BACKGROUND: Endotracheal intubation is accomplished for safe airway establishment, anaesthesia and operation in operating room, intensive care unit and emergency room mostly. Therefore, it will be beneficial that we predict and provide against difficult airway. With this view, our study was planned and carried out. METHODS: For 251 patients with ASA physical status I or II undergoing general aneathesia, the correlation between their age, sex, height, weight, BMI (body mass index), Samsoon & Young classification and laryngoscopic grades by Cormack & Lehane was investigated. RESULTS: Laryngoscopic grades were correlated significantly with patients' age and Samsoon & Young classification. Endotracheal intubation succeeded all, but, 8 patients (3.2%) were difficultly intubated with cricoid cartilage compression and stylet-using. CONCLUSIONS: Before intubating the trachea, it is desirable that patient' age, Samsoon & Young classification and the extent of neck's movement are assessed.
Classification ; Cricoid Cartilage ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Intubation, Intratracheal* ; Operating Rooms ; Trachea

BACKGROUND: Mivacurium has a characteristics of rapid onset and the shortest duration of non- depolarizing neuromuscular relaxants and the onset of action could be accelerate more rapidly by using priming principle. The purpose of this study was to compare the onset time of mivacurium by priming principle with succinylcholine during rapid endotracheal intubation. METHODS: 36 patients were randomly divided into 3 groups: mivacurium group by priming principle (Group 1), mivacurium group by bolus injection (Group 2) and succinylcholine group (Group 3). In Group 1, subparalyzing dose of 0.02 mg/kg was administered 2 minutes before principle dose of 0.25 mg/kg was given. Onset time and intubating conditions were observed when twitch tension was reduced by 25% block in each group. RESULTS: The onset of Group 1 (75 sec) was significantly faster than that of Group 2 (90 sec) (p<0.05) but was significantly slower than that of Group 3 (37.5 sec) (p<0.05). Intubating conditions were excellent in all groups. CONCLUSIONS: The attempts of priming principle with mivacurium could accelerate the onset of action of mivacurium compared with that of bolus injection but their onsets were shorter than those produced by succinylcholine.
Humans ; Intubation, Intratracheal* ; Succinylcholine*

Sodium thiopental is a popular intravenous anesthetic that has been used extensively throughout the world. The rare adverse reactions to thiopental consist mainly of anaphylactic shock, bronchospasm, and local thrombophlebitis. The reported incidence of presumed anaphylactic reaction (Type l hypersensitivity) to thiopental are extremely rare. Although the mechanism of these adverse reactiona is unclear, the clinical features (generalized erythema, hypotension, edema and bronchspasm) are thought to result from massive discharge of histamine and other vasoactive substance from basophils and mast cells. Since such reactions are life threatening, they must be recognized immediately and the appmpriate treatment given. The successful management of anaphylaxis requires a thorough understanding of this syndrome and the application of therapeutic agents. The authors report a case of anaphylactoid response to thiopental in a 34 years old healthy male patient and briefly review the literature.
Adult ; Anaphylaxis ; Basophils ; Bronchial Spasm ; Edema ; Erythema ; Histamine ; Humans ; Hypotension ; Incidence ; Male ; Mast Cells ; Sodium ; Thiopental* ; Thrombophlebitis

BACKGROUND: The implementation of intraoperative normovolemic hemodilution is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential complications. The goal of this study was to evaluate the safety and efficacy of moderate intraoperative normovolemic hemodilution. METHODS: Fifteen patients scheduled for posterolateral spinal fusion underwent intraoperative normovolemic hemodilution with 10% pentastarch to a target hematocrit level of 25% (hemodilution group). All units of blood procured by hemodilution and additional allogeneic blood was transfused in the perioperative period to maintain the hematocrit level of>25%. We investigated the effect of hemodilution on whole blood coagulation as measured by the thromboelastography and, evaluated its efficacy of decreasing the need for allogeneic blood transfusion as compared to the nonhemodilution group, retrospectively. RESULTS: Hemodilution with pentastarch caused a decrease in response and coagulation time (p<0.01) but did not influence on the alpha angle and maximum amplitude on thromboelstogram. Amount of transfusion of allogeneic blood was 4.1 1.7 units for the hemodilution group and 5.0 1.5 units for the nonhemodilution group. Net red blood cell volume ""saved"" from hemodilution was about 120 ml. CONCLUSION: Moderate intraoperative normovolemic hemodilution with pentastarch does not affect the coagulability of whole blood. But its efficacy of decreasing the need for allogeneic blood transfusion is minimal.
Blood Coagulation ; Blood Transfusion ; Erythrocytes ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Perioperative Period ; Retrospective Studies ; Spinal Fusion* ; Thrombelastography

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 case of difficult intubation is described in which the problem was overcome by use of the laryngeal mask airway (LMA). The patient had difficulty in mouth opening due to severe burn scar contracture around the mouth and limited access prevented tracheal intubation. The use of LMA is shown to have obviated the need for tracheal intubation in the case of a patient whose injuries would have made this technique difficult.
Adult ; Cicatrix/complications ; Contracture/etiology ; Face ; Female ; Humans ; *Intubation, Intratracheal ; *Laryngeal Masks

Laryngeal mask airway(LMA) is a new type of airway, which may be used as an alternative to either the endotracheal tube or the face-mask with either spontaneous or positive pressure ventilation without penetration of the larynx or esophagus. LMA have many advantages of easy intubation without laryngoscope and muscle relaxants, decreasing damages of larynx and pharynx., and also useful in difficult intubation or emergency airway care. Recently its interesting has been increased. Clinical studies of LMA was done in 242 patients, about hemodynamic changes, volume and pressure changes of cuff, problems and complications during insertion and maintaining of LMA. The results were as follows: 1) The average time taken to insert the laryngeal mask airway was 9.9sec(range:5~60sec), and 43 cases were correct placement at the second attempt. And the total insertion time was 103 min(range:15~355min). 2) Total ari volume of cuff was 20.5ml(range:15~35ml) in LMA No 3, 28.1 ml(range:25~60ml) in LMA No 4. The least volume of cuff without air leakage was 15ml in LMa No 3 and 25ml in LMA No 4. During positive pressure ventilation the peak airway pressure was 20 cmH2O(15mmHg). 3) In hemodynamic changes, blood pressure was increased about 27.5 mmHg in systolic, 21.2 mmHg in diastolic, and 22.4 mmHg in mean arterial pressure after LMA insertion. 4) Cuff pressure was increased from 70.5mmHg at insertion to 98.9mmHg after 1hours with use of N2O for anesthesia and more increased than without N2O. 5) LMA was used 229 patients in supine position and 5 patients in lateral position. In 8 cases was failed to insertion of LMA. 6) Compilcations were 3 cases of gastric distention, 1 case of difficult nasogastirc tube insertion, and 1 case of severe sore throat with mucosal bleeding on pharyax. Sor throat was complained 26.9% without regard to severity.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Emergencies ; Esophagus ; Hemodynamics ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopes ; Larynx ; Pharyngitis ; Pharynx ; Positive-Pressure Respiration ; Supine Position

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

BACKGROUND: The laryngeal mask airway (LMA) has many advantages including easy insertion, less trauma, minimal cardiovascular changes. And the elderly have many problems such as poor dentition, limited cervical extension and age related cardiovascular changes, so endotracheal intubation in geriatric patient is sometimes difficult and harzardous. This clinical study was designed to investigate availability and problems of LMA insertion in geriatric patients. METHODS: 60 geriatric patients undergoing elective surgery were induced with intravenous injection of pentothal sodium or propofol, vecuronium or atracurium and inhalation of O2, N2O, enflurane or isoflurane. After deep anethesia and full muscle relaxation LMA was inserted and cuff was inflated. When blind insertion was failed, laryngoscope was used. Anesthesia was maintained with inhalation of O2, N2O, enflurane or isoflurane under positive pressure ventilation. Thereafter, we observed peak inspiratory pressure and any incident including gas leakage, stomach distension, regurgitation of stomach content intraoperatively and then any complication postoperatively. RESULTS: LMA placement was successful in 98.8%, but LMA insertion in geriatric patient had some difficulty because patient's tongue slided down with LMA due to oropharyngeal dryness, teeth loss. Intraoperatively LMA was well maintained under positive pressure ventilation. There was no critical incident associated with LMA use. CONCLUSIONS: LMA is safe and may have a useful role in the anesthetic management of geriatric patients who have many problems such as poor dentition, limited cervical extension and age related cardiovascular changes.
Aged ; Anesthesia ; Atracurium ; Dentition ; Enflurane ; Gastrointestinal Contents ; Humans ; Inhalation ; Injections, Intravenous ; Intubation, Intratracheal ; Isoflurane ; Laryngeal Masks* ; Laryngoscopes ; Muscle Relaxation ; Positive-Pressure Respiration ; Propofol ; Sodium ; Stomach ; Thiopental ; Tongue ; Tooth ; Vecuronium Bromide

BACKGROUND: A tourniquet is often used during limb surgery to minimize surgical bleeding and to keep the clear surgical field. However the tourniquet is associated with severe hemodynamic changes and tourniquet-induced hypertension. We investigated the incidences of tourniquet-induced hypertension by tourniquet duration and anesthetic methods. METHODS: One hundred thirteen patients who underwent a total knee arthroplasty were assigned into four groups according to the types of anesthesia; general anesthesia (group I, n = 30), general anesthesia and intravenous adjuvants (group II, n = 30), general and epidural anesthesia (group III, n = 22), and spinal anesthesia (group IV, n = 31). Mean arterial pressure and heart rate were recorded at ward, before induction, one minute after tourniquet inflation and every 10 minutes until 60 mininutes. The extremity was exsanguinated and a tourniquet pressure of 350 mmHg (9 cm width) was applied in all groups. RESULTS: The mean arterial pressure increased in group I and II during the tourniquet inflation period. The incidence of tourniquet-induced hypertension was higher in group I (6.7%) than other groups but there was no statistical significance among the groups. Heart rates were not changed in any groups. CONCLUSIONS: We concluded that the shorter the tourniquet time the less the occurrence of tourniquet-induced hypertension under any type of anesthesia.
Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Spinal ; Arterial Pressure ; Arthroplasty* ; Extremities ; Heart Rate ; Hemodynamics ; Hemorrhage ; Humans ; Hypertension* ; Incidence ; Inflation, Economic ; Knee* ; Tourniquets*