Adverse Effect of Absolute Alcohol Embolization in a Patient with Pelvic Arteriovenous Malformation: A case report / 대한마취과학회지

Generally, absolute alcohol embolization has been commonly used for treatment of arteriovenous malformation (AVM) because complete surgical extirpation of AVM can be an extremely hazardous and difficult. Even if absolute alcohol is safe embolic agent, it can result in pain, pulmonary hypertension, pulmonary embolism and post-embolization syndrome such as nausea, vomiting, hemolysis and myoglobinuria. So, general anesthesia is needed for alcohol embolization. In this case, anesthesia was induced with intravenous (IV) propofol 110 mg and succinylcholine 60 mg and maintained with propofol and vecuronium. The pulmonary artery pressure was monitored with a Swan-Ganz catheter. After alcohol injectons, systolic pulmonary artery pressure was increased, ranging 35-40 mmHg. And cola-colored urine was noticed. For treatment of pulmonary hypertension, nitroglycerine was given IV. The IV fluid rate was increased and furocemide was given IV to increase the urine output. After general anesthesia, the patient was awake but appeared to be alcohol-intoxicated. Blood alcohol level was 42 mg/dl. Urinalysis showed large amounts of myoglobin, hemoglobin and albumin. So, anesthesiologists have to keep in mind of such complications when absolute alcohol embolization is done.

Hemodynamic Effects of Combination of General and Caudal Anesthesia in Children / 대한마취과학회지

BACKGROUND: Caudal anesthesia has gained wide acceptance in pediatric anesthesia as a technique for providing postoperative pain relief and reducing general anesthetic requirement for surgical procedures below umbilicus. Although blood pressure has been shown to be well maintained with caudal anesthesia in pediatrics, little is known about the change in hemodynamics with combined general and caudal anesthesia. This study was designed to investigate the hemodynamic changes of combined general and caudal anesthesia for lower abdominal surgery in children. METHODS: Sixty children scheduled for lower abdominal surgery were involved. They were randomly divided into 2 groups: group G (n = 30); anesthesia with enflurane and N2O, and the group GC (n = 30); anesthesia with combined caudal block using 1% lidocaine 1 ml/kg and enflurane. Systolic (SBP), diastolic (DBP), mean blood pressure (MBP), and heart rate (HR) were measured at the 6 different time periods; at before induction (T1), just before skin incision (T2), just after skin incision (T3), 5 min (T4), 10 min (T5), and 30 min (T6) after skin incision. RESULTS: There were no significant differences in variables of hemodynamics between both group. Compared with the values at T1, those of SBP, DBP, and MBP at T2, T3, T4, T5, and T6 were decreased in both groups. However, there were no difference in those values at the same time periods between the two groups. The values of SBP, DBP, and MAP at T3, T4, T5, T6 in group G were higher compared with those at T2. CONCLUSIONS: From these results, we concluded that there were no significant changes in hemodynamics by combined general and caudal anesthesia in pediatric patients.

Cardiac Arrest due to High Concentration Epinephrine Soaking on the Nasal Mucosa during Halothane Anesthesia / 대한마취과학회지

There is increasing tendency to use epinephrine injection or topical application to obtain clear operative field and hemostasis under general anesthesia. Even if the surgeons can get the good operative field for surgery, it is well known that the anesthetic problem may be anticipated due to using epinephrine under the halothane anesthesia. We experienced a case of cardiac arrest during halothane anesthesia due to inadvertant soaking with high concentration epinephrine cotton on the nasal cavity. The patient was resuscitated immediately and followed up carefully. Because the nasal cavity is in high vascularity, only soaking of epinephrine can cause cardiac arrest, so it well be preferable to have some attention for using the high concentration of epinephrine on the specific area.

Cardiovascular Effects of Epinephrine Administration for Hemostasis to Pediatric Patients for Tonsillectomy during Halothane Anesthesia / 대한마취과학회지

Epinephrine induced cardiac dysrhythmias and cardiovascular responses during halothane anesthesia for 70 pediatric tonsillectomy cases were observed at Taegu Catholic Medical College from January to July, 1991 We have evaluated the frequencies of cardiac arrhythmia, and the changes of heart rate and blood pressure according to the administration of epinephrine for the purpase of hemostasis on the operating fields. All patients were divided into 3 groups as follows: Group I; Epinephrine used under halothane anesthesia(n=30). Group II; Epinephrine used under halothane anesthesia with fentanyl(n=20). Group III; Epinephrine used under halothane anesthesia with fentanyl, but shut-off the halothane inhalation briefly(n=20). The results were as follows: l) Systolic blood pressure, Increases of systolic blood pressure were observed in all groups compared with pre-injection state and there were statistical significances in group L 2) Heart rate; Decreases of heart rate were observed in group III compared with pre-injection state and there were statistical significances in group III compared with group I. 3) Dysrhythmias; Most childrens electrocardiograms revealed the sinus rhythms except only 4 cases of premature ventricular contraction and 2 cases of nodal rhythm. These benign dysrhythmias were restored to normal sinus rhythms immediately after administration of small doses of lidocaine & 100% oxygen and simultaneously shut-off the inhalation of halothane.

The Effect of Enflurane Anesthesia on HBsAg Positive Patient / 대한마취과학회지

It is well known that halogenated anesthetics have been mainly used for inhalation anesthesia these days. However many controversies still exist concerning hepatic cellular damage after halothane anesthesia. Although several articles have been issued concerning the effects of halogenated anesthetics for hepatitis B surface antigen positive patients, a study of frequent research and strict case collections is meaningful. The authors observed the effects of enflurane anesthesia on 15 HBsAg positive patients who had not recognized themselves whether they had hepatitis symptoms or were carriers. During the period of study, all groups(enflurane study group and enflurane and halothane control groups) did not experience any difficulty with the anesthesia, blood transfusion, and jaundice, etc. The comparative data of liver function tests did not show great differences during the convalescent period. According to this and other recent studies, we can positively conclude that halogenated anesthetics, especially enflurane, may favorably be used to administer HBsAg positive patients, unless any undesirable problems related to anesthesia exist.

Effect of Central Vacuum Scavenger in Controlling Air Pollution in the Operating Room due to Halothane / 대한마취과학회지

A central vacuum scavenger modified by the authors, was used to control the atmospheric contamination of the operating room by anesthetic gases and vapours. Air pollution was monitored by measuring the concentrations of halothane vapour in the air of the operating room with the gas chromatograph. Under endotrachal intubation, the semi-colsed circle absorber system was used for anesthetic administration and maintained with 0.8~1.2% Halothane. Total gas flow rates were 4 liter/min with 50% oxygen in nitrous oxide for daily work. Air sampling was taken early in the morning at 10cm high from the floor before anesthesia. After daily work, they were also done at 10cm, 120cm, and 140cm high from the floor and at the corridor of the operating room. We investigated the differences of halothane concentration according to each sits by the changing central vacuum pressure. Results are followings: The atmospheric halothane concentration of the operating room before anesthesia were 0.27+/-0.12, 0.22+/-0.11 and 0.15+/-0.06 ppm.The atmospheric halothane concentration of the operating room after daily work were 7.94 +/- 1.30 ppm without the active central vacuum pressure.The atmospheric halothane concentration of the operating room after daily work were 1.41 +/-0.48ppm of 20mmHg of central vacuum pressure.The tmospheric halothane concentration of the operating room after daily work were 0.49+/-0.18ppm of 40mmHg of central vacuum pressure. The atmospheric halothane concentrations at the corridor of the operating room after daily work were 1.09+/-0.19, 0.77+/-0.11n and 0.36+/-0.17ppm when each vacuum pressure was 0mmHg, 20mmHg and 40mmHg. A significant reduction (p<0.01) in atmospheric halothane concentration of the operation room was obtained by the use of the central vacuum pressure with the scavenger. The higher the vacuum pressure, the greater reduction of the operating room air pollution was observed.

A Case of Aspiration Pneumonitis during Induction of Anesthesia for Cesarean Section / 대한마취과학회지

Gradually there are increasing tendencies toward Cesarean sections, either intentionally or inevitably. Since two lives are simultaneously in one case, we must make all efforts to administer anesthesia even more cautiously for Cesarean section patients than for other cases. Occasionally, grave problems occur during induction of anesthesia, especially in general anesthesia. Among them, one of the most serious accidents is aspiration of the stomach contents into the lungs by vomiting or regurgitation. This may induce severe complications, such as chemical pneumonitis due to aspiration of liquid acid contents and/or death due to asphyxia of solid materials. Already several decades ago Mendelson and other authorities described a lung syndrome which was associated with aspiration of vomitus in various degrees of acidity. In an emergency Cesarean section, the authors experienced a case of Mendelson's syndrome which was produced by aspiration of liquid acid stomach contents because of an intubation mistake. Immediately after the operation. the patient began to complain of severe respiratory discomfort and a febrile state which continued for several days post-operatively. However, because of intensive nursing care with oxygenation, intermittent positive pressure breathing, large doses of steroids and antibiotics, the patients condition was restored from the acute febrile stage to the pre-operative level. Within five days the chest X-ray films were normal and on the seventh day the patient and her baby were discharged in good condition. We would like to conclude that many different kinds of drugs and/or methods of anesthesia are not alone sufficient in managing dangerous situations, such as energency Cesarean section but intensive pre-operative care and highly proficient techniques are essential as a prophylactic method in undesirable complications.

A Retrospective Observation of Major Serum Electrolytes in Pre-anesthetic Patients / 대한마취과학회지

Pre-anesthetic assessment of laboratory findings in proposed operative patients is one of the most important procedures in evaluating the patients condition. The more diffuse and minutely the findings are carried out, the better the results are in controlling the patients during and after anesthesia. The serum electrolytes are the most essential laboratory findings in ascertaining whether or not the body components deviate beyond the norm. If there should be a severe deterioration of the major electrolytes for any cause, the physiological response of the various mechanisms of the body tissue will attempt to restore the normal status. At times, it is impossible to obtain normal conditions because of too serious impairment of the cellular functions due to severe electrolyte imbalance. The authors studied the pre-anesthetic major serum electrolytes in elective operative cases retrospectively and the results were classified into two groups of GI diseases and others. These results were compared with the normal values and ranges. Although most of the mean values of our data shifted to the lower level of the normal, the deviations were still within the normal range. Even though the lower levels were observed in a few more incidents in the GI diseases than in the other disease group, still these were of no great significance.

Serial Electric Counteishock in a Case of Arrested Angina Pectoris during Induction of Anesthesia / 대한마취과학회지

Angina pectoris is a state of coronary artery disease, If the myocardial oxygen consumption (MVO2) is greater than the coronary blood flow from any cause, myocardial ischemic damage will almost always follow due to lack of oxygen. The authors experienced cardiac arrest in a patient of unstable angina pectoris during induction of general anesthesia. External cardiac massage was carried out and essential drugs were given immediately, but they did not restore the normal sinus rhythm. We then gave 100 J. of DC countershock at first with failure, then another 200, 300 and 400 J. were given intermittently under the observation of continuous ECG monitoring. Thereafter, complete normal sinus rhythm was restored without any dysrrhythmias, and the patient regained consciousness from the stuporous state due to the induction agents. Because of the light premedicants and also the light induction agents and pancuronium during intubation, the patient's heart could not endure any more in this state of oxygen lack. Patients who have serious organic heart diseases should indeed be prepared with great caution before and during an anesthesia.

A case of human fascioliasis in Korea

Fascioliasis has not been confirmed as a human disease entity until now in Korea despite of sporadic discovery of ova of Fasciola sp. in human fecal materials being never traced to the confirmation of infection. Almost all of the cases with ova in their stool have been related with consumption of cattle liver whether eaten in raw or processed. The present authors confirmed a human fascioliasis case who was a Korean housewife of 42-year-old living in Seoul, during the exploratory laparotomy. The patient had been healthy until October 1975 when abrupt onset of urticaria, dyspepsia, epigastric discomfort developed. And the fluctuation of these symptoms was followed by epigastric colicky pain attacks from December 4, 1975. A complete worm of Fasciola sp. was removed during the bile-duct exploration with stone forceps in lower half of common bile duct, on January 20, 1976. The patient only agreed that she had eaten some raw liver of cattle on September 1975 but denied any possible sources of infection such as drinking of untreated water, handling of water flower and grass, and eating of raw watercress. The measurements of the removed worm: 35. 61 mm in body length, 14.00 mm in maximum body width(Length/width ratio, 2.54:1), distribution of testes to body length 33.9 per cent , number of branches of ovary 22, the size of intrauterine ova 157.2 x 108. 4 micrometer in average. These findings are not compatible with the classical descriptions of both Fasciola hepatica and F. gigantica, and it was concluded it is so-called Fasciola sp. which is intermediate between two species as proposed by many Japanese workers.