Between january 1, 1981 and December 31, 1986, 1,310 Cesarean sections (26.7%) were performed among 4,898 paturient women at St. Mary's pospital, Catholic Medical College. The perioperative condition of the newborns along with morbidity and mortality after Cesarean section wha analyzed. The incidencea of Cesarean sections between 1981 and 1986 were 25.0% 27 .6%, 23.4%, 29.5%, 31.2% and 27.1%, respectively. The anesthetic methods employed were inhalation anesthesia with thiopental sodium for induction and nitrous oxide-oxygen-halothane for maintenance of anesthesia. This study did net include the 76 cases of lumbar epidural or spinal technique performed during this Period. Based on one minute Apgar scores, 82 infants (6.26%) were assessed as moderately (score 4-6) depressed, and 44 infants (3.36%) were rated as severely (score 0~3) depressed. Twenty (45.5%) of the severely depressed newborns were promptly resuscitated and given ade- quate treatement, but 11 infants (25.0%) did not survive. The incidence of idiopathic respiratory distress syndrome (IRDS) in this study was 9 cases (0.79%) Ammong 7he total 1,310 cases; this induded 7 cases of premature birth or low birth weight and 2 cases of aspiration pneumonia. The mortality of the IRDS group was 4 of 9 cases (44.4%). Among the severely depressed group, the time from induction to delivery was five minutes in 8 case? (18.2%) , six to ten minutes in 22 cases (57.777) and more than 11 minutes in 14 cases (31.8%) . The pro7n7stic status of newborn babies was evaluated with respect to the anesthetic procedure and the outcome of deliveries by Cesarean sections performed between 1981 and 1986 at St. Mar's Hospital, Catholic Medical College, Seoul, Korea.
Anesthesia ; Anesthesia, Inhalation ; Cesarean Section* ; Female ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn* ; Korea ; Mortality ; Pneumonia, Aspiration ; Pregnancy ; Premature Birth ; Seoul ; Thiopental

BACKGROUND: Hepatic dysfunction may occur after single, or more usually repeated, exposures to the halogenated inhaled anesthetics. The cause may be free radical snd metabolites of inhaled anesthetics, immune reaction and hypoxic damage by decreasing total flows. The purpose of this study is to evaluate postoperative liver function between the general anesthesia and the thoracic epidural blockade supplemented with the light general anesthesia. METHODS: Thirty patients were divided into two groups; 15 patients were aneshtetized with 2 vo1% of enflurane combined with nitrous oxide(2 I/min) and oxygen(1.5 l/min) in the general anesthesia group, and in 15 patients of the thoracic epidural blockade group thoracic epidural blockade with 2% lidocaine and light general anesthesia using nitrous oxide(2 l/min) and oxygen(1.5 l/min) were performed. Serum glutamic oxalacetic transaminase(SGOT), serum glutamic pyruvic transaminase(SGPT) and alkaline phosphatase were evaluated before anesthesia, 1, 3, 5 and 7 days after gastric surgery on both groups. RESULTS: In the general anesthesia group, postoperative SGOT levels were increased above normal range but were within normal limits in the thoracic epidural blockade group. SGPT level was increased above normal range on postoperative one day in the general anesthesia group but no increase of postoperative SGPT levels was observed in the thoracic epidural blockade group. On postoperative seven days the level of alkaline phosphatase was increased within normal range in the general anesthesia but in the thoracic epidural blockade group the levels of alkaline phosphatase were not increased. CONCLUSIONS: We consider that postoperative liver function is not influenced with thoracic epidural blockade supplemented with light general anesthesia for upper abdominal surgery.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Aspartate Aminotransferases ; Enflurane* ; Humans ; Lidocaine ; Liver* ; Reference Values

Direct surgical repair of complex intracranial vascular lesions is difficult. Sometimes the neurosurgery is performed under circulatory arrest, profound hypothermia and barbiturates cerebral protection. Total ischemia is tolerated for 30~60 minutes because oxygen requirements of the brain decrease exponentially as body temperature is lowered. We experienced that this technique was successfully used for inoperable basilar artery aneurysm. We reviewed the surgical and anesthetic considerations of basilar artery aneurysm.
Aneurysm* ; Barbiturates ; Body Temperature ; Brain ; Hypothermia* ; Intracranial Aneurysm ; Ischemia ; Neurosurgery ; Oxygen

BACKGROUND: Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is known to have analgesic properties in subanesthetic doses and has been used as an analgesic in the postoperative period by variable routes. The effect of adding ketamine to analgesia using intravenous PCA morphine was evaluated in 90 women after cesarean section. METHODS: Ninety parturients were randomly allocated to three groups and each group had 30 women. The parturients in group 1 were given analgesics of morphine only, group 2 were given analgesics of the 2 : 1 mixture of morphine and ketamine, and group 3 were given analgesics of the 1 : 1 mixture of morphine and ketamine. We evaluated the analgesic requirement, numerical rating pain score, side effects and patient's satisfaction. RESULTS: The morphine requirement in group 3 was significantly lower than that in groups 1 and 2 at 3, 6, 12, 24 and 48 hours postoperatively. The pain score in group 2 was lower than that in group 1 at 3 and 6 hours and the pain score in group 3 was lowest of all groups at 3 and 6 hours. The incidence of dizziness was higher in group 3 than in groups 1 or 2. CONCLUSIONS: We concluded that adding ketamine with morphine in using an intravenous PCA can decrease analgesic requirements and improve analgesic property.
Analgesia ; Analgesics ; Cesarean Section* ; Dizziness ; Female ; Humans ; Incidence ; Ketamine* ; Morphine* ; N-Methylaspartate ; Passive Cutaneous Anaphylaxis* ; Postoperative Period ; Pregnancy

The caudal block has been used as an alternative to general anesthesia in specific circumstances such as anal surgery, perineal surgery or surgery of lower extremity etc. It has been also used as an adjunct to general anesthesia, administered at the completion of surgery to provide postoperative analgesia especially in children. But, it has variable complications such as generalized intoxication, pain on the injection site, infection or urinary retention etc. We report an unusual case of metastatic sacrococcygeal tumor from adenocarcinoma of lung presenting as severe anal pain and sciatica which was aggravated after the trial of caudal anesthesia.
Adenocarcinoma* ; Analgesia ; Anesthesia, Caudal* ; Anesthesia, General ; Child ; Humans ; Lower Extremity ; Lung* ; Sciatica ; Urinary Retention

Patients with diabetes or chronic renal failure may develop profound hypotension after anesthesia induction. In a patient with chronic renal failure, inappropriate dialysis may aggravate the hypotension. Combined autonomic neuropathy in diabetes mellitus is the main cause of the undesirable changes in blood pressure after anesthesia induction. We report a case of hypotension refractory to fluid replacement and inotropes in a patient with chronic renal failure for 10 years and diabetes mellitus for 5 years. The patient received hemodialysis on the day before surgery and had developed various symptoms suggestive of autonomic neuropathy (i.e., dizziness on standing, esophageal spasm, intermittent diarrhea).
Anesthesia ; Blood Pressure ; Diabetes Mellitus ; Diabetic Neuropathies ; Dialysis ; Dizziness ; Esophageal Spasm, Diffuse ; Humans ; Hypotension ; Kidney Failure, Chronic ; Renal Dialysis

Epidural block is widely used for the diagnosis and treatment of the acute and chronic pain in pain clinic. But, it has several complications like as headache, spinal injury, epidural hematoma and infection including epidural abscess, meningitis and osteomyelitis. Among them, the simultaneous occurrence of psoas and epidural abscesses is extremely rare. We report a patient diagnosed as epidural and psoas absesses one month after lumbar epidural block and treated successfully with surgical decompression and drainage.
Chronic Pain ; Decompression, Surgical ; Diagnosis ; Drainage ; Epidural Abscess ; Headache ; Hematoma ; Humans ; Meningitis ; Osteomyelitis ; Pain Clinics ; Psoas Abscess* ; Spinal Injuries

BACKGROUND: Preoxygenation is routine prior to rapid sequence induction of general anesthesia for a cesarean section. The aim of this study was to evaluate the preoxygenation techniques of tidal volume breathing (TVB) and deep breathing (DB) for a cesarean section. METHODS: One hundred twenty ASA I and II patients scheduled for a cesarean section under general anesthesia participated in the study. Preoxygenation was performed with 5, 7, and 10 L/min 100% oxygen. The following techniques were tested: 1) normal TVB for a 5-min period (TVB/5 min) and 2) DB for a 2-min period (4 DB/0.5 min, 8 DB/min, 12 DB/1.5 min and 16 DB/2 min). Inspired (FIO2) and end-tidal oxygen fraction (FETO2), end-tidal carbon dioxide pressure (ETCO2) and oxygen saturation (SpO2) were measured at 0.5-min intervals. RESULTS: During TVB, FETO2 increased rapidly between 0.5 and 3.5 min and plateaued by 3.5 min at 78.5%, 83.3% and 90.8% with 5, 7 and 10 L/min 100% oxygen, respectively. Four DB/0.5 min increased FETO2 to 64.7%, 67.2% and 72.3% at 5, 7, and 10 L/min 100% oxygen, respectively. As compared with four DB/0.5 min, the values of FETO2 with TVB/1.5 min and TVB/2 min were high at 7, 10 and 5 L/min 100% oxygen. CONCLUSIONS: We concluded that TVB/2 min was more effective than four DB/0.5 min in achieving preoxygenation but eight DB/min could be used in case of an emergent operation.
Anesthesia, General ; Carbon Dioxide ; Cesarean Section* ; Female ; Humans ; Oxygen ; Pregnancy ; Respiration* ; Tidal Volume*

Large symptomatic vallecular cyst is rare, but may cause difficulty or inability in conventional tracheal intubation during induction of general anesthesia. A flexible fiberoptic bronchoscope is the most useful general purpose aid to awake intubation in the patient with a known difficult airway. We experienced a case of flexible video image fiberoptic bronchoscopic awake orotracheal intubation in a patient with the large symptomatic vallecular cyst. A 35-year-old male suffered from foreign body sensation, voice change and dyspnea one month after upper respiratory tract infection. The two step flexible fiberoptic bronchoscopic approach was performed in the management of a known difficult intubation due to a vallecular cyst. We had an uneventful general anesthesia for removal of large symptomatic vallecular cyst because we anticipated difficult intubation.
Adult ; Anesthesia, General ; Bronchoscopes ; Dyspnea ; Foreign Bodies ; Humans ; Intubation ; Male ; Respiratory Tract Infections ; Sensation ; Voice

Large symptomatic vallecular cyst is rare, but may cause difficulty or inability in conventional tracheal intubation during induction of general anesthesia. A flexible fiberoptic bronchoscope is the most useful general purpose aid to awake intubation in the patient with a known difficult airway. We experienced a case of flexible video image fiberoptic bronchoscopic awake orotracheal intubation in a patient with the large symptomatic vallecular cyst. A 35-year-old male suffered from foreign body sensation, voice change and dyspnea one month after upper respiratory tract infection. The two step flexible fiberoptic bronchoscopic approach was performed in the management of a known difficult intubation due to a vallecular cyst. We had an uneventful general anesthesia for removal of large symptomatic vallecular cyst because we anticipated difficult intubation.
Adult ; Anesthesia, General ; Bronchoscopes ; Dyspnea ; Foreign Bodies ; Humans ; Intubation ; Male ; Respiratory Tract Infections ; Sensation ; Voice