Ketamine Anesthesia for the Shocked Patient / 대한마취과학회지

ABSTRACT

In order to determine the usefulness of Ketamine for the shocked patient, 31 cases were divided into 3 groups. Group 1 No hemorrhage or shock. Well maintained vital signs, 10 cases Group 2 Mild to moderate degree of hemorrhage. Fluid and blood replaced, 10 cases. Group 3 Hemorrhagic or septic shock state, 11 cases. The result of case analysis and change of vital sign after ketamine injection were as follows 1. Physical status Range of class of physical states in group 1, 2 and 3 were 1~3, 2~4 and 3~4 respectively, and 50% of group 1 and all cases of group 2 and 3 were emergency surgery. 2. Age distribution The range of age distribution in groups 1, 2 and 3 was 23~62, 18~65 and 16~64 years old respectively. 3. Type of operation In group 1, lobectomy, laparotomy and other operations were performed. Howrever in group 2 and 3, thoracotomy, laparotomy and other procedures were performed for hemostatic purposes. except one total hysterectomy for sepsis. 4. Premedicants In one third of the total cases, mostly in group 1, secobarbital, meperidine or diazipam were given. Atropire was given in 45% of the total cases, and 45%, mostly in group 2 snd 3, were not given any premedicants. 5. Anesthesia induction Following preoxygenation, mastly in group 2 and 3, anesthesia was induced with ketamine (1~2 mg/kg) and intubation was done with succinylcholine, except for 3 cases in group 1. 6. Anesthesia maintenance Ketamine as a sole anesthetic agent was given to 9 cases in operations of less than 1(1/2) hrs. duration. In other cases N2O or N2O with ether, halothane or methoxyflurane were administered according to the vital signs, and muscle relaxants (succinylcholine or gallamine) were given if necessary. 7. Duration of anesthesia The range of duration of anesthesia in group 1, 2 and 3 was 40~360, 60~315 and 85~4845 min respectively. The average duration was 2.6, 2.5 and 4.3 hr in each group. 8. Blood and fluid replacement during anesthesia The average blood replacement in each group was 259.6, 886.7 and 954.5 ml/hr for the entire surgical procedure, whole fluid replacement averaged 243.1, 228.0 and 432. 3 ml/hr respectively. 9. Hemoglobin The range of Hb in preanesthetic state 8.2~14,9.5~12.8 and 7, 913.9 gm/dl in groups 1,2 and 3 and averaged 11 .8, 10.9 and 10.8. These Hb values increased after operation with blood and fluid to 12. 3, 11.0 and 12.3 gm/dl respectively. 10. Blood pressure Before anesthesia the average systolic and diastolic Bp was 122.5/84.0, 94.5/68.0 and 108/79 mmHg in each group. Following the administration of ketamine, the systolic pressure increased 5.3, 14.3 and 26.7% respectively after 10 min. 11. Pulse rate Change in pulse rate after ketamine injection was not significant in mast of cases. 12. Respiration No remarkable change in respiration was observed however respiration was assiteded or controlled adequately through the anesthesia. With the above results, the rise of BP induced by ketamine during the induction period was found to be advantageous with such patients. We concluded that ketamine anesthesia for shocked patients of any etiology was safe, useful and satisfactory.