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

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

Hydroxyzine hydrochloride, a minor tranquilizer and a ataratic, was tested clinically for effectiveness as a premedicant separate dosages of 1 and 2 mg/kg. Each 30 patients were in the physical status class 1 and 2 by A.S.A. classification, and the age distribution was from 20 to 60 years. The following results were obtained. 1) Emotionally calm response was seen in 70% in the hydroxyzine 1 mg/kg (group 1), and in 93.3%, in the 2 mg/kg (group 2). 2) Mental alertness was seen in 86. 6% in group 1, and in 66. 6% in group 2. 3) Complications after premedication were chilling and shivering, hypertension, nausea, and headache, and were not serious. Therefore this premedication was satisfactory in most cases, especially in group 2.
Age Distribution ; Classification ; Headache ; Humans ; Hydroxyzine* ; Hypertension ; Nausea ; Premedication ; Shivering

Hexafluorenium was used to potentiat succinylcholine in 36 patients undergoing major surgery, mainly abdominal, of from 1/2 to 7 hours duration. Anesthesia consisted of thiopental-nitrous oxide-oxygen-ether or haIothane and ventilation was controlled. In a first group, succinylcholine was administered for intubaticn and repeated intermittently as required with a single dose of hexafluorenium after the intubating dose of succinylcholine had worn off. In a second group, succinylcholine was administered similary but hexafluorenium was also given intermittenly. In a third group, a single initial dose of hexafluorenium was given followed by succinylcholine intermittently. In a fourth group, both drugs were given intermittently throughout, 1) The apnea time of succinylcholine was prolonged about 8times after a single dose of hexafluorenium in the first and third groups but the prolongation was gradually lessened with successive doses of succinylchohne. Rut in second and fourth groups, the apnea times were significantly prolonged following successive dose of both drugs. 2) In third and fourth groups, fasieulation following succinylcholine was not observed and nausea, vomiting and muscle pains were not noted. 3) In recovery room, about 80% of patients could raise their heads by themselves but ether required longer recovery than halthane. 4) No bronchospasm or cardiovascular side effects were noted. It is considered that this drug combinations provides excellent relatation for surgery. The technique with a single dose of hexafluorenium seems particularlly suitable in cases which last from 30 minutes up to 2 or 3 hours and repeated doses of hexafluorenium and succinylchloin are advisable for longer major cases.
Anesthesia* ; Apnea ; Bronchial Spasm ; Drug Combinations ; Ether ; Head ; Humans ; Myalgia ; Nausea ; Recovery Room ; Relaxation* ; Succinylcholine ; Ventilation ; Vomiting

The intensive care unit(ICU) of Severance Hospital was opened on October 18, 1968 with 7 beds and expanded to 19 beds on February 2, 1981. Statistical analysis of the ICU patients has already been reported three time from 1970 to 1981. The following is clinical analysis of 3,498 cases and ventilator cases from March 1981 to February 1984. 1) During the 3 years the total number of patients was 3,498. In 1981 1,053 patients, in 1982 1,179 patients, in 1983 1,256 patients were admitted. 2) Total admission time in the ICU was 17,061 days. The average patient stay in ICU was 4.9days. The majority of the patients (2,675 cases, 76.6%) stayed in ICU less than 5 days. The number of patients stayin in ICU more than 9 days increased every year from 94 cases (8.8%) in 1981 to 130 cases (10.4%) in 1983. 2) The number of pre-teens was 1,090 cases, about 31.2% of the total patients and represented the highest number of patients admitted to the ICU. The mortality in the pre-teen group was the highest of numbered 148, a mortality rate of 13.6%. 4) The number of patients admitted to the cardiothoracic surgery department was 1,591 cases(45.5%) being highest among all department. Out of 100 patients who died, the pediatric service had the highest mortality rate, 29.2%. 5) All ICU patients have been divided into two categories, operative and non-operative cases. The operative cases numbered 1,889 and non-operative 1,609. Mortality rate was 4.9% for the operative cases and 15% for the non-operative. 6) Total mortality was 334 in number, an overall mortality rate of 9.5% in 3 years. It has decreased annually, 131 cases (mortality rate 12.3%) in 1981, 105 case (7.7%) in 1982, 97 cases(7.7%) in 1983. 7) Ventilator cases numbered 1,921 in 3years. Ventilator day increased year by year, 1, 220 days in 1981, 19,904 in 1982, 2,299 days in 1983. Total ventilatior days in 1983 increased 72.9% compared with the number in 1981. 8) The number of deaths under ventilator support was 90 in 1981, 71 in 1982 and 80 in 1983 respectively. Mortality rate has decreased every year: 16.1% in 1981, 11.2% in 1982 and 10.8% in 1983. From the above results, it can be concluded that the total number of ICU patients and ventilator cases are increasing and the attendant mortality rate is decreasing year by year.
Humans ; Critical Care ; Mortality ; Ventilators, Mechanical

Continuous epidural block was used for pain control during and after operation and for herpes zoster in two cases. A 63 year old male patient with herpes zoster on the right T 12 level for 2 weeks was treated by continuous epidural block. After 10 days, elective right inguinal hernioplasty was performed under epidural blocks by the previously inserted catheter. Postoperative pain and herpes zoster have been controlled in the same manner. Two weeks later, he was discharged without post-herpetic sequelae. The second case, a 82 year old man, was admitted with dysuria and also herpes zoster on the right T 10 level for 10 days. Using only continuous epidural block, suprapubic prostatectomy was done and post-operative pain was controlled. Two days later, the catheter was removed by the urological department. However, two weeks after operation, post-herpetic neuralgia developed and continuous epidural block was restarted for 2 weeks. Then epidural methylprednisolone injection, 2 times, and transcutaneous electrical stimulations were required for 3 more months for complete recovery. This indicated that continuous epidural block was beneficial not only for the treatment of herpes zoster but also for the prevention of post-herpetic neuralgia.
Catheters ; Dysuria ; Electric Stimulation ; Herniorrhaphy ; Herpes Zoster* ; Humans ; Male ; Methylprednisolone ; Neuralgia ; Pain, Postoperative ; Prostatectomy

The loss of Substantial portion of critically ill patient'a tidal volume through a broncho-pleural fistula may significantly alter the intrapulmonary distribution of ventilation, ventilation-perfusion matching and arterial blood gases. Prompt localization of surgical closure of bronchopleural fistu1a remains the treatment of Choice in most Patients. We had a chance to use a Univent tube with movable blocker to the patienta of breach-opleural fistula whith developed durinf esophageal bougienation. The endotracheal tube has two compartment, a large lumen for conventional air passage and a small lumen where a movable tube is placed. Intubation a accomplished by ordinary technique, advancement of the bronchial tube to the right lowers bronchus being guided by fiheroptic bronchoscopy.
Bronchi ; Bronchoscopy ; Critical Illness ; Fistula* ; Gases ; Humans ; Intubation ; Tidal Volume ; Ventilation

Transcutaneous oxygen and carbon dioxide tension (PtcO2 and PtcCO2) measured with a heated electrode was compared with arterial owygen and carbon dioxide tension (PaO2 and PaCO2) in 5 groups of 37 patients admitted to the Intensive Care Unit, Severance hospital, from October 1985 to February, 1986. The results were as follows 1) In the group I (6 neonate patients), the PtcO2 and PtcCO2 index was 0.89. 1.02. The relationship of the two method is given br the regreasion equation(in mmHg) : PaO2= 1.15 (PtcO2) +0.77(r: 0.86 P<0.001) PaCO2=0.87 (PtcCO2) +5.12(r: 0.91 P<0.001) 2) In the group 2(13 mpmsirgocal patients) the PtcO2 and PtCO2 index was 0.71, 1.03. The relationship of the two methods is given by the regression equation(in mmH7) : PaO2 = 1.42(7t707) -0.27 (r: 7.53 p<0.001) rac07=1.73 (7tc007) -7.43 (r: 0.74 p<0.001) 3) In the group 3(8 immediate postopen heart patients) PtCO2 index was 0.20, PtcCO2 index was 1.25. There was no correlation between PtcO2 and PaO2. The relationship of the two method is given by the regression equation(in mmHg) : PaCO2= 0.40(ftcCO2) +2l. 68(r: 0.60 p<0,005) 4) In the Group 4(9 postpen heart patient after extubation) PtCO2 & PtCO2 index was 0.60, 1.05, and the relationship of the two method is given by the regression equation (in mmHg): PaO2 =1.92 (PtcO2)+67.26 (r=0.68 P<0.001) 7aCO2=0.64 (PtcCO2)+14.87 (r=0.66 p<0.001) 5) In the group 5(COPD Patient) the Ptco2 and rtcc09 index was 0.84, 1.04. and th? relationship of the two method is given br the regression equation(in mmHg) PaO2 = 1,10 (PtcO2) +7.35 (r=0.81 p<0.001) PaCO2=0.52 (PtcCO2) +21.59 (r: 0.63 P<0.001) Continuous montiroing can reveal large fluctuations in PaO2 and PaCO2 which would be missed by the use of intermittent arterial samples. The transcutaneous electrode can be employed usefully in the neonate and hemodynamic-allr stable adult patient in Intensive Care Unit. However this method is not recommended to the patients in shock, immediate postoper-ative patient with peripheral vasoconstriction and poor perfusion.
Adult ; Blood Gas Monitoring, Transcutaneous ; Carbon Dioxide ; Electrodes ; Heart ; Hot Temperature ; Humans ; Infant, Newborn ; Intensive Care Units ; Oxygen ; Perfusion ; Shock ; Vasoconstriction

Feasibility and neurologic complications accompanying spinal anesthesia with variable specific gravities were examined in 56 lumbar disc operation from March 1977 to October 1978. Patients' age ranged from 21 to 36 years with 54 cases of males and 2 females. On myelography, lateral and partial blocks were observed in 50 cases and total blocks in 6 cases. These cases were classified depending on the specific gravity and local anesthetics as follows: .Isobaric group: a) 1% tetracain solution, ampule, mixed with C.S.F., 20 cases. b) tetracaine powder with C.S.F., 11 cases. c) 10% procaine solution with C.S.F., 9 cases. .Hyperbaric group: 1% tetracaine solution with 10% dextrose in water, 10 cases. . Hypobaric group: tetracaine powder with water, 6 cases. Under isobaric, hyperbaric and hypobaric spinal anesthesia, good to excellent results were obtained in 90, 90 and 16.6% respectively. More than 10% of systolic blood pressure fall after block was seen in 15, 90 and 16.6% respectively. No neurologic sequalae were observed. Isobaric spinal anesthesia with tetracaine solution is indicated as safer for recently herniated lumbar disc operations.
Anesthesia, Spinal* ; Anesthetics, Local ; Blood Pressure ; Female ; Glucose ; Humans ; Male ; Myelography ; Procaine ; Specific Gravity ; Tetracaine ; Water

Arterial hypoxemia is a frequent occurence in the immediate postoperative period. For this reason many patients are given supplemental oxygen after operation. A common method of delivering oxygen is with a catheter placed through one nostril and extended into the oropharynx. An alternative method is the use of a nasal cathetn inserted 2~3cm into one nostril and wedged in place with a small sponge. We have compared these two methods in two groups of post-surgical patients. Eight patients in each group were selected at random for study during the immediate postoperative period. Each .patient received O2 at 6L/min. flow by both methods. In the first group of patients the nasopharyngeal catheter was placed first, and in the other group the nasal catheter with a sponge was placed first. Previously blood from the femoral artery was drawn into aheparinized syringe after 15 to 20 minutes of breathing room air. Two subsequent samples of arterial blood were obtained from each patient. In the first group one sample was drawn after 15-20 minutes of oxygen administration via the nasopharyngel catheter and the other sample after 15-20 minutes of oxygen administration via the nasal catheter with a sponge. In the second group similar samples were taken with the order reversed. Arterial gas tensions were measured with a radiometer apparatus. A majority of patients did have low arterial oxygen tensions when breathing air in the immediate postoperative period. The average PaO2 during breathing of room air was 73.7mmHg. With the 6L/min. O2 flow via the nasopharyngeal catheter, the average PaO2 was 155. 9mmHg while the catheter with a sponge resulted in an average PaO2 of 144. 8mmHg in both groups. Thus the PaO2 of the former is slightly higher than the that of later. However both gave adequate PaO2 values with 6L/min O2 flow. Therefore, the nasal catheter with a sponge compares favorably with the nesopharyngeal catheter because of comfort, convenience, natural humidifying effect and elemination of the possibility of gastric distension or mediasinal emphysema.
Anesthesia, General* ; Anoxia ; Catheters* ; Emphysema ; Femoral Artery ; Humans ; Oropharynx ; Oxygen* ; Porifera* ; Postoperative Period ; Respiration ; Syringes