BACKGROUND: The laparoscopy requires carbon dioxide (CO2) insufflation and Trendelenburg position for operational convenience. However, the above circumstances affect the cardiopulmonary systems significantly and intraocular pressure (IOP) may be also influenced. METHODS: In 27 non-glaucoma patients right and left intraocular pressure (RIOP, LIOP) were measured 5 minutes after induction of general anesthesia (control value), 15 and 30 minutes after CO2 insufflation and endelenburg-lithotomy position. RESULTS: The control values of RIOP and LIOP were 11.3 4.7 mmHg and 11.5 4.7 mmHg respectively. At 15 minutes after CO2 insufflation and Trendelenburg-lithotomy position, they increased to 16.6 5.3 mmHg and 17.0 5.9 mmHg (p<0.05). At 30 minutes, 18.4 3.5 mmHg and 18.2 4.1 mmHg (p<0.05). CONCLUSION: CO2 insufflation and Trendelenburg-lithotomy position increase IOP significantly in non-glaucoma patients during laparoscopy.
Anesthesia, General ; Carbon Dioxide ; Head-Down Tilt ; Humans ; Insufflation* ; Intraocular Pressure* ; Laparoscopy*

BACKGROUND: Various kinds of methods had been tried to reduce pain on injection of propofol. In this study, the effect of lidocaine pretreatment and that of temperature controlled injections were compared and evaluated its clinical utility. METHODS: One hundred and twenty patients were randomly allocated into 4 groups after permission. Room temperature propofol was used as induction agent in group P,. In group C, cooling (4 degrees C) propofol was used and warming propofol (37 degrees C) in group H. And room temperature propofol following lidocaine (1 mg/kg) was used in group L. Injection dosage of propofol was 2 mg/kg and injection speed was 2 ml/sec in all groups. In each patients, pain score and visual analog scale were measured and tested by ANOVA or Kruskal-Wallis test. RESULTS: There were no statistical significant difference in pain score among the 4 groups. But in visual analog scale analysis, group L markedly reduced values than the other groups by statistically significant manner (in Duncan grouping). CONCLUSION: The alleviating effect of lidocaine pretreatment on painful injection was better than that of changing temperature of propofol itself. More over effectiveness, in view of simplicity, we recommend lidocaine pretreatment.
Humans ; Lidocaine ; Propofol* ; Visual Analog Scale

In relief of postoperative pain, the value of epidural or subdural injection of opioids including morphine, methadone, petidine and fentanyl is now well established. The advantages of epidural or subdural over parenteral opioids is prolonged duration of analgesia, which last from several hours to several days, without sympathetic and motor blockade. But undesirable side effects include pruritus, urinary retention, delayed onset of somnolence, and cardiovascular and respiratory depression. To reduce postoperative pain, we evaluated the effects of caudal pentazocine 0.2-0.4 mg/kg with lidocaine 1.5% 400 mg for perianal surgery in 36 cases. The results were as follows: 1) There was no difference in analgesic onset between the Control Group (used lidocaine only) and Group A and B (mixed use of lidocaine and pentazocine: Group A, 0.2 mg/kg pentazocine; Group B, 0.4 mg/kg) 2) Mean duration of analgesia following caudal pentazocine and lidocaine injection was over 12 hours, but was less than 5 hours in the used lidocaine only. 3) Urinary retention was observed in all groups; 3 case in the Control group, and 4 cases in Group A and B. 4) In Group A and B, 6 cases had not used analgesics within 24 hours after caudal anesthesia. 5) No specific clinical changes were noted in the vital signs in all groups.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia, Caudal ; Fentanyl ; Lidocaine ; Methadone ; Morphine ; Pain, Postoperative ; Pentazocine* ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vital Signs

BACKGROUND: High-frequency jet ventilaion is considered a reliable technique for anesthesia and critical care including respiratory failure but there are adverse reactions such as carbon dioxide retension and dry of respiratory mucosa. The purpose of this study was to confirm the effects of combined high- frequency jet ventilation (HFJV) and converntional mechanical ventilation (CMV) on the cardiovascular system, arterial blood gases tension and mean airway pressure in 9 Korea mongrel dogs with pulmonary edema induced by oleic acid. METHODS: During CMV with 20 breaths/minute, 10 ml/kg of tidal volume and F1O2 1.0, parameers were evaluated (base line value). When pulmonary edema was developed, HFJV was applied initially with 120 breaths/minute, inspiratory time 30% and driving pressure 40 psi F1O2 1.0 for 60 minutes (control value) and thereafter simultaneous use of CMV was applied with the tidal volume of 10 ml/kg and each respiratory rate 8, 4, 2, 1, 0.5 per minute for 30 minutes. RESULTS: Combined application of HFJV and CMV (above repiratory rate 1 per minute) achieved the improvement of oxygenation and carbon dioxide elimination, and Paw was decreased without undesirable effects on cardiovascular system in case of the induced pulmonary edema. CONCUSIONS: From above results we recommanded that HFJV combined with CMV may be a useful method of treatment for respiratory failure.
Anesthesia ; Animals ; Carbon Dioxide ; Cardiovascular System ; Critical Care ; Dogs* ; Gases ; High-Frequency Jet Ventilation* ; Korea ; Oleic Acid* ; Oxygen ; Pulmonary Edema* ; Respiration, Artificial* ; Respiratory Insufficiency ; Respiratory Mucosa ; Respiratory Rate ; Tidal Volume ; Ventilation

Postoperative hypoxemia has been well known is adults but not in infants and children, although they are potentially more susceptible to airway closure and to disturbances in pulmonary gas exchange. We measured blood gas parameters of capillary blood in 30 cases of ASA physical status class l infants and children breathing room air, before and after general anesthesis for superficial surgical procedures. The blood samples were taken preoperatively, on arrival and 4~6 minutes later in the recovery room. The results are as follows: 1) The blood gas parameters on arrival in the recovery room showed significant change in pH nad PCO2(p<0.01) and increased PCO2(p<0.01) in comparison with preoperative gases. 2) The blood gas parameters checked at 4~6 minutes later in the recovery room showed insignificant differences from preoperative values of PO2 and SO2, but significantly increased PCO2 and decreased pH(p<0.01). 3) As a results of this study, it is suggested that for the safe management of patients, supplementary oxygen be provided for at least 10 minutes in the early recovery period to all pediatric patients.
Adult ; Anesthesia, General* ; Anoxia* ; Blood Gas Analysis ; Capillaries ; Child* ; Gases ; Humans ; Hydrogen-Ion Concentration ; Infant ; NAD ; Oxygen ; Pulmonary Gas Exchange ; Recovery Room ; Respiration

Today, the medical disputes are increased with the background of increased awareness of human rights, depersonalization in patient-physician correlationship, commercialization of medieal delivery and non-existence of social compensation for medical damage. Especially the anes olagists worked at operative wards have the risk of several pmblems occurred from various surgical and medical causes, and be involved in legal action alleging malpractice. To reduce this problems of medical dispute, theoretically anesthesiologist must always establish the rapport with patients, and summary the patient's pertinent points of the history, results of physical exarnination, laboratory examination and interview, including a statement of any unusual risk, type of anesthesia planned, and the reasons for the choice of anesthesia after careful evaluation of patient's condition, and get the "informed consent" from patient. Therefore we investigated the statement of the informed consent for anesthesia in Korean general hospitals. Specific formula of anesthetic informed consent was used in only 7 hospitals (12.7%), and 19 of 55 generai hospitals (34.5%) get the informed consent in cases of high risk with cardiac, respiratory, central nervous system, hepatic and renal diseases.
Anesthesia ; Central Nervous System ; Compensation and Redress ; Depersonalization ; Dissent and Disputes ; Hospitals, General ; Human Rights ; Humans ; Informed Consent* ; Malpractice

BACKGROUND: Recently, using propofol as intravenous anesthetic agent is increasing. And it is known that propofol has little effects on liver function even after long operation such as plastic surgery. But its effect on liver functon after hepatobilliary operation which may damage liver was not studied. Thus, authors carried out this study to evaluate the effect of propofol on liver function by comparing with enflurane in the patients who had laparoscopic cholecystectomy. METHODS: Patients's anesthesia records and hospital charts from January 1994 to June 1996 were anlaysed retrospectively. Three hundred and thirty three patients who had normal liver function preoperatively and had no complications during and after operation were selected. They were divided into two groups ; propofol group (n=191) and enflurane group (n=142). The preoperative values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were compared with those of 1 and 3 days after operation. RESULTS: One day after operation, both propofol and enflurane group showed significant increase in AST and ALT (p<0.05) and decrease in ALP (p<0.05). But there was no difference between two groups. CONCLUSION: Concerned to liver function, propofol is as useful as enflurane to the patients who scheduled for laparoscopic cholecystectomy.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Aspartate Aminotransferases ; Cholecystectomy, Laparoscopic* ; Enflurane* ; Humans ; Liver* ; Propofol* ; Retrospective Studies ; Surgery, Plastic

BACKGROUND: Even though surgery and anesthesia give stress to patients, adequate anesthesia could attenuate stress reactions and minimize side effects from these reactions. Abnormal glucose homeostasis is well documented side effect during anesthesia, especially when inhalational anesthetics are used. We planned this study to investigate and compare the effects of two popular anesthetics-between propofol, intravenous anesthetics, and enflurane, inhalational agents on blood glucose level. METHODS: Adult patients free of diabetes mellitus and any other endocrine disease were randomly allocated into two groups. In both groups, anesthesia was induced with 2.5% pentothal sodium 5 mg/kg and succinylcholine 1 mg/kg. After intubation, propofol 6~10 mg/kg with 50 % N2O-O2 mixture 4 liter were used for maintenance in one group (Group P). In other group, enflurane 1.5~2% with 50% N2O-O2 mixture 4 liter were used (Group E). Hartmann's solutions were used for maintenance fluid in both groups. Blood glucose levels were measured at preintubation period, postintubation 5, 10, 15 minutes and just-preincision period. Blood glucose level at admission was regarded as control value and statistical analysis was done by Student's t-test. RESULTS: In group E, there was significant increase of the blood glucose level about 23 minutes after induction but in group P, there was no significant increase of glucose level during entire experimental time. Blood glucose levels were higher from postintubation 5 minutes to just-preincision period with statistical significance in group E than group P. CONCLUSIONS: Propofol maintained stable blood glucose level compared to enflurane during general anesthesia.
Adult ; Anesthesia ; Anesthesia, General ; Anesthetics ; Anesthetics, Intravenous ; Blood Glucose* ; Diabetes Mellitus ; Endocrine System Diseases ; Enflurane* ; Glucose ; Homeostasis ; Humans ; Intubation ; Propofol* ; Sodium ; Succinylcholine ; Thiopental

BACKGROUND: As the problems of medical malpractices become a very serious social issue, it is necessary to increasingly relate law to medical practice and evaluate medical services. However, it is not easy to legally call someone to account, as medical services are highly specific, especially anesthetic management. Anesthesiologist can expect to be involved in legal action alleging malpractice, either as a defendant or expert witness. METHODS: The anesthetic informed consent form was examined at 42 general hospitals in the Republic of Korea. The chief physician of the department of anesthesiology and pain medicine was asked for the anesthetic informed consent form they used in clinical anesthetic practice, and then what constitutes adequate informed consent analyzed. RESULTS: All of the hospitals were using informed consent forms, but 42.9% of the hospital used a specific form to describe the complications or risks associated with anesthetic management. In 71.4% of hospitals, the anesthesiologists or anesthetic residents explained the anesthetic risk, but 28.6% of hospitals the anesthetic complications were explained by nurses or surgeons. In 76.2% of hospitals, the anesthetic risks were explained to both the patients and parents, but in 23.8% these were explained to parents only. CONCLUSIONS: We propose a new anesthetic informed consent form for adequate explanation and agreement to legal requirements.
Anesthesiology ; Consent Forms ; Expert Testimony ; Hospitals, General ; Humans ; Informed Consent* ; Jurisprudence ; Malpractice ; Parents ; Republic of Korea

Superior mesenteric artery syndrome (SMAS) is a rare clinical disease. SMAS is defined as the entrapment of the third portion of the duodenum by the aorta and the superior mesenteric artery. A 14-year-old male patient was admitted to the local hospital for an emergency appendectomy under general anesthesia. In the process of inducing general anesthesia, massive pulmonary aspiration of gastric contents and bile juice occurred by accident. After surgery, he was transferred to our hospital due to severe ARDS. The gastroduodenoscopy observations, CT, and clinical symptoms, were indicative of SMAS. Surgery was considered because medical conservative treatment of SMAS was ineffective. SMAS was confirmed on the surgical fields. We report our experience with a review of the relevant literature because this condition can be associated with serious complications during general anesthesia.
Adolescent ; Anesthesia, General* ; Aorta ; Appendectomy ; Bile ; Duodenum ; Emergencies ; Humans ; Male ; Mesenteric Artery, Superior* ; Pneumonia, Aspiration* ; Superior Mesenteric Artery Syndrome*