Clinical study of weaning process from ventilator support in acute respiratory failure / 대한구급학회지

No abstract available.

Clinical Study of Endotracheal Anesthesia with Flunitrzepam-Ketamine-Alcuronium / 대한마취과학회지

This study was undertaken to evaluate the effect of flunitrazepam as a premedicant on the prevention undesirable side effects such as hypertension, tachycardia and emergence phenomena associated with ketamine anesthesia. Twenty surgical adult patients were given flunitrazepam(2 mg) and atropine intramusculary before anesthesia. Endotracheal anesthesia was induced by ketamine and alcuronium and maintained with 0.1% ketamine infusion, 02-N2O and alcuronium. The results were as follows. 1) Sedative effect of flunitrazepam as a premedication waa satisfactory in 90% of the patients. 2) Anesthesia was induced smoothly with ketamine(average 0.98mg/kg) and alcuronium (av. 0.33 mg/kg) for intubation. Total dose of ketamine averaged 0.014 mg/kg/min during anesthesia. and was less than that of the Lorazeam group. 3) The influence on blood pressure and pulse rate due to flunitrazepam were not significant but they were increased an average 18 and 16% immediatly after intubation. More than 20% increase from preoperative blood pressure and pulse rate during anesthesia waa noted in 4 and 6 cases respectively. 4) As emergence phenomena, diplopia with moderate delirium and visual hallucination was reported in 2 cases. However unpleasant dreams were not complained of and a long amnesic effect experienced in all cases. From the above results, it may be concluded that, premedication with flunitrazepam and endotracheal anesthesia with ketamine infusion, alcuronium, N20 and 02 can reduce the undesirable effects of ketamine and this is one of the suitable balanced anesthesia techniqes for long operation especially in old, critically ill patients.

A Clinical Study for the Anesthetic Care of Tetralogy of Fallot / 대한마취과학회지

Tetralogy of Fallot constitutes the highest proportion of cyanotic congenital heart disease and has four basic abnormal anatomical pictures including ventricular septal defect, pulmonary stenosis, aortic overriding and right ventricular hypertrophy. The work of Edward, et al(1965), Guntheroth, et al(1965) and Lev and Eckner(1964) has shown that the anatomical picture in a combination of just first two morphological characteristics, the aortic overriding and right ventricular hypertrophy being a consequence of the ventricular septal defect and pulmonary stenosis. Basic signs involve two categories, one is change of shunt rate depending on pulmonary stenosis, ventricular septal defect and systemic vascular resistance, and the other is physiological response to the chronically lowered PaO2. Thus the pathophysiological status presents to us more problems than other congenital heart disease in the care of patients during operation and anesthesia. Therefore, the anesthesiologist must understand the basic pathophysiology, various findings of examination, symptoms and signs, the problems during anesthesia and postoperative care. The purpose of this study was to evaluate the anesthetic management in total corrective surgery of tetralogy of Fallo which was performed at Severance Hospital. Out of consecutive 160 cases of tetralogy of Fallot in our past ten years experiences from 1971 to 1980, we selected the clinical results on anesthetic care of 12 cases which received total corrective surgery under hypothermia and extracorporeal circulation. The results were as follows: 1) Out of 121 cases, 82 cases were male(67.8%) and female was 39 cases(32.2%). The group aging from 6 to 10 year old was the highest proportion (44.6%) and the next proportion was the group aging from 11 to 15(22.3%). 2) Out of 121 cases, 91 cases were cyanotic(75.2%). On the diagnostic distribution, tetralogy of Fallot without any other anomaly was the most common(66.9%). 3) As for premedicants, secobarbital was the highest proportion(28.1%). For anesthetic maintenance, methoxyflurane with nitrous oxide was the most common(43.8%). 4) During cardio-pulmonary bypass, high flow perfusion was commonly used and the highest mean arterial pressure was 89.09+/-1.21 mmHg and the lowest mean arterial pressure was 36.33+/-1.21mmHg. 5) The major complications after operation and anesthesia were dysrhythmia(13.1%), pleural effusion(10.3%), main wound infection(10.3%), hemorrhage(8.3%), acute renal failure(8.3%), heart failure(6.9%), low output syndrome(4.1%) and cerebral infarction due to air emboliam(2.7%). 6) Out of 121 cases were expired and hospital mortality was 23.1%. The causes of death were heart failure(50%), acute renal failure(14.3%) and cerebral infarction(14.3%). in conclusion, anesthetic care for total corrective surgery of teralogy of Fallot should be based upon the understanding of the pathophysiology of disorder itself.