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

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

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*

The term flail chest is used to describe the condition in which a portion of the chest wall moves in a direction opposite to the rest of the thorax. This condition generally results from multiple rib fractures caused by external thoracic compression. Most characteristically, this occurs as a result of bilateral rib fractures after a steering-wheel injury or a crushing chest injury. In this article, 3 cases of flail chest developed following cardiopulmonary resuscitation showing a typical paradoxical respiration. The first case, a 69 year old male, had cardiac arrest during direct laryngoscopy in the operating room and was successfully resuscitated with external heart compression. He was then found to have separation of all costochondral junctions with paradoxical respirations. He was intubated and his respirations were controlled with a volume controlled respirator. Two days later, surgical traction was applied to his sternum, and was maintained for three weeks. He went home in good health after removal of the traction. The second case, a 48 year old male in hypovolemic shock, had a cardiac arrest postoperatively. He was resuscitated and then found to have paradoxical respiration which was controlled by a volume controlled respirator. He died of brain damage resulting from insufficient C.P.R. on the third day after the incident. The third case, a 57 year old male, was admitted to this institution from a local clinic with a flail chest as a result of costochondral separation after C.P.R. had been performed. He was intubated and his respirations were controlled by a volume setting respirator. On the second day following admission, traction was applied surgically to his sternum, thereafter he had normal respirations. However, his consciousness never returned and he died fo suspected brain damage fifteen days following admission. Cardiopulmonary resuscitation is vitally important to maintain artificial circulation and respiration. Cardiac compression must be sufficient to force blood out of the ventricles between the sternum and the spin(Fig.3). Even though the most common complication of C.P.R. is rib fractures, a sufficient heart compression is still the most important factor. However, rib fractures may be avoided by proper placement of the hands over the sternum during manual heart compression(Fig. 2). Once flail chest occurs, it should be actively treated by a volume controlled respirator and traction.
Aged ; Brain ; Cardiopulmonary Resuscitation* ; Consciousness ; Flail Chest* ; Hand ; Heart ; Heart Arrest ; Humans ; Laryngoscopy ; Male ; Middle Aged ; Operating Rooms ; Respiration ; Rib Fractures ; Shock ; Sternum ; Thoracic Injuries ; Thoracic Wall ; Thorax ; Traction ; Ventilators, Mechanical

No abstract available.
Tuberculosis, Pulmonary*

Interest in cardiac arrhythmia during surgery has increased in korea because the number of patients with cardiac diseases has increased and cardiac arrhythmia can be a warning that the patient is physiologic or anesthetic distress and that rapid remedial action is necessary. Our institution since 1975 has atarted a routine pre-operative ECG order on the patients over the age of 40. During the year of 1982, out of 5,800 cases of various surgeries, 252 patients were found to haveabnormal ECG findings. They were LVH, myocardial abnormality, RBBB, sinus arrythmia, PVC, AF, 1st A-V block, LBBB and myocardial infarction in this order of incidence. The significance of pre-operative ECG record was emphasized, and the intra-operatve ECG monitoring, dysrrhythmia, cardiac abnormality and its management are described.
Anesthesia* ; Arrhythmias, Cardiac ; Electrocardiography* ; Heart Diseases ; Humans ; Incidence ; Korea ; Myocardial Infarction

Since intsaspinal morphine and demerol anesthesia have been reported we have noted anesthetic effects from the intraspinal nareotic injection. However, intraspinal mophine anesthesia appeared to cause prolonged respiratory depression with a slow onset and a very long duration which is not suitable for short surgical procedures. On the other hand, demerol or pentazocine were found to have a very short onset and duration with excellent local anesthetic effects. This study was primarily an attempt to take advantage of the rapid onset and short duration of demerol and pentazocine for simple and short surgical procedures. We had 43 cases scheduled for surgeries in the saddle ares i.e. hemorrhoidectomy, T.U.R., radium appli cator insertion and vaginal hysterectomy. All operations were performed under intraspinal demerol or pentazocine anesthesia, witch was satisfactory and the following results were obtained: 1) intraspinal dosage of demerol was 50mg or pentazocine was 30mg ofr hemorrhoidectomy, radium applicator insertion and T.U.R. For vaginal hysterectomy, the dosage was increased to 75mg~100mg for with demerol or 45mg with pentazocine. 2) Both analgesic effects apeeared from 1~2minutes after intraspinal injection and lasted 2 hours. 3) Mild somnolences were observed occasionally but no respiratory depression was seen. 4) Hemodynamics were stable throughout the entire procedures as well as postoperatively. 5) We came to the conclusion that a saddle block induced by intraspinal demerol or pentazocine injection was quite satisfactory in anesthesia practice for perineal surgery.
Anesthesia ; Anesthetics ; Female ; Hand ; Hemodynamics ; Hemorrhoidectomy ; Hysterectomy, Vaginal ; Injections, Spinal ; Meperidine ; Morphine ; Pentazocine ; Radium ; Respiratory Insufficiency

In the present study, an effort was directed to assess the changes of hepatic ensymes according to the exposed in short and long surgical cases under halothane anesthesia. 60 surgical cases were studied in two different group. Halothane anesthesia was given for less than 2 hours in the first group of 30 cases and for more than 2 hours in the second group of 30 cases. The results were compared with the normal values and summarized as follows: In the first group, the changes after halothane exposure for less than 2 hours were negligible. In the second group, SGOT and SGPT were elevated significantly and the number of enzyme-elevated cases were 5~6 greater in group 1.
Alanine Transaminase* ; Anesthesia* ; Aspartate Aminotransferases* ; Halothane* ; Reference Values

This is a case of an accidental prolonged tourniquet application on the lower extremity. A 31 year old, well developed male had an open reduction for a clavicle fracture and nerve graft of the injured arm. To obtain the nerve from the leg, a tourniquet was applied and remained on the right lower extremity for 4hours. Post-operatively, he developed severe edema with paralysis of that leg. Thereafter, progressively he had signs of acute tubularnecrosis with oliguria, myoglobinuria, elevation of BUN and creatinine, and finally pulmonary edema. He recovered graually from the renal failure, pulmonary edema and paralysis of the leg as he received intermittent peritoneal dialysis for renal failure and intensive respiratory care for pulmonary edema. He went home in good condition only with a slight residual sensory loss of the injured leg 90 days after his admission.
Adult ; Arm ; Clavicle ; Creatinine ; Edema ; Humans ; Leg* ; Lower Extremity ; Male ; Myoglobinuria ; Oliguria ; Paralysis* ; Peritoneal Dialysis ; Pulmonary Edema ; Renal Insufficiency* ; Tourniquets* ; Transplants