Acid-base balances in the CSF have been reported by a number of groups during the past 20 years. The CSF contains only neligilbe concentrations of buffer anions other than HCO3(-). Acid-base balances in the CSF depend mainly on arterial PCO2 because arterial CO2 diffuses easily into the blood-brain barrier to form H2CO2 in the CSF. This study was primarily undertaken to observe the changes of pH, CO2 and HCO3(-) values in the CSF in the acute stage of hyperventilation. We have studied relatively healthy patients who were scheduled for surgery for cerebral aneuryams. Prior to induction of anesthesia, the radial artery was cannulated for and arterial line and blood samples taken and lumbar tapping was performed at the level of L3-4 using at 14 gause long needle, then a 18 gauze catheter was inserted through the needle. Pre-operative samples for gases were taken, then the patient was anesthetized and his repiration was controlled and maintained at the PaCO2 of 30 torr. The samples in both blood and CSF for gases were obtained at intervals of 15, 30, 45 and 60 minutes and observed and compared. The results were as follows: The PCO2 in CSF decreased as rapidly as the arterial PCO2 decreased by hyperventilation. The data obtained after hyperventilation of 45 minutes showed a significant decrease of CO2 value in the CSF as compared to the control group. The pH in the CSF increased as rapidly as the pH of the arterial blood. The arterial HCO3(-) decreased significantly in the groups of 15, 30 and 45 minutes and it was highly significant in the 60 minutes group, despite this the HCO3(-) in the CSF showed no significant changes in any of the groups. In conclusion as a result of this study, no visible metabolic compensation in the CSF for respiratory alkalosis was observed in an acute stage of hyperventilation.
Alkalosis, Respiratory ; Anesthesia ; Anions ; Blood-Brain Barrier ; Catheters ; Compensation and Redress ; Gases ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation* ; Needles ; Radial Artery ; Vascular Access Devices

This is a case of cervical cord injury which is a rare complication of endotracheal intubation. A 32 year old muscular male with a short neck had a laparotomy for panperitonitis. He was tranfered to the recovery room after surgery, and the anesthetic procedure wase completed uneventfully. Endotracheal intubation was attempted on several occations on an emergency basis because of unexpected cyanosis associated with hiccups and vomiting in the recovery room. Therefore, his respiration was controlled by the respirator, but he was not able to breath spontaneously for several days. The condition was due to a cervical cord injury with signs of paralysis of the respiratory muscles and upper extremities. The mechanism and process was described.
Adult ; Cyanosis ; Emergencies ; Hiccup ; Humans ; Intubation* ; Intubation, Intratracheal ; Laparotomy ; Male ; Neck ; Paralysis ; Recovery Room ; Respiration ; Respiratory Muscles ; Upper Extremity ; Ventilators, Mechanical ; Vomiting

Halothane is most easily blamed when a postoperative casef hepatitis occurs because it is most commonly used as an anesthetic agent and hepatitis has been intermittently reported for time. However, it is not easy to prove halothane induced the hepatitis clinically because there a long are many factors causing hepatitis. We had two cases of acute hepatitis developing following surgery. Case 1. A 49 year old male underwent surgery for femur fracture under halothane anesthesia. The preperative liver function tests were normal and the operation was uneventful. He developed epigastirc descomfor on the second postoperative day and jsundice with marked elevation of SGOT, SGPT, alkaline phosphatase and bilirubin on the 3rd day. Since the 7th postoperative day, the signs of acute renal failure with ascites became evident, therefore, dialysis was carried out. The died of acute respiratory and renal failure on the 20th postoperative day. We consider the nonA, nonB viral hepatitis infection as a possible cause in this case. Case 2. A 35 year old male had an operation for right femur fracture under repeated halothane anesthesia. On the 3rd day, he developed high fever of 39 degrees C. Liver function tests showed marked elevation of SGOT, SGPT, alkaline phosphatase and leukocytosis with eosinophilia, followed by gross jaundice. HBs Ag(-) and anti-HBs(+) were reported. He recovered gradually from the hepatitis and went home in good health on the 30th postoperative day. A possible cause of the hepatitis in this case was considered to be the halothane anesthetic.
Acute Kidney Injury ; Adult ; Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Ascites ; Aspartate Aminotransferases ; Bilirubin ; Dialysis ; Eosinophilia ; Femur ; Fever ; Halothane ; Hepatitis* ; Humans ; Jaundice ; Leukocytosis ; Liver Function Tests ; Male ; Middle Aged ; Renal Insufficiency

Various anesthetic agents have been recommended for pheochromocytoma surgery. However, in general, no ideal anesthetic agent has been accepted as yet. The use of the well known agents, halothane still remains a contraversial issue for pheochromocytoma surgery. According to our experience and a review of the literature, it is strongly suggested that halothane is the anesthetic agent of choice among the anesthetic agents currently available. We believe that the incidence of arrythmia from halothane is not higher than that from other anesthetic agents and arrthmia is not caused primarily by halothane, but results mostly from endogenous catecholamines during surgery. In addition to these advantages, it is a rapid induction agent accompained by a peripheral vessel dilating effect. Lidocaine also is readily available to counteract the disadvantages of the arrythmic effect of halothane. We have had two uneventful cases of pheochromocytoma surgery. One was prepared with phenoxybeaxamine preoperatively and anesthetized with halothane. The other was not prepared with phenoxybeaxamine, but was anesthetized with halothane. The patient prepared with phenoxybeaxamine had prolonged hypotension for two days postoperatively and was treated with Neo-Synephrine drip. However, the patient wihout preoperative phenoxybeaxamine had no problem with his blood pressure post operatively. As a result of this experience, we believe the preoperative use of phenoxybeaxamine is not necessary, plus it also creates more problems with postoperative hypotension. Halothane can act as a vasodilator in place of phenoxybeaxamine during anesthesia. Therefore, halothane is currently the ideal anesthetic agent of choice without phenoxybeaxamine preparation when lidocaine is available.
Anesthesia* ; Anesthetics ; Arrhythmias, Cardiac ; Blood Pressure ; Catecholamines ; Halothane* ; Humans ; Hypotension ; Incidence ; Lidocaine ; Phenylephrine ; Pheochromocytoma*

Cauda equina syndrome is characterized by urinary retention, loss of sexual function, loss of sensation in the perineal region and incontinence of feces. It had been reported by Courville, Kennedy, et al early in 1950. Since then Dripps, Vandam, Philips and others have reviewed many thousands of cases for evalustion of neurologic complications following spinal anesthesia, but there has not been a single case of permanent neurologic sequels reported. This 32 year old male with this postspinal neurologic complication was admitted to this institution on the twelveth post-operative day. His surgery had been carried out under spinal anesthesia for removal of an exostosis of the left knee at a local clinic. According to the history at the local clinic, a lumbar tap was performed at the level between L4-5, then 5% lidocaine in 5% D/W was injected into the subarachnoid space and the surgery was finished untevenfully. He developed pain in his buttocks and coccygeal region 6 hours after the surgery was done, so morphine sulfate was injected into the epidural space. After that, the pain was relieved for a while but he again started having the same pain associated with loss of sensation of the lower extremities, urinary retention, constipation and penile impotence on the 10th post-operative day. He came to this institution for 3 months with the above symptoms on the twelveth post-operative day. A cystoscopy and cystometry was done and showed a neurogenic bladder. He was treated with Urecholine for urinary retention and Dexamethasone for arachnoiditis for 2 months. He also had enemas intermittently for severe constipation and a Foley catheter was inserted. He was trained to void by himself by pressing his lower abdomen. He went home with the same symptoms after the Foley catheter was removed. The possible complications and preventions were listed in tabel l and ll. We will follow the patient.
Abdomen ; Adult ; Anesthesia, Spinal ; Arachnoid ; Arachnoiditis ; Bethanechol Compounds ; Buttocks ; Catheters ; Cauda Equina* ; Constipation ; Cystoscopy ; Dexamethasone ; Enema ; Epidural Space ; Erectile Dysfunction ; Exostoses ; Feces ; Humans ; Knee ; Lidocaine ; Lower Extremity ; Male ; Morphine ; Polyradiculopathy* ; Sacrococcygeal Region ; Sensation ; Subarachnoid Space ; Urinary Bladder, Neurogenic ; Urinary Retention

Epontol is well known as an ultra-short-acting intravenous anesthetic which can be used for minor surgery. This case report is to present the possibility of cardiac arrest while using Epontol in a patient with heart disease because its pharmacological action causes acute hypotension due to myocardial depression and histamine release. This 30 year old female who had a history of rheumatic fever with incomplete RBBB manifested by ECG, was admitted with vaginal bleeding and 500 mg of 5% Epontol was .administered for D % C. The patient appeared to have acute cyanosis immediately after Epontol administeration, followed by cardiac arrest. Despite cardiac resuscitation was performed adequately, the patient remained comatose for 1 year and 4 months and died of respiratory failure with sepsis.
Anesthesia, Intravenous* ; Coma ; Cyanosis ; Depression ; Electrocardiography ; Female ; Heart Arrest* ; Heart Diseases ; Histamine Release ; Humans ; Hypotension ; Minor Surgical Procedures ; Propanidid* ; Respiratory Insufficiency ; Resuscitation ; Rheumatic Fever ; Sepsis ; Uterine Hemorrhage

Central venous pressure is an extremely useful parameter in the effective monitoring of patients who are seriously ill. Since the subclavian venepuncture for central venous pressure was introduced by Ashbough in 1963, it has become extremely useful for prolonged intravenous administration of fluids, for a reliable intravenous route in cases of peripheral vascular collapse, and for hyperalimentation. Since then several different techniques for large vein puncture i.e., subclavian vein and internal jugular vein, have been developed. Since 1974, 265 cases of catheterizations have been recorded by the anesthesia department in the Dong San Medical Center. These were performed mostly by the supraclavicular approach. We have observed the following advantages of this approach over the infraclavicular approach. 1) More definitive skin landmark. 2) The distance between the skin and the vein is shorter. 3) The direction of the needle is easily controlled. 4) There is less tissue trauma because the pectoralis major muscle is not penetrated. 5) There is less incidence of pneumothorax or hydrothorax. 6) The procedure can be performed during surgery by an anesthesiologist. 7) The failure rate is lower. The subclavian vein is located within the costo-clavicular-scalene triangle and is approximately 3 to 4 cm long and 1 to 2cm in diameter in adults. The patient is placed in a supine and Trendelenberg position to allow the subclavian vein to distend and to help prevent air embolization when the vessel is cannulated. Following preparation of the supraclavicular fossa, a 16 gauge needle with a 10cc syringe attached is inserted and advanced in the direction of the innominate vein, approximately 1 cm from the- junction of the clavicle and the lateral border of the sternocleidomastoid muscle (clavister- nomastoid angle, fig. I) It is important to maintain a negative pressure while advancing the needle until a free- flow of blood is observed in the svrinre. When blood is observed a catheter is inserted and. threaded through the needle then the needle is removed. The catheter is connected to a 3 way stopcock which is connected to the intravenaus solution line. It is also important at the time that the needle is removed to put the patient in a semi- Fowlers position to decrease hematoma formation and allow the walls of the vein to contract around the inserted catheter. The complications of subclavian venepuncture and catheterization include pneumothorax hydrothorax, hemothorax, air embolism, hematoma, catheter embolism, thrombosis and sepsis etc. Fewer complications from a supraclavicular approach in comparison to a infraclavicular approach have been reported in various journals. In the supraclavicular subclavian vein catheterization, the above complications have not been major problems when attemptedunder careful supervision in our institution.
Administration, Intravenous ; Adult ; Anesthesia Department, Hospital ; Brachiocephalic Veins ; Catheterization* ; Catheters* ; Central Venous Pressure ; Clavicle ; Embolism ; Embolism, Air ; Hematoma ; Hemothorax ; Humans ; Hydrothorax ; Incidence ; Jugular Veins ; Needles ; Organization and Administration ; Pneumothorax ; Punctures ; Sepsis ; Skin ; Subclavian Vein* ; Syringes ; Thrombosis ; Veins

No abstract available.
Tuberculosis, Pulmonary*

The cerebrospinal fluid(CSF) contains only negligible concentrations of buffer anions other than HCO3- because there is no hemoglobin buffer syatem. CSF gas values have been reported and it has been shown that arterial CO2 diffuses easily into the blood brain barrier to form H2CO3 in the CSF. No study for normal valuea of CSF gaaes in Koreans has been reported. The study was attempted to obtain the normal. values of CSF gases and also to compare values of gases in the three different components, j,e. CSF, arterial and venous blood. Relatively healthy patients with no respiratory or systemic disturbances who were sch-eduled for simple operations have been studied. Prior to the induction of aneathesia, Ium-bar tapping was Performed at a level of L3-4 using a 22 gauge needle and CSF samples-were obtained. Then the racial samples were taken. The subclavian vein was cannulated with a 20 gauge catheter and venous b1ood samples were obtained. All the gas values were-compared as shown in the tab1es and figures. The results obtained were as fallows: PCSF O2 was 76.5+/-8.6 torr and PcsF CO2 was 44.9+/-3.6 torr. Both data in the CSF fall in the middle of the arterial and venous valses. The pH of the CSF was 7.329+/-0.017, HCO3- was 23.6+/-1.8 mEq/L and the base excess was -2.2+/-1.5. All the above data are the lowest among the three components, The pH of the CSF is more acid than arterial or venous blood and that pH regulation of the CSF is seemed to be limited because there is no compensatory hemoglobin buffer in the CSF. The finding of the CSF gas values obtained in this study is introduced as a normal data for further physiological study of the CSF.
Anions ; Blood-Brain Barrier ; Catheters ; Gases ; Humans ; Hydrogen-Ion Concentration ; Needles ; Subclavian Vein

Urinary retention has been well documented as a complication of spinal anesthesia. This occurs somewhat more frequently than after general anesthesia because the bladder wall, supplied by the parasympathetic system is paralysed by local anesthetics and its fibers from S2 are very susceptihle to analgesic solution. For 5 years since 1974, 127 cases of urinary retention were recorded from 4733 cases of spinal analgesia performed at the Dong San Medical Center. The incidence of urinary retention is 2.7% in our data. In this article, two cases of prolonged urinary retention due to spinal anesthesia are described. Case l A 44 year old female was scheduled for a vaginal hysterectomy because of a prolapse of the uterine cervix. Spinal tapping was performed at L(4~5), and 16 mg of 0.4% Pontocaine was administered. The surgery was uneventful and the patient slept from Nembutal during the whole procedure. Postoperatively the patient developed retention of urine without any abnormality observed by cystoscopy, so that she was treated with urecholine orally and recovered on the 14 th postoperative day. Case ll The patient was a 39 year old female, scheduled for a cholecystectomy. Spinal analgesia was performed and the patient was put to sleep by Nembutal and the surgery was uneventful during the whole procedure. She complained of the difficulty of voiding postoperatively. She was started on urecholine 20 mg tid orally from the 7th postoperative day, then she started voiding on the 10th postoperative day. Since then there have been no problems. The mechanism and the precipitating factors are described.
Analgesia ; Anesthesia, General ; Anesthesia, Spinal* ; Anesthetics, Local ; Bethanechol Compounds ; Cervix Uteri ; Cholecystectomy ; Cystoscopy ; Female ; Humans ; Hysterectomy, Vaginal ; Incidence ; Pentobarbital ; Precipitating Factors ; Prolapse ; Spinal Puncture ; Tetracaine ; Urinary Bladder ; Urinary Retention*