg. Whole blood and fresh frozen plasma were transfused and norepinephrine 0.5 ug/kg was infused to maintain the blood pressure for 40 min. Postanesthestic recovery course was uneventful.

Cardiac Arrest in the Hyperkalemic Patient - A case report / 대한마취과학회지

A 69 year-old male patient was admitted for lumboperitoneal shunt operation due to normotensive hydrocephalus. There was not significant laboratory findings except slightly increased serum potassium(5.0 mEq/1). But we ignored this hyperkalemia probably due to hemolysis because ECG at word and operation room did not reveal any evidence of hyperkalemia. Following induction of an anesthesia with fentanyl 100 ug thiopental(2.5%) 100 mg injection, succinylcholine 60 mg was administered intravenously, and endotracheal intubation was performed. Vecuronium 5 mg was administered intravenously for neuromscular blook. Anesthesia was maintained with nitrous oxide, oxygen and enflurane. During the course of operative procedure, his vital signs were stable(blood pressure 120/70 mmHg, pulse 60/min). After lumboperitoneal shunt was completed without problem, neostigmine 5 mg and glycopyrrolate 0.2 mg was administered for reversal of vecuronium. About 10 minutes after arrival in recovery room, his general condition deteriorated suddenly and radial arterial pulse could not be palpated. Radial arteiial blood pressure wave did not appear and ECG showed asystole and stand-still. Cardiopulmonary resuscitation(CPR) was started with Ambu-bagging, sodium bicarbonate and epinephrine injection with external cardiac massage, but the immediate response was not so good. We re-examined the patients chart and found the past history of chronic renal function impairment. CPR was directed for hyperkalemia including calcium chloride, sodium bicar-bonate and 10% dextrose with insulin. At 5 minutes after CPR, ECG showed regular sinus rhythm with stable vital signs. But ECG still showed hyperkalemic pattern(high tented T wave and prolonged P-R interval). After vigorous and continous treatment for hyperkalemia in recovery room, he regained consciousness and he was transfered to the neurosurgical intensive care unit for further evaluation and treatment. Postoperative course was relatively good and he was discharged on 25th postoperative day without any sequale of cardiac arrest.

Cardiac Arrest in the Hyperkalemic Patient - A case report / 대한마취과학회지

A 69 year-old male patient was admitted for lumboperitoneal shunt operation due to normotensive hydrocephalus. There was not significant laboratory findings except slightly increased serum potassium(5.0 mEq/1). But we ignored this hyperkalemia probably due to hemolysis because ECG at word and operation room did not reveal any evidence of hyperkalemia. Following induction of an anesthesia with fentanyl 100 ug thiopental(2.5%) 100 mg injection, succinylcholine 60 mg was administered intravenously, and endotracheal intubation was performed. Vecuronium 5 mg was administered intravenously for neuromscular blook. Anesthesia was maintained with nitrous oxide, oxygen and enflurane. During the course of operative procedure, his vital signs were stable(blood pressure 120/70 mmHg, pulse 60/min). After lumboperitoneal shunt was completed without problem, neostigmine 5 mg and glycopyrrolate 0.2 mg was administered for reversal of vecuronium. About 10 minutes after arrival in recovery room, his general condition deteriorated suddenly and radial arterial pulse could not be palpated. Radial arteiial blood pressure wave did not appear and ECG showed asystole and stand-still. Cardiopulmonary resuscitation(CPR) was started with Ambu-bagging, sodium bicarbonate and epinephrine injection with external cardiac massage, but the immediate response was not so good. We re-examined the patients chart and found the past history of chronic renal function impairment. CPR was directed for hyperkalemia including calcium chloride, sodium bicar-bonate and 10% dextrose with insulin. At 5 minutes after CPR, ECG showed regular sinus rhythm with stable vital signs. But ECG still showed hyperkalemic pattern(high tented T wave and prolonged P-R interval). After vigorous and continous treatment for hyperkalemia in recovery room, he regained consciousness and he was transfered to the neurosurgical intensive care unit for further evaluation and treatment. Postoperative course was relatively good and he was discharged on 25th postoperative day without any sequale of cardiac arrest.

Emergency Retrograde Endotracheal Intubation in a Child with Sublingual Teratoma and Congenital Tracheal Stenosis / 대한마취과학회지

Because of failure to intubate 2-year-old male patient suffering from respiratory difficulty due to sublingual mass (teratoma), emergent tracheostomy was planned. During induction with 100% oxygen and halothane with face mask, sudden cardiopulmonary arrest was occured. Circulation was resuscitated promptly but airway was not kept due to difficult intubation. So ventilation was proceeded through 16 gauge angiocatheter by cricothyroid membrane puncture and retrograde intubation was carried out with epidural catheter through another cricothyroid membrane puncture after then tracheostomy and removal of teratoma was carried out without event. But the patient has had severe dyspnea frequently in postoperative period. On postoperative 7th day, funnel shaped congenital tracheal stenosis was found with bronchogram. Therefore, we concluded that the post-tracheostomy respiratory problem was due to congenital tracheal stenosis. In conclusion, retrograde intubation is a valuable alternative for the emergent unexpected difficult intubation for adults or children because it has a high success rate, easy to learn, requires little practice and does not require complex apparatus. And the failure of a suitable tube to insert the trachea after it passed through the vocal cords or continuous dyspnea after intubation or tracheostomy be considered as the presence of airway narrowing and, possibly, congenital tracheal stenosis.

Non-invasive Cardiovascular Monitoring / 대한마취과학회지

No abstract available.