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*

A reliable intravenous route is extremely important not only in surgical patients for prolonged administration of fluid and massive transfusion but also in patients with peripheral vascular collapse for hyperalimentation and critical patients. Since the subclavian vein catheterisation in a supraclavicular approach was introduced by J.K. Jeon in 1974 in our institution, it has been extremely popular for prolonged intravenous administration of fluids ratehr than for the measurement of central venous pressure. Therefore, the method of supraclavicular cannulation was modified by was of a more simple and easier method, using a 2inch Angiocath instead of an 8 inch intracath. We had 300 cases of supraclavicular subclavian vein cannulation which were done in various surgical patients of all ages. We have observed the following advantages of this method(2inch Angiocath) over the previous method. 1) No bleeding around the catheter 2) Simple and easy technique 3) Easy to fix the catheter 4) No need to wear gloves 5) Less complications such as air and catheter embolism 6) Bigger internal diasmeter in the Angiocath even with the sam size 7) Easy to keep the catheter open 8) Cheaper The subclavian vein is located within the costo-clavicular-scalene triangle and is approximately 3 to 4cm long and 1 to 2 cm in diameter in adults. The patient is placed in a supine and trendelenburg position to allow the subclavian vein to distend and to help prevent an air compolism when the vessel is cannulated. Follwing the preparation of the supraclavicular foses, a 2 inch Anglocath with a 10 cc syringe attached is inserted and advanced in the direction of the innominate vein, approximately 1cm from the junction of the clavicle and the lateral border of the sternocleidomastoid muscle(Clavisternomastoid angle. Fig.2). It is important to maintain a negative pressure while advancing the needle until a free flow of blood is observed in the syringe. When blood is observed in the syringe, a catheter is inserted and threaded all the way to the end then the needle is removed. The tip of the catheter is connected to the intravenous solution and fixed with adhesive tape. There is no need to press the puncture site or change the position in order to prevent bleeding around the catheter. The complications of a subclavian vein cannulation with an Anglocath are the same as with an Intracath. Those are pneumothorax, hydrothorax, hemothorax, catheter embolism, thrombosis and sepsis but the incidence is lower in this method. In the supraclavicular cannulation in our series, we have not experienced any of the above complications among the 300 cases done her due to the fact that only a few well qualified doctors have performed this technique.
Adhesives ; Administration, Intravenous ; Adult ; Brachiocephalic Veins ; Catheterization* ; Catheters ; Central Venous Pressure ; Clavicle ; Embolism ; Head-Down Tilt ; Hemorrhage ; Hemothorax ; Humans ; Hydrothorax ; Incidence ; Needles ; Pneumothorax ; Punctures ; Sepsis ; Subclavian Vein* ; Syringes ; Thrombosis

Postoperative hoarsness is a rather common complication resulting from endotracheal intubation. However prolonged hoaraness without organic damage can hardly be seen as a post intubation complication. We have two cases with prolonged hoarsness Postoperatively. The first case, a 50-years old woman, was observed to have an arytenoid fracture and dislocation on the left side after a neck mass was removed under general anesthesia. The second case, a 28-years old woman, was found to have a right vocal cord granuloma in association with progressing hoarsness after a cesarean section was done under general anesthesia. We concluded that the prolonged hoarsness with arytenoid fracture and vocal cord granulom had resulted from the endotracheal intubation.
Adult ; Anesthesia, General ; Cesarean Section ; Dislocations ; Female ; Granuloma* ; Humans ; Intubation ; Intubation, Intratracheal* ; Middle Aged ; Neck ; Pregnancy ; Vocal Cords*

The changes of blood gases, K and glucose levels of ACD banked blood according to the days of storage were observed. The samples were taken from the blood stored in the blood bank of Dong San Medical Center just before transfusing them in to patients. The results were as follows: 1) The pH value of one day stored blood was 6,720+/-0.0035. The PH gradually decreased according to the number of days it was stored which was significant statistically(p<0.05). 2) The O2 tension of one day stored blood was 24.1+/-3.25 torr and there was no significant changes in O2 tension according to the storage time. 3) The K level of one day stored blood was 5.7+/-0.5mg and this increased gradually as the storage time increased which was statistically significant(p<0.001). 4) The CO2 tension of one day stored blood was 133.1+/-6.4 torr and this increased according to the days of storage but it was not significant statistically. 5) The blood glucose level of one day stored blood was 338.5+/-0.5mg% and there was no significant increase or decrease as the storage time increased.
Blood Banks ; Blood Glucose ; Gases ; Glucose* ; Humans ; Hydrogen-Ion Concentration

Since 1971, (for 14 years) we have run the oxygen therapy unit in the Department of Anesthesiology. During this time, unauthorized personnel have carried out the duties in the unit under the supervision of anesthesiologist. We came to realize the necessity of having educated personnel to do the work in the oxygen therapy unit. 1) Our data on oxygen therapy increases yearly because the use of respiratory care is gradually increasing. 2) The postoperative use of a respirator increases due to the increase of critical surgical patients such as those who have had open heart and cerebral aneurysm surgery. 3) Hyperbaric oxygen treatment has decreased yearly. 4) Oxygen therapy was most frequently used in patients in the first 10 years of life. 5) The cases which had oxygen treatment were: pneumonia, atelectsis, pulmonary edema, CVA, head trauma, Gullian-Barre syndrome, sepsis, asthma and tetanus in that order. 6) Seasonally, the cases were more frequent in the spiring and fall.
Anesthesiology ; Asthma ; Craniocerebral Trauma ; Heart ; Humans ; Intracranial Aneurysm ; Organization and Administration ; Oxygen* ; Pneumonia ; Pulmonary Edema ; Seasons ; Systemic Inflammatory Response Syndrome ; Tetanus ; Ventilators, Mechanical

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