The Jackson Rees technique has become increasingly popular in pediatric anesthesia. This article presents an original Jackson Rees technique that we have used on 1235 cases for the past 7 years, and which is known as Pentothal-Curare-Hyperventilation technique or the Liverpool technique because of its origin and agents used. Technique 1) Atropine and demerol generally are given as premedication but atropine is only given in the newborn baby. 2) Patients are given pentothal 4mg/kg to sleep. 3) A dose of curare 0.6mg/kg is administered to paralyse and the patient is intubated with an appropriate size tube. 4) The patient is hyperventilated with three times the minute volume of N2O/O2 in a 1:2 ratio using a Jackson Rees modification unit. 5) At the end of surgery N2O is discontinued and curare is reversed with prostigmine 0.1mg/kg and atropine 0.03mg/kg. As a result of our experience this technique has been considered to be a very satisfactory technique in all fields of pediatric andsthesia. The advantages and controverses are discussed.
Anesthesia* ; Atropine ; Curare ; Humans ; Infant, Newborn ; Meperidine ; Neostigmine ; Premedication ; Thiopental

Succinylcholine is still widespread use, despite the lack of understanding of the mechanisms of its action at the neuromuscular junetion. It is assumed that succinylcholine acts exclusively on the post-junctional structure of the neuromuscular junction, phase I block, but after administration of additional large doses, this phase I block is followed by the appearance of phaae II block, curare like. These phase I and II block are purely descriptive terms and do not imply a mechanism of action. Not only would administration of repeat of large doses of succinylcholine for study in vivo be dangerous but objective measurement of their effect can be difficult to interpret. Therefore, the present study was designed to determine succinylcholine doses response relationships for the incremental bolus and its divided doses using isolated arm test which is isolated from systemic circulation appling tourniquet on upper arm and using small dose of muscle relaxant safely, and measuring the force of contraction of adductor pollicis with Accelograph under the enflurane and 50% N2O anesthesia. The tourniquet was kept inflated for 4 minutes to allow retrograde spread of some of the succinylcholine into the capillary bed where neuromuscular block was established. At the end of 4 minutes, the tourniquet was released and the interpretation of twitch response was started: 1. The incremental doses of succinylcholine induced significantly prolongation of duration (p< 0.005) but no significant different in recovery index. 2. TOF ratio runs down definitely from over 40 mg incremental doses with bolus injection and more in divided doses than bolus. 3) The relationship between incremental doses and TOF ratio decreasing was statistically signifi-cant (y=-0.49x+84.5, r= 0.65, p<0.005)
Anesthesia ; Arm* ; Capillaries ; Curare ; Enflurane ; Neuromuscular Blockade ; Neuromuscular Junction ; Succinylcholine* ; Tourniquets

Succinylcholine is still widespread use, despite the lack of understanding of the mechanisms of its action at the neuromuscular junetion. It is assumed that succinylcholine acts exclusively on the post-junctional structure of the neuromuscular junction, phase I block, but after administration of additional large doses, this phase I block is followed by the appearance of phaae II block, curare like. These phase I and II block are purely descriptive terms and do not imply a mechanism of action. Not only would administration of repeat of large doses of succinylcholine for study in vivo be dangerous but objective measurement of their effect can be difficult to interpret. Therefore, the present study was designed to determine succinylcholine doses response relationships for the incremental bolus and its divided doses using isolated arm test which is isolated from systemic circulation appling tourniquet on upper arm and using small dose of muscle relaxant safely, and measuring the force of contraction of adductor pollicis with Accelograph under the enflurane and 50% N2O anesthesia. The tourniquet was kept inflated for 4 minutes to allow retrograde spread of some of the succinylcholine into the capillary bed where neuromuscular block was established. At the end of 4 minutes, the tourniquet was released and the interpretation of twitch response was started: 1. The incremental doses of succinylcholine induced significantly prolongation of duration (p< 0.005) but no significant different in recovery index. 2. TOF ratio runs down definitely from over 40 mg incremental doses with bolus injection and more in divided doses than bolus. 3) The relationship between incremental doses and TOF ratio decreasing was statistically signifi-cant (y=-0.49x+84.5, r= 0.65, p<0.005)
Anesthesia ; Arm* ; Capillaries ; Curare ; Enflurane ; Neuromuscular Blockade ; Neuromuscular Junction ; Succinylcholine* ; Tourniquets

A fifty-eight years old male patient was given general anesthesia for the clipping of aneurysm on the posterior communicating artery. The respiration of the patient was controlled with Ohmeda 7000 anesthesia ventilator. During the surgery there appeared curare cleft on the capnogram which did not disappear after the administration of neuromuscular blocker, but disappeared after the change of the anesthesia ventilator with another one. After that another curare cleft was made by the transient obstruction of the outlet of the excess patient circuit gas of the new anesthesia ventilator. It may be said that inappropriately functioning pop-off valve of the anesthesia ventilator can be one of the causes of curare cleft on the capnogram.
Anesthesia ; Anesthesia, General ; Aneurysm ; Arteries ; Curare* ; Humans ; Male ; Neuromuscular Blockade ; Respiration ; Ventilators, Mechanical

It is a known fact that the increase of intraocular pressure results from the action of succinylcholine, endotracheal stimulation to carina, bucking and coughing etc during the induction arid recovery periods. Efforts have been made by several inveatigators to prevent intraocular hypertension by giving trimetaphan, inderal or curare. However, their effects were not remarkable. In this study, lidocaine Img/tg was administered intravenously to selectee patients 2-3 minutes hefore induction ; followed by regular induction with pentothal, succinylcholine and incubation. Intraocular pressures were measured at the pre-induction and post-intutation time, and every 30 minutes until the early recovery period, thereafter. The result of this study showed that the post-intubational increase of intraocular pressure was prevented in 86.7% of the lidocaine pretreated cases. The increase of post-extuba-tional intraocular pressure was also reduced significantly in the lidocaine pretreated group-as well. We came to the conclusion that lidocaine pretreatment technic can be used effectively to prevent intraocular hyperteilsion caused by induction and extubation in clinical practice.
Cough ; Curare ; Humans ; Hypertension ; Intraocular Pressure ; Lidocaine* ; Propranolol ; Succinylcholine ; Thiopental ; Trimethaphan

A focus on patient safety has heightened the awareness of pateint mornitoring. The importantce of clinical application of capnography continues to grow, as reflected by the increasing number of medical societies recommending its use. We recently encountered an abnormal capnography undergoing gastrectomy. It was noted that the waveform was not sustained zero-baseline formation as seen during inspiratory phase, immediately upsloping for expiratory plateau followed by inspiratoy downsloping as like a shape of curare cleft. But PaCO2 was within normal range. We found that the source of the problem was the incorrect (bottom up) assembly of spring with absorber valve into the CUBE, the circle breathing system of Dameca Ventilator. Spring with absorber valve divides CUBE circle into inspiratory and expiratory space. We concluded that the unusual capnography was resulted from the incorrect assembly of it, subsequently mixing of inspiratory and exhaled gases and rebreathing was occurred with the block of a gas flow to CO2 canister. After correcting assembly, the capnography was normalized.
Capnography* ; Curare ; Gases ; Gastrectomy ; Patient Safety ; Reference Values ; Respiration* ; Societies, Medical ; Ventilators, Mechanical

The Griffith and Johnson's report of the successful use of curare in 1942 brought a revolution in anesthetic care. The only depolarizing agent still in use is succinylcholine due to its rapid onset of action and rapid recovery. However, its use is limited by serious side effects (hyperkalemia, malignant hyperthermia, arrhythmia, etc). New non-depolarizing neuromuscular blocking agents have been studied to replace succinylcholine, which are still at a preclinical level. Rocuronium is an aminosteroid compound and has an intermediate duration of action, but the onset is shorter. A new method of reversing neuromuscular blockade has been advocated by the introduction of a cyclodextrin, sugammadex (Org 25969), which is still at the investigational stage in humans. It has a high affinity for rocuronium, with which it forms a complex. Sugammadex has a lower affinity for other steroidal neuromuscular blocking agents such as vecuronium and pancuronium, and does not bind benzylisoquinoline-type neuromuscular blocking agents. The ability to produce a rapid return of twitch height even at deep levels of paralysis and the lack of side effects make this compound a promising new agent for anesthesia.
Anesthesia ; Arrhythmias, Cardiac ; Curare ; Humans ; Malignant Hyperthermia ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents ; Pancuronium ; Paralysis ; Succinylcholine ; Vecuronium Bromide

Since Willis described 'fatigable weakness' in 1672, most physicians consider it as a kind of hysteria due to the inconsistent fluctuation of symptoms. Erb presented three cases of 'bulbal palsy' in the 1870s, and Oppenheim and Hopper considered myasthenia gravis as a disease similar to curare poisoning and as a disease induced by attack of the motor centers by intrinsic toxins, respectively. In 1903, Elliot suggested that a 'chemical substance' mediates the nerve impulses at synapse. However, it was not until 1921 that this was demonstrated by Loewi, who provided evidence from the famous two-frog-hearts experiment. Dale later revealed the substance to be acetylcholine, and he also suggested that myasthenia gravis is due to a problem with the motor end plate. In 1934, Walker was prompted by the resemblance between myasthenia gravis and curare poisoning to apply physostigmine, a curare-poisoning antidote, to a patient, which produced a dramatic result. Since then the use of anticholinesterase inhibitors has been adopted for standard therapeutic modality. Some prominent surgeons have also applied thymectomy as a surgical modality. The most recent focus of myasthenia gravis has been immunological. In 1960, Simpson proposed the autoimmune hypothesis, and Chang et al. showed that snake venom contained a selective antagonist of the nicotinic acetylcholine receptor, alpha-bungarotoxin. The immunization of rabbits with acetylcholine receptor purified from the electrical organs of electric eels by Patrick et al. induced myasthenic symptoms and signs, and these were reversed by acetylcholinesterase inhibitors. The role of the autoimmune system has led to the introduction of an immunosuppressive modality and plasma exchange to the field of clinical neurology.
Acetylcholine ; Action Potentials ; Bungarotoxins ; Cholinesterase Inhibitors ; Curare ; Electrophorus ; History of Medicine ; Humans ; Hysteria ; Immunization ; Motor Endplate ; Myasthenia Gravis ; Physostigmine ; Plasma Exchange ; Rabbits ; Receptors, Nicotinic ; Snake Venoms ; Synapses ; Thymectomy