BACKGROUND: Geriatric patients undergoing hip arthroplasty are generally considered to be at high risk for anesthesia and surgery. Thus, the evaluation of safe anesthetic methods for hip arthroplasty in geriatric patients is important and necessary. METHODS: 228 geriatrics, either sex, older than 65 years, who were performed hip arthroplasty from Mar. 1985 to Jun. 1995, were investigated for anesthetic techniques, postoperative complications and the other problems, retrospectively. According to the kinds of anesthetic techniques, the items including primary indication for operation, name of operation, blood loss, perioperative complications, time from the end of operation to the first analgesic requirement and frequency of analgesic requirements for postoperative 72 hours were analyzed. RESULTS: The mean age of the patients with caudal anesthesia was significantly higher than that with general inhalation anesthesia. The blood loss in patients with epidural anesthesia was significantly more than that in hypobaric spinal anesthesia. The most frequent perioperative complications were cardiovascular problems including hypotension, hypertension, arrythmias, and myocardial infarction. The numbers of analgesic requirement within the postoperative 72 hours was the lowest in epidural anesthesia. There was one postoperative fatal case, whose the cause of death was found to pulmonary thromboembolism by autopsy. CONCLUSIONS: This study suggested that there were many risks for anesthesia and operation in geriatric patients with hip arthroplasty, and the cardiovascular complications were the most frequent. Thus, for hip arthroplasty in geriatrics, the choice of optimal anesthetic techniques depending on the patients physical status and physicians skill should be emphasized with the proper perioperative anesthetic management.
Analgesia ; Anesthesia* ; Anesthesia, Caudal ; Anesthesia, Epidural ; Anesthesia, Inhalation ; Anesthesia, Spinal ; Arrhythmias, Cardiac ; Arthroplasty* ; Autopsy ; Cause of Death ; Geriatrics* ; Hip* ; Humans ; Hypertension ; Hypotension ; Myocardial Infarction ; Orthopedics ; Postoperative Complications ; Pulmonary Embolism ; Retrospective Studies*

Total 1950 cases of general, spinal and epidural anesthesia for cesarean section were performed in Department of Anesthesiology, Yonsei University, Wonju College of Medicine from June 1982 to May 1987. The followings are results of the observations on 1950 cases. 1) The incidence of cesarean section was 21.76 percent of total deliveries and the tendency is increasing. 2) Types of anesthesia are General anesthesia(1004 cases), Spinal anesthesia(557 cases), Epidural anesthesia(389 cases). 3) One minute Apgar score in spinal, epidural anesthesia are better than in general anesthesia. 4) Perinatal mortality of total deliveries is 1.007%. 5) Painless delivery: 50 cases. 6) Postoperative pain control: Spinal anesthesia: 48 cases. Epidural catheter: 335 cases(Ketamine:50 cases)
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Obstetrical* ; Anesthesia, Spinal ; Anesthesiology ; Apgar Score ; Catheters ; Cesarean Section ; Female ; Gangwon-do ; Incidence ; Pain, Postoperative ; Perinatal Mortality ; Pregnancy

Obstetric anesthesia in a parturient with severe osteogenesis imperfecta is challenging in many aspects, particularly concerning maternal pathophysiological problems and the technical difficulties of anesthesia. Here, we report a case of successful spinal anesthesia, instead of general or epidural anesthesia, during a cesarean delivery in a patient with severe osteogenesis imperfecta.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, Obstetrical ; Anesthesia, Spinal ; Cesarean Section ; Female ; Humans ; Osteogenesis ; Osteogenesis Imperfecta ; Pregnancy

Pediatric patients often could not be cooperated with physician during various procedures. So, many agents such as inbalation anesthetics and intravenous anesthetics have been used to decrease pain, anxiety and awareness during regional anesthesia in children. The purpose of this study was to compare propofol with midazolam and inhalation anesthetics for emergence time from sedation in caudal anesthesia of children. Forty five patients were randomly divided three groups. In propofol group(Group P, n=15), induction dose of 1.0 mg/kg propofol(Diprivan) was received followed by continuous infusion of 3~5 mg/kg/hr. In midazolam group(Group M, n=15), induction dose of 0.15 mg/kg midazolam(Dormicum) was received followed by continuous infusion of 0.06~0.08 mg/kg/hr. In inhalation anesthetic group(Group E, n=15), O2-NO2-Enflurane(3L/min, 3L/min, 0.6~1.0 vo1% respectively) inhalated through face mask by non-rebreathing system for sedation. The blood pressure, heart rate, arterial oxygen saturation during anesthesia and emergence time, complications were measured. The results were as follows: 1) The blood pressure was significantly decreased in group M and E. Heart rate was also significantly increased in group M and E. 2) The arterial oxygen saturation was not significantly changed in each three groups. 3) In the group P and E, emergence time was shorter than in the group M. From the above results, we conclude that propofol is more excellent intravenous anesthetics than midazolam in respect to emergence time and hemodynamic changes in pediatric caudal anesthesia.
Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Conduction ; Anesthetics ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Anxiety ; Blood Pressure ; Child ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives* ; Inhalation ; Masks ; Midazolam* ; Oxygen ; Propofol*

BACKGROUND: A tourniquet is often used during limb surgery to minimize surgical bleeding and to keep the clear surgical field. However the tourniquet is associated with severe hemodynamic changes and tourniquet-induced hypertension. We investigated the incidences of tourniquet-induced hypertension by tourniquet duration and anesthetic methods. METHODS: One hundred thirteen patients who underwent a total knee arthroplasty were assigned into four groups according to the types of anesthesia; general anesthesia (group I, n = 30), general anesthesia and intravenous adjuvants (group II, n = 30), general and epidural anesthesia (group III, n = 22), and spinal anesthesia (group IV, n = 31). Mean arterial pressure and heart rate were recorded at ward, before induction, one minute after tourniquet inflation and every 10 minutes until 60 mininutes. The extremity was exsanguinated and a tourniquet pressure of 350 mmHg (9 cm width) was applied in all groups. RESULTS: The mean arterial pressure increased in group I and II during the tourniquet inflation period. The incidence of tourniquet-induced hypertension was higher in group I (6.7%) than other groups but there was no statistical significance among the groups. Heart rates were not changed in any groups. CONCLUSIONS: We concluded that the shorter the tourniquet time the less the occurrence of tourniquet-induced hypertension under any type of anesthesia.
Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Spinal ; Arterial Pressure ; Arthroplasty* ; Extremities ; Heart Rate ; Hemodynamics ; Hemorrhage ; Humans ; Hypertension* ; Incidence ; Inflation, Economic ; Knee* ; Tourniquets*

Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and mtraoperative supplementation to general anesthesia for children. Caudal anesthesia was given to 63 infants and children under 15 years of age, who received lower abdominal surgery. After thiopental sodium 4-5 mg/kg IV and 1-2Vo1% halothane inhalation, caudal block was performed in the lateral position. Halothane was stopped immediately after caudal block and only 50% NO in oxygen was inhaled through the mask during operation. The patients were randomly divided into four groups: Group 1; 0.33% bupivacaine 0.7 ml/kg, Group 11; 0.33% bupivacaine 1.0 ml/kg, Group III; fentanyl 1 ug/kg combined with 0.33% bupivacaine 1.0 ml/kg, Group IV; 1.5% lidocaine 1.0 ml/kg. The time of onset, duration of analgesia, side effects during and after operation, intial voiding time, and use of analgesics in the ward were observed. The results were as follows: 1) Caudal block was successful at the 1st attempt in most cases. 2) During operation, supplementation of other inhalational anesthesies were need. 3) In all groups, surgical anesthesia could be obtained within 10 minutes. 4) Intraoperative adverse effects were not detected except for minimal movements on skin incision and spermatic cord traction in 12 cases and vomiting in 2 cases. 5) Postoperative analgetic effects were good in all groups, especially in fentanyl group. 6) In most cases, patients ean void within 6 hours without urinary catheterization. 7) Postoperative analgesics were not needed and patients parent's were highly satisfied with caudal anesthesia in all cases. From the above results, it was suggested that caudal anesthesia with 0.33% bupivacaine or 1.5% lidocaine without potent inhalational anesthetics was satisfactory for lawer abdominal surgery and l ug/kg of fentanyl had some benefits in postoperative analgesia in children.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Bupivacaine ; Child ; Fentanyl ; Halothane ; Humans ; Infant ; Inhalation ; Lidocaine ; Masks ; Oxygen ; Pain, Postoperative ; Skin ; Spermatic Cord ; Thiopental ; Traction ; Urinary Catheterization ; Urinary Catheters ; Vomiting

Combined anesthesia has been associated with less sedation, earlier ambulation, higher pulmonary flow rates, improved oxygenation, blunting of stress response and better pain control in the postoperative period than general anesthesia. Total intravenous anesthesia has many advantages compared with inhalation anesthesia, but also has several disadvantages such as hypertension, inappropriate anesthetic, delayed recovery and emergence delirium For improvement of this problems, the authors tried epidural anesthesia combined with continuous intravenous infusion of propofol which is a short acting intravenous anesthetic and has characteristics of rapid and clear-headed recovery. Fifty-three patients undergoing elective thoracic operation were randomly assigned to receive anesthesia with N2O-O2-enflurane (n=23), epidural anesthesia combined with N2O-O2-propofol infusion (3 mg/kg/hy; n=15), or epidural anesthesia combined with medical air-O2-propofol infusion (6 mg/kg/hy; n=15). We studied the hemodynamic changes and occurence of awareness and recovery time on those three groups. Although there were significant changes in the hemodynamics among the groups except CVP, but all values were within normal limit and there were no difference in the recovery time. We concluded that epidural anesthesia with medical air-O2-propofol infusion (6 mg/kg/hr) is acceptable altemative method for thoracic surgery.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Delirium ; Hemodynamics ; Humans ; Hypertension ; Infusions, Intravenous* ; Oxygen ; Postoperative Period ; Propofol* ; Thoracic Surgery* ; Walking

From September 1979 through April 1980, we had carried out continuous lumbar epidural anesthesia(2% lidocaine, 20ml) with small dose of morphine and single dose caudal anesthesia(2% lidocaine, 15-20ml) for 16 cases of lumbar laminectomy,And also we observed the effects of postanesthetic pain relief by administered morphine(2mg) into lumbar epidural space, The results of this study were as follows: 1) Age distribution was from 20 to 60 years, sex distribution was 14 in man and 2 in woman, and physical status was in ASA class I in all cases. 2) The site of herniated intervertebral disc was L4~5 in 15 cases and L3~4 in one, The epidural puncture site was selected 2~3 vertebral segments cephalad from the lesion, 3) The morphine amount administered with lidocaine into lumbar epidural space was 2mg in all cases. 4) The duration of pain relief from the induction of anesthesia was average 17. 5 hours, and from the additional epidural injection of morphine(2mg) in ward was average 13.5 hours. 5) There was no neurological deficit or sequele except nausea in one case postoperatively. Therefore this anesthetic method was not only satisfactory for laminectomy but also safer and simpler in the fixation of spinal anesthetic level by patient's position change than spinal anesthesia, and faster in the postanesthetic ambulation than general anesthesia. Moreover, surgeon's acceptability.
Age Distribution ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, General ; Anesthesia, Spinal ; Epidural Space ; Female ; Humans ; Injections, Epidural ; Intervertebral Disc ; Laminectomy* ; Lidocaine ; Methods ; Morphine* ; Nausea ; Punctures ; Sex Distribution ; Walking

BACKGROUND: Minimum effective anesthetic concentration (MEAC) of local anesthetics for spinal anesthesia, defined as the concentration at which a spinal anesthetic agent produces surgical anesthesia within 20 minutes of administration in 50% of patients. This concept is similar to the concept of minimum alveolar concentration (MAC) for inhalation anesthetic. Furthermore, as MEAC may vary with the administered dose, it will be determined using 10 mg of hyperbaric tetracaine. METHODS: 10 mg hyperbaric tetracaine containing dextrose 10 % was administered intrathecally to 12 patients (ASA I-II, age 20~40 yr), who were undergoing lower limb or urological procedures within 90 minutes, at concentrations ranging from 0.07~0.1%. The choice of tetracaine concentration was determined by Dixon's up-and-down method. Complete anesthesia was defined as: (1) pinprick anesthesia at or higher than T10 and (2) complete leg paralysis; all occurring in both lower extremities within 20 min. General anesthesia was initiated if spinal anesthesia was incomplete. RESULTS: MEAC of 10 mg hyperbaric tetracaine was 0.083 %. Mean anesthetic duration was 75.2 minutes (range: 40~100 min). The maximum sensory block level ranged from T3~T8. CONCLUSION: The aim of this study was to establish new concept of minimum effective anesthetic concentration of hyperbaric tetracaine for spinal anesthesia. We recognized that spinal anesthesia can be accomplished with very dilute solution. As fixed dose, no correlation was found between concentration of the spinal tetracaine solution with the highest sensory level, anesthetic duration and the degree of mean arterial pressure decreased.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Anesthetics, Local ; Arterial Pressure ; Glucose ; Humans ; Inhalation ; Leg ; Lower Extremity ; Paralysis ; Tetracaine*

BACKGROUND: Minimum effective anesthetic concentration (MEAC) of local anesthetics for spinal anesthesia, defined as the concentration at which a spinal anesthetic agent produces surgical anesthesia within 20 minutes of administration in 50% of patients. This concept is similar to the concept of minimum alveolar concentration (MAC) for inhalation anesthetic. Furthermore, as MEAC may vary with the administered dose, it will be determined using 10 mg of hyperbaric tetracaine. METHODS: 10 mg hyperbaric tetracaine containing dextrose 10 % was administered intrathecally to 12 patients (ASA I-II, age 20~40 yr), who were undergoing lower limb or urological procedures within 90 minutes, at concentrations ranging from 0.07~0.1%. The choice of tetracaine concentration was determined by Dixon's up-and-down method. Complete anesthesia was defined as: (1) pinprick anesthesia at or higher than T10 and (2) complete leg paralysis; all occurring in both lower extremities within 20 min. General anesthesia was initiated if spinal anesthesia was incomplete. RESULTS: MEAC of 10 mg hyperbaric tetracaine was 0.083 %. Mean anesthetic duration was 75.2 minutes (range: 40~100 min). The maximum sensory block level ranged from T3~T8. CONCLUSION: The aim of this study was to establish new concept of minimum effective anesthetic concentration of hyperbaric tetracaine for spinal anesthesia. We recognized that spinal anesthesia can be accomplished with very dilute solution. As fixed dose, no correlation was found between concentration of the spinal tetracaine solution with the highest sensory level, anesthetic duration and the degree of mean arterial pressure decreased.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Anesthetics, Local ; Arterial Pressure ; Glucose ; Humans ; Inhalation ; Leg ; Lower Extremity ; Paralysis ; Tetracaine*