No abstract available.
Diazepam* ; Hemodynamics* ; Morphine* ; Pancuronium* ; Respiration, Artificial*

No abstract available.
APACHE* ; Intensive Care Units* ; Critical Care*

Trigeminal neuralgia has been treated in many ways, both medical and surgical. We wished to determine the efficancy of low frequency electrical acupuncture therapy for nine patients suffering from trigeminal neuralgia with Model 6,26 and G6805 Electrotherapeutic Apparatus. The results were as follows: (1)Initisl.beneficial during 1aw frequency electrical acupuncture therapy was recognized in a11 cases (2) Longterm.baneficial effect was seen in 77%, excluding 3 cases with no improvement. (3) Low frequency elactrical acupuncture therapy seemed to be valuable, preceding medical and .surgical treatment for acute trigemieal neuralgia.
Acupuncture Therapy ; Acupuncture* ; Humans ; Neuralgia ; Trigeminal Neuralgia*

Pain is as old as mankind and is one of the physiological defense mechanisms, but when it lasts long, it may be harmful. We decided to conduct an exploratory trial with nerve block and acupuncture for 134 patients referred to this clinic with chronic or intractable pain syndromes. We used Model 6.25 and G6805 Electrotherapeutic Apparatus for acupuncture therapy. The results were as follows: (1) Sex and age distribution: 64 were male, 79 were female and 91 patients were over 40 years of age. (2) Localigation of pain: Scapular and upper extemities in 53 among 143 patients. (3) Method of treatment: Nerve block 84, low frequency electrical acupuncture 92 and combined therapy in 3 patients. (4) Effect of treatment: 92% of various nerve blocks and 88% of low frequency electrical acupuncture therapy gave good results.
Acupuncture ; Acupuncture Therapy ; Age Distribution ; Defense Mechanisms ; Female ; Humans ; Male ; Nerve Block* ; Pain Clinics* ; Pain, Intractable

A 27 year-old male patient, who had cervical tracheal stenosis due to accidental inhalation of zinc dichloride gas, underwent tracheal reconstruction (tracheal resection and end to end anastomosis). Preoperatively, a special radiologic study (tracheography), pulmonary function tests and arterial blood gas analysis were performed for accurate diagnosis (to determine the location, degree and extent of the stricture) and to detect any associated abnormalities in the lung-function. Atropine and diazepam were given for premedication. After intramuscular injection of ketamine and succinylcholine, orotracheal intubation was done above the lesion, and N2O and halothane were added for maintenance of anesthesia. Respiration was assisted or controlled when necessary with gallamine. The lesion was approached through an anterior transverse cervical incision. The trachea. was dissected clear and transected distal to the lesion. The distal tracheal segment was then intubated through the operating field with a sterile cuffed endotracheal tube (the 2nd tube). This was connected to the anesthetic machine. After resection of the lesion and anastomosis. of the posterior tracheal wall, the 2nd tube was removed and orotracheal tube was pushed into the distal trachea. After complete anastomosis the orotracheal tube was placed above the suture line.Continuous arterial blood gas analysis during and after anesthesia was helpful for evaluation of the state of arterial blood oxygenation and ventilation.
Adult ; Anesthesia* ; Atropine ; Blood Gas Analysis ; Diagnosis ; Diazepam ; Gallamine Triethiodide ; Halothane ; Humans ; Inhalation ; Injections, Intramuscular ; Intubation ; Ketamine ; Male ; Oxygen ; Premedication ; Respiration ; Respiratory Function Tests ; Succinylcholine ; Sutures ; Trachea ; Tracheal Stenosis ; Ventilation ; Zinc

The pharmacological actions of ketamine in human volunteers were reported by Domino et al. in 1965, and use in 130 patients by Corssen and Domino (1966). Since then, its use in a wide variety of surgical procedures has been reported throughout the world. Several authors(Galloon, 1971; Gallon and Dick, 1971; Spoerel, 1971)reported that katamine has several advantages over conventional anesthetics. The advantages of using katamine anesthesia are: preservation of pharyngeal reflex and airway maintenance during induction of anesthesia, stimulation of the cardiovascular system, wide safety margin, short duration, fast recovery, little nausea and vomiting after anesthesia, little depression of the fetus and good uterine contraction with minimal bleeding. On the other hand, ketamine has also disadvantages: elevation of arterial pressure and pulse rate temporarily during induction of anesthesia, poor muscle relaxation and post-operative psychotic reactions are not uncommonly found. The authors tried to find out the feasibility of ketamine anesthesia for Cesarean section over the conventional method of thiopental muscle relaxant N2O with IPPV technique. Materials and Methods.52 Korean parturients were selected for Cesarean section including emergency and elective operation for this study. Thiopental Group. 25 cases were induced for anesthesia with 3.5+/-1.64mg/kg of thiopental and intubated with the help of 1 mg/kg of succinylcholine followed by N2O with controlled ventilation. After delivering the baby, anesthesia was maintained with N2O-O2-ether throughout the procedures. Ketamine A Group. 9 cases, just before skin incision, were injected intravenously with katamine 1.67+/-0.03mg/kg slowly for over one minute with or without N2O: O2(2: 1 L/min) through a mask. After delivering the fetus, a supplement of ketamine and diazepam 10mg I.V. was given intermittently. Ketamine B Group. Anesthesia was induced by 1.72+/-0.05mg/kg ketamine and 1mg/kg of succinylcholine with endotracheal intubation. After delivery, N2O with O2 and additional ketamine were given to 9 patients. Ketamine C Group. Anesthesia was performed with 1. 30+/-0.15mg/kg of ketamine, 0.08mg/kg of pancuronium, N2O, with endotracheal intubation for 9 patients, ether supplement was given following delivery .Conclusion .With these mentioned methods of anesthesia, the authors formed several conclusions about ketamine anesthesia in Cesarean section. 1. Ketamine can be used as the main anesthetic or for induction in elective and emergency Cesarean section because of its rapid onset and intense analgesic effect. 2. As in the method of anesthesia, it is useful to combine N2O-O2 mixture and muscle relaxants such as succinylcholine or pancuronium. This technique is more suitable for maintenance of anesthesia because of the poor muscle relaxation of ketamine alone. 3. For induction of anesthesia, under 1.6mg/kg of ketamine is advisable. Exceeding this dose, the infant respiration is more likely to be depressed because of hypertonicity of the skeletal musculature. 4. Ketamine has a maternal cardiovascular stimulation effect particularly diastolic blood pressure and pulse rate in the Ketamine-pancuronium-N2O-intubation group. 5. Less bleeding was found during and after the delivery, possibly due to an increased uterine contraction from ketamine. 6. Disadvantages of ketamine included a prolonged maternal recovery period, and newborn respiratory depression end these seemed to be dose related. Fro the above, ketamine anesthesia appears to be another safe and satisfactory method of anesthesia for Casarean section, provided that toxema of pregnancy patients with hypertension and patients who have had psychotic problems previously are avoided.
Anesthesia* ; Anesthetics ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Cesarean Section* ; Depression ; Diazepam ; Emergencies ; Ether ; Female ; Fetus ; Gagging ; Hand ; Healthy Volunteers ; Heart Rate ; Hemorrhage ; Humans ; Hypertension ; Infant ; Infant, Newborn ; Intermittent Positive-Pressure Ventilation ; Intubation, Intratracheal ; Ketamine* ; Masks ; Muscle Relaxation ; Nausea ; Pancuronium ; Pregnancy ; Respiration ; Respiratory Insufficiency ; Skin ; Succinylcholine ; Thiopental ; Uterine Contraction ; Ventilation ; Vomiting

Since the first successful use by Zoll (1952) of electrical stimulation through the chest wall to restart the arrested human heart, technical advances have made long-term electical stimulation of the heart effective in preventing recurrent Stokes-Adams syndromes and in treating the debilitating effects of low cardiac output in patients with heart block. This paper reviews experiences with anesthesia administered from Jan. 1968 through May 1975 to 17 patients who had cardiac pacemaker electrodes implanted, under general anesthesia in. 5 cases and local anesthesia in 12 cases. The 5 patients under light general anesthesia received respectively halothane in 2 cases, methoxyflurane in 1, ether in 1 and ketamine in one. No significant difference in morbidity and mortality was attributed to any of the anesthetics used. In 3 of the 5 cases under light general anesthesia, the implantation of permanent cardiac pacemakers was transvenously performed for complete heart block. The implantation of a temporary epicardial electrode in one of the 5 cases was performed because complete heart block had developed immediately after mitral valve replacement during cardiopulmonary bypass. Of the 5 cases under light general anesthesia, one. already had a transvenous pacemaker implanted permanently, and exploratory laparotamy was performed for repair of E-loop obstruction with recurrent stomach cancer. Of the 12 patients who had permanent cardiac pacemakers inserted transvenously under local anesthesia (1% procaine in 10 cases and 0.5% or 1% lidocaine in 2 cases), electrode malpositions appeared in 3 cases and infected electrodes in 3 cases respectively. There were no deaths during anesthesia and operation more important than the particular agent used were the precautions applied for control of cardiac action before and during anesthesia.
Anesthesia* ; Anesthesia, General ; Anesthesia, Local ; Anesthetics ; Cardiac Output, Low ; Cardiopulmonary Bypass ; Electric Stimulation ; Electrodes ; Ether ; Halothane ; Heart ; Heart Block ; Humans ; Ketamine ; Lidocaine ; Methoxyflurane ; Mitral Valve ; Mortality ; Procaine ; Stomach Neoplasms ; Thoracic Wall

Because of rarity of its incidence, a case of anaphy lactic hypotension developed following thiopental administration is reported with a brief review of the literature. This 55 year old female, at another hospital, twice cancelled proposed cholecystectomy due to hypotension to thiopental induction with 250 mg and 200 mg respectively. At the admission time, she had no abnormalities on C.B.C., urinalysis, E.K.G., chest X-ray, Thorn test and urine porphyrin test except increased alkaline phosphotase in liver function test and positive amobarbital test with 200 mg. This patient was premedicated with atropine 0. 3 mg. only without sedatives. Difficult induction with nitrous oxide and halothane in this non-cooperative patient was supplemented by 2.5% thiopental 4 ml. in divided doses. At this point blood pressure dropped from 140/90 mmHg. to 80/60 mmHg. 100% oxygen was, therefore, administered by the mask and 20mg. of ephedrine was given intravenously and intubated following succinylcholine. After intubation blood pressure rose to 140/80 mmHg. Two hours later the patient had apparently fully recovered. Postoperative course was uneventful. It was confirmed that this rare reaction during anesthesia was due to thiopental by intravenous testing with divided doses of the durg.
Amobarbital ; Anaphylaxis* ; Anesthesia ; Atropine ; Blood Pressure ; Cholecystectomy ; Ephedrine ; Female ; Halothane ; Humans ; Hypnotics and Sedatives ; Hypotension ; Incidence ; Intubation ; Liver Function Tests ; Masks ; Middle Aged ; Nitrous Oxide ; Oxygen ; Succinylcholine ; Thiopental* ; Thorax ; Urinalysis

Midazolam, a water-soluble benzodiazepine that is shorter-acting, more potent, and less irritating to veins than diazepam, has been suggested for use for induction of anesthesia. The cardiovascular effects of an induction dose(0.2~0.3mg/kg) of midazolam in ASA class lll cardiac surgical patients (N=15) were compared in a couble-blind fashion with a similar group of patients (N=15) receiving thiopental (5.0mg/kg). The patients were premedicated by triflupromasine, pethidine, hydroxyzine, atropine and diazepam. The results were summarized as follows. 1) The thiopental group were more decreased in blood pressure and increase in heart rates than midazolam group. 2) Spontaneous eye closing time and loss of eyelash reflexes were observed. But those were a poor sign of adequate induction became of heavy preanesthetic sedation. 3) The changes of blood pressure and pulse rate after induction and intubation were almost similar in the two groups, but greater individual variation was seen in midazolam groups, depends on preload state before induction. From the above results, midazolam was sufficient as an induction agent for open heart cases. But a hypovolemic patients and completely beta blocked patients should be used cautiously because they may be developed severe hypotension and tachycardia.
Anesthesia ; Atropine ; Benzodiazepines ; Blood Pressure ; Diazepam ; Heart Rate ; Heart* ; Humans ; Hydroxyzine ; Hypotension ; Hypovolemia ; Intubation ; Meperidine ; Midazolam* ; Reflex ; Tachycardia ; Thiopental ; Thoracic Surgery* ; Veins

Since 1959 neuroleptanalgesia has been used for poor risk patients and open heart surgery. From august 1973 we have used a modified neuroleptanalgesia and anesthesia with droperidol-pentazocine- N2O in 40 cases. Age ranged 10 to 69 years; 22 were male and 18 female. Physical status was. Class I and II except for 4 patients in Class III and IV. In Group I (20 patients) for induction of neuroleptanalgesia, a mixture combining droperidol, 0.25mg/kg, and pentaocine, 1.0~1.2 mg/kg, was administered intravenously. In Group II (20 patients) for induction initially droperidol only, 0.25 mg/kg, was injected intravenously and 5~10 minutes later pentazocine, 1.0~1.2mg/kg, was given intravenously. Endotracheal intubation following a sleep dose of thiopental, 75~100 mg, and succinycholine, 40~60 mg, was performed in 36 cases. During the operation anesthesia was maintained with N2O-O2, supplemented with muscle relaxants. Neuroleptanalgesia without thiopentaJ, relaxants, intubat- ion or N2O, to four patients (laryngeal suspension-2 cases, and percutaneous cordotomy 2 cases). An additional quarter of the initial dose of droperidol was given,if anesthesia time exceeded .3 4 hours. Pentazocine, half the initial dose was also repeated when the patient showed signs of inadequate anesthesia, as body movement, tachycardia, increased blood pressure and lacrimation. The patients were deeply tranquilized but did not sleep with only droperidol and pentazocine. However when N2O inhalation was given, the corneal reflex was lost and the patient quickly went to sleep. The pupils persisted in miosis after pentazocine was given. The course of induction was smooth and there was no sweating, bradycardia or generalized muscular contractions seen at that time. Nausea and vomiting 12 hrs after anesthesia appeared in only 10% of cases. Blood pressure in Group I remained stable after the mixture but in Group II fell somewhat after the droperidol injection. Pulse rates was stable in both groups. Moderate respiratory depression was observed in Group I as soon as the mixture was administered, however during anesthesia and operation, the respiratory rate, tidal volume and minute volume gradually increased and were normal postoperatively. In Group II after pentazocine administration, respiratory depression increased significantly to about the same level in Group I but persisted after the end of the operation. In neither group was there any statistically significant change in pH and Base-Excess values. Recovery from anesthesia was very rapid and patients opened their eyes on command in 2~3 minutes after N2O was stopped and awakened within 5~6 minutes. The analgesic effect of pentazocine as excellent, persisting for 12 hours postoperatively. In conclusion the circulatory and respiratory response to the administration of the droperidol and pentazocine mixture were more stable than when they were administered seperatedly.
Anesthesia* ; Blood Pressure ; Bradycardia ; Clinical Study* ; Cordotomy ; Droperidol ; Female ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Inhalation ; Intubation, Intratracheal ; Male ; Miosis ; Muscle Contraction ; Nausea ; Neuroleptanalgesia* ; Pentazocine ; Pupil ; Reflex ; Respiratory Insufficiency ; Respiratory Rate ; Sweat ; Sweating ; Tachycardia ; Thiopental ; Thoracic Surgery ; Tidal Volume ; Vomiting