Severe Clonic Movement of Extremities suspected as Conversion Reaction after Continuous Epidural and General Anesthesia / 대한마취과학회지

Spontaneous shivering-like postanesthetic tremor occurs in about 40% of patients during recovery from all types anesthesia. Although most postoperative tremor is associated with intraoperative hypothermia, some is abnormal, centrally mediated thermoregulatory shivering. Conversion reactions are well known pathologic means to reduce uncontrolled anxiety and one of conversion symptom is clonic movement. 26-year old woman was brought to the operating room for surgery of ovarian cyst torsion. We had done combined continuous epidural and general anesthesia induced by pentothal sodium, succinylcholine, followed endotracheal intubation and maintained by inhalation of N2O-O2 (4: 2) We experienced severe localized clonic movement of upper extremities of the patient during recovery from general anesthesia. Clonic movement was not easily controlled by valium and naloxon. Patient had past history of unstable emotion and experienced pain during early period of epidural anesthesia, but her vital signs including body temperature were stable. We could not find any physical causes. Result of psychological review disclosed patient's clonic movement conversion reaction. Frequency and degree of clonic movement was reduced by psychiatric manipulation and lorazepam after 3 hours of recovery from anesthesia. Several episodes of clonic movement had developed at ward but she could discharged without any other complications.

A Clinical Survey of 1, 441 Anesthesia Cases over 60 Years of Age / 대한마취과학회지

To evaluate geriatric anesthetic experience, 1,441 cases of patients aged over 60 years. Out of 29,692 surgical cases admitted to St. Mary's Hospital from January 1971 to December 1980 were analyzed according to age, sex, surgery, preoperative condition, technique of anesthesia, duration of anesthesia, anesthetics, and mortality. The results were as follows: 1) The percentage of geriatric cases were 4.9% in average which ranged between 3.9% and 6.0% and showed steady numbers in this period. The distribution of the number of patient according to the age were 1,150 cases(79.8%) in the group of 60~69 years, 262 cases (18.2%) in 70~79 years, and 29 cases(2.0%) over 80 years. 2) There were 833 male(57.8%) and 608 female(42.2%) cases. 3) 833 cases(57.8%) were in general surgery: the most prevalent diagnosis were empyema of gallbladder and cholelithiasis which amounted to 195 cases(13.6%) 4) The rates of elective to emergency surgery were 75.4% (1086 cases) to 24.6%(355 cases). 5) Premedicants were mainly atropine with sedatives(785 cases, 61.2%) and atropine with analgesics(220 cases, 17.1%). 6) Preoperative hemoglobin level ranged between 10.1 and 12.0gm/dl in 40.1% of the patients. 7) The techniques of anesthesia were (1,234 cases, 85.6%) general anesthesia, (75 cases, 5.2%) intravenous anesthesia and spinal anesthesia(60 cases, 4.2%). 8) The duration of anesthesia (500 cases, 34.7%) were 1~2 hours in average. 9) The inhalation anesthetics were Halothane(1,110 cases, 90.0%) , Methoxyflurane(112 cases, 9.1%), N2O (6 cases, 0.5%), and Ether(6 cases, 0.5%). 10) The preoperative chest X-ray and clinical signs showed that 963 cases (54.3%) were normal. 159 cases(10.6%) had emphysems, 152 cases(10.1%) had pulmonary tuberculosis and 41 cases (2.7%) had bronchitis. 11) The preoperative EKG and clinical symptom revealed that 952 cases(62.1%) were normal in cardiovascular aspect, 23 cases (15.1%) showed hypertension, 124 cases(8.1%) had arrhythmis, and 79 cases(5.2%) had myocardial ischemia. 12) During the surgical procedure cardiac arrest were experienced in 5 cases(0.3%) and sudden hypotensive pisods in 18 cases, which were successfully resuscitated. There were no operative mortalities within 48 hours. In summary, the patients over the 69 to 80 age group had a poor surgical risk, but they were able to withstand this risk when properly managed with modern anesthesia.