A clinical study of traumatic amputation by railroad accidents was made an 124 patients with 154 amputee, who had been treated at Department of Orthopaedic Surgery, National Seoul Hospital, during the 4 years period from January 1976 to December 1979. The results of this study are as follows: 1. The ratio of male to female was 9 to 1. The 3rd decade of age group showed the hightest number of accident causalties, as much as 37.1%. 2. Causalties showes a maximum during the sprlng (37.1%) and a minimum during winter. 3. The most common injured sites of the amputee were B–K in 44 cases among 154 cases of the amputee. 4. Considering the number of the multiple amputee in 26 casee among 124 cases, frequently they developed in 2 sites with 22 cases, 3 sites with 4 cases. 5. The frequent fracture sites with combined amputation were 18 cases of the pelvic bone, 12 cases of femur in amputation of the lower extremity. 6. Our methods of treatment were debridement, debridement and primary skin closure, debridement with open amputation, circular amputation, closed amputation with skin graft, and closed amputation. 7. The major complications were phantom limb in 108 cases (70.1%), infection in 44 cases (28.6%). 8. The most frequent infectious agent was pseudomonas (16 cases).
Amputation ; Amputation, Traumatic ; Amputees ; Clinical Study ; Debridement ; Female ; Femur ; Humans ; Lower Extremity ; Male ; Pelvic Bones ; Phantom Limb ; Pseudomonas ; Railroads ; Seoul ; Skin ; Transplants

BACKGROUND: Mivacurium has a characteristics of rapid onset and the shortest duration of non- depolarizing neuromuscular relaxants and the onset of action could be accelerate more rapidly by using priming principle. The purpose of this study was to compare the onset time of mivacurium by priming principle with succinylcholine during rapid endotracheal intubation. METHODS: 36 patients were randomly divided into 3 groups: mivacurium group by priming principle (Group 1), mivacurium group by bolus injection (Group 2) and succinylcholine group (Group 3). In Group 1, subparalyzing dose of 0.02 mg/kg was administered 2 minutes before principle dose of 0.25 mg/kg was given. Onset time and intubating conditions were observed when twitch tension was reduced by 25% block in each group. RESULTS: The onset of Group 1 (75 sec) was significantly faster than that of Group 2 (90 sec) (p<0.05) but was significantly slower than that of Group 3 (37.5 sec) (p<0.05). Intubating conditions were excellent in all groups. CONCLUSIONS: The attempts of priming principle with mivacurium could accelerate the onset of action of mivacurium compared with that of bolus injection but their onsets were shorter than those produced by succinylcholine.
Humans ; Intubation, Intratracheal* ; Succinylcholine*

Malignant hyperthermia is a dramatic syndrome that rarely arises during anesthesia and which is still fatal in the majority of cases. It is a hypermetabolic muscle condition characterized by hyperpyrexia and skeletal muscle rigidity. Any potent inhalation anesthetic agent or any skeletal muscle relaxant can trigger this acute catast rophic reaction. A case is presented of a 28 year old femal with a family history of malignant hyperthermia in herrelatives. She sunderwent repair of a retinal detachment under N2O-O2-halothane withcinduction by thiopenthal and succinylcholine. One and half hours after induction, arrhythmia developed and was followed by unstable blood pressure, hyperpyrexia, muscular rigidity. Anesthesia was ended and vigorous emergency treatment was attempted. But she died postoperatively on the 4th day after anesthesia. The etiologic factors, incidence, clinical feature, prevention, treatment and prognosis of malignant hyperthermia are discussed.
Incidence

The purpose of this study is to investigate the effects of doxapram on the rates of spontaneous and neostigmine-induced recovery from neuromuscular block with vecuronium and atracurium. Following intravenous injection of either vecuronium (40 patients) or atracurium (40 patients), recovery index (RI) was measured without administering either doxapram or neostigmine (Group 1), or after administration of a combination of neostigmine 40 ug/kg and doxapram 1 mg/kg (Group 2), neostigmine 40 ug/kg (Group 3) or doxapram 1 mg/kg (Group 4) when twitch tension returned to 25% block of train of four response, each of the four group had 10 patients. The results were such that RI was significantly prolonged after vecuronium in the presence of doxapram compared with Group 1 (13.5 min vs 8.2 min). There was no significant difference in the RI after atracurium in the presence of doxapram compared with Group 1 (7.0 min vs 7.1 min). There was rapid recovery which was significant when neostigmine was administered with or without doxapram (2.4 min vs 2.3 min respectively after vecuronium; 2.3 min vs 2.4 min respectively after atracurium). The authors conclude that administration of doxapram in situation where neuromuscular block with vecuronium is not adequately antagonized does not contribute to rapid recovery from neuromuscular block.
Atracurium* ; Doxapram* ; Humans ; Injections, Intravenous ; Neostigmine ; Neuromuscular Blockade ; Vecuronium Bromide*

BACKGROUND: Paramedian approach is more useful than midline approach when degenerative changes are encountered in the interspinous structure and when ideal positioning of the patient can not be achieved. The purpose of this study was to determine the guideline of depth from skin to subarachnoid space by midline or paramedian approach in Korean adult. METHODS: The distance from skin to subarachnoid space was measured in 47 patients recieving spinal anesthesia by midline approach and 30 patients by paramedian approach at L3-4 level. RESULTS: The mean depth to subarachnoid space was 5.44+/-0.47 cm in midline approach. In paramedian approach by 18.0degrees of caudal and 18.5degrees of lateral angle, mean depth was 6.24+/-0.60 cm. There were significant correlation between depth and weight, and depth and ponderal index. In ages over 50 years old, difficult cases were significantly more in midline approach than in paramedian approach. CONCLUSIONS: Measurement of factors as weight or ponderal index can be used to predict the depth. Paramedian approach is more useful than midline approach in ages over 50 years old.
Adult* ; Anesthesia, Spinal* ; Humans ; Middle Aged ; Needles* ; Punctures* ; Skin ; Subarachnoid Space

Ritodrine hydrochloride (Yutopar (R)) is widely used for the treatment of premature uterine contraction with betasympathomimetic effect on the uterus but adverse effects associated with cardiopulmonary system are frequently reported. We experienced a case of pulmonary edema that occurred suddenly during cesarean section under epidural anesthesia. She had been treated with ritodrine for 3 days to arrest preterm labor of twin pregnancy. Intensive care including mechanical ventilation with PEEP via endotracheal intubation and diuretic therapy was attempted. At the 3rd day after operation patient was transferred to general ward without any sequale.
Anesthesia, Epidural* ; Cesarean Section* ; Female ; Humans ; Critical Care ; Intubation, Intratracheal ; Obstetric Labor, Premature ; Patients' Rooms ; Pregnancy ; Pregnancy, Twin ; Pulmonary Edema* ; Respiration, Artificial ; Ritodrine* ; Uterine Contraction ; Uterus

Transient increases in blood pressure and heart rate following laryngoscopy and endotracheal intubation are well documented in normotensive patients. These circulatory effects are alicited by mechanical stimulation of the laryngopharynx and traches via efferent cervical sympathetic fibers. The hypertension during induction of anesthesia in hypertensive patients can be sccompanized by cerebreal hemorrhage, left ventricular failure and life breatening cardiac arrhythmia. The present study was undertaken to observe the effects of sodium nitroprusside(SNP) on the change in systolic blood pressure and heart rate during and after laryngoscopy for tracheal intubation. Eight adult patients who had received elective operation under general anesthesia with endotracheal intubation were randomly selected and devided into 3 groups. Group l served as a normotensive group. Group ll served as a hypertensive group withou SNP. Group lll served as a hypertensive group receiving 1ug/kg of SNP 15 seconds before starting laryngoscopy. The changes of systolic blood pressure and pulse rate were analysed and data were compared between groups. The results were as follows: 1) Attenuation of increase in blood pressure was statistically significant in the hypertensive group with prior SNP compared with the group not receiving SNP (p<0.05). The magnitude of blood pressure increase in the hypertensive group without prior SNP was significantly greater than in the normotensive group(p<0.001). 2) SNP had no effect on the increase in heart rate associated with tracheal intubation. In conclusion, it is suggested that a single rapid intravenous injection of SNP is a practial pharmacological method to attenuate blood pressure increase during direct laryngoscopy and tracheal intubation in hypertensive patients.
Adrenergic Fibers ; Adult ; Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiovascular System* ; Heart Rate ; Hemorrhage ; Humans ; Hypertension ; Hypopharynx ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Nitroprusside* ; Sodium*

BACKGROUND: The goal of this study was to demonstrate the effect of esmolol to prevent reflex tachycardia occurred during sodium nitroprusside(SNP) induced hypotension. METHODS: Thirty patients were randomly assigned to the SNP group(n=15) received continuous infusion of SNP at 2.72+/-0.56 mcg/kg/min or combined SNP and esmolol(SNP-ESM) group(n=l5) received combined continuous infusion of SNP at 1.54+/-0.34 mcg/kg/min and esmolol at 200 mcg/kg/min for 1 hour to maintain a 20~25% reduction of mean arterial pressure(MAP) from baseline. Heart rate(HR) and MAP were measured at baseline, during hypotensive period(5, 10, 20, 30, 60 min) and after hypotensive period(70, 80, 90,1 20 min). RESULTS: SNP-induced hypotension resulted in significant(P<0.001) increases in heart rate during hypotensive period and MAP after the end of SNP infusion. However, infusion of SNP-ESM resulted in significant(p<0.05) reduction in heart rate and SNP requirement during hypotensive period, and rebound hypertension was not observed after the end of induced hypotension. CONCLUSIONS: SNP-ESM infusion is a safe and effective pharmacologic means and provides several advantages over single SNP that include reduction in SNP requirement, no reflex tachycardia during induced hypotension and no rebound hypertension following hypotensive period.
Heart Rate* ; Heart* ; Humans ; Hypertension ; Hypotension* ; Nitroprusside* ; Reflex ; Sodium* ; Tachycardia

BACKGROUND: The goal of this study was to demonstrate the effect of esmolol to prevent reflex tachycardia occurred during sodium nitroprusside(SNP) induced hypotension. METHODS: Thirty patients were randomly assigned to the SNP group(n=15) received continuous infusion of SNP at 2.72+/-0.56 mcg/kg/min or combined SNP and esmolol(SNP-ESM) group(n=l5) received combined continuous infusion of SNP at 1.54+/-0.34 mcg/kg/min and esmolol at 200 mcg/kg/min for 1 hour to maintain a 20~25% reduction of mean arterial pressure(MAP) from baseline. Heart rate(HR) and MAP were measured at baseline, during hypotensive period(5, 10, 20, 30, 60 min) and after hypotensive period(70, 80, 90,1 20 min). RESULTS: SNP-induced hypotension resulted in significant(P<0.001) increases in heart rate during hypotensive period and MAP after the end of SNP infusion. However, infusion of SNP-ESM resulted in significant(p<0.05) reduction in heart rate and SNP requirement during hypotensive period, and rebound hypertension was not observed after the end of induced hypotension. CONCLUSIONS: SNP-ESM infusion is a safe and effective pharmacologic means and provides several advantages over single SNP that include reduction in SNP requirement, no reflex tachycardia during induced hypotension and no rebound hypertension following hypotensive period.
Heart Rate* ; Heart* ; Humans ; Hypertension ; Hypotension* ; Nitroprusside* ; Reflex ; Sodium* ; Tachycardia

A fifty five-year-old man who had been decrease in levels of coagulation factors V, VIII, X and XI was monitored by thromboelastography(TEG) to evaluate the effectiveness of blood component replacement therapy during operation of chest wall reconstruction. Cryoprecipitate(9 units) was infused in the preoperative day because the clot formation rate was slow( : 27.5 ). During the operation cryoprecipitate(9 units), fresh frozen plasma(9 units), whole blood(2 units) and packed red blood cells(6 units) were transfused for blood loss of 4000 ml and abnormal findings on TEG. The operation site was not abnormal bleeding tendency. So TEG patterns were normal toward the end of operation. As a result, TEG is effective to monitor hemostasis and guide for transfusion therapy of coagulation abnormalities associated with intraoperative blood loss.
Blood Coagulation Factors ; Hemorrhage ; Hemostasis ; Humans ; Thoracic Wall ; Thrombelastography*