Comparison of Gastric Volume and Acidity between Children and Adults / 대한마취과학회지

BACKGROUND: Aspiration of gastric contents into the lungs is one of the most feared complications during anesthesia. Various factors combine to make pediatric patients more susceptible to regurgitation and aspiration than adults. We compared the risk of incidence of acid aspiration in two groups, after examining the pH, and volume of gastric contents in pediatric and adult patients. METHODS: This study was carried out with inpatients scheduled for elective surgery under general anesthesia. Sixty patients from 1 to 13 years old were included in the pediatric age group, and sixty patients from 18 to 60 years old were included in the adult age group. After induction of anesthesia and stabilization of the condition of the patient, gastric contents were collected via a 10 - 18 French Salem Sump tube. Gastric volume and pH were measured. RESULTS: The mean gastric volume in the pediatric group was significantly higher than those in the adult group, whereas, The mean gastric pH in the adult group was significantly higher than those in the pediatric group. CONCLUSIONS: We concluded that pediatric patients have a lower gastric pH but a higher gastric volume than adult patients.

Effects of Preoperative Clear Fluid Intake and Concomitant Administration of Ranitidine on Gastric Volume and pH / 대한마취과학회지

BACKGROUND: Aspiration of gastric contents is one of the most feared complications during anesthesia. But the routine preoperative order "NPO after midnight" produces thirst, hunger, irritability and other unpleasant experiences in elective inpatients. So, we evaluated the effect of preoperative clear fluid (orange juice) intake, with and without ranitidine, on gastric volume and pH. METHODS: Sixty unpremedicated adult patients, ASA class I or II, scheduled for elective operation were randomly divided into three groups. Group I (n = 20) fasted after midnight. Group II (n = 20) ingested orange juice 150 ml, 2 3 hours before anesthesia. Group III (n = 20) ingested orange juice 150 ml with ranitidine 150 mg, 2 3 hours before anesthesia. As soon as the patients were intubated and stabilized after induction, gastric contents were collected via 16 18 French Salem Sump tube. Gastric volume and pH were measured. RESULTS: Statistically significant differences were found between groups I and II on the hand and group III on the other, in both of gastric volume and pH. But there were no significant differences between groups I and II. CONCLUSIONS: These results suggest that preoperative clear fluid intake does not affect gastric volume and pH. Moreover, concomitant administration of ranitidine decreases gastric volume and increases pH.

Effects of Preoperative Clear Fluid Intake and Concomitant Administration of Ranitidine on Gastric Volume and pH / 대한마취과학회지

BACKGROUND: Aspiration of gastric contents is one of the most feared complications during anesthesia. But the routine preoperative order "NPO after midnight" produces thirst, hunger, irritability and other unpleasant experiences in elective inpatients. So, we evaluated the effect of preoperative clear fluid (orange juice) intake, with and without ranitidine, on gastric volume and pH. METHODS: Sixty unpremedicated adult patients, ASA class I or II, scheduled for elective operation were randomly divided into three groups. Group I (n = 20) fasted after midnight. Group II (n = 20) ingested orange juice 150 ml, 2 3 hours before anesthesia. Group III (n = 20) ingested orange juice 150 ml with ranitidine 150 mg, 2 3 hours before anesthesia. As soon as the patients were intubated and stabilized after induction, gastric contents were collected via 16 18 French Salem Sump tube. Gastric volume and pH were measured. RESULTS: Statistically significant differences were found between groups I and II on the hand and group III on the other, in both of gastric volume and pH. But there were no significant differences between groups I and II. CONCLUSIONS: These results suggest that preoperative clear fluid intake does not affect gastric volume and pH. Moreover, concomitant administration of ranitidine decreases gastric volume and increases pH.

Hypotension Controlled by Infusion of Norepinephrine during Pheochromocytoma Excision: Case report / 대한마취과학회지

We report a case in which a 63-year-old male patient with pheochromocytoma developed persistent hypotension during surgery despite rapid volume replacement and administration of vasopressors. The patient was prepared for surgery with phenoxybenzamine for 13 days. Anesthesia was induced with thiopental sodium and maintained with N2O, O2, and enflurane. Sodium nitroprusside (SNP) was initiated and titrated based upon intraarterial blood pressure. Hypertensive episode during tumor manipulation was effectively managed by increased infusion of SNP. After surgical removal of tumor, this patient developed profound hypotension, which was aggressively managed by intravenous administration of crystalloid and blood as well as dopamine and epinephrine. However, this hypotension was persistent and aggravated. Accordingly, Infusion of norepinephrine (Levophed(R))was started and then the patient recoverd from his hemodynamic aberrations. We conclude that the cause of the persistent hypotension was cumulative and residual effect of preoperative phenoxybenzamine. Therefore, norepinephrine should be readily available for the treatment of hypotension resistant to other pharmacologic interventions.

Unilateral Vocal Cord Paralysis Following Tracheal Extubation: A case report / 대한마취과학회지

We experienced a case of unilateral vocal cord paralysis following tracheal extubation. The patient was a 60-year-old man undergoing subtotal gastrectomy. He had no laryngeal symptoms prior to operation and the trachea was intubated with a cuffed endotracheal tube. The surgical procedure lasted 6 hours and was uneventful. Three days later after operation, he began to complain of hoarseness and mild aspiration symptom. On endoscopic examination, left vocal cord paralysis was found. Fifteen weeks later the voice and left vocal cord function return to normal without specific management. In this case, we suggested that possible causes of unilateral vocal cord paralysis are compression of recurrent laryngeal nerve by overexpanded endotracheal cuff, laryngeal trauma during difficult intubation, stretching of the nerve as a result of traction on distant organ, decreased elasticity of trachea and surrounding tissues in the older age group and long operating time.

The Effects of Epidural Bupivacaine and Morphine Mixture on Bowel Motility after Upper Abdominal Surgery / 대한마취과학회지

BACKGROUND: The stress of operation inhibits bowel motility. The blockade of efferent sympathetic nerve is helpful to recovery of bowel motility. So we tried to examine that the extent of sympathetic blockade by alterations of bupivacaine infusion rate affected the recovery of bowel motility. METHODS: Group 1 (N = 25) received postoperative meperidine intramuscular injection on demand as a control group, group 2 (N = 25) received postoperative epidural 0.125% bupivacaine 100 ml plus morphine 10mg by infusion pump, 1 ml/hour, for 4days, group 3 (N = 25) received 0.125% bupivacaine 400 ml plus morphine 10mg by infusion pump, 4 ml/hour, for 4days. The Group 2 and 3 received additional morphine 2mg in 0.2% bupivacaine 10 ml epidurally as a single bolus when the peritoneum was closed. The time interval from termination of operation to the first passage of flatus was estimated. RESULTS: In group 1, bowel motility was regained at 92+/-23 hours, group 2 ; 90+/-19 hours and group 3 ; 91+/-19 hours. All values are not significantly different among the groups (p>0.05). CONCLUSIONS: The alteration of epidural bupivacaine and morphine infusion rate did not affect the recovery of postoperative bowel motility.

Bradycardia and Hyprtension during General Anesthesia in a Diabetic Patient with Autonomic Neuropathy / 대한마취과학회지

The major risk factors for diabetics undergoing surgery are the end-organ diseases associated with diabetes. Autonomic neuropathy is relatively common in diabetic patients and associated with an increased risk of perioperative cardiovascular instability. We experienced a case of severe bradycardia and hypotension during general anesthesia for subtotal gastrectomy in a 59 year-old male diabetic patient. Anesthesia was induced with thiopental and vecuronium, and was maintained with nitrous oxide, oxygen and enflurane. Five minutes after induction, severe bradycardia and hypotension developed without specific events. The bradycardia was unresponsive to intravenous atropine and ephedrine, but the blood pressure was restored by administration of ephedrine. During operation his blood pressure was maintained in normal range but the bradycardia was not restored by additional administration of atropine. Postoperatively, myocardial infarcton was ruled out. The test performed after operation suggested that his cardiovascular autonomic nervous system was severely impaired. We think that cardiovascular autonomic dysfunction should be evaluated during preoperative period to plan the anesthetic management and to prevent severe cardiovascular complications in diabetic patients.

Crystalloid Resuscitation in Experimental Hemorrhagic Shock in Dogs / 대한마취과학회지

Although crystalloid solutions such as Ringer's lactate have become the standard for initial volume replacement after hemorrhage, it is controversy whether this fluid alone restores and maintains the depressed physiologic function after severe hemorrhage. Six anesthetized dogs were bled(35ml/kg) and resuscitated with Ringers lactate solution (100 ml/kg). Physiologic variables are measured initialy, after hemorrhage, after resucitation. Compared with initial value, after resuscitation data show marked reduction in hemoglobin, oxygen carrying capacity, vascular resistance, and electrolyte. But cardiac output and blood gas analysis data was not changed. Prothrombin time and partial thromboplastin time was prolongated. From this study crystalloid resuscitation in severe hemorrhagic shock restore cardiac output and perfusion, but fail to maintain adequate oxygen carrying capacity.

The Effect of Sufentanil and Vecuronium Affect to Cardiovascular System during Induction of Anesthesia for Open Heart Sugery / 대한마취과학회지

Narcotics and Some Neuromuscular blockers are used for open heart sugery anesthesia. Rapid induction of intravenous narcotics techniques may cause some reductjon in blood pressure and systemic vascular resistance, however, the selection of a narcotic and neuromuscular blocker influences subsequent Hemodynamic responses. 72 patients having open heart surgery were investigated using three combination of a narcotic and neuromuscular blocker: Group I (fentanyl 50 ug/kg, pancuronium 100 ug/kg): Group II (fentanyl 50 ug/kg, Vecuronium 80 ug/kg) Group III (sufentanil 10 u/kg, vecuronium 80 u/kg), each combination being administered over 2 minutes. Hemodynamic functions were then monitored for 10 minutes before tracheal intubation. 1) Significant changes included increases in heart nate in the groups receiving pancuronium and decrease in those receiving vecuronium. 2) In all groups mean arterial pressure initially decreased: systemic vascular resistance index decreased significantly in all groups except sufentanil and vecuronium group. 3) Cardiac index decreased significantly only in ufentanil-Vecuronium groups. Time of onset of neuromuscular blockade did not differ among the three groups, but transient chest wall rigidity occurred significantly more often with sufentanil than with fentanyl. Overall, the fentanyl-Pancuronium combination afforded the greatest hemodynamic stability, whereas the sufentanil-Vecuronium Combination proved least Satisfactory because of bradycardia, hypotension, increase of chest wall rigidity.