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

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

Since halothane, as a new potent, non-explosive, volatile agent, was introduced by Raventos(1956) and studied clinically by Johnstone(1958), Bryce-Smith (1958) and Stephen(1958), it has been used extensively all over the world. However recent case reports of liver necrosis following halothane anesthesia have raised the possibility that the agent may, under certain circumstance, damage the liver. Following the announcement of cooperative study of effects of halothane on the liver by the National Research Council Committee on anesthesia of U.S.A. in 1963, this investigation was undertaken. Experiments were carried out in 31 anesthetixed mongrel dogs, weighing approximately 10kg. After anesthesia with pentothel sodium (25mg/kg), an endotracheal tube with cuff was passed and connected to a closed circle absorption system using an Ohio Heidbrink machine. Oxygen flow was 300 to 500 ml/min. Fluotec Mark II vaporizer, using 1.5 to 2% for induction and 0.5 to 1% for maintenance, was set up outside of the circle system. Depth of anesthesia was judged mainly by clinical signs eg. respiration and blood pressure, and halothane anesthesia lasted for 3 hours. After laparotomy, a ligation of the cystic duct was done and bile was collected from the cannulated common bile duct continuously. Studies have been made on the cardiac output and hepatic blood flow with changes of blood pressure, bile formation, function of dye excretion, changes of serum protein, prothrombin time, coagulation time and histopathological changes of the liver. The results obtained may be summarixed as follows. 1. Measuring of cardiac output using RIHSA after halothane administration with lowered blood pressure, as compared with investigations before halothane (average blood pressure 155mmHg),showed 12.4% decrease in light anesthesia (average B.P. 140mmHg) and 27% in deep anesthesia (average B.P. 70mmHg). 2. Hepatic blood flow measured with radioactive colloidal gold(Au198) showed 218 ml/min in the control group (B.P. 170mmHg) and 309 ml/min in the deep halothane anesthesia group (B.P. 80mmHg). Thus there was a 42% increase in deep halothane anesthesia. As the blood pressure decreased the cardiac output also decreased but the hepatic blood flow showed a tendency to increase. 3. The amount of bile flow and cholate output in the pre-halothane state was 0.040 ml/min and 1. 069 mg/min, respectively. After halothane administration, the bile was significantly increased to 0. 061 ml/min at 90 min. Thereafter it returned to the initial level 3 hours later and cholateoutput continuously decreased for 3 hrs., showing that halothane may have a hydrocholeretic effect. Before and after the halothane administration, pO2 in arteral blood was 344 and 377 mmHg, pCO2 in arterial blood was 38.5 and 40.9mmHg, respectively. The pO2, pCO2, pH and electrolytes (sodium, potassium and chloride concentration) in the hepatic bile did not reveal a significant change. Electrolytes (sodium, potassium and chloride), and osmolarity in urine did not show significant changes.4. The function of biliary dye excretion was studied using bromsulfalein (BSP), phenol red (PSP) and indocyanine green. The one hour biliary excretion of indocyanine green did not show significant changes between the control group, the group with exposure only, and the group with two exposures with an interval of 1 week. However, the biliary excretion of indocyanine green for 2 hours was 45% of the given amount for the control group, 41% for one exposure, and 37% for the group with two exposures. PSP biliary clearance, before and after haIothane administration, showed 19.62 ml/min and 13. 35 ml/min respectively, but BSP biliary clearances were 21. 3 ml/min and 22. 0 ml/min respectively. It is concluded that the biliary excretion of indocyanine green and PSP showed a tendency for a decrease following halothane administration. 5. The coagulation time and prothrombin time, measured after halothane administration, were shortened during the first hour, and after this, they were gradually prolonged, returning to normal m two to three hours after the administration. The values of serum protein and thymol turbidity did not show significant differences among each group and between the time before and after halothane administration. 6. The histopathological examination showed that the anesthetic group had a much more intense degree of degenerative changes of liver parenchymal cells including vacuolar formation and hydropic degeneration, in addition to vasodilatetion, compared with the biopsy before halothane. 7. The above studies indicate that halothane administration exerts a slight influence on the hepatic function and induces histological changes in the liver. However, quantitative comparison between halothane and other anesthetic drugs will be clarified by further studies.
Absorption ; Anesthesia ; Anesthetics ; Animals ; Bile ; Biopsy ; Blood Pressure ; Cardiac Output ; Cholates ; Colloids ; Common Bile Duct ; Cystic Duct ; Dogs* ; Electrolytes ; Halothane* ; Hydrogen-Ion Concentration ; Indocyanine Green ; Laparotomy ; Ligation ; Liver ; National Academy of Sciences (U.S.) ; Nebulizers and Vaporizers ; Necrosis ; Ohio ; Osmolar Concentration ; Oxygen ; Phenolsulfonphthalein ; Potassium ; Prothrombin Time ; Respiration ; Sodium ; Thymol

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

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

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

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

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