The Anatomy of the Lumbar Epidural Space using Magnetic Resonance Imaging / 대한마취과학회지

MRI(Magnetic Resonance Imaging) have provided for greater image resolution, detailed tissue contrast without use of contrast media and images acquired in any plane. The purpose of this study was to examine the anatomy and dimension of the epidural space using MRI(Magnetic Resonance Imaging) and to compare the information obtained with that from other investigative technique. The anatomy of the lumbar epidural space was studied retrospectively using lumbar MRI scans of 90 patients. The epidural width(E.W.) is divided into three distance between the anterior surface of the ligamentum flavum and the dura at the caudal end of the lumbar segment(A), at the mid point of the ligamentum flavum(B) and at the cranial end of the lumbar segment(C). The distance from skin to supraspinous ligament(S-L) and from supraspinous ligament to epidural space(L-E) were measured. And then with adding both the distance, We measured the distance from skin to epidural space(S-E). Results were as follows; I) Posterior to the dural sac, epidural fat which is of high signal(white) on Tlw(T1 weighted) image is demonstrated at levels Tl I-T12 to L5-Sl giving 'Saw toothed' pattem to the epidural space. The fat is divided into segments by the interposing laminar, and the epidural space is deeper at cranial end than caudal end. 2) It was the relatively wide epidural space in L2-3 and L3-4 level, and the narrowest epidural space in L5-Sl level. 3) The distance from skin to supraspinous ligament was noted marked variation(2-40mm) according to the individual disparity. And the distance from supraspinous ligament to epidural space is 17-43mm. In distance from skin to epidural space, the most narrow place is Ll-21evel (37.95+/-7.65mm). The most deep place is IA-5 level(46.35+/-7.20mm). As the age increase, epidural width is decreased at L3-4 level (p<0.05).

Development of Thyrotoxic Crisis during the Treatment of Postherpetic Neuralgia / 대한마취과학회지

Thyrotoxic crisis is a life-threatening exacerbation of hyperthyroidism seen during periods of stress, which requires early recognition and adequate treatment. A 52-year-old female who suffered from severe right thoracic pain due to postherpetic neuralgia with hyperthyroidism, has been initially treated with antiviral agent and anticonvulsant in the department of neurology. She was transfered to our pain clinic because of uncontrolled severe pain. In our pain clinic, continuous thoracic epidural administration of bupivacaine and clonidine and oral analgesic medications produce visual analog scale from 8-9 to 5-6. She was admitted because of partially controlled pain and she was performed intercostal neurolysis with 10% phenol. As a result, visual analog scale was decreased from 5-6 to 2-3. After 3 days admission, extreme irritability, delirium, tachypnea, mild fever and tachycardia(heart rate: 160-180/min) were developed suddenly. Three hours later of proper treatment with oxygen inhalation, rapid fluid administration, diazepam 10 mg injection and antithyroid drug medication, heart rate and consciousness were returned to normal. Thoracic sympathetic ganglion neurolysis with absolute alcohol was performed without any sequelaes for the treatment of remnant visceral pain. And then, she was discharged with the relief of pain. The purpose of the present report is to review our experience with the clinical manifestations and management of thyrotoxic crisis developed during the treatment of postherpetic neuralgia, and to review of the treatment of thyrotoxic crisis and postherpetic neuralgia.

The Effect of Transdermal Scopolamine Patch on Nausea and Vomiting after Epidural Injection of Morphine / 대한마취과학회지

Sixty patients, undergoing major gynecologic surgery with lumbar epidural anesthesia, were randomly selected 32 patients to apply a transdermal scopolamine patch (Kimite MyoungMoon, Korea) on the skin behind one ear. We were divided into 2 groups. Control group; epidural morphine 4mg were given and not applied scopolamine patch. Experimental group; epidural morphine 4mg were given and applied transdermal scopolamine patch on the skin behind her ear at the night before surgery. They were followed up for 3 days postoperatively and statistical analysis was done. There was a significant (p<0.05) reduction in nausea and vomiting between experimental group and control group. There was no significant incresed incidence in scopolamine side effects. However, despite receiving transderrnal scopolamine patch there was still a high incidence (43.8%) of nausea and vomiting.

The effect of Propofol on the Recovery Period of Vecuronium induced Neuromuscular Blockade / 대한마취과학회지

Propofol (2,6-diisopropyl phenol) is chemically unrelated to the other intravenous anesthetic agents. The compound is an oil at room temperature and is formulated as an 1% emulsion in soybean oil and egg phosphate. Rapid induction of anesthesia and recovery suggest that it will be valuable for ambulatory patients who are undergoing brief procedures and for sedation in intensive care units. The original formulation of propofol in cremophor may potentiate vecuronium neuromuscular blockade in both experimental and dinical setting. There were a little reports interaction between the emulsion formulation of propofol and vecuronium This study was designed to investigate the effect of propofol on the recovery period of vecuronium neuromuscular blockade in humans. Neuromuscular block was monitored by measuring the force of contraction of the adductor pollicis muscle after train of four stimulation of ulnar nerve, using ABM (Anesthesia and Brain activity Monitor, Datex CO, Finland). Fourty-two patients undergoing gynecological operations were included. All patients conformed to ASA physical states class 1 or 2. All patients were anesthetized by continuous lumbar epidural block with 1.5% lidocaine 4 mg/kg followed by general anethesia, with droperidol, 2.5% pentothal sodium, and vecuronium administered intravenously. Patients were classified 3 groups, as follows ; Group I (control group n=14): vecuronium 0.1 mg/kg i.v. only Group II (n=14): propofol, 1 mg/kg i.v. at the recovery time of Train of Four ratio 25% Group III (n=14): propofol, 2 mg/kg i.v. at the recovery time of Train of Four ratio 25% We monitered the recovery index (TOF 25-50%, 25-75%) and the time and degree of maximal depression in propofol groups. Results were as follows', 1) Recovery Index-50 (TOF 25-50%): The recovery time from TOF 25% to 50% were, 332+/-47.2, 445+/-54.3, 765+/-292.0 secs in groups I,II,III, respectively. (p<0.05) 2) Recovery Index-75 (TOF 25-75%): The recovery time from TOF 25% to 75% were, 742+/-156.0, 948+/-194.0, 1494+/-499.0 secs, in groups I,II,III, respetively. (p<0.05) 3) The time and degree of maximal twitch depression after injection of propofol: 20+/-4.0% of maximal twitch depression were observed for 25+/-15.2 sec after injection of propofol in 3 patients of Group II, and 17+/-4.8% of maximal twitch depression were observed for 190+/-130.0 sec after injection of propofol in 7 patients of Group III. With the above results, we concluded that propofol has a synergistic effect on the recovery period of vecuronium induced neuromuscular blockade.

The effect of Propofol on the Recovery Period of Vecuronium induced Neuromuscular Blockade / 대한마취과학회지

Propofol (2,6-diisopropyl phenol) is chemically unrelated to the other intravenous anesthetic agents. The compound is an oil at room temperature and is formulated as an 1% emulsion in soybean oil and egg phosphate. Rapid induction of anesthesia and recovery suggest that it will be valuable for ambulatory patients who are undergoing brief procedures and for sedation in intensive care units. The original formulation of propofol in cremophor may potentiate vecuronium neuromuscular blockade in both experimental and dinical setting. There were a little reports interaction between the emulsion formulation of propofol and vecuronium This study was designed to investigate the effect of propofol on the recovery period of vecuronium neuromuscular blockade in humans. Neuromuscular block was monitored by measuring the force of contraction of the adductor pollicis muscle after train of four stimulation of ulnar nerve, using ABM (Anesthesia and Brain activity Monitor, Datex CO, Finland). Fourty-two patients undergoing gynecological operations were included. All patients conformed to ASA physical states class 1 or 2. All patients were anesthetized by continuous lumbar epidural block with 1.5% lidocaine 4 mg/kg followed by general anethesia, with droperidol, 2.5% pentothal sodium, and vecuronium administered intravenously. Patients were classified 3 groups, as follows ; Group I (control group n=14): vecuronium 0.1 mg/kg i.v. only Group II (n=14): propofol, 1 mg/kg i.v. at the recovery time of Train of Four ratio 25% Group III (n=14): propofol, 2 mg/kg i.v. at the recovery time of Train of Four ratio 25% We monitered the recovery index (TOF 25-50%, 25-75%) and the time and degree of maximal depression in propofol groups. Results were as follows', 1) Recovery Index-50 (TOF 25-50%): The recovery time from TOF 25% to 50% were, 332+/-47.2, 445+/-54.3, 765+/-292.0 secs in groups I,II,III, respectively. (p<0.05) 2) Recovery Index-75 (TOF 25-75%): The recovery time from TOF 25% to 75% were, 742+/-156.0, 948+/-194.0, 1494+/-499.0 secs, in groups I,II,III, respetively. (p<0.05) 3) The time and degree of maximal twitch depression after injection of propofol: 20+/-4.0% of maximal twitch depression were observed for 25+/-15.2 sec after injection of propofol in 3 patients of Group II, and 17+/-4.8% of maximal twitch depression were observed for 190+/-130.0 sec after injection of propofol in 7 patients of Group III. With the above results, we concluded that propofol has a synergistic effect on the recovery period of vecuronium induced neuromuscular blockade.

Anesthesia for Liver Transplantation / 대한마취과학회지

We experienced one case of anesthesia for liver transplantation in 32-year-old male patient with liver cirrhosis. The liver donor was 27-year-old male patient who was diagnosed brain death due to car accident. The operation was finished successfuly for 12 hours with intensive monitoring and treatrnent with using TEG and RIS. Patient was transfered to ICU after operation with intubated state. Extubation was done 2 days after operation and patient discharged without complication about 2 months later.

The Effect of Lidocaine HCI Administered into Epidural Space on the Neuromuscular Blocking Action of Vecuronium / 대한마취과학회지

Most local anesthetics intravenously administered inhibit neuromuscular transmission or enhance the neuromuscular block of both nondepolarizing and depolarizing musde relaxants. Local anesthetics used to treat cardiac arrhythmias intraoperatively or postoperatively may, therefore, greatly augment a residual neuromuscular block. To obtain adequate balanced anesthesia and postoperative analgesia, general anesthesia with epidural anesthesia is frequently selected. In the present study we investigated the effects of lidocaine HC1 administered into epidural space on the neuromuscular blocking action of vecuronium. Eighty adult gynecological patients of ASA class I or II were studied. Patients were divided into four groups as follows ; Group I (n=20); vecuronium 0.1 mg/kg iv administered only Group II(n=20); vecuronium 0.1 mg/kg iv and lidocaine 6 mg/kg administered into epidural space Group III(n=20); vecuronium 0.1 mg/kg iv and lidocaine 8 mg/kg administered into epidural space Group IV(n=20); vecuronium 0.1 mg/kg iv and lidocaine 10 mg/kg administered into epidural space Patients of experimental groups II, III and IV were anesthetized by epidural block with 2 % lidocaine followed by general anesthesia 15 minutes later. Before induction with fentanyl(3 ug/kg), droperidol(0.04 mg/kg), thiopental sodium (5 mg/kg) and vecuronium(0.1 mg/kg) iv, neuromuscular monitoring was set by using ABM(Anesthesia and Brain activity Monitor, Datex Co, Finland) which stimulating ulnar nerve at the wrist with supramaximal stimuli at a frequency of 2 Hz and 20 seconds interval. The electromyographic response of hypothenar muscles was recorded. Following stabilization of the control twitch height, vecuronium(0.1 mg/kg) was intravenously injected, and tracheal intubation was performed when the first twitch height of the train of four twitch response(T1) was 5 % of the controL Anesthesia was maintained with O2 (2 L/min) and N2O (4 L/min). The time of onset of action (time from vecuronium iv to 0 % of T1), time of maximal twitch depression (time from loss of T1 to reappearance of T1), Recovery index (time from recovery of 25 % of T1 to 75 % of T1) and T4 ratios (ratio of the height of the fourth twitch to T1) at 25 %, 50 % and 75% of T1 were measured and compared among the groups. The results were as follows ; 1. The time of onset of action was 3.99+/-0.92 minutes in the control group and 2.94+/-0.89 minutes in the lidocaine 10 mg/kg administered group(P0.05). These results suggest that the effect of lidocaine HC1 administered into epidural space on the neuromuscular blocking action of vecuronium showed prolonged depression and recovery time, and reduced time of the onset of action with dose larger than lidocaine 8 mg/kg.

A Combination of Thoracic Epidural and General Anesthesia for Pheochromocytoma / 대한마취과학회지

Pheochromocytoma remains one of the great challenges to anesthesiologists during anesthesia and postoperative period. Virtually all anesthetic agents and techniques have been used with success but associated with a high rate of transient intraoperative arrhythmia and hypertension. We now report one case who was given thoracic epidural block and neuroleptic anesthesia for resection of right adrenal and presacral pheochromocytoma. Blood pressure and heart rate were stable during induction, tumor manipulation and postoperative intensive care unit with out the use of vasodilating or antiarrhythmic druas. While this report describes only one encouraging case, the potential advantages of thoracic epidural & general anesthesia in pheochromocytoma appear to warrant the further trial.

The Effect of a Large Dose of Epidural Ketamine for Postoperative Pain Relief / 대한마취과학회지

Intrathecal and epidural narcotics have been widely used since 1979 to relieve pain and provide postoperative analgesia. Ketamine hydrochloride, a potent analgesic and anesthetic, has also been studied to its usefulness in epidural administration for postoperative pain relief devoid of the respiratory depression caused by morphine. This study was performed to evaluate whether a large dose of ketamine is effective for postoperative pain relief and the results were compared with those of epidural morphine. Forty patients undergoing lower abdominal and extremity surgery were randomly assigned in two groups of twenty. No patient was receiving narcotics or analgesic at the time of study. The operative anesthesia was provided by continuous epidural anesthesia with 27 ml of 1.5% lidocaine with 1:200,000 epinephrine. Ketamine 30mg or morphine 3-4 mg was administered about 30 minutes before the end of operation through the epidural catheter respectively. Patients were monitored every 15 minutes during the first hour and every hour during first 24 hours. Pain complaint, respiratory rate, heart rate, blood pressure, SaO2 and potential side effects were recorded. The results were as follows; 1) Two cases in the ketamine group and nine cases in the morphine group did not need the additional analgesics after operation. The duration of pain relief in the ketamine group varied from 1.83 hour to over 48 hours (less than 3 hours in 50% of patients). Mean analgesic time in the morphine group was 28.3+/-5.6 hours. 2) Dissociative anesthesia with hypotension (one), sedation (fifteen), dizziness (seven), nausea (six) and vomiting (six) in the ketamine group, whereas nausea (nine), and vomiting (five) in the morphine group were developed. We conclude that ketamine 30 mg administered epidurally, which had a more central actions and less analgesic effect than morphine, is inadequate for postoperative pain relief after lower abdomimal and extremity surgery.

Anesthetic Management for Surgery of Patients with Budd-Chiari Syndrome / 대한마취과학회지

Budd-Chiari Syndrome is a rare disorder due to obstruction of hepatic venous outflow and generally follows a rapid fatal course. Hepatic vein thrombosis is a common complication with a high mortality rate and surgery for this condition is associated with a high perioperative mortality. Those who survive the acute phase almost invariably go on to develop cirrhosis of the liver and die within a few years from hepaic failure, bleeding esophageal varices or other complications of chronic liver disease. We have experienced the anesthetic management of three parients with Budd-Chiari syndrome who were treated with finger fracture and mesoatrial shunt. It is important that the anesthesiologist realizes that certain pathophysiological changes occur during the several surgical approaches to relieve the effect of hepatic vein obstruction, and perioper-ative hepatic dysfunction.

Retrograde Endotracheal Intubation Using a Guide Wire in a Pediatric Patient / 대한마취과학회지

An 8-year-old male with ankylosis of both temporomandibular joints was scheduled for an elective condylectomy. Physical examination revealed a relatively healthy appearing child, weighing 25 kg, with 5-7mm of maximal oral opening. The EKG, chest x-ray and laboratory data were within normal limits. An attempt at local infiltration after injection of droperidol 2.5 mg for retrograde technique was unsuccessful. Subsequently, anesthesia was induced with thiopental, halothane, nitrous oxide and oxygen via a mask. The cricothyroid membrane was punctured with an 18 gauge Touhy needle. After confirmation of the intratracheal position by aspiration of air into a fluid filled syringe, a flexible guide wire tip of CVP catheter (VYGON) was threaded via this needle superiorly into the posterior pharynx through the larynx. After introduction of the guide wire into right naris, the nasotracheal tube was threaded over the wire, and the tip of the tube in the trachea at the site of the cricothyroid membrane puncture was confirmed by palpation and visual inspection. The nasotracheal tube was advaned further into the trachea after removal of the guide wire. Auscultation confirmed appropriate intratracheal placement.

Anesthetic Management for the patient with Carotid Carotid Artery Aneurysm - 2 case reports / 대한마취과학회지

Aneurysm of the carotid artery in the neck is rare lesion and may elicited in patient with Behcet's disease. To achieve maintenance of critical perfusion pressure of brain during the cross clamping of the carotid body, the anesthesiologist is familiar with the use, reliability and limitation of various monitoring modalities and posses a working knowledge of basic brain physiology and protective measures available to protect against cerebral ischemia and hypoxia. We report here our anesthetic experiences and considerations of 2 surgical patients with both common carotid artery aneurysm and false carotid artery aneurysm associated with Behcet's disease.

Train of Four Responses as Indicies of Onset and Recovery during Pancuronium Induced Neuromuscular Blockade / 대한마취과학회지

The train of four (TOF) stimulation is commonly used in animal research and clinical practice to determine the degree of neuromuscular blockade. It has been suggested that relationship existed between the degree of single, or initial twitch depression and the amount of TOF fade responses within train. Although block produced by all non-depolarising muscle relaxants is associated with fade in response to tetanic or TOF stimulation, recent studies have shown quantitative difference in degree of these fade between various agent. However, more recently, the variability of this relationship with the same neuromuscular blocker during onset and spontaneous recovery of neuromuscular blockade has been demonstrated. And so, the degree of fade may be affect the reliability in assessment of degree of block and recovery of block in comparison to single twitch stimulation. In present study, we has assessed the effect of pancuronium 0.04 mg/kg on the pattern of TOF (T(4) ratio) and first twitch response in the train compared with control twitch (T(1) ratio) and, thereafter, the twitch responses of vecuronium 0.02 mg/kg on recovery period from pancuronium induced neuromuscular blockade in 14 rabbits. The changes in neuromuscular transmission were measured by recording the isometric contraction of the left gastrocnemius muscle evoked by supramaximal stimulation of the tibial nerve. The results were as follows: 1) The effect of pancuronium 0.04 mg/kg was variable, ranging from incomplete (64.3%) to complete (35.7%) neuromuscular block. 2) During the onset of action, there was greater reduction associated with T(1) than T(4), ratio in all cases. The changes of T(1) ratio decreased steadily in all cases, but the changes of T(4) ratio in cases of incomplete neuromuscular blockade was biphasic, showing initial decrease to 77.2+/-8.1% followed by increase to 100% of T(4) rato when T(1) ratio was 4.6+/-3.2%. 3) During the recovery period, T(4) ratio was increased linearly with T(1) ratio which reached 25% when T(4) ratio was approximately 22.5+/-18.8% in cases of complete neuromuscular blockade. In cases of incomplete neuromuscular blockade, T(1) ratio was increased linearly depending on time course, but the change of T(4) ratio was biphasic, showing initial decrease to 28.2+/-16.6% when T(1) ratio was 25%, followed by increased linearly with T(1) ratio. 4) The twitch response during the onset of the action and recovery after vecuronium 0.02 mg/kg on 75% recovery period of pancuronium induced neuromscular blokade was similar to that of pancuronium. The results of this study suggest that the TOF ratio and the depression of the single twitch bear no fixed relationship. The clinical use of TOF using the T(4) ratio only, as a monitor of the degree of block and recovery from non-depolarising block has been useful, but we would recommended that T, ratio of TOF should be considered to evaluated the incomplete neuromuscular block of pancuronium and vecuronium in rabbit.

Physiology of Neuromuscular Junction / 대한마취과학회지

No abstract available.

The Neuromuscular Responses of Atracurium in Myasthenia Patieats / 대한마취과학회지

Myasthenia gravis is now considered as one of autoimmune disease eintities and characterized by progressive muscle weakness upon exertion and high sensitivity to the motor end plate. Special considerations are required in the anesthetic management of the myasthenic patient undergoing surgery under general anesthesia. The myasthenic patient is generally highly sensitve to non-depolarising agents and resistant to depolarizing agents. it is advisable to avoid the non-depolarzing agents or use only small dose during anesthesia, if neccessary. Atractrium is an intermediate acting bisquatenary ammonium compound and it's effects are well dissipated by hofmann elimination and ester hydrolysis. We have had myasthenic patient undergo thymectomy. Muscle relaxation was obtained by using a small dose of atracurium during anesthesia. Patient's perianesthetic course was not remarkable except slow spontaneous recovery, but it was well reversed by anticholinesterase.

Anesthetic Management for a Patient with a Silicon Tracheal T-tube / 대한마취과학회지

The silicon tracheal T-tube was designed to maintain an adequate tracheal airway as well as to provide support in the stenotic trachea which has been reconstructed. Replacement of the T-tube was obviously undesirable following recent reconstruction of an unstable fracture of the airway. The loss of anesthetic gas through a T-tube while it is in place during anesthesia has been a problem. This report describes a simple method of establishing a satisfactory airway in a patient with a tracheal T-tube, and reviews the anesthesia aspects of modern surgical reconstruction of the larynx and cervical traches.

Preoperative Anesthetic Management of the Patient with Hypoprothrombinemia / 대한마취과학회지

Disorders of coagulation and uncontrollable bleeding are major problems during a major surgical operation. The correct diagnosis, appropriate treatment and preparation for abnormal coagulation and bleeding conditions with specific factors and blood products are procedure of utmost importance. Detailed history, physical examination and performance of appropriate laboratory tests including specific factor assay are essential for the diagnosis of an abnormal coagulation and bleeding problem. We have experienced a case of factor ll deficient patient who had surgery for a glioma of the forebrain. He had a past history of two episodes of massive bleeding during operation and showed a bleeding tendency after angiography for this last admission, but he didn't show any abnormal blood coagulation tests except for a factor ll deficiency. He had received Vitamine K 20 mg/day for 7days preoperatively. All laboratory coagulstion tests became normal and he had a surgical removal of a forebrain glioma uneventfully under general anesthesia. He received only 1 unit of fresh frozen plasma during operation and had an uneventful postoperative course.

Pulse Rate Changes and Antagonism to Neuromuscular Blockade by Dose-Related Neostigmine and Atropine / 대한마취과학회지

Neostigmine, an antagonist of the competitive muscle relaxants, is the reversal agent most commonly used clinically. Neostigmine produce a vagotonic effect causing bradycardia. For this reason, it has always been advocated that it shoud be blocked by anticholinergic drugs. Earlier clinical studies had demonstrated dose of atropine and neostigmine require to reverse the neuromuscular block and to prevent bradycardia. Several authors recommended titrating the amount neostigmine and atropine to a specific end point, but adequate dose was not established. Therefore, this study were designated to compare the heart rate changes and recovery index followed by dose related neostigmine and atropine. Forty patients undergoing general anesthesia were randomly divided in neostigmine 30ug/mg-atropine 15ug/kg(group A) and neostigmine 40ug/kg-atropine 15ug/kg(group B) group. All patients are received atropine 0.01mg/kg and valium 0.18mg/kg for preanesthetic medications. Anesthesia was induced with thiopental sodium 4~5mg/kg, followed by succinylcholine 1mg/kg to facilitate the intubation. Anesthesia was maintained with 50% N2O in oxygen with 1% halothane. In all patients following induction of anesthesia, neuromuscular block was monitored continuously throughout the study. Pancuronium was administered, as a bolus, in a dose of 0.04mg/kg with increment of 0.02mg/kg, when necessary, to depress the T4/T2 ratio less than 10%. When muscle twitch activity, following pancuronium administration, had recovered spontaneously to 20% of T4/T2 ratio, each dose of atropine and neoatigmine was given. Heart rate counted from the ECG tracing and blood pressure was checked for 30 minutes after injection. Recovery index was calculated. The results were as follows. 1) In group A, maximal increase of pulse rate by intravenous atropine was 23.3+/-4.79%, maximal decrease of pulse rate was 22.6+/-11.50% within 12.2+/-6.07 minutes. Recovery index was 7.5+/-4.82minutes. 2) In group B, maximal increase of pulse rate by intravenous atropine was 13.5+/-10.08%, Maximal decrease of pulse rate was 29.9+/-8.30% within 10.9+/-2.81 minutes. Recovery index was 6.3+/-3.95 minutes. 3) In A and B group, neuromuscular blockade induced by pancuronium 0.04mg/kg was adequately recovered by neostigmine 30~40 ug/kg in all cases. 4) Severe bradycardia was developed after mixed injection of atropine 15ug/kg to neostigmine 30~40 ug/kg in A and B group.

The Effect of Ketamine on Intraocular Pressure in Children / 대한마취과학회지

Intraocular pressure(IOP) in children is often measured during anesthesia because it is difficult to obtain aedquate cooperation from and awake child. Evaluation of the impact of anesthetic drugs on IOP is imperative for accurate diagnosis and essential in avoiding untoward alterations in IOP during intraocular surgery. IT has been widely believed that IOP is reduced by inhalation anesthetic agenta, but ketamine has been reported to increase IOP have no effect on IOP and to decrease on IOP. WE have investigated the effect of ketamine only, ketamine and halothane, and pentothal sodium and halothane anesthesia on IOP in children. Thirty patients, ranging in age from 5 to 10 years and ASA physical status l to ll, scheduled for elective surgery, were the study group. No patients had glaucoma or corneal laceration. The patients were not premedicated. After instillation of local anesthetic solution into the conjunctival sac, control measurements of IOP were obtained in one eye with a pneumatic Applanation Tonometer(Alcon). The patients were then randomly divided into 4 groups. In group A(10), IOP measurements were recorded for 10 minutes at one minute interval after ketamine 2mg/kg i.v. In group B(10), anesthesia was induced with ketamine 2mg/kg i.v. and succinylcholine 1mg/kg was used to facilitate tracheal intubation. IOP was measured one minute after thiopental and after intubation. Anesthesia was maintained with haothane (1%)-N2O(2L/min)-O2(2L/min) and IOP were measured for 10 minutes at one minute intervals. In group C(10), succinylcholine 1mg/kg given one minute after thiopental 4~5 mg/kg, trachea was intubated following fasciculation and anesthesia was maintained with halothane (1%)-N2O(2L/min)-O2(2L/min). Thereafter IOP was measured for 10 minutes at one minute intervals. All IOP measurements were made by the same examiner using the same instrument. Pulse and blood pressure were simultaneously monitored. The results were as follows: 1) In group : The control value of IOP was 22.1+/-31 mmHg. Two minutes after ketamine 2mg/kg i.v., mild a increase (2~4mmHg) of IOP was observed and persisted thoroughout the 10 minutes but it was not statistically significant(p>0.05). 2) In group B: After ketamine and succinylcholine, IOP was moderately increased (29.8+/-3.86mmHg) over the control (24.0+/-4.09mmHg). AFter intubation, IOP was markedly increased (32.0+/-4.04mmHg) (p<0.05). Apparently, the elevation in IOP after intubation became reverted and stabilized in 6 minutes to normal or below control level under halothane anesthesia. 3) In group C: The control value of IOP was 20.7+/-1.11mmHg. It showed that thiopental by itself caused a significant decreased in IOP (17.4+/-2.87mmHg) (p<0.05). As in B group, IOP increased after succinylcholine(23.0+/-3.87 mmHg) and intubation(29.4+/-3.69mmHg)(p<0.05). Elevated IOP lowered and stabilized in 4 minutes after halothane anesthesia.

Effect of Oxytocin on the Succinylcholine Induced Neuromuscular Blockade / 대한마취과학회지

Oxytocin has a stimulant effect on the smooth muscle of the uterus and mammary gland. Infusion or bolus injection of oxytocin followed later by the administration of succinylcholine is a fairly frequent sequence of events in our practice of obstetrical anesthesia. There were few reports and conflicting results about the effect of oxytocin on the response to a muscle relaxant. To assess the effect of oxytocin on the response to succinylcholine, we studied pregnant women(20 cases) compared with non pregnant women(20 cases). All patients were free of hepatic, renal, endocrine or neuromuscular disease. The ulnar nerve was stimulated at elbow using surface electrodes with square wave, supramaximal stimuli of 0.2 ms duration at a frequency of 1 Hz(Emerson peripheral nerve stimulator, U.S.A). The isometric twitch tension of indirectly stimulated adductor muscle was recorded by biophysiograph(San Ei, Japan). The effect of single bolus injection of oxytocin 10 I.U at the 50% recovery of succinylcholine induced neuromuscular blockade was compared in the pregnant and non pregnant patients. The results were as follows: 1) In the pregnant patients group: Twitch height was unaffected in 50% of patients while 10% of the patients were observed with 100% twitch height depression. Mean maximal twitch height depression was 61.2+/-28.58% and the duration of twitch depression was 95.2+/-43.45 sec. The effect of oxytocin on serum potassium change was not significant statistically(p0.05).