To 250 heavily premedicated patients older than 5 years of age, fluothane was administred for almost all types of surgical procedures of varying durations up to 7 hours, utilizing a No.8 Heidbrink ether vaporizer with its wick removed and placed on the inspiratory side of the closed circle carbon dioxide absorption system. Anesthesis was induced with intravenous thiopental in adults and older children or nitrous oxide-oxyen-fluothane in younger children. All patients had their trachess intubated and respiration controlled with the use of muscle relaxants. Anesthesia could adquately be maintained with basal oxygen flow (500ml/min) and fluothane (setting No.4 or 5) without serious complications. The anesthetic course was monitored by determination of blood pressure, pulse rate and respiration, and estimation of depth by usual clinical signs. Lead ll of the electrocardiogram and fronto-occipital lead of electroencephalogram were observed in 46 patients. In 15 patients concentration of fluothane in inspired gas was measured by the use of a Liston-Becker infrared analyser sensitive to fluothane. The amount of fluothane consumed for each operation was also measured. A battery of liver function tests indicated that the hepatic functions were not affected to a greater degree by fluothane anesthesia than by ether or cyclopropane anesthesis. It is concluded that closed circuit fluothane anesthesia utilizing No.8 Heidbrink ether vaporizer is safe, simple, economical and effective.
Absorption ; Adult ; Anesthesia* ; Blood Pressure ; Carbon Dioxide ; Child ; Electrocardiography ; Electroencephalography ; Ether* ; Halothane* ; Heart Rate ; Humans ; Liver Function Tests ; Nebulizers and Vaporizers* ; Oxygen ; Respiration ; Thiopental

Since succinyl choline was introduced, into clinical anesthesia, it has been used as main muscle relaxant because of its rare side effects and short duration of action. Our interest in the effects of this drug on extraocular muscles and intraocular pressure began in 1957 following reports of vitreous expulsion in patients who received succinylcholine during ocular surgery. The effects of muscle relaxants on the intraocular pressure were studied in 60 healthy human subjects. When succinylcholine was given alone, 20 human subjects had a mean increase in intraocular pressure of 10. 5 mmHg. When gallamine 2. 5 mg/kg or pancuronium 80 ug/kg was used, 20 subjects showed a mean decrease of 3. 1 mm Hg from control. Giving gallamine (20 mg) or dtubo curarine(3 mg) 2-3 minutes prior to the administration of succinylcholine, 20 human subjects had no significant change in intraocular pressure. This simple method prevents the increase in intraocular pressure associated with the use of succinylcholine.
Anesthesia ; Choline ; Gallamine Triethiodide ; Humans ; Intraocular Pressure* ; Methods ; Muscles ; Pancuronium ; Succinylcholine

Cardiac arrhythmias were produced in the dog by the injection of epinephrine during the inhalation of 26 per cent cyclopropane in oxygen. Cardiac arrhythmias were usually associated with a rise in arterial pressure, but they were also seen with no change or decrease in blood pressure. The beta adrenergic blocking agent propranolol (0.3 mg/kg) caused transient but significant decrease in blood pressure and heart rate, increased the pressor response to epinephrine, abolished or diminished the tachycardia following epinephrine, and ccnsistentiy increased the arrhythmia threshold dose of epinephrine to 12 times that of control. Lidocaine (1.0 mg/kg) did not significantly alter the blood pressure or heart rate, moderate the tachycardia following epinephrine, or consistently increase the arrhythmia threshold dose of epinephrine. From the available evidence together with the authors' it seems reasonable to conclude that the mode of antiarrhythmic action of propranolol differs from that of lidocaine and that the anesthetic-catecholamine cardiac arrhythmias are due to stimulation of beta adrenergic receptors.
Animals ; Arrhythmias, Cardiac* ; Arterial Pressure ; Blood Pressure ; Dogs ; Epinephrine ; Heart Rate ; Inhalation ; Lidocaine* ; Oxygen ; Propranolol* ; Receptors, Adrenergic, beta ; Tachycardia

It is well known that undue pressure and prolonged use of tourniquets on an extremity can cause peripheral nerve palsy and vascular damage either from direct pressure or from acid metabolites accumulating in the tissues distal to the tourniquet applied. After release of a tourniquet that has been on for 2 hours, the acidotic changes in the limb take approximately half an hour to recover, and it has been suggested that two hours' ischemia should never be exceeded. The authors have conducted a study to clarify the effect of these acid metabolites on the systemic circulation upon release of tourniquet after 105 minutes (mean) use. In 12 orthopedic patients, 20~32 years of age, who underwent operations below the knee, anesthesia was induced by the intravenous thiopental-succinylcholine-endotracheal intubation sequence and maintained with nitrous oxide-oxygen-halothane in a semiclosed circle absorption system. Respiration was controlled throughout the procedure. Measurements of PO2, PCO2 and pH in the femoral vein and radial artery before inflation of a tourniquet and 15 minutes, 10 minutes, 20 minutes, and again 30 minutes were performed following the release of tourniquet. The results are as follows: 1) Femoral vein pH significantly decreased with concommitant increase in PCO2 reflecting severe metabolic acidcsis during the tourniquet time. 2) Femoral vein PO2 was significantly increased, suggesting the presence of A-V shunt in the extremity. 3) These changes continued to exist for approximately half an hour after release of tourniquet. 4) Analyses of radial arterial blood for PO2, PCO2 and pH revealed no significant changes throughout the study. 5) It is concluded that acid metabolites produced by tourniquet application do not seriously affect when tourniquet is released as long as the buffering capacity and blood volume are kept normal and the patient is kept alkalemic by controlled ventilation.
Absorption ; Anesthesia ; Blood Volume ; Extremities ; Femoral Vein ; Humans ; Hydrogen-Ion Concentration* ; Inflation, Economic ; Intubation ; Ischemia ; Knee ; Orthopedics ; Paralysis ; Peripheral Nerves ; Radial Artery ; Respiration ; Tourniquets* ; Ventilation

Methoxyflurane, a new anesthetic agent, was administered to one hundred surgical patients. The following are the results of clinical observation and liver function tests. (1) Methoxyflurane is easily administered with a relatively simple vaporizer such as Heidbrink No.8 ether vaporizer in semi-closed system. (2) Blood pressure, pulse rate and cardiac rhythm are remarkably stable if deep anesthesia is avoided. (3) Excellent muscle relaxation is produced at intermediate levels of anesthesia without producing apnea. To avoid overdose it is recommended, however, to use muscle relaxants for operations which require highest degree of muscle relaxation such as upper abdominal procedures. (4) Assisted respirstion is advocated since methoxyflurane tends to depress respiration. (5) Depth of anesthesia is easily controlled with growing experience so that overdose can be avoided. (6) Analgesia extends into the recovery phase, minimizing the need for narcotics in the immediate postoperative period. (7) lnduction of and recovery from anesthesia is relatively prolonged. However, nausea, vomiting or delirium is less frequent than after ether anesthesia. (8) Hepatotoxicity, as determined by bromsulphalein, retention is of the same magnitude as that determined for diethyl ether.
Analgesia ; Anesthesia ; Apnea ; Blood Pressure ; Delirium ; Ether ; Heart Rate ; Humans ; Liver Function Tests ; Methoxyflurane* ; Muscle Relaxation ; Narcotics ; Nausea ; Nebulizers and Vaporizers ; Postoperative Period ; Respiration ; Sulfobromophthalein ; Vomiting

In anesthetized normocapnic and normotensive dogs, the effect of arterial hypoxemia on cerebral blood flow and oxidative carbohydrate metabolism was studied. The results are as follows: 1) The hypoxic vasodilatory effect on cerevral vessels is intact even at profound systemic hypoxemia(Pao2 30 torr) if Paco2 is controlled within normal limits. 2) CMRO2 did not significantly increase above the normal even during profound arterial hopoxemis, indicating that CMRO2 levels are poor indices of hypoxia. 3) A disporportinately high glycolysis at Pao2 of 50 torr suggested early cerebral metabolic changes which became more marked with further decrease in Pao2. 4) One hour after restitution of normoxia, however, carebral blood flow and metabolism manifested complete recovery. 6) It is concluded that a transient(20 minutes) profoun systemic arterial hypoxemia does not produce prolonged disorder of cerebral blood flow and oxidative carbohydrate metabolism provided that the cerebral perfusion pressure is kept normal.
Animals ; Anoxia* ; Carbohydrate Metabolism ; Cerebrovascular Circulation* ; Dogs ; Glycolysis ; Metabolism*

To ten male volunteers, 25 to 35 years old and without any known disease, physiological saline solution (placebo) 1 ml, morphine 10mg, and Remeflin 16 mg were administered intramuscularly. Effects of tbese agents upon ventilation at rest and respiratory response to carbon dioxide rebreathing were studied. The results are as follows: 1) Morphine significantly decreased respiratory rate, minute volume, and Pao2 and increased Paco2 without significantly affecting either tidal volume or arterial pH. 2) In morphine-induced respiratory depression, Remeflin improved ventilation by significantly increasing tidal volume and minute volume with resultant increase in Pao2 and decrease in Paco2, Remeflin did not significantly alter respiratory rate and arterial pH 3) Morphine displaced respiratory response curve to carbon dioxide obtained with placebo 7 torr to the right and Remeflin 6 torr to the left. No changes in slope of the curves were observed. 4) It is concluded that Remeflin stimlulatea respiration by directly acting upon the respiratory center.
Adult ; Carbon Dioxide ; Humans ; Hydrogen-Ion Concentration ; Male ; Morphine ; Respiration ; Respiratory Center ; Respiratory Insufficiency ; Respiratory Rate ; Sodium Chloride ; Tidal Volume ; Ventilation ; Volunteers

An anesthetic experience with right adrenalectomy for pheochromocytoma in a 24 year-old woman has been reported. Thiopental was used for induction followed by nitrous oxide-oxygen-fluothane supplemented with fractional doses of morphine for analgesia and succinylcholine (0.1 per cent intravenous drip) for muscular relaxation. An endotracheal semi-closed circle absorption technique with controlled ventilation was employed. The patient tolerated the ansthesia and surgery well with appropriate cardiovascular control using Regitine to suppress excessive hypertension and Levophed, whole blood and cortisone to combat hypotension after removal of the tumor. Importance of preoperative preparation, sufficient sedation, smooth induction, complete analgesia, good muscular relaxation, adequate alveoiar ventilation and proper cardiovascular control has been stressed and discussed together with the choice of anesthetic agent and technique.
Absorption ; Adrenalectomy ; Analgesia ; Cortisone ; Female ; Humans ; Hypertension ; Hypotension ; Morphine ; Norepinephrine ; Phentolamine ; Pheochromocytoma ; Relaxation ; Succinylcholine ; Thiopental ; Ventilation ; Young Adult

One-lung ventilation (anesthesia) has been indicated for certain intrathoracic surgery. However the recommended oxygen concentrations and ventilatory patterns have been variously reported. To clarify this, the author has investigate the effect of left lung collapse and right lung ventilation with relatively large, constant tidal volume of 100% oxygen on pulmonary homodyamic and shunt ratio in 10 mongrel dogs with their left main bronchi ligated and cut following thoracotomy under Pentothal anesthesia. The results are as follows: 1) Heart rate, mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure did not change significantly. 2) Mean pulmonary artery pressure and pulmonary vascular resistance increased significantly during one-lung ventilation. 3) Cardiac output decreased slightly, and alveolar-arterial oxygen tension difference and pulmonary shunt ratio increased significantly. However arterial oxygen and carbon dioxide tensions remained in the normal range. It is concluded that to maintain noramil arterial oxygen and carbon dioxide tensions during one-lung ventilation, it is mandatory to ventilate with relatively large, constant tidal volume of 100% oxygen and all measures and precautions should be exercised to maintain normal cardiac output.
Anesthesia ; Animals ; Arterial Pressure ; Bronchi ; Carbon Dioxide ; Cardiac Output ; Central Venous Pressure ; Dogs* ; Heart Rate ; Hemodynamics* ; Lung* ; One-Lung Ventilation* ; Oxygen ; Pulmonary Artery ; Pulmonary Atelectasis* ; Pulmonary Wedge Pressure ; Reference Values ; Thiopental ; Thoracotomy ; Tidal Volume ; Vascular Resistance ; Ventilation

While halothane, cyclopropane, chloroform and trichloroethylene have been clearly implicated to sensitize the myocardum and increase the risk of ventricular fibrillation, newer inhalation anesthetics have shown relatively less arrhythmogenecity. Isoflurane has been suggested to be compatible with epinephrine, while controversial data suggest enflurane, an isomer of isoflurane, may or may not sensitize the myocardium, which is to be clarified by the authors study. By constant intravenous infusion using VIP pump at the rate of 2.5ug/kg/min, the dosage of epinephrine causing premature ventricular contractions was measured in ten male mongrel dogs during halothane and enflurane anesthesia. While premature ventricular contractions were observed in all dogs anesthetized with halothane, the cardiac arrhythythmia was seen in only two dogs anesthetized with enflurane. Epinephrine dosage causing premature ventricular contractions and the resultant increase in mean arterial pressure at which arrhythmias occurred were significantly higher(p< 0. 05) during enflurane anesthesia than durinh halothane anesthesiae. These results suggest that enflurane, in comparison with halothane, is relatively less arrhythmogenic.
Anesthesia* ; Anesthetics, Inhalation ; Animals ; Arrhythmias, Cardiac* ; Arterial Pressure ; Chloroform ; Dogs ; Enflurane* ; Epinephrine* ; Halothane* ; Humans ; Infusions, Intravenous ; Isoflurane ; Male ; Myocardium ; Trichloroethylene ; Ventricular Fibrillation ; Ventricular Premature Complexes