"Train of Four" Response to Intravenous Suceinylcholine Chloride in Rabbits / 대한마취과학회지

The history of muscle relaxants is fascinating, and their use for clinical applications has been accepted. Depolarizing drugs can produce a non-depolarizing type of neuromuscular block. Decamethonium produces a nondepolarizing block in the isolated rabbit lumbrical muscle. Electromyographic studies of the hand muscles in man have demonstrated that a dual block will be produced with doses of succinylcholine varying from 500 to 1,500 mg (initially a delpolarizing block and subsequently a non-depolarizing block exists). The common peroneal nerve in the rabbit knee was stimulated by a "train of four" method (Ali et al) repeated intermittently. The muscle response with the "train of four" method to intravenous succinylcholine chloride (1 mg/kg) in the rabbit was recorded and analysed after a single injection and repeated intravenous injections of succinylcholine chloride 1 mg/kg. Result were as follows: 1) Time after the "train of four" to depression of muscle twiteh of 25, 50, 75 & 100% was 128. 2, 135. 3, 142. 8 and 159 seconds respectively. 2) Recovery index of a single intravenous injection of succinylcholine chloride 1 mg/kg was observed as 3 minutes and 14 seconds. 3) A depolarizing form of "train of four" response to the first succinylcholine chloride injection 1 mg/kg was observed and, a non-depolarizing form of "train of four" response to the second dose of succinylcholine chloride 1 mg/kg was observed definitely.

Thalamonal-N2O-O2 Anesthesia for Orthopedic Surgery / 대한마취과학회지

Orthopedic surgery was performed under Thalamonal-N2O-O2 anesthesia by an intravenous injection of a small dose of Thalamonal and N2O inhalation. Respiratory rate was compared before and after intravenous administration of nalorphine at the end of operation. From 22 cases, the following results were obtained: 1) Average dose of Thalamonal during induction of anesthesia was 1.67ml/10kg. During induction, rigidity of chest wall developed in 5 cases, 2) Intermittent injections of Thalamonal for maintenance of anesthesia were needed at. each 43. 8 min. interval, and average dose of Thalamonal was 0. 013 ml/kg/30min. 3) After injection of nalorphine, average rate of respiration per minute increased from 15. 1 to 21. 1(39. 9%) 4) 21 cases among 22 cases recovered promptly after discontinuation of N2O, and recovery was delayed in 1 case. Self extubation was seen in 3 cases.

Anesthesia for Renal Transplantation - Report of 24 Cases / 대한마취과학회지

This is a report of anesthesia done for 24 cases of renal transplantation performed at St. Mary's Hospital, Catholic Medical college, Seoul, Korea, between 25 March 1969 and 19 August 1976. The recipient of renal transplantation show many critical conditions which require special considerations in performing anesthesia. The patients preoperative condition should be evaluated more carefully than most other kinds of surgical patients and anesthesia technic also must be selected specially. All kidney grafts were obtained from living donors. The family linkage of 24 donors was: 7 cases(29.1%) were from parents, 3 cases(12.5%) from children, 9 cases (37.5%) from siblings, 3 cases(12. 5%) from other relatives and 2 cases (8. 3%) were from nonrelated prsons. In the sex distribution of the donors, each sex was equally distributed.: All donors were anesthetized by means of endotracheal anesthesia using halothane, nitrous oxide and oxygen. As to complications during the nephrectomy of donors, a case of hiccup and two cases of pleural tear were encountered. The removed kidney was perfused with Hartmanns solution before transplantation and the choice of anesthetic agents caused no problems in the function of transplanted kidneys. The recipients had histories of chronic glomerulozephritis or pyelonephritis from 6 months to 32 years and showed uremic conditions. Their mean age was 38 years, ranging from 18 years to 59 years. The most frequent age group of the recipients was the 30 and 40 year group. Most recipients were males; among 24 cases, only 3 were females. Most of the recipients had decreased function of heart and lungs, severe anemia difficult to correct by blood transfusion(Hb, 7. 3 gm%, Hct. 24, 2%), increased BUN(70. 36+/-31. 34 mg/dl), hyperkalemia (4. 67+/-0. 63 mEq/L), poor and fragile veins, bleeding tendency and decreased kidney function(serum creatinine 10. 48 edmea, +/-2. 99 mg/dl). Prolonged medication to the recipient was another hazard to anesthesia. To lessen the risk during the anesthesia maintenance, preoperative preperation of the recipient The Journal of The Korean Society of Anesthesiologists Vol. 10, No. 1, 1977 Premedication of the recipients was perfor med by valium(515 mg) and atropine(0. 4 0. 5 mg) one hour before anestl esia. For tlie anesthetic technic, endotracheal anesthesia was applied to aI1 cases. Induction was done with intravenous pentothal soium, l00~ 200 mg or Epontol 250~500mg. As to the muscle relaxant to facilitate intubation, succinylchline for ll cases of the initial period of the transplantation, later gallamine for one case and pancuronium for the recent 12 cases. All anesthesia was maintained with halothane, nitrous oxide and oxygen. Muscle relaxants were used in al) cases during the surgery: succinylcholine drip for the initial 7 cases, d-Tubocurarine for 2 cases, gallamine for 2 cases and pancuronium for the recent 12 cases. Galllamine seems to be not contraindicated, as far as the active diuresis could be anticipated after the transplantation. Amount of blood transfused during operation was 2, 041 ml in average, ranging from 800 ml to 5000 ml and fluid infused was 1, 242 m] of Hartmann's sol. and/or other solutions. Respiration was controlled manually or mechanically. During the anesthesia, 16 cases of hypertension, 7 cases of arterial hypotension, 3 cases of arrhythmia, one cas of tight chest and one case of tachycardia, were encountered. Emergence of anesthesia was within 15 minutes. After the transplantation, diuresis started in 33 minutes on the average and most patients showed marked diuresis in which urine volume of 24 hours was 10, 164 ml on the average. The total surgical procedure lasted 4 hours and 50 minutes on the average, ranging from 3 hours 50 minutes to 7 hours. The ischemic tine of the removed kidney was 32 minutes in average. Followup of the patients showed that 10 cases died out of 24 cases between 4 months and 4 years after the surgery Patients surviving more than 1 year were 11 cases out of 15 cases(73. 3%), two cases out of 8 cases(25%) survived more than 2 years and two cases out of 8 cases(25%) more than 3 years. One case had the longest survival of 7 1/3 years.

Acute Pulmonory Edema during Massive Transfusion - a Case of Nasopharyngeal Angiofibroma / 대한마취과학회지

Acute pulmonary edema was experienced during the mass excision of a nasopharyngeal angiofibroma clue to massive transfusion (8,000ml of blood within 3 hours). High FIoz with manual PEEP, diuretics, steroid and digitalis were given immediately. Full recovery was observed after 18 hours of ICU care.

Geriatric Anesthesia -past 10 years- / 대한마취과학회지

It is a fallacy on the part of the anesthesiologist and surgeon to think that the same principles of anesthesia and surgery apply in the younger patient as in the aged who have a multiplicity of preoperative pathologic and physiologic states which may affect them during surgery and postoperatively and which must be considered in their preoperative preparation. Changes of importance are related to diminished cardiac, pulmonary, renal and hepatic reserves. With this steady increase of candidates for geriatric anesthesia, it is necessary that periodic reviews be presented so that the problems associated with the management of this enlarging group of patients may be elucidated. In this paper presented 1, 208 cases of geriatric anesthesia during 1964~1973 (10 years) at St. Mary's hospital and were analysed. Results were as follows; 1. Number of the total operative cases were 24, 970, among them over 60 years of age were 1,208 cases. Incidence was 4.9%. 2. Among the 1,208 cases, 967 cases were over 60~69 years of age (80%), 210 cases were over 70~79 years of age (17.4%) and 31 cases were over 80 years of age (2.6%). 3. Emergency versus elective surgical cases re 29.1% versus 78.9% 4. Among the 1,208 cases, 726 cases were general surgery(60.1%), each of 138 cases were orthopedics and urological ones(11.4%). 5. Inhalation anesthesia was performed 1,127 cases(90.4%) and spinal anesthesia was 29 cases(2.3%). 6. Halothane and methoxyflurane anesthesia were markedly increased after 1970 instead of diethyl ether anesthesia. 7. ECG was checked 42.2% of the cases preoperatively. 8. Post-anesthetic related death was not evaluated because of the insufficient record.

Serum Potassium Change in Burned Patient Intravenous Suceinylcholine Iodide / 대한마취과학회지

Transient hyperkalemia is well known to occur in man following intravenous administration of succinylcholine chloride (Anectine). Furthermore, massive hyperkalemia following succinylcholine chloride administration is a recognized danger in patients with severe burns, massive trauma, muscle dystrophy, and peripheral nerve injury or lesions on central nervous system with skeletal muscle paralysis. Increased serum potassium may lead to severe cardiac arrhythmia or cardiac arrest. Reported mary literatures, this was shown for succinylcholine chloride but not for succinylcholine iodide. The authors studied succinylcholine iodide intravenous administration for burned patient as to whether serum potassium changes or not. Effects of intravenous succinylcholine iodide on serum potassium, ECG and fasciculation were studied in fifteen burned patients. For serum potassium change, venous blood sample was drawn at preoperative period and at 10 minutes after succinylcholine iodide administration. Results were as follows; 1. Serum potassium was increased at 10 minutes after succinylcholine administration (4.47+/-0.65 mEq/L) than the preoperative value (4.17+/-0.51 mEq/L). Mean increase was 0.30 mEq/L. 2. In ECG change, only one patient showed transient premature ventricular contraction during induction of anesthesia. In this case serum potassium was increased 0.8 mEq/L (delta K). Occurance of this arrhythmia, it was not confirmed whetner it was due to increased serum potassium(delta K=0.8 mEq/L) or other factors. 3. Surprisingly, fasciculation was minimal level in all cases. 4. Significance in statistical analysis did not correspond with clinical signs. 5. Succinylcholine iodide intravenous administration was not contraindicated for intubation in. burned patient.

New trends in intraoperative blood and fluid replacement / 대한마취과학회지

Transfusion therapy has changed in the past several years, largely as a result of improved knowledge of the physIology of hypovolemia, development of plasma expenders and plastic blood-collection equipment, the possibility of blood mediated infection and also shortage of whole blood Supply. In Korea, the difficulty of getting blood is remarkably increasing recently. According to recent studies, the patient seems can undergo rapid loss of 1000 to 2000mL, or up to 40 percent of their blood volume without developing irreversible shock, and that blood pressure can be maintained by the administration of saline fluids, lactated Ringer solution being presently most in vogue. If there is further blood loss, it may be necessary to augument the bodys circulating hemoglobin, but this can be done by the administration of packed cells. During 1968 and 1970 at St. Mary's Hospital took place 6904 general anesthesia. Blood transfusion or these cases were analysed. In the past several years, we have tried to reduce the whole blood transfusion during surgery and to use lactated Ringer's solution and plasma expanders like hemaccel and macrodex, etc. In this review there was significant change in intraoperative blood and fluid replacement and the trend of decreasing blood transfusion and increasing lactated Ringers solution and plasma expander was noticed. Supply of packed cell is required to improve the transfusion technique in future.