To evaluate the historical trend of anesthetic experience for the past 22 years a total of 68,473 cases which were performed at the National Medical Center from 1959 to 1981 were studied. To simplify the analysis statistically, the author selected the anesthetic cases every other year(12 years). 1) General anesthesia was performed in more than 78% of the total cases and of this number endotracheal intubation has been used with increasing frequency(average 92.8%). 2) For intravenous induction, thiopental sodium was used as the main agent, in more than 90% since 1980. 3) Trichlorethylene, cyclopropane and ethylchloride which had been used since 1961, were abandoned from 1978 except for training purposes. Methoxyflurane was used from 1973 to 1979, but given up there after because of it's nephrotoxicity. The use of halothane has steadily increased(86% of the total inhalation anesthetics) and ethrane has also been used with increasing frequency since 1980. 4) Pancuronium has been used as a primary muscle relaxant instead of gallamine and D-tubocurarine which had been used as the main durgs from 1959 till 1979. 5) Innovar and morphine as intravenous anesthetics, have recently been with increasing grequency.
Anesthesia, General ; Anesthetics, Intravenous ; Enflurane ; Gallamine Triethiodide ; Halothane ; Inhalation ; Intubation, Intratracheal ; Methoxyflurane ; Morphine ; Pancuronium ; Thiopental ; Tubocurarine

BACKGROUND: Using rotational thromboelastometry (ROTEM) analysis, we investigated the difference in blood hemostasis, based on the primary anesthetic agents used during general anesthesia. METHODS: Sixty-six adult patients scheduled for elective ophthalmic surgery under general anesthesia were evaluated with regard to changes in each parameter in INTEM, EXTEM, and FIBTEM analyses. The patients received intravenous anesthesia with propofol and remifentanil (TIVA group) or inhalation anesthesia with sevoflurane (SEVO group). The ROTEM tests were performed 10 min before starting anesthesia and 1 h after finishing anesthesia. The INTEM and EXTEM analyses included the clotting time (CT), clot firmness time (CFT), alpha angle (alpha), and maximum clot firmness (MCF). The FIBTEM analyzed only MCF. Maximum clot elasticity (MCE) was calculated by (MCF x 100) / (100 - MCF). The platelet component of clot strength was calculated as follows: MCE(platelet) = MCE(EXTEM) - MCE(FIBTEM). RESULTS: The preoperative and postoperative parameters (CT, CFT, alpha, and MCF) in the INTEM, EXTEM, and FIBTEM analyses were not significantly different between the two groups. The MCE(platelet) also did not show a significant difference. CONCLUSIONS: Presuming that the ophthalmic surgery had a minimal traumatic effect, we conclude that both anesthetic agents cause negligible changes in ROTEM analyses postoperatively.
Adult ; Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Anesthetics ; Blood Platelets ; Elasticity ; Hemostasis* ; Humans ; Propofol* ; Thrombelastography

To evaluate geriatric anesthetic experience, 1,441 cases of patients aged over 60 years. Out of 29,692 surgical cases admitted to St. Mary's Hospital from January 1971 to December 1980 were analyzed according to age, sex, surgery, preoperative condition, technique of anesthesia, duration of anesthesia, anesthetics, and mortality. The results were as follows: 1) The percentage of geriatric cases were 4.9% in average which ranged between 3.9% and 6.0% and showed steady numbers in this period. The distribution of the number of patient according to the age were 1,150 cases(79.8%) in the group of 60~69 years, 262 cases (18.2%) in 70~79 years, and 29 cases(2.0%) over 80 years. 2) There were 833 male(57.8%) and 608 female(42.2%) cases. 3) 833 cases(57.8%) were in general surgery: the most prevalent diagnosis were empyema of gallbladder and cholelithiasis which amounted to 195 cases(13.6%) 4) The rates of elective to emergency surgery were 75.4% (1086 cases) to 24.6%(355 cases). 5) Premedicants were mainly atropine with sedatives(785 cases, 61.2%) and atropine with analgesics(220 cases, 17.1%). 6) Preoperative hemoglobin level ranged between 10.1 and 12.0gm/dl in 40.1% of the patients. 7) The techniques of anesthesia were (1,234 cases, 85.6%) general anesthesia, (75 cases, 5.2%) intravenous anesthesia and spinal anesthesia(60 cases, 4.2%). 8) The duration of anesthesia (500 cases, 34.7%) were 1~2 hours in average. 9) The inhalation anesthetics were Halothane(1,110 cases, 90.0%) , Methoxyflurane(112 cases, 9.1%), N2O (6 cases, 0.5%), and Ether(6 cases, 0.5%). 10) The preoperative chest X-ray and clinical signs showed that 963 cases (54.3%) were normal. 159 cases(10.6%) had emphysems, 152 cases(10.1%) had pulmonary tuberculosis and 41 cases (2.7%) had bronchitis. 11) The preoperative EKG and clinical symptom revealed that 952 cases(62.1%) were normal in cardiovascular aspect, 23 cases (15.1%) showed hypertension, 124 cases(8.1%) had arrhythmis, and 79 cases(5.2%) had myocardial ischemia. 12) During the surgical procedure cardiac arrest were experienced in 5 cases(0.3%) and sudden hypotensive pisods in 18 cases, which were successfully resuscitated. There were no operative mortalities within 48 hours. In summary, the patients over the 69 to 80 age group had a poor surgical risk, but they were able to withstand this risk when properly managed with modern anesthesia.
Anesthesia* ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Anesthetics, Inhalation ; Atropine ; Bronchitis ; Cholelithiasis ; Diagnosis ; Electrocardiography ; Emergencies ; Empyema ; Gallbladder ; Heart Arrest ; Humans ; Hypertension ; Mortality ; Myocardial Ischemia ; Thorax ; Tuberculosis, Pulmonary

OBJECTIVETo observe the effect of electro-acupuncture (EA) on auto regressive with exogenous input model (ARX-model) auditory evoked index (AAI) in patients anesthetized with different anesthetics.

METHODSForty-eight adult patients undergoing scheduled surgical operation were enrolled and divided into two groups (24 in each group) according to the anesthetics applied, Group A was anesthetized with propofol sedation and Group B with Isoflurane-epidural anesthesia. Group A was subdivided into three groups of low, middle and high concentration of target effect-site of 1.0 microg/ml, 1.5 microg/ml and 2.0 microg/ml through target controlled infusion (TCI) and Group B into 3 subgroups of minimum alveolar effective concentration of isoflurane (0.4 MAC, 0.6 MAC and 0.8 MAC for B1, B2 and B3 subgroups) respectively, with 8 patients in every subgroup. EA on acupoints of Hegu (LI4) and Neiguan (P6) was applied on all the patients during anesthesia, and the change of AAI at various time points was recorded.

RESULTSIn the three subgroups of Group A, levels of AAI were significantly elevated in the first few minutes after EA, and significantly lowered 20 min after EA in subgroup A2. While in the subgroups of Group B, except the elevating in Group B1 1-2 min after EA, levels of AAI remained unchanged at other time points.

CONCLUSIONPain response could be reflected by AAI during EA. EA could enhance the sedative effect of propofol in middle concentration, but its effect on isoflurane epidural anesthesia is insignificant.

Acupuncture Points ; Adult ; Anesthesia, General ; Anesthetics ; pharmacology ; Anesthetics, Inhalation ; pharmacology ; Anesthetics, Intravenous ; pharmacology ; Conscious Sedation ; Electroacupuncture ; Evoked Potentials, Auditory ; drug effects ; Female ; Humans ; Isoflurane ; pharmacology ; Laparotomy ; Male ; Middle Aged ; Monitoring, Intraoperative ; Pain Measurement ; Propofol ; pharmacology

High frequency jet ventilation(HFJV) induces adequate gas exchange with tidal volume smaller than that of other conventional ventilation method. In critically ill patients, HFJV reduces the unwanted hemodynamic effects of conventional ventilation caused by the increase in intrathoracic pressure. But general anesthesia with jet ventilator has been dependent only on intravenous anesthetics. Therefore, this study was done to administer inhalation anesthetics(N2O, enflurane) during HFJV. This study was carried out from June 1992 to January 1993 in the 64 operated patients who beIonged to ASA class I, II in Chung Ang University Hospital The 22 patients using conventional ventilation were control group and the other 42 patients who had inhalation anesthesia by using HFJV were experimental group. In all patients, blood pressure and heart rate were checked on preinduction, postinductive 0, 5, 10, 15, 20, and 30 minutes. The result were as follows I) Systolic blood pressure was increased just on postinduction in both groups(P<0.05). It was decreased from postinductive 5 minutes to 30 minutes in control group, but there was no change in experimental group(P<0.05). 2) Diastolic blood pressure was increaeed just on postinduction in both groups(P<0.05). But it was increased from postinductive 5 minutes to 30 minutes in experimental group(P<0.05). 3) Mean blood pressure was increased just on postinduction in both groups(P<0.05). It was increased from postinductive 5 minutes to 15 minutes in control group and from postinductive 5 minutes to 30 minutes in experimental group(P<0.05). 4) Heart rate was increased just on postinduction and postinductive 5 minutes in control groupg <0.05), and increased from postinductive 0 minute to postinductive 30 minutes in experimental group(P<0.05). 5) pH was increased on postinductive 30 minutes compared to that of preinduction in both groups(P <0.05). 6) PaCO2 was more decreased on postinductive 30 minutes than preinduction in both groups (P<0.05), but there was no clinical significance. And PaO2 was increased at postinductive 30 minutes(P<0.05), which resulted from the increase of FiO2. As above results, inhalation anesthesia with HFJV is supposed to be useful if the difficulty of controlling the concentration of inhalation anesthetics and the contamination of operating room by expelled inhalation anesthetics were solved.
Anesthesia, General ; Anesthesia, Inhalation* ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Blood Pressure ; Critical Illness ; Heart Rate ; Hemodynamics ; High-Frequency Jet Ventilation* ; Humans ; Hydrogen-Ion Concentration ; Inhalation* ; Operating Rooms ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

OBJECTIVETo investigate the value of Narcotrend (NT) index monitoring versus standard hemodynamic parameters in predicting the recovery of consciousness in patients undergoing abdominal surgery.

METHODSForty ASA I or II patients undergoing elective abdominal surgery were randomized into two groups to receive sevoflurane-sufentanil anesthesia monitored by NT index or solely by clinical parameters. Anesthesia was induced with the inhalation of 8% sevoflurane and sufentanil target-controlled infusion at 0.2-0.5 ng/ml. The values of NT stage (NTS), NT index (NTI), and hemodynamic parameters (MAP and HR) were recorded during the period of recovery. The prediction probability (Pk) of each parameter was calculated and compared.

RESULTSNTS and NTl were closely correlated to the changes of consciousness during the recovery from general anesthesia. The Pk values of NTS and NTI in predicting eye opening and orientation recovery were 0.95, 0.92, and 0.92, 0.89, respectively, obviously higher than the Pk values of MAP and HR (P<0.05).

CONCLUSIONNT monitoring can be used to effectively predict the recovery of consciousness in patients undergoing abdominal surgery and facilitates a significant reduction of the recovery time and sufentanil dosage during a sevoflurane-sufentanil anesthesia.

Abdomen ; surgery ; Adolescent ; Adult ; Aged ; Anesthesia Recovery Period ; Anesthesia, General ; Anesthetics, Inhalation ; administration & dosage ; Anesthetics, Intravenous ; Electroencephalography ; methods ; Female ; Hemodynamics ; Humans ; Male ; Methyl Ethers ; administration & dosage ; Middle Aged ; Monitoring, Intraoperative ; methods ; Sufentanil ; administration & dosage ; Unconsciousness ; chemically induced ; Young Adult

High frequency ventilation techniques are accepted for upper airway and intrathoracic surgery under general anesthesia. Good oxygenation and ventilation are acheived with good airway control and operative conditions. However, the jet ventilating system is of an open-character with mandatory use of intravenous anesthesia. The present study was done to administer inhalation anesthetics(halothane)during high frequency ventilation. The high frequency injector was adapted to an angiocartheter wit a swivel connector, while the entrainment orifice of the side port was connected to the anesthesia circuit to facilitiate the administration of inhalation anesthetics. Variables thought to be important in determing the inspiratory peak halothane concentration and diluting inspiratory oxygen concentration for estimation of gaseous influx from the anesthesia circuit were evaluated in an experimental lung model Changing the halothane concentration of the vaporise(1,3,5%), inspiratory: expiratory(I:E) ratio(0.2:0.2, 0.2:0.4, 0.2:0.6, 0.2:0.8, 0.2:1.0 sec.), driving gas pressure(DGP)(10,30,50 psi), the inspiratory peak halothane and oxygen concentration were measured. The results were analyzed to predict the association and relationship of the inspiratory peak halothane and oxygen concentration with each variable. Partial coefficient of halothane concentration of the vaporizer, I:E ratio, DGP were -0.7224, 0.3724, 0.3386 and R squares were 0.5219, 0.6605, 0.7752 to the inspiratory peak halothane concentration. Partial coefficient of I:E ratio, DGP were-0.9386, 0.1138 and R squares were 0.8809, 0.8939 to the inspiratory oxygen concentration. Halothane concentration of the vaporizer was the most associated factor to the inspiratory peak halothane concentration and I:E ratio to the inspiratory oxygen concentration. Clinically, if DGP and I:E ratio are determined, the halothane concentration of the vaporizer will be the predictor of the inspiratory halothane concentration. But in a certain condition, the inspiratory peak halothane concentration could not be achieved to a proper level for maintaing anesthesia by this experimental model. In conclusion, most of the high frequency jet systems used clinically are of the open character allowing entrainment of additional gases and difficult to apply if volitile agents are to be used. Special predictable vaporizers have to be developed to apply volitile agents in any situation of I:E ratio and DGP by this method of administering inhalation agents during high frequency jet ventilation.
Airway Management ; Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics, Inhalation ; Gases ; Halothane* ; High-Frequency Jet Ventilation* ; High-Frequency Ventilation ; Inhalation* ; Lung* ; Models, Theoretical ; Nebulizers and Vaporizers ; Oxygen ; Ventilation

BACKGROUND: Anesthetic agents used for general anesthesia are emerging possible influential factors for surgical site infection (SSI). In this retrospective study, we evaluated the incidence of SSI after colorectal surgery according to the main anesthetic agents: volatile anesthetics vs. propofol. METHODS: A total 1,934 adult patients, who underwent elective colorectal surgery under general anesthesia between January 2011 and December 2013, were surveyed to evaluate the incidence of SSI: 1,519 using volatile anesthetics and 415 using propofol for main anesthetic agents. Patient, surgery, and anesthesia-related factors were investigated from all patients. Propensity-score matching was performed to reduce the risk of confounding and produced 390 patients in each group. RESULTS: Within the propensity-score matched groups, the incidence of SSI was higher in the volatile group compared with the propofol group (10 [2.6%] vs. 2 [0.5%], OR = 5.0 [95% CI = 1.1-2.8]). C-reactive protein was higher in the volatile group than in the propofol group (8.4 ± 5.6 vs. 7.1 ± 5.3 mg/dl, P = 0.001), and postoperative white blood cells count was higher in the volatile group than in the propofol group (9.2 ± 3.2 × 10³/µl vs. 8.6 ± 3.4 × 10³/µl, P = 0.041). CONCLUSIONS: The results of this study suggest that intravenous anesthesia may have beneficial effects for reducing SSI in colorectal surgery compared to volatile anesthesia.
Adult ; Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Anesthetics* ; C-Reactive Protein ; Colorectal Surgery* ; Humans ; Incidence ; Leukocytes ; Propofol* ; Research Design ; Retrospective Studies* ; Surgical Wound Infection*

This case involves a 43-year-old man who had been diagnosed as having Charcot-Marie-Tooth disease (CMTD) 9 years ago and was scheduled to undergo posterior fusion of its spine due to a compression fracture. General anesthesia using propofol was selected as the anesthetic method, in order to avoid the occurrence of malignant hyperthermia due to inhalation anesthetics. The patient was given 100 mg of propofol for anesthetic induction, and then propofol was infused at a rate of 4-5 mg/kg/h with intermittent administration of fentanyl for anesthetic maintenance. Rocuronium 50 mg was injected for endotracheal intubation, and then rocuronium 10 mg was injected at 45 min intervals. There was no delay in awakening, and the patient experienced no problems postoperatively. Intravenous anesthesia using propofol is thought to be a safe and effective method of anesthesia for patients with CMTD.
Adult ; Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics, Inhalation ; Charcot-Marie-Tooth Disease* ; Fentanyl ; Fractures, Compression ; Humans ; Intubation, Intratracheal ; Malignant Hyperthermia ; Propofol* ; Spine

PURPOSE: Anesthesia and surgery commonly cause hypothermia, and this caused by a combination of anesthetic-induced impairment of thermoregulatory control, a cold operation room environment and other factors that promote heat loss. All the general anesthetics markedly impair normal autonomic thermoregulatory control. The aim of this study is to evaluate the effect of two different types of propofol versus inhalation anesthetic on the body temperature. MATERIALS AND METHODS: In this randomized controlled study, 36 patients scheduled for elective laparoscopic gastrectomy were allocated into three groups; group S (sevoflurane, n=12), group L (lipid-emulsion propofol, n=12) and group M (micro-emulsion propofol, n=12). Anesthesia was maintained with typical doses of the study drugs and all the groups received continuous remifentanil infusion. The body temperature was continuously monitored after the induction of general anesthesia until the end of surgery. RESULTS: The body temperature was decreased in all the groups. The temperature gradient of each group (group S, group L and group M) at 180 minutes from induction of anesthesia was 2.5+/-0.6degrees C, 1.6+/-0.5degrees C and 2.3+/-0.6degrees C, respectively. The body temperature of group L was significantly higher than that of group S and group M at 30 minutes and 75 minute after induction of anesthesia, respectively. There were no temperature differences between group S and group M. CONCLUSION: The body temperature is maintained at a higher level in elderly patients anesthetized with lipid-emulsion propofol.
Aged ; Aging ; Anesthesia, General/*methods ; Anesthetics, Combined/administration & dosage ; Anesthetics, Inhalation/*administration & dosage ; Anesthetics, Intravenous/*administration & dosage ; Body Temperature/*drug effects ; Body Temperature Regulation/drug effects ; Fat Emulsions, Intravenous ; Female ; Humans ; Male ; Methyl Ethers/*administration & dosage ; Middle Aged ; Propofol/*administration & dosage