Intrathecal Block with 10 % Phenol-Glycerine for Cancer Pain / 대한마취과학회지

Since 1979 forty-three cancer patients have been given intrathecal block at the pain clinic of Yonsei Medical Center. The male patients numbered 23 and female 20 and most of them were in the 4th and 5th decades of age. In 78.6% of the patients, the diagnosis was rectal cancer in 20 cases, cervix cancer in 7 cases, bladder cancer in 4 cases and colon cancer in 3 cases. Thirty six patients with cancer pain were treated by intrathecal 10% phenol-glycerine block and rest of them had only test block. Fourteen patients whose pain sites were lumber or lumber and upper sacral dermatomes were put into the lateral recumbent position on the fluoroscopic table. The spinal puncture was performed as close to the spinal roots to be impregnated as possible. In 22 patients the pain sites were covered by the sacral dermatomes and so the L5-S1 interspace was punctured in the sitting position shifted 15 degree to the affected site. Fifty one blocks were performed and their results are classified into three categories: good, fair and poor. We achieved good results in 38 patients(77.1%), fair in 6 patients(17.1%) and poor in 2 patient(5.7%). Thus a satisfactory pain relief was achieved in 94.2% of patients. After intrathecal block with phenol glycerine, transient voiding difficulty was noted in 7, defecation difficulty in 1, and transient paresthesia and/or muscle weakness was present in 3 patients. The mean duration of pain relief was 2.5 months and longer than the mean survival time of 2.25 months. When patients are selected carefully and the block is performed with great caution and good technique, the risk is minimal and a long lasting relief of intractable cancer pain achieves a patinless life until death.

Severe Hypotension and Cardiac Arrest following Methylmethacylate Bone Cement during Total Hip Replacement / 대한마취과학회지

Introduction of acrylic cement during total hip replacement has become popular in the las 30 years. Sometimes it precipitates severe hypotension and cardiac arrest, and may be due to toxicity of methylmethacrylae monomer. Fat embolism, air embolism, or neurogenic reflex may be other possible causes of the hypotension. The anesthetist should keep in mind these risk factors, and to prevent these adverse effects, the central venous pressure line, esophageal sterthoscope or Doppler ultrasonic transducer, and adequate fluid volume maintenance are required. We have experienced two cases of complication following bone cement insertion: One case developed severe hypotension and the other case cardiac arrest. The former occured under epidural anesthesia and the latter under general anesthesia after prosthetic implantation in a total hip replacement.

Clinical Survey of Pstients in the Intensive Care Unit / 대한마취과학회지

The ICU at Severance Hopital was opened with 7 beds on October 18, 1968 and expanded to 19 beds on February 2, 1981. From 1970-977, We statistically analyzed 3,072 ICU patients. During the period of years from March 1975 to February 1982, We have analyzed clinically 4,348 ICU patients. The Results were as Follows: 1) During the 7 years the total number of patients was 4,383. ln 1981, 1063 patients were admitted to the ICU: this number being almost twice that of in 1980. 2) During the 7 years, the overall mortality was 15.1%, highest in 1976(30.1%) and lowest in 1979(11.5%). It has decreased annually, 12.4% in 1980, 12.3% in 1981. 3) Total admission days in ICU were 18,148 days, the average patient stay in ICU being 4.17 days. The majority of the patients(81.2%) stayed in ICU less than 5 days. The number of patients staying in ICU more than 6 days increased every year from 14.2% in 1975 to 22% in 1981. 4) About 50% of the patients admitted were under the forties-age group. The number under the teens old group was 19%, this group representing the highest number of patients admitted to the ICU. The highest mortality(18.5%) occurred in the 1 to 10 yearold-age group. 5) The number of patients admitted to the department of internal medicine was 1,574 cases, which was the highest among all departments. The mortality rate was highest in the neurosurgery department(41.9%). In 1981, the number of ICU patients in cardiac surgery and pediatrics was increased three time compared with that of 1975. 6) All ICU patients have been divided into two categories, operative and non-operative cases. The operative cases were 2,150, non-operative cases 2,198 cases. Mortality rate was 10% in operative cases, 20% in non-operative cases. 7) Case expired from march 1981 to February 1982: The number of expired parients including those with a poor prognosis was 183 cases. The number of patients that expired under the 10-year-age group was the highest, 78 cases. The cases that expired in internal medicine and pediatrics were 63 and 58 cases respectively. The causes of death were due to damage of central nervous system, cardiovascular system, respiratory system in that order. From the above results, it can be concluded that in spite of an increase in patients, the mortality rate has decreased annually.

Postoperative Pain Relief using Epidural Morphine / 대한마취과학회지

Postoperative pain relief and the side effects of epidurally injected morphine were investigated in 164 patients who received various types of operation including abdominal, genitourinary and lower extremities. Epidural morphine injection was given via an epidural catheter after operation. In 58% of total patients, pain relief was considered excellent, good in 30% and fair in 12%. The analgesia of each dose of epidural morphine lasted for 13 hours with everage. The side effects of epidural morphine were few and mild but urinary retention was in 9.8% of total patients, respiratory depression, pruritus, vomiting, catheter obstruction, catheter dislogement and bleeding through the catheter in one case respectively.

Adult Respiratory Distress Syndrome Following Trauma - Case report / 대한마취과학회지

Adult respiratory distress syndrome(ARDS) is described under various names in the medical literature: post-traumatic pulmonary insufficiency, wet lung. DaNang lung and shock lung etc., and the syndrome has been used to describe a serious and often fatal conditions which may develop in any patient subjected to severe trauma, major surgery or critical illness. ARDS is characterized by increasing intrapulmonary shunting, increasing work of breathing and decreasing lung compliance. There is still desagreement about exact nature of ARDS as well as its care and revention. In ARDS, the use of positive end-expiratory pressure(PEEP) has been widely debated since its introduction by Ashbaugh and Petty in 1969. Its purpose is to increase the lung volume, especially functional residual capacity at end expiration in order to obtain better alveolar expansion and improved pulmonary gas exchange. This report described two cases of ARDS following trauma, and respiratory care problems were reviewed and discussed.

Anesthetic Management for Reconstruetive Surgery of Tracheal Stenosis using Cardiopulmonary Bypaas / 대한마취과학회지

Tracheal stenosis is now a well-recognized, and very serious complication following increased use endotracheal tubes of tracheostomies with air inflated cuffed tubes and assisted ventilation. Up to 10% of patients surviving treatment have been reported to develop stenosis following closure of tracheostomy and some prospective studies predict a 16~20% incidence of stricture following prolonged cuffed tube ventilation. The most important principle is prevention. Once stenosis is established, the logical approach is resection of the stenotic segment and reestablishment of an adequate airway by primary anastomosis or the insertion of a tracheal substitute. In this regard, Pearsor, Grillo, Naef and Binet have made major contributions to the technique of reconstruction of the tracheo-bornchial tree after extensive resection. Strictures are described both in the region of the stoma and at the level of the inflatable cuff. Anesthetic management of these patients should focus on maintenance of the airway and adequate ventilation. If not, hypoxia or cardiac arrest can occur during a prolonged operation due to alvsolar hypoventilation. Extracorporeal circulation for tracheal stenosis reconstruction was first used by Woods for prevention of hypercarbia and hypoxia. The Department of Anesthesiology of Yonsei University has had experience in the anesthetic management of two cases of tracheal stenosis reconstruction using extracorporeal circulation during surgery, these cases are reported along hear with references from the literature.

The Effects of Trimethaphan on Responses of the Cardiovascular System During Endotracheal Intubation / 대한마취과학회지

Tachycardia and hypertension are well documented complications of laryngoscopy and tracheal intubation in normal patients(Reid and Brace, 1940; Burstein et al, 1950; King et al 1951; Takeshima et al, 1964; Forbes and Dally, 1970). This phenomenon has been studied in detail in cats by Tomori and Widdicombe(1969), who found it to be associated with an increased impulse traffic in the cervical sympathetic efferent fibers. This nervous activity was especially increased by stimulation of the epipharyngeal and laryngopharyngeal regions, and was accompanied by the largest hypertensive response(Takki et al, 1972). Also various arrhythmias were elicited by vagal stimulation during endotracheal intubation(Burstein et al, 1950: King et al, 1951; Forbes et al, 1970), and it has been known that cardiac arrest could be observed in severe cases(Burstein et al, 1950; Dwyer, 1953; Raffan, 1954; Lander and Mayer, 1965). That hypertension during induction of anesthesia in critically ill patients may be harmful is substantiated by reports of cerebral hemorrhage, left ventricular failure and life threatening cardiac arrhythmia(Forbes and Dally, 1970; Dingle, 1966; Masson, 1964; Katz and Bigger, 1970). Pharmacologic attempts to attenuate these blood pressure and heart rate elevations and appearances of arrhythmia have been tried but theese approaches have been only partially successful. We selected at random 60 adult patients who had received operation under the general anesthesia with intubation at Severance Hospital from August to September, 1979. They were divided into 4 groups. Group l was normotensive without trimethaphan(n=20), Group ll was normotensive with trimethaphan(n=20), Group ll was hypertensive without trimethaphsn(n=10) and Group lV was hypertensive with trimethaphan(n=10). The changes of arterial blood pressure and pulse rate, and appearance of arrnythmia were analyzed and data were compared between groups. The results were as follows; 1. In the trimethaphan injected group, during induction attenuation of increase in blood pressure was not significant in the normotensive group but was statistically significant in the hypertensive group. 2, The effects of trimethaphan on changes of pulse rate were not significant during laryngoscopic insertion under general anesthesia. 3, On EKG of hypertensive patients the trimethaphan injected group revealed fewer abnormal EKG findings than the control group. It is suggested from the above results that intravenous injection of a small amount(0.1 mg/kg) of trimethaphan in a hypertensive patient just before endotracheal intubation can be used as one method to prevent a dangerous hypertensive crisis.

Anesthetic Experiences with 16,457 Cases / 대한마취과학회지

To compare geographic differences in anesthesia between Wonju City and another city, Seoul, anesthetic experiences of a total of l6,457 cases performed at the Department of Anesthesiology of Wonju Christian Hospital, Yonsei University Medical College, from Nov. 1957 tO Dec. 1977 were analyzed statistically according to age, sex, physical status, emergency operation, anesthetic agents and methods and complications. The results are as follows: 1) The cases of anesthesia tended to increase year by year and the rate of increasing was remarkable in female patients. 2) Sexual distribution was 8994 cases of males(54.7%) and 7463 cases of females(45.3%). 3) 44. 5% of cases were of patients in the 2nd to 4th decade of age and the patients under 10 years and over 60 years of age tended to increase. 4) The patients in general surgery were more than half of the total cases and the patients in neurosurgery tended to increase. 5) General anesthesia was given to 91. 6% of total cases, and regional anesthesia to 8.4%. 6) Ether anesthesia was used in about 67% of all surgical patients. 7) About 30% of total cases were emergency cases. 8) Of ll cases of cardiac arrest, 7 cases were successfully resuscitated.

A Clinical Study of Halothane Induced Hypotension for Intracranial Aneurysm Surgery / 대한마취과학회지

For lesions like intracranial aneurysms which are located near highly vascularized regions, adequate dissection becomes almost impossible unless local blood flow can be reduced. Deliberate hypotension, purposefully lowering the arterial pressure to a level at which bleeding is no longer a problem, facilitates surgery, allows performance of a better dissection, and shortens the length of the procedure. Currently, the most useful method for induced hypotensive anesthesia is the use of chemical drugs, such as trimethaphan, nitroprusside and halothane. Induced hypotension with halothane has been reported to be a relatively safe and useful method by Murtagh (1960) and Schettini, et al (1967). Halothane has the effect of depression of myocardial contractility, central autonomic inhibition, ganglionic blocking action and suppression of the peripheral actions of norepinephrine and direct vasodilation on the vessel wall. The advantage of halothane is the reduction of mean arterial pressure slowly (1-3 mm Hg/min) and it has a transient effect on EKG, little effect on brain cortical function and appropriate oxygen supply to brain tissue. The halothane induced hypotension in 100 cases of intracranial aneurysm surgery, which were performed at Severance Hospital of the Yonsei University College of Medicine from .1972 to 1977, was investigated clinically. The results of our study were as follows: 1) The locations of intracranial aneurysm in order were the anterior cerebral artery (37 cases), internal carotid artery (35 cases), middle cerebral artery (23 cases) and posterior cerebral artey (2 cases). Three cases of multiple cerebral aneurysm were found in our study. 2) In the hypotensive phase, the mean systolic and diastolic pressures were 73. 45 mmHg+/- 0. 86, 54. 95 mmHg+/- 0. 86 and the mean duration was 34. 74 min+/- l. 60. 3) The blood pressure control by halothane was comparatively easy and there was no cliaical evidence of direct injury to the brain, heart, kidney and liver due to halothane induced hypotension. 4) The mortality rate in the 100 cases of the intracranial aneurysm was 16 percent. From the above observation it may be concluded that the technique of deliberate hypotension induced by halothane anesthesia is a useful method in the surgery of intracranial aneurysm.

Anesthetic Management of Pheochromocytoma employing Methoxyflurane as a Primary Anesthetic Agent / 대한마취과학회지

Various anesthetic agents have successfully used for patients undergoing surgery for pheochromocytoma removal. A review of the literature on the anenthetic marnagement of pheochromocytoma discloses no general agreement regarding choice of an anesthetic agent. It would appear that the selection of the anesthetic agent is not as important as the proper management of the patient Previously the anesthetic experience of a case of pheochromocythma removal managed under methoxyflurane anesthesis has been reported by us. Thereafter we have had another five eases of pheochromocytoma removal operation under general anesthesia, employing methoxyflmrane as a primary anesthetic, with relatively satisfactory results.