Rupture of Hedden Cerebral Aneurysm during Induction of General Anesthesia / 대한마취과학회지

Unexplained incidental intracranial hemorrhages during induction of general anesthesia are very rare. When it dose occur, anesthetists are involved in serious problems which can lead to disaster. We had a case where a hidden cerebral aneurysm ruptured during the induction in a patient. A 56 year old female was scheduled for a skin graft procedure on her face, anterior chest and both arms. For general anesthesia, she was induced with 300 mg of thiopental and 75 mg of succinylcholine. This was followed by endotraeheal intubation. The Anesthesia was maintained with N2O/O2 and enflurane. Appoximately 10 minutes after the induction was started the patient's pupil became fully dilated and we observed that her light reflexes were gone. Consequently, all anesthetics were discontinued, and the schedule was cancelled. She had a brain CT taken which showed subarachnoid hemorrhage. She died of rebleeding from cerebral aneurysm on the 12th postoperative day during the recovery process.

Arterial Oxygen Desaturation Rate Following Obstructive Apnea in Parturients / 대한마취과학회지

Preoxygenation is a standard anesthetic technique for preventing a significant hypoxemia during the induction of anesthesia. Complete denitrogenation is especially important in clinical situations of difficult intubation or in patients with decreased functional residual capacity, and in situations where oxygen saturation is critical. Oxygen consumption in pregnancy is markedly increased at term as compaired to the nonpregnant stage. It is important to evaluate how long parturient women can withstand apneic hypoxemia during induction of general anesthesia. This study was carried out to measure the duration of time required to decrease the SaO2 to 90% After written informed consent was obtained from six healthy parturients who were to under go elective Cesarean section and six healthy non-pregnant women who were to have total abdominal hysterectomies. All subjects had a tight fitting anesthesia mask applied and breathed 100% oxygen, and a single isolated apnea was carried out. Arterial oxygen saturation and gas tensions were measured at a time SaO2 decreased to 90%, also blood gas data of 4 minutes after apnea in the non-pregnant women were obtained. From these, arterial oxyhemoglobin content was calculated, and mean desaturation rate from denitrogenation to the time SaO2 decreased to 90% was calculated. The mean time to obtain 90% saturation was 7.5+/-0.9 minutes in the nonpregnant women and 3.6+/-0.8 minutes in the parturient group. The mean slope of desaturation was steeper in the paturient(-3.336) than the nonpregnant (-1.52). The PaO2 inereased over 400mmHg in both the groups after denitrogenatio. After 4 minutes of apnea, the mean PaO2 decreased to 200mmHg in the non-pregnant women. The rate of rise of alveolar PCO2 during apnea were alower in the non-pregnant women(2.8+/-1.2mmHg/minute) than in the parturient women(6.8+/-1.8mmHg/minute). This study demonstrates that the rate of oxygen desaturation is faster in the parturients than the nonpregnant women. It is suggested that those results came out because of pregnancy-in-duced increase of oxygen consumption rate and decrease in FRC. The results of this study show the induction for term parturients should be speeded up with caution after full oxygenation in comparison with non-pregnant patients.

Inadvertent Subdural Block Developed by Epidural Anesthesia / 대한마취과학회지

Dural puncture in a well recognised complications of lumbar epidural anesthesia, as is extensive block after extradural injection of local anesthetic solutions in patients in whom the dura has been punctured. A healthy 43-year-old woman entered for trans-abdominal hysterectomy under lumbar epidural anesthesia. After an accidental dural puncture was noticed then the epidural puncture was reattempted at the same site and a catheter was inserted succesfully. An extensive segmental anesthesia along with hypotension and pupil dilatation developed about 45 minutes after the first injection of lidocain. Such extensive segmental anesthesia may be the result of injection into the subdural space. However, it was not confirmed in this case radiologically.

Analysis of Hepatotoxicity Following Surgery with General Anesthesia / 대한마취과학회지

Postoperative hepaotoxicity may develope as a result of many causes. These poasble cau may include direct injury to the liver cella due to anesthetic drugs such as halothane, chronic liver disease, viral hepatitis, sepsis, severe burns, pregnancy, drug administration and transfusion. We had seven cases of acute hepatitis following surgery for the past 6 months. CASE 1: A 26-year-old male had an operation for maxillar fracture under isoflurane anesthesia. The preoperative liver enzyme (SGOT, SGPT) were elevated but other tests were within normal range. He developed high fever, marked elevation of SGOT, SGPT, upper abdominal pain and nausea on the 7th postoperative day. He died of acute respiratory and renal failure on the 23 rd postoperative day. CASE 2: A 55-year-old woman had an operation for cervical spondylosis under halothane anesthesia. She developed high fever, headache and leukocytosis on the 12th postoperative day. Liver function tests showed marked elevation of SGOT, SGPT, bilirubin and hypoalbuminemia on the 17th day. She died of acute respiratory failure on the 30th postoperative day. CASE 3: A 53-year-old woman had an operation for epidermal cyst under halothane anesthesia. On the 12th postoperative day she developed high fever, skin rash, marked elevation of SGOT, SGPT and leukopenia. She recovered gradually from hepatitis and went home in good health on the 30th postoperative day. CASE 4: A 68-year-old man had an operation for oral cancer under enflurane anesthesia. On the 16th postoperative day, liver function tests showed elevation of SGOT, SGPT and leukopenia, He gradually recovered on the 19th postoperative day. CASE 5: A 64-year-old woman had an operation for MCA aneurysm under enflurane anesthesia. He developed hypotension on the 20th postoperative day and respiratory difficult and marked elevation of SGOT, SGPT, BUN, creatinine, and generalized edema on the 22nd day. She recovered gradually and went home in good health on the 45th postoperative day. CASE 6: A 23-year-old woman had an operation for mandible fracture under enflurane anesthesia. The preoperative liver function tests showed a mild elevation of SGOT, SGPT, ALP. She recovered gradually and went home in good health on the 30th postoperative day. CASE 7: A 19-year-old woman had an operation for mandible fracture under halothane anesthesia. On the 30th postoperative day, she developed jaundice and marked elevation of SGOT, SGPT. She recovered gradually and went home in good health on the 55th postoperative day.