AnaIysis of Anesthesia for Total Correction of TOF / 대한마취과학회지

TOF is a congenital cyanotic heart disease which has severe physiodynamic changes in the cardiovascular system. The anesthesiologist should be able to manage the anesthesia for open heart surgery, be aware of the operation procedure, and have knowledge and experience to cope with the unpredictable changes of the patient's condition during operation. One hundred open heart anesthesias have been performed in BNUH from July 1981 to August 1983, of which 17 cases of anesthesia for total correction of TOF were analyzed and the following results were obtained. 1) It was difficult to predict the prognosis for the patient after open heart anesthesia by the chest X-ray, echocardiogram or electrocardiogram. 2) Anesthesia were performed by the combination of halothane-N2O0morphine as the main anesthetic agents. 3) Postoperative complication were wound infection(4 cases, 14.3%), arrhythmia(3 cases, 10.7%), low cardiac output syndrome(3 cases, 10.7%) and cardiac arrest (3 cases, 10.7%). 4) In 7 cases of death, the causes of death were low cardiac output syndrome(3 cases, 43.9%), heart failure (2 cases, 28.5%), renal failure (1 case, 14.3%) and aneurysmal rupture (1case, 14.3%).

Effects of Glycopyrrolate and Atropine on Heart Rate During Anesthesia for Strabiemus Surgery in Children / 대한마취과학회지

The objectives of this study were to investigate the efficacy and dose-effect relationship for glycopyrrolate in the suppression of the oculocardiac reflex, and to compare glycopyrrolate with the reported equivalent dose of atropine. Glycopyrrolate 5 and 7.5ug/kg and atropine 10 and 15ug/kg were studied in 40 paediatric patients to assess more fully the dose of glycopyrrolate required for adequate prevention of the oculocardiac reflex. The results obtained were summarized as follows: 1) The increase in the mean heart rate 5 min after the test drug was statistically significant in all of the four groups. 2) Both drugs showed a dose-related response for reduction in slowing of heart rate after rectus muscle traction. 3) There is great individual variation in response to muscle traction within each group, no group being fully protected from marked slowing in heart rate. 4) The frequency of arrhythmias with low doses of both drugs was more than in high doses with both drugs.

The Effects of an Intravenous Drip of Ketamine Hydrochlor ide in the Poor Risk Surgieal Patients / 대한마취과학회지

The author observed the effects of an intravenous drip of ketamine hydrochloride to 60 patients with in high surgical risk who had undergone abdominal surgery at Pusan National University Hospital from March, 1981 to February, 1982. The results obtained were follows. 1) Average duration of anesthesia was 148 minutes and the rate of intravenous drip of ketamine was ranged from 0.017 to 0.02mg/kg/min. Total dose of ketamine was 264.2mg on and average. 2) Significant increase in blood pressure and heart rate was observed in the ketamine drip group during the operation (p<0.05). 3) Changes in values of arterial blood gas analysis during ketamine drip were within normal limits. 4) Duration from anesthesis to awakening in recovery room was longer in ketamine drip group than thiopental-halothane group. 5) Psychotomimetic symptoms after ketamin administration included convulsions, discomfort, and hallucinations etc. and diazepam premedcation could not completely relieve the above symptoms. 6) Relief of postoperative incisiional pain was excellent in ketamine drip group.

Brachial Plexus Block with Bupivacaine Hydrochloride / 대한마취과학회지

General anesthesia has been improved technically and applied in a wide field of surgery, but the undesirable side effects of inhalational anesthetics and its adjuvants such as muscle relxants have frequently claimed our attention in current anesthetic practice. For these reasons, various techniques of brachial plexus block have been developed for the purpose of surgical, diagnostic and therapeutic procedures. The short duration of local anesthetics requires repeated drug administration for a long lasting operation, therefore drug overdosage may cause toxic reaction. Recently introduced bupivacaine hydrochloride(Marcain), an anilide derivative, has longer duration of action and higher potency than other local anesthetics. Brachial plexus block with bupivacaine hydrochloride and lidocaine was performed on 166 patients undertaking various surgical operations for upper extremities at the Department of Anesthesiology, Pusan National University Hospital form October, 1981 to Mary, 1982, the results were summarized as follows: 1) 156 cases of a total 166 patients had successful operations under brachial plexus block but remained the remaining 10 cases required general anesthesia. 2) There were 9 cases of pulmonary diseases, 17 cardiovascular diseases and 2 nephritis in the preoperative evaluation of the patients. 3) The average duration of analgesia for lidocaine and bupivacaine hydrochloride group was 180 and 360 minutes respectively. 4) Complications and side reaction of brachial plexus block included 3 cases of pneumothorax, 15 Horner's syndrome, 2 hematoma formation and 1 toxic sign.

The Effect of Intratheeal Morphine Administration on Postoperative Pain Relief in General Anesthesia / 대한마취과학회지

After abdominal surgery, it is well known that a significant decrease in ventilatory function, arterial oxygenation, and coughing ability occurs and this may lead to retainment of bronchial secretions and eventually atelectasie. The author selected 32 patients who received abdominal surgery under general anesthesia. A small dose of morphine was administered intrathecally before induction of general anesthesia, in an attempt to relive postoperative pain. The development of pain was observed until it was sufficient enough to require intramusclar or intravenous injections of analgesics. The results of this study were as follows: 1) A small dose of intrathecally injected morphine did not affect postoperative arterial blood pressure and respiratory rate of the patients. 2) Fifty percent of the patients required no analgesics for pain control within 24 hours of postoperative periods. Intrathecal dose of morphine from 0.1 to 0.3 mg had the similar effect for the postoperative pain control. 3) Central nevous system depression was not noted, but side effects such as nausa(44%) and pruritus(19%) were commonly observed.

A Clinical Observation on the Effect of Intrathecal Morphine Hydrochloride in Abdominal Surgery / 대한마취과학회지

The author made a clinical study of postoperative respiratory function and analgesic effect of intrathecal morphine HCI which had been administered to 40 of a total 80 adult male and female patients who underwent abdorminal operation with spinal anesthesia from March, 1980 to September, 1981 at Department of Anesthesiology, Pusan National University Hospital. The results obtained were as follows: 1) Vital capacity during 6 to 12 hours after operation was significantly increased in patients given intrathecal morphine as compared with other groups of patients. 2) Patients given intrathecal morphine showed a significant increase in tidal volume during 6 hours after operation. 3) There was no significant change in the level of arterial oxygen tension at pre-and postoperative period in all groups of patients. 4) The average duration of postoperative analgesia was 33.6 and 33.8 hours respectively in patients who were given intrathecal morphine.

Recovery from Cardiac Arrested Patiens due to Intracardiac Stab Wound by Electric Defibrillator / 대한마취과학회지

Recently, there was improved cardiopulmonary resuscitation in parallel with development of electric defibrillator. This 18-year-old male arrived at our hospital emergency room in shock state about 1 hour after trauma. Cardiac arrest was occurred at operating table. Promptly, open thoracotomy was performed under endotracheal intubation. There was found left ventricular laceration about 3cm in length, therefore primary closure of lacerated ventricle was done and open cardiac message, too. But ventricular fibrillation was remained. Myocardial fibrillation was disappeared after operation of defibrillator internally at 20 W/sec and 40 W/sec for 30 minutes. Thereafter, operation was finished successfully. This patient was admitted in our hospital for 32 days and discharged.

The Clinical Observation on the Volume of Blood Transfused during Anesthesia / 대한마취과학회지

To avoid untoward reactions from blood transfusions and to make the best use the limited supply of blood, anesthesiologists must seek the most logical indications for blood transfusion. The study was carried out on 973 patients who received blood transfusion during anesthesia among a total of 3510 operative cases, from January to December 1980. The results obtained were as follows: 1) In the age distribution of the 973 cases who received transfusion 599(61.6%) case were in the 3rd, 4th and 5th decade. 2) Among the 973 cases, the department of orthopedic surgery had 274 cases(23.2%) general surgery 211 cases(21.7%) and neurosurgery 162 cases(16.6%). 3) For the preperative hemoglobin level, 641 cases(65.9%) were within the 10~15 gm/dl range and 273 cases(23.4%) had 5~10gm/dl. 4) In the total of 2684 units of transfused whole blood, 1138 units(42.4%) were in elective and emergency surgery of the abdomen. *Unit (Whole blood 320ml, ACD solution 80ml). 5) The amount of transfused whole blood for elective and emergency surgery was 1596 units(59.5%) and 1088 units(40.5%) respectively. 6) Of the 47,480 units from the Blood Bank of Pusan Red Cross, 9435 units(19.9%) were supplied to BNU hospital and 2684 units(5.7%) were used during anesthesia in the surgical theater. 7) In the total of 2931 units of whole blood 247 units were not used in the operative theater. 8) In the comparison of the number of transfused units of blood, one unit of whole blood was given to 266 cases(27.3%), 2~5 units for 536 cases(55.1%), 6~10 units in 75 cases(7.7%), and more than 11 units were given in 19 cases(2.0%), 77 cases(7.9%) were not transfused during anesthesia. 9) In the total of 896 recipients, urticaria occurred in 78 cases(8.7%).

The Clinical Study of Liver function in Operative Patients / 대한마취과학회지

Since ether was first introduced in Boston in 1846, many kinds of anesthetic techniques and agents have been developed. At the same time, there have been many controversies about the side effects following the use of anesthetic agents and they are studied actively by many investigators at the present time. The author chose 355 patients randomly who had received elective operation at the Pusan National University Hospital from October 1980 to March 1981 and made a study of their preand post-operative liver function test. The patients were divided into 3 groups and 214 the patients belonging to group l were anesthetized with general anesthesia and group 2 comprising 118 patients had spinal anesthesia and brachial plexus block was used in the group 3 of 23 patients. The results obtained were as follows: 1) The male to female ratio was about 3 to 2 (209 cases: 146 cases) and age distribution showed a range from 20 to 50 years(210 cases). 2) Pre-operative liver function test of group 1,2, and 3 proved to be abnormal in 75 cases, 23 cases, 6 cases respectively. 3) In patients of group 1, halothane alone(54 cases) and halothane with nitrous oxide(111 cases) were the most commonly used anesthetics. 4) Post-operative checkup of liver function test of 10 patients who were randomly selected from each group and who had previously had normal liver functions, 4 cases of group 1 turned out to be abnormal, but patients in group 2, and 3 showed no significant abnormality in the post-operative liver function test. 5) Anesthesia aggravated liver dysfunction of the patients of group l who had abnormal liver function prior to operation, but it returned to the pre-operative level within 10 days after operation.

Clinical Observation of the Comatose Patiente in the Postoperative Period / 대한마취과학회지

The etiology of postoperative unconsciousness is p is various in origin. From Jan. 1973 to May 1981, 14 unconscious patients via the emergency room were treated in the intensive care unit at Pusan National University Hospital. The results are summarized as follows: 1) Sex distribution was 5 males and 9 males, and the age distribution was from 7 to 54. 2) The type of surgery were mainly hystrectomy and oophorectomy(6 cases) and the others were appendectomy(4 cases), gastrectomy(1 case), Cholecystectomy(1 case), and anal fistulectomy( 1case). 3) Seven cases were performed under spinal anesthesia, 6 cases were under inhalation anesthesia, and 1 case was done under Ketamine Hcl intravenous anesthesia. 4) On arrival at ICU, 12 patients were fully comatose and the others were semicomatese. 5) Meperidine was injected in 4 cases for the purpose of postoperative pain relief. 6) Ten cases expired, 3 cases recovered and 1 case was discharged without hope.

General Anesthetic Experience for Removal of Trscheobronchesl Foreign Bodies / 대한마취과학회지

The authors analyzed a total of 49 cases of general anesthesia for the removal of tracheo bronchial foreign bodies, from Jan. 1970 to Aug. 1980. The results were as follows; 1) Sex distribution was 36 males(73.5%) and 13 females(26.5%). 2) Age distribution was 14 cases under 1 year and also 14 of 1-3 year olds(total 57. 2%). 3) Anesthetic agents were halothane, 32 cases(65.3%), diethyl ether, 9 cases(18.4%) and others. 4) The kinds of foreign bodies were peanuts in 24 cases(49.0%) and the others were various. 5) The sites of foreign bodies were Rt. main bronchus 29 cases(59. 2%), Lt. main bronchus in 12 cases of(24.5%), trachea 7 cases(14.3%) and vocal-cord 1 case(2.0%). 6) Anesthetic duration was within 1 hour, 41 cases(83. 7%). 7) Complications during operation were tachycardia in 36 cases. 8) Postoperative pulmonary complications were pneumonia, 4 cases and 1 case each of pyothorax, atelectasis and death.

Clinical Observation of Toxicity in Local Anesthetics / 대한마취과학회지

Frequently local anesthesia csn be a more useful method than general anesthesia for simple operations, but numerous complications have been reported. High blood level of the drug injected causes the majority of reactions, probably 99% or better, and alIergy to the drug employed comprises a very small fraction, probably less than 1%. The authors treated 5 cases of cardiopulmonary arrest and convulsion due to generalized toxicity of local anesthetics. In 5 cases, 4 patients recovered, but one patient expired. It can be emphasized that careful administration of agents and proper treatment for convuIsion is indicated.

Exylosion of Oxygen Delivery Tube Connected to Anesthesia Machine / 대한마취과학회지

In comparison with other hazards of anesthesia, fires and explosions occur very infrequently because of precautions for their prevention so that they are relatively insignificant. The authors had experience of a case of explosion with fire in an oxygen delivery tube and the wrapping cloth of the oxygen cylinder. A piece of plaster used for prevention of leakage from the oxygen delivery tube occluded the filter in a pin-index system of an anesthesia machine. It is suspected that adiabatic compression may produce a momentary temperature of over 900 degrees C in an occluding part, thus igniting minute particles detached by the gas stream from the walls of the oxygen delivery tube. In case of malfunctioning in anesthetic apparatus, it should be repaired only by expert engineers.

Clinical Observations of Anesthesia on Cesarean Section / 대한마취과학회지

The following are summary of the clinical observations on 184 pregnant women underwent cesarean section under general and spinal anesthesia. 1. Ages of pregnant women ranged from 18 to 45 years The second and third decades. comprised 94% of all cases. 2. 83% of the cases were emergency and others were elective operations. 3. Surgical indications revealed dystocia in 43%, hemorrhage in 35%, and others in 22%. 4. 92 cases were performed by general anesthesia, 88 cases by spinal and the remains by local. 5. Apgar scores checked one minute after delivery were as follows. That was Poor category (0 to 4): 42% Fair category (5 to 7): 19% Good category (8 to 10): 39% Resuscitation of Apgar score 0 babies were successful in 8 cases.

Statistical Analysis of the Postoperative Mortality / 대한마취과학회지

We experienced 4,945 cases of surgical operation at the Busan National University Hospital from Jan. 1966 to Dec. 1970. The cases that expired within the first 24 hours pastoperatively, were recorded as the postoperative death in this analysis. Thus, postoperative deaths were 126 cases, comprising 2,6 per cent of all the surgical operation. Emergency operation was 119 cases and neurosurgery was 90 cases among 126 cases, Above results imply that more careful attention and efforts to every emergency and neurosurgical case were needed.

Treatment of Comatous Patient following Spinal Anesthesia: Cases / 대한마취과학회지

Authors experienced three cases of comatous patient, accompanied with headache and convulsion following spinal anesthesia for hysterectomy, reduction of intuegussuption and appendectomy in the private clinics. Three cases suspecting chemical or asceptic meningitis were treated under the proper fluid and symptomatic therapy with oxygen inhalation and maintenance of airway. One case which had cardiopulmonary arrest at the private clinic, died after two days' admission. Two cases recovered within 4 and 7 days without any specific neurological complications .

An Experience of Anesthesia for a Case of Renovascular Hypertension / 대한마취과학회지

Authors experienced an anesthesia for aortorenal shunt operation for renovascular hypertension caused by atherosclerosis in a 38-year-old male. Tracheal topical anesthesia with 4% lidocaine was performed prior to induction of anesthesia with intravenous thiopental sodium and nitrous oxide-oxygen by mask. Semiclosed circle system with nitrous oxide-oxygen-halothane was used in the maintenance of anesthesia. Blood pressure and pulse rate were increased during manipulation of perirenal tissues in spite of administration of high concentration of halothane with nitrous oxide-oxygen and controlled respiration under positive pressure.

General Anesthesia for Congenital Esophageal Atresia with Tracheo-esophageal Fistula - Report of two cases / 대한마취과학회지

The authors have experienced two cases of general anesthesia for operation of congenital tracheo-esophageal fistula and the results were obtained as follows. 1. The anesthetic agent should be selected as considering of lesser irritating to respiratory system and smaller amount of tracheobronchial secretion. 2. The infant circle absorber system has been preferred to the Ayres T-piece apparatus, because maintaining normal body temperature and removal of carbon dioxide easily. 3. Removal of secretion from trreheobronchial tree, intermittent positive pressure breathing, maintaining normal body temperature and humidity were thought to be necessary for the prevention and treatment of postogerative pneumonia or atelectasis.

Pulmonary Resuscitation on a Case of Respiratory Arrest due to Possible Acute Alcohol Intoxieation - A Case Report / 대한마취과학회지

A patient who had been admitted to the B.N.U.H. with coma and respiratory arrest from possible acute alcohol intoxication, has been treated with intensive care and discharged without any complication. It should be emphasized that a patient with respiratory arrest even due to unknown etiology must have continued intensive care, without giving up the patient.

Pulmonary Resuscitation on a Case of Respiratory Arrest due to Possible Acute Alcohol Intoxieation - A Case Report / 대한마취과학회지

A patient who had been admitted to the B.N.U.H. with coma and respiratory arrest from possible acute alcohol intoxication, has been treated with intensive care and discharged without any complication. It should be emphasized that a patient with respiratory arrest even due to unknown etiology must have continued intensive care, without giving up the patient.