The authors analyzed statistically 1,147 cases of pediatric anesthesia (under age 10) performed at Ewha Womans University Hospital from January 1972 to December 1978. The results were as follows: 1) The most common age group was under 1-year old group and the overall ratio of male to female was 2:1. 2) The case frequency was highest in the Department of General Surgery (466 cases, 41%). 3) The most common site of operation was the head and neck area(37.7%). 4) It was the combination of atropine sulfate and meperdine that was commonly used as premedicants(28.9%). 5) For the induction of anesthesia the combination of thiopental sodium and succinylcholine chloride was mainly used(53.0%). 6) The use of halothane has statistically been increased as the main anesthetic(45.9%). 7) In the distribution of anesthetic methods the circle system was 33.7%, and the non-rebreathing system was 33.8%. 8) Of tatal cases those with physical status of ASA class l were 773 (67.4%). 9) There were little seasonal variations in case distribution. 10) Of total cases under age 1 the acpured disease was greater in frequency than the congenital disease.
Anesthesia* ; Atropine ; Female ; Halothane ; Head ; Humans ; Male ; Neck ; Seasons ; Succinylcholine ; Thiopental

BACKGROUND: Patients with a prior myocardial infarction who undergo noncardiac surgery have a higher risk of perioperative morbidity and mortality. Therefore, this study was designed to assess the outcomes after non-cardiac surgery in patients who had a previous myocardial infarction. METHODS: Ninety three patients who had a prior myocardial infarction and underwent noncardiac surgery were included in this study. The patients were divided as follows: the Complication group versus the Non-Complication group. A retrospective analysis was performed to determine if age, gender, ejection fraction, prior coronary revascularization, ASA physical status, operation time and type, perioperative vital signs, cardiac risk factor, preoperative medications and coronary multivessel disease influence the perioperative morbidity and mortality. RESULTS: Fourteen of the 93 patients (15.1%) had perioperative complications, of which 3 (3.2%) were fatal. All fatal patients had undergone noncardiac surgery within 3 months after the previous coronary revascularization. The incidence of intraoperative tachycardia and oliguria, operation time and the ASA physical status were longer and greater in the Complication group (P<0.05). Otherwise there were no significant differences between the two groups. CONCLUSIONS: The incidence of intraoperative tachycardia and oliguria, the operation time and ASA physical status influence the outcomes after noncardiac surgery of patients with a prior myocardial infarction. In addition, the interval between the coronary revascularization procedure and the noncardiac surgery has a major impact on postoperative mortality. However, prospective multi-center studies will be needed to determine the effects of several variables.
Humans ; Incidence ; Mortality* ; Myocardial Infarction* ; Oliguria ; Retrospective Studies ; Risk Factors ; Tachycardia ; Vital Signs

Acute hyperkalemia may result from excessive load, transcellular shift, decreased renal excretion and so on. Potassium release following succinylcholine administration is sufficient to cause ventricular dysrrhythmia and cardiac arrest in some conditions such as severe burn, massive trauma, spinal cord injury, some neuromuscular disease, and cerebral damage. We experienced a case of acute hyperkalemia associated with cardiac arrythmia immediately after administration of succinylcholine in a 80 year-old male patient who was diagnosed as spondylitis tuberculosa and psoas abscess. The hyperkalemia was attenuated by calcium chloride and sodium bicarbonate and cardiovascular instability was treated by vasoactive drugs symptomatically. Though the eldery patient with diabetes mellitus had been shown chronic hypokalemia, we should be aware of occurrence of sudden hyperkalemia after administration of succinylcholine.
Aged* ; Aged, 80 and over ; Arrhythmias, Cardiac ; Burns ; Calcium Chloride ; Diabetes Mellitus ; Heart Arrest ; Humans ; Hyperkalemia* ; Hypokalemia* ; Male ; Neuromuscular Diseases ; Potassium ; Psoas Abscess ; Sodium Bicarbonate ; Spinal Cord Injuries ; Spondylitis ; Succinylcholine*

BACKGROUND: Potent inhalation anesthetics potentiate the neuromuscular blocking effects of non-depolarizing muscle relaxants. Therefore, sevoflurane may increase the safety margin at the end of anesthesia by reducing the muscle relaxant dose requirements. We studied the recovery from rocuronium-induced neuromuscular blockade during sevoflurane- versus propofol-based anesthesia in children. METHODS: Fifty pediatric patients were randomly allocated to maintenance of anesthesia with sevoflurane (n = 25) or propofol (n = 25). Neuromuscular block was maintained with rocuronium and monitored by acceleromyography (TOF-Watch?) using train-of-four (TOF) stimulation every 12 seconds. Anesthetic agent administration was gradually reduced and then stopped toward the end of procedure. At the end of surgery, neostigmine 0.04 mg/kg was administered. Time of tracheal extubation, time of arrival in PACU, amount of rocuronium given were recorded. RESULTS: TOF ratio at the end of surgery was greater in sevoflurane group (73.0 +/- 30.0) than in propofol group (50.0 +/- 37.1)(P < 0.05). The dose of rocuronium administered as supplemental increments in sevoflurane group was significantly smaller than that in propofol group (0.9 +/- 1.6 vs 2.8 +/- 2.4microgram/kg/min)(P < 0.05). Time to extubation (7.3 +/- 2.0 vs 9.0 +/- 2.6 min), and time to arrival in PACU (11.5 +/- 2.9 vs 13.9 +/- 2.6 min) from end of surgery were shorter in sevoflurane group than in propofol group (P < 0.05). CONCLUSIONS: These results support the postulate that the potentiation of neuromuscular block by sevoflurane may provide additional safety for pediatric patients by reducing the muscle relaxant dose requirements.
Airway Extubation ; Anesthesia* ; Anesthetics, Inhalation ; Child ; Humans ; Neostigmine ; Neuromuscular Blockade* ; Neuromuscular Nondepolarizing Agents ; Propofol*

BACKGROUND: Laryngoscopic and tracheal intubation often causes an increase in blood pressure and heart rate. The purpose of this study was to evaluate the influence of the duration of laryngoscopy and tracheal intubation on hemodynamic response. METHODS: We studied 110 patients undergoing elective surgery. Anesthesia was induced with fentanyl 1microgram/kg and thiopental 5 mg/kg, and rocuronium 0.6 mg/kg was administrated prior to intubation. The duration of laryngoscopy and tracheal intubation was defined as the interval between the insertion of a laryngoscope into a patient's mouth and its removal after successful tracheal intubation. Patients were divided into three groups according to the duration of intubation: Group 1 (duration < or = 15 seconds); Group 2 (15 < duration < or = 30 seconds); Group 3 (duration > 30 seconds). Systolic blood pressure, diastolic blood pressure and heart rate were measured before intubation, after induction, immediately after intubation, and 1 min and 3 min after intubation. RESULTS: Systolic blood pressure at 1 min after intubation was significantly higher in Group 3 than in Group 1, but no significant differences were observed in diastolic blood pressure or heart rate. Regarding the correlation between systolic blood pressure and the duration of laryngoscopy and tracheal intubation, the linear regression r2 value was 0.03. CONCLUSION: This study suggests that the duration of laryngoscopy and tracheal intubation is not significantly correlated with blood pressure. However, it also shows that when the time to intubation exceeds 30 seconds, that the systolic blood pressure is significantly increased. Thus, when the duration of tracheal intubation is anticipated to be prolonged, attempts to attenuate hemodynamic response to tracheal intubation are necessary.
Anesthesia ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Laryngoscopes ; Laryngoscopy ; Linear Models ; Mouth ; Thiopental*