A prospective study of 99 pediatric patients were performed to investigate the incidence of perioperative airway complications presenting for various surgery with mild upper respiratory infections(URI's). Anesthesia administered via either face mask or endotracheal intubation. The severity of respiratory complications were scored. Endotracheal intubation in itself increased complication score compared to inhalation anesthesia with face mask. There were significant differences in the complication scores between control children and children fulfilling predetermined URI criteria. Complications showing significant differences were cough, airway obstruction, secretion. However, mean scores were too low to draw CONCLUSION that children with URI's should be postponed elective surgery.
Airway Obstruction ; Anesthesia ; Anesthesia, Inhalation ; Child* ; Cough ; Humans ; Incidence* ; Intubation, Intratracheal ; Masks ; Prospective Studies

BACKGROUND: It has been a standard practice in many institutions to combine light general anesthesia with epidural block for abdominal and pelvic surgery. We attempted to prove the effectiveness of prehydration and to find an suitable epidural local anesthetic dose in terms of hemodynamic stability for upper abdominal surgery. METHODS: For preliminary studies, 11 patients scheduled for elective upper abdominal surgery had received general anesthesia immediately after epidural anesthesia. After epidural injection of 10~16 mL of 2% plain lidocaine into the T9~10 intervertebral space, the changes in blood pressure were observed. Thirty-two patients scheduled for elective upper abdominal surgery were divided into two groups. In group A (study group), after prehydration with Hartmann solution (10 mL/kg), 5~7 mL of 2% plain lidocaine was injected into T8~9 or T9~10 intervertebral space and general anesthesia was then induced. Group B (control group) received general anesthesia only. RESULTS: There were no significant differences in hemodynamics between the epidural with general anesthesia and the control group except SVR (systemic vascular resistance). SVR in group A increased in contrast to the group B in which it remained unchanged. CONCLUSIONS: The combined epidural and general anesthesia, using prehydration and 0.5~1 mL/segment of 2% plain lidocaine at the T8~9 or T9~10 intervertebral space was safe without significant hemodynamic changes.
Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Hemodynamics* ; Humans ; Injections, Epidural ; Lidocaine

BACKGROUND: The effects of a muscle relaxant may differ in elderly compared with young adult patients for a variety of the pharmacokinetic and pharmacodynamic reasons. Atracurium is eliminated by nonorgan dependent pathway, Hofmann elimination and ester hydrolysis. So there are some arguments for age-related differences. The purpose of this study was to compare the differences of the onset and duration of atracurium in young and elderly. METHODS: Eighteen young adults (21-54 yr) and 18 elderly (>65 yr) patients anesthetized with nitrous oxide and enflurane. Atracurium (0.5 mg/kg) was given and then intubation was performed after T1 response was blocked more than 80%. Neuromuscular relaxation was measured by the first twitch of train-of-four (T1) response at the adductor pollicis after supramaximal stimulation of ulnar nerve at 2Hz every 12 sec. The onset (disappearance of T1) and duration of 5, 25, 50, 75% recovery time of T1 and recovery index (time for 25-75% recovery of T1) were recorded. RESULTS: Onset of block was not significantly different between the young and elderly. Recovery time of 5, 25, 50, 75% and recovery index were not prolonged in elderly compared with young adults. CONCLUSIONS: There were no significant differences between young and elderly adults in onest time, recovery time of 5, 25, 50, 75% and recovery index when atracurium is used in a single bolus dose. The results suggest that atracurium in elderly patients has similar onset and action duration compared with younger patients.
Adult ; Aged* ; Atracurium* ; Enflurane ; Humans ; Hydrolysis ; Intubation ; Nitrous Oxide ; Relaxation ; Ulnar Nerve ; Young Adult

A 36 years old man was scheduled for carinal resction, left pneumonectomy, and tracheobronchial anastomosis under the diagncais of malignant tumor in the carina and left main bronchus. During the procedure of carinal resection, anesthesia had been maintained with a right bronchial tube which was intubated through operating thoracic cavity. The E.K.G. was monitored continuously and a radial artery canula was inserted for disect arterial pressure monitoring and blood gas analysis sampling. Anesthetic course was uneventful with nitrous oxide, ahlothane and pancuronium under controlled respiration. Postoperative course had minor problem with right upper lobe atelectasis which disappeared soon after tracheal suction.
Adult ; Anesthesia ; Arterial Pressure ; Blood Gas Analysis ; Bronchi ; Humans ; Nitrous Oxide ; Pancuronium ; Pneumonectomy ; Pulmonary Atelectasis ; Radial Artery ; Respiration ; Suction ; Thoracic Cavity

We managed three cases of anesthesia for living related liver transplantation from December 1994 to July 1995. Donors were recipient's parents and two of them were 35-year old man, the other was 25-year-old woman. The recipients were suffered from congenital liver diseases (two of them were diagnosed as biliary atresia and the other Byler's disease). They had presented severe jaundice and cholangitis and their mean age & body weight were 15 +/- 4.9 months and 8.6 +/- 1.22 kg, respectively. Average duration of anesthesia was about 15 hours, and anhepatic time was 140 minutes, 80 m inutes and 50 minutes, respectively. Careful attention was paid to body temperature, serum potassium, ionized calcium, blood coagulation function, as well as to general condition and respiratory function. Hemodynamic value was relatively stable through out the operation and postoperative mechanical ventilatory support was required for about 3 days.
Adult ; Anesthesia ; Biliary Atresia ; Blood Coagulation ; Body Temperature ; Body Weight ; Calcium ; Child* ; Cholangitis ; Female ; Hemodynamics ; Humans ; Jaundice ; Liver Diseases ; Liver Transplantation* ; Liver* ; Parents ; Potassium ; Tissue Donors*

We noted hemoglobinuris during and after extracorporeal circulation for one case of mitral valve replacement. Laboratory results revealed autoimmune hemolytic anemia(AIHA) including a positive direct Coombs test. A patient with AIHA is serologically incompatible with his own red cells and with the red cells of most blood donors. Red cell transfusion is essential for the management of life threatenting anemia especially in this case. So it is essential, therefore, to have efficient clinician blood bank communication in order to arrive at a rational transfusion therapy for these patients.
Anemia ; Anemia, Hemolytic* ; Blood Banks ; Blood Donors ; Coombs Test ; Extracorporeal Circulation* ; Humans ; Mitral Valve

We studied the cardiovascular and intracranial pressure(ICP) effects of Vecuronium in cats with normal and artificially increased ICP. Under pentobarbital and nitrous oxide anesthesia, monitors for ICP, Mean Arterial Pressure(MAP), Heart Rate(HR), and Central Venous Pressure(CVP) were placed in the cats. The cats were then divided into two groups: one with normal ICP( N-ICP) (n=8) and the other with artificially increased ICP (AI-ICP) (n=8). In the AI-ICP group, a size 8F Foley catheter was placed in the epidural space through a 5 mm trephined hole on the right parietal area. In each group, ICP, MAP, HR, CVP, and Cerebral Perfusion Pressure(CPP) were measured after Vecuronium injection(80ug/kg)(CPP=MAP-ICP). Results showed no statistically significant changes in cats with N-ICP and AI-ICP.
Anesthesia ; Animals ; Catheters ; Cats* ; Epidural Space ; Heart ; Hemodynamics* ; Intracranial Pressure* ; Nitrous Oxide ; Pentobarbital ; Perfusion ; Rabeprazole ; Vecuronium Bromide*

The effects of Norepinephrine(NE), Isoproterenol(ISO) and Nitroglycerin(NTG) on the hemodynamic, arterial and venous blood gas analysis changes in air embolized cats were investigated. Under general anesthesia with Halothane, cats were injected 1ml/kg of air acutely to decrease mean arterial pressure(MAP) about 30 to 40 percent of control value through superior vena cava. 14 cats were divided into two groups of 7 each (group 1 and 2). Group 1 cats received NE and then NE with NTG therapies. In group 2, ISO and then ISO with NTG therapies were taken. The results were as follows: 1) Hemodynamic changes. Group 1: NE increased the MAP from 69+/-8 mmHg(mean+/-SD) to 116+/-14mmHg(p<0.05), decreased the right atrial pressure(RAP) from 18+/-4mmHg to 11+/-3mmHg(p<0.05). Combined therapy with NTG decreased the MAP from 116+/-14 mmHg to 101+/-10 mmHg(p<0.05), the HR from 167+/-16 beats/min(bpm) to 150+/-4 bpm(p<0.05), the RAP from 11+/-3 mmHg to 8+/-3mmHg(p<0.05). Group 2: ISO increased the MAP from 81+/-8mmHg to 112+/-14 mmHg(p<0.05), and the HR from 152+/-21 bpm to 190+/-24 bpm(p<0.05). Combined therpy with NTG decreased the HR from 190+/-24 bpm to 174+/-19 bpm(p<0.05), the CVP from 14+/-7mmHg to 14+/-3mmHg(p<0.05), and the RAP from 13+/-3mmHg to 12+/-3mmHg(p<0.05). 2) Blood gas analysis changes. Group 1: NE with NTG combined therapy increased the arterial oxygen tension from 335+/-54 mmHg to 372+/-49mmHg, decreased the venous CO2 tension from 52+/-9mmHg to 47+/-4mmHg. Group 2: ISO with NTG combined therapy increased the arterial oxygen tension from 344+/-85mmHg to 375+/-50mmHgIp<0.05). (paired t-test, p<0.05). In conclusion, NE and ISO increased MAP in venous air embolism with moderately decreased MAP. Inotropic agent with NTG therapy improved arterial oxygenation.
Anesthesia, General ; Animals ; Blood Gas Analysis* ; Cats* ; Embolism, Air ; Halothane ; Hemodynamics* ; Isoproterenol* ; Nitroglycerin* ; Norepinephrine* ; Oxygen ; Vena Cava, Superior

Surgical and anesthetic management in patients with complex vascular lesions is often challenging. Cardiopulmonary bypass followed by total circulatory arrest, deep hypothermia and barbiturate cerebral protection are efficacious adjuncts in the surgical treatment of giant basilar artery aneurysm. These techniques were utillized in two large basilar artery aneurysm patients with good results, and the surgical and anesthetic considerations are reviewed.
Aneurysm* ; Basilar Artery* ; Cardiopulmonary Bypass ; Humans ; Hypothermia* ; Intracranial Aneurysm

BACKGROUND: Blood-brain barrier(BBB) permeability and intravascular hydrostatic pressure are main factors for developing brain edema. Selective cooling of the brain could attenuate the ischemia-induced increase of BBB permeability. Because the method can provide driving pressure for edema formation, a beneficial effect of hypothermic perfusion on reducing edema would be questionable. The goal of this study was to evaluate the effect of isolated cerebral perfusion during the cerebral ischemia on the formation of brain edema. METHODS: Both vertebral arteries were cauterized, right carotid artery was cannulated to provide an infusion route. After left carotid artery was snared, cold saline was immediately perfused into the right carotid artery for 10 min in the perfusion group. To produce ischemia in no perfusion group carotid arteries were clamped bilaterally for 10 min. Brain water contents were measured using the kerosene/bromobenzene density gradient after reperfusion and compared with no perfusion and normal control group. RESULTS: Brain water content of perfusion group measured at 90 min after reperfusion showed increased water content compared to no perfusion and normal control group(p<0.05). However, at 180 min after reperfusion, there were no statistically significant differences between the perfusion and no perfusion group. CONCLUSIONS: Cerebral saline perfusion during the ischemia enhanced the formation of brain edema even though hypothermia could reduce BBB permeability. These results show driving force is more important than permeability for the development of brain edema in this type of experiments.
Brain Edema ; Brain Ischemia* ; Brain* ; Carotid Arteries ; Edema ; Hydrostatic Pressure ; Hypothermia ; Ischemia ; Perfusion ; Permeability ; Reperfusion ; SNARE Proteins ; Vertebral Artery