The Effects of 0.45% and 0.9% Saline Solutions on Serum Sodium Concentrations in Chronic Renal Failure Patients / 대한마취과학회지

BACKGORUND: To choose optimal potassium free solutions in chronic renal failure patients, we studied the effects of 0.45% or 0.9% saline solutions on the serum sodium concentrations of patients undergoing kidney transplantation surgery. METHODS: Sixty two patients, ASA physical status iii iV, undergoing kidney transplantation surgery, were allocated to receive either 0.45% saline (n = 26) or 0.9% saline solutions (n = 36). The patients received 2 L of 0.45% or 0.9% saline solutions with a CVP of 10 mmHg prior to a renal vein anastomosis. Serum sodium and potassium concentrations were measured before (Na0, K0) and after the administration of 2 L of 0.45% or 0.9% saline solutions (Na2, K2), respectively. RESULTS: Serum sodium concentrations decreased after the administration of 0.45% saline solutions, and after administrating 2 L of 0.9% saline, the serum sodium concentrations increased in patients with baseline serum sodium concentrations lower than 136 mEq/L. When we administered 0.9% saline, which had a sodium concentration lower than the serum sodium concentration, the serum sodium concentration measured after 2 L of 0.9% saline infusion proportionally decreased in patients with baseline serum sodium concentration greater than 136 mEq/L (P<0.001). CONCLUSiONS: For ideal fluid selection in chronic renal failure patients, this study suggests a 0.45% saline solution for chronic renal failure patients with a baseline serum sodium concentration below the normal range and a 0.9% saline solution for patients with a baseline sodium concentration within the normal range.

Temperature Changes during General Anesthesia / 대한마취과학회지

Temperature changes during general anesthesia were studied in relation to age, the duration and type of operative procedure(gastrectomy versus tympanoplasty) and the type of anesthetic(halothane versus conflurane) in 41 patients undergoing surgery in our centrally air-conditioned operating room. Body temperatures were recorded every 15 minutes after intubation by measuring the esophageal temperature in adults and the nasopharyngeal temperature in children. A comparison of temperature changes between adults and children showed a significant temperature decreases in adults during general anesthesia(-0.6 degrees C, p<0.001), while the temperatures of children remained stable. Comparisons of gastrectomy versus tympanoplasty groups indicated the operative site had little effect on the patient's body temperature. Patients who underwent a gastrectomy showed an average fall in esophageal temperature of 0.8 degrees C, where as there was an average temperature decline of 0.5 degrees C in tympanoplasty. Body temperature decrease was dependent on the duration of the operative procedure. The longer the procedure, the greater change in temperature. There was no significant difference between the effects of the volatile anesthetic agents on patient's body temperatures.

Spinal Anesthesia with 0.5 % Plain Bupivacaine / 대한마취과학회지

Spinal Anesthesia employing 0.5% plain bupivacaine was administered to 40 patients scheduled for lower limb or perineum surgery at Kyungpook National University Hospital. Two different volumes(3 and 4ml) and 2 different injection sites(lumbar interspaces L2/3 and L3/4) were used and their effects were compared. The patients were divided into four groups of 10: group A received 3ml of bupivacaine at L3/4, group B 3ml at L2/3, group C 4ml at L3/4 and group D 4ml at L2/3. The results were as follows: No significant difference were found between the 4 groups of patients in relation to age, height weight and length of surgery. The time for maximal sensory spread was 18.0+/-7.15 and 18.5+/-7.84 minutes in group B and C (p<0.05) and 20.0+/-7.84 minutes in group D (p<0.01) which showed a significant increase compared with 11.0+/-5.6 minutes in group A. Significant differences(p<0.05) in maximal sensory spread levels were observed between group A, B(T9) and group C, D(T7). No significant differences were found among the four groups in relation to the time of maximal motor blockade. Complete motor block was observed in all groups 20 minutes after spinal injection. Changes in blood pressure and pulse rate showed a significant(p<0.05) decrease in 10~15 minutes, and a very significant(p<0.01) decrease 20~30 minutes after spinal injection. Four patients experienced hypotension or bradycardia and two patients developed nauses or vomiting, but none of the patients developed a postspinal headache or micturition difficulty.

Changes in SGOT and CK - MB Levels during for Open Heart Surgery Anesthesia / 대한마취과학회지

The purpose of this study were to investigate the changes in serum SGOT, CK and CK-MB levels and the significance of these changes during general anesthesia for open heart surgery. Fourteen patients, who had open heart surgery at Kyungpook National University hospital, were chosen at random their serum SGOT, CK and CK-MB levels were recorded before anesthesia(control group), pre cardiopulmonary bypass, during cardiopulmonary bypass and in the recovery room. The results were as follows: The serum SGOT levels were 21.83+/-4.91 IU/L, 27.20+/-11.83, 34.81+/-16.60 and 72.58+/-37.77, respectively. They very significantly increased (p<0.01) during cardiopulmonary bypass and recovery room compared with pre anesthesia. The serum CK levels were 58.07+/-6.31 IU/L, 91.79+/-44.58, 141.93+/-66.55 and 347.43+/-84.61 respectively. They significantly increased (p<0.05) at pre cardiopulmonary bypass, very significantly increased(p<0.01) during cardiopulmonary hypass and recovery room compared with the preanesthesia. The serum CK-MB levels were 0.00 U/L, 4.54+/-11.80, 14.66+/-17.61 and 80.07+/-34.72 respectively. They very significantly increased(p<0.01) during the cariopulmonary bypass and recovery room.

Comparison of Temperatures at Various Sites during Open Heart Surgery Anesthesia / 대한마취과학회지

Because wide swings in temperature can occur during cardiac anesthesia all patients undergoing cardiac anesthesia should have their temperatures monitered. This is especially true in situations where deliberate hypothermia during cardiopulmonary surgery is an area of controversy. This study of 20 cases of open heart surgery was undertaken to compare the changes in tympanic membrane, nasopharyngeal, rectal and great toe temperatures and of to evaluate their correlation during the induction, cardiopulmonary bypass, rewarming and post-cardiopulmonary bypass periods. The temperature at each site was monitored every 10 minutes for 60 minutes of each period. The results were as follows, During the induction period, the temperature of the tympanic membrane, nasopharynx and rectum decreased significantly(p<0.05~p<0.01), but the temperatures of the great toe temperatures increased for 20 minutes and then slowly decreased during the next 30 to 60 minutes. During the cardiopulmonary bypass period, the sympanic membrane temperatures which were best correlated with the nasopharyngeal temperatures(p<0.05~p<0.01), decreased faster than the rectal, nasopharyngeal and great toe temperatures. During the rewarming period, the tympanic membrane temperatures increased most quickly and were significantly correlated with the nasopharyngeal temperatures(p<0.05) only at 0 and 10 minutes. During the post-cardiopulmonary bypass period, the tympanic membrane and nasopharyngeal temperatures decreased slowly and were significantly correlated with each other(p<0.01), but the rectal and the great toe temperatures increased slowly.

An Anslysis of Operative Patients after Enforcement of Medical Insuranes System / 대한마취과학회지

12,688 cases of operative patients who received operation at kyungpook National University Hospital from Jul. 1977 to Dec. 1981 were analyzed according to each year, each surgical department, anesthetic technique, and the ratio of medical insurance patients after enforcement of medical insurance system. 1) Total operative patients were 12,688 cases including general patients 7,084 cases(54%) insurance patients 3,934 cases(31%), public assistance recipient 906 cases(7%), and industrial accident patients 764 cases(6%). 2) Total patients and insurance patients increased annually, while general patients decreased gradually. 3) Though regional and general anesthetic cases of general patients, decreased annually, those of insurance patients increased year by year. 4) Among the surgical department, the highest rate wwas neurosurgery 850 cases(73%) in general patients, E.N.T. 354 cases(54%) in insurance patinets, chest surgery 94 cases(17%) in public assistance recipient, and orthopedic surgery 350 cases(17%) in industrial accident patients. 5) E.N.T. department showed largest increase in insurance patients among surgical sections.

d-tubocurarine Anaphylaxis / 대한마취과학회지

Numerous reports of anaphylactoid reaction to d-tubocurarine have appeared since 1936. Also it has been suggested that histamine released as a consequence of clinical doses of d-tubocur arine is not in sufficient quantity to evoke symptoms. We recently had experience with a case who had of severe circulatory collapse and urticarial reaction while being anesthetized with ether and d-tubocurarine. This report draws attention to the risk of administering histamine releasing drugs and references are reviewed.