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

Morphine anesthesia for cardiac surgery became very popular since Lowenstein at al. reported that 1.5~3.0mg/kg of morphine administered intravenously during ventilating with 100% oxygen did not alter cardiovascular dynamics in patients without heart disease and improved them in patients with aortic valve disease. However, morphine anesthesia soon appeared to cause significant disadvantages and many problems such as intraoperative awareness, histamine reactions marked increases in intraoperative blood pressure and prolonges postoperative respiratory depression. This study was primarily undertaken to evaluate the effects of intraspinal morphine anesthesia and compare them with the problems resulting from intravenous morphine anesthesia. We had 25 patients scheduled for open heart surgery. They were anesthetized mainly by intraspinal morphine and intravenous tranquilizers. Spinal tapping using Whitacre pencil point needle was performed in a sitting position at a level between L2-L4 and spinal fluid was drawn and mixed with morphine by a 10cc syringe and was administered rapidly with barbotage 3 times. Then the patient was given pentothal and anectin, and was intubated, followed by intravenous administration of Ativan or valium. The patient's respiration was controlled with 100% oxygen throughout the entire surgery. 1) The dosages of intraspinal morphine ranged between 6~10mg which was bridfly calculated by 0.1mg/kg with some variation according to heights and patients conditions. 2) Activan or valium was administered intravenously to eliminate intraoperative awareness. Ativan was preferred to valium for valve surgery. 3) Cardiovascular dynamics appeared stable throughout the intraoperative, recovery and ICUcare periods. 4) Respiratory depression seemed to be most serious between 12~16hour after intraspinal injection of morphine. Therfore this technique is recommended only in patients who need a controlled respiration for more than 12 hours because respiratory arrest occurs more commonly at that hour. 5) Respiratory care in the ICU was very effective satisfactory without any further medication for synchronisation between patient and respiratior becauses of the length of respiratory depression. 6) Somnolence lasts 24~36hours with no inadvertent reactions. 7) Well documented complications such as respiratory depression, pruritis and urinary retention were not problems in patients for open heart surgery. 8) The anesthesia induced by intraspinal morphine injection was satisfactory in anesthesia practice for open heart surgery. Therefore, we have called this procedure which has not been reported yet intraspinal morphine anesthesia.
Administration, Intravenous ; Anesthesia* ; Aortic Valve ; Blood Pressure ; Diazepam ; Heart Diseases ; Heart* ; Histamine ; Humans ; Injections, Spinal ; Intraoperative Awareness ; Lorazepam ; Morphine* ; Needles ; Oxygen ; Pruritus ; Respiration ; Respiratory Insufficiency ; Spinal Puncture ; Syringes ; Thiopental ; Thoracic Surgery* ; Urinary Retention

PURPOSE: Due to its size and locatin, the liver is frequently injured in abdominal trauma. Recently, nonoperative management for liver injuries has been extended due to the development CT imaging, intensive care units, and their equipment and techniques. Herein, patients with traumatic liver injury were analyzed to evaluate its treatment and prognostic factors. METHODS: From 2001, January to 2003, July, 65 patients at our facility were confirmed to have traumatic liver injury. The operative or nonoperative managements were decided on the basis of the systolic blood pressure if no peritoneal irritation sign was noted. If the systolic blood pressure was stable, or recovered to within the normal range following hydration and transfusion at the emergency room, patients were managed nonoperatively. Hemodynamically unstable patients were managed operatively. The data were analysed using the SPSS program (Chi-squared tests and logistic regression analyses). RESULTS: 48 patients were treated nonoperatively, with 3 mortalities. The overall mortality rate was 15.8%, but only 6.4% in the nonoperative management group, compared to 67% in operative management group. In a Multivariate analysis the systolic blood pressure was found to be a reliable factor in traumatic liver injury and the mentality and ISS (injury severity score) reliable in finding complications in the nonoperative management group. The mentality was found statistically reliable for determining mortality in the operative management group, with the exception for the systolic blood pressure. CONCLUSION: The systolic blood pressure was an important indicator when considering the treatment plan in traumatic liver injury. An extensive study will be required that incorporates both nonoperative and operative management groups.
Blood Pressure ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Liver* ; Logistic Models ; Mortality ; Multivariate Analysis ; Reference Values

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*

No abstract available.
Seizures*

Pospinal complications have been reported and decumented for a century since the spinal anesthesia started in 1885. Prevention and treatment of postpinal headache still remains a malor problem. However, we have no statistics on postspinal complications in Korea. During the five year period from 1974 to 1979, 5318 cases of spinal analgesia, mainly using the premixed 5 percent lidocaine solution with 5 percent dextrose, were recorded by Dong San Medical Center. Thie study was primarily undertaken to observe several aspects of postspinal heudache i.e. incidence, localization, distribution according to age and sex, and treatment. As a result of this study, we can summarize as follows: 1) The mean age of these cases was 43 years. 2) The main anesthetic was the premixed 5 percent lidocaine solution with 5 percent dextrose. 3) The needle for the lumbar puncture was mainly 22 gauze Whitacre pencil point needle. 4) The overall incidenee of headache was 3.4 percent. The incidence between 20 to 29 years was 5. 4 percent and 6. 0 percent from 30 to 39 years. This age distribution showed that 6. 0 percent from 30 to 39years. This age distribution showed that the highest incidence was from 20 to 40 years. 5) 94 percent of the headaches were frontal and 6 percent were occipital. 6) Treatment results: a) 162 percent of the patients hed mild headache(110 cases). These were cured spontaneously or by the intraveneus infusion only. b) 31 percent of the patients had moderate headache(56 cases). The se were treated with the analgesics. c) 7 percent of the patients had secere headache(13 cases). These were treated with the epidural blood patches. These results are compared with the phillips and Dripps series.
Age Distribution ; Analgesia ; Analgesics ; Anesthesia, Spinal ; Blood Patch, Epidural ; Glucose ; Headache* ; Humans ; Incidence ; Korea ; Lidocaine ; Needles ; Punctures* ; Spinal Puncture

Intraspinal morphine anesthesis for open heart surgery was first publicized by Jeon early in 1986. We came to the conclusion that the anesthesia induced by an intraspinal morphine injection was satisfactory in anesthesia practice for open heart surgery and we have called this procedure, "Intraspinal Morphine Anesthesia". However, respiratory depression seemed to be most serious between 12~16hrs, after an intraspinal injection of morphine so that this technique is recommended only in patients who need controlled respiration for more than 12 hours because respiratory arrest occurs more commonly at that time. In other words intraspinal morphine anesthesia is absolutely not recommended in patients for simple operations. This study was undertaken to evaluate the effects of demerol injected in the subarachnoid space and to compare them with the effects of intraspinal morphine anesthesia. This attempt was made to take advantage of the rapid onset and short duration of demerol action for simple and short procedures. We had 32 cases scheduled for open heart surgery but those were all simple cases such as ASD and VSD in which controlled respiration was not expected to be needed. They were anesthetized mainly by intraspinal demerol and intravenous tranquilizers with 100% oxygen throughout the surgery. 1) The dosage of intraspinal demerol which ranged between 1~2 mg/kg did not seem to be proportional to the duration and potency of the drug. 2) Valium was administered intravenously to eliminate intraoperative awareness. Valium was preferred to Activan for simple cases. 3) The main action of demerol seemed to last 3~4 hours and no respiratory problems were observed 4 hours after the injection of demerol. 4) The onset of an anlgesic effect appeared at 5~7 minutes and the respiratory depression or arrest occuresd around10 minutes after the injection. 5) Cardiovascular dynamics appeared stable throughout the surgery except for transient bradycardia with mild hypotension whcih was seem occasionally. 6) Respiratory depression seemed to be no problem in the recovery room and ICU periods. 7)Somnolence lasts around 2~4 hours with no inadvertent resctions. 8) documented complications such as pruritus and voiding difficulty were not problems with the use of demerol for open heart surgery. 9) The aneshtesia induced by intraspinal demerol injection was satisfactory in anesthesia practice for simple cases. Therefore, we have called this procedure "Intraspinal Demerol Anesthesia". However, this technique sometimes is inconvenient in clinical practice because of its short action.
Anesthesia* ; Bradycardia ; Diazepam ; Humans ; Hypotension ; Injections, Spinal ; Intraoperative Awareness ; Meperidine* ; Morphine ; Oxygen ; Pruritus ; Recovery Room ; Respiration ; Respiratory Insufficiency ; Subarachnoid Space ; Thoracic Surgery

Balanced anesthesia is being equilibrated with the maintenance of light planes of anesthesia and the relatively free utilization of muscle relaxants to prevent untoward movement of the patient in response to surgical stimuli. However, muscle relaxants per se do not contributes to the state of hypnosis or analgesia. Therfore, awareness during modern anesthesia must be seriously taken. We have given anesthesia in 175 cases for cesarean section in order to investigate intraoperative awareness. Among the 175 anesthetic cases, 13 cases had awareness of pain and 19 cases had auditor awareness. Accordingly the total incidence of awareness in our investigation was 16% which was significantly high and should be considered in clinical anesthesia practice.
Analgesia ; Anesthesia* ; Balanced Anesthesia ; Cesarean Section* ; Female ; Humans ; Hypnosis ; Incidence ; Intraoperative Awareness ; Pregnancy

Voiding difficulty has been well documented as a complication after spinal anesthesia. This occurs somewhat more frequently after spinal anesthesia than after general anesthesia. However, the cause and mechanism of postspinal voiding difficulty has not been clarified, so in this study we have attempted to discover the mechanism of the voiding difficulty. Cystometry was performed on 30 healthy women who were scheduled for simple hystrectomy and the results were compared in three different groups. In the first group, cystometry was performed on 30 cases under only the premedication before the induction of anesthesia. In the second group, it waa performed on 14 cases under general anesthesia and in the 3 rd group, performed on 16 cases under spinal anesthesia. The results were as follows: 1) In the first group of 30 cases before anesthesia, the first voiding desire starts at approximately 150-250 ml (24 cases) and the average pressure of the bladder at the first voiding desire is approximately 5-10 cm H2O(19 cases). The volume at the maximum voiding desire is about 450-550ml(20 cases) and its pressure was 16-20cm H2O(12 patients). The average pressure tension curve of the cystometry was very similar to the normal one. 2) In the 2nd group of 16 cases under general anesthesia, measurement was not obtainable at the first and maximum voiding desire because they were under the effect of the anesthesia. The average pressure tension curve of the cystometry was lower than Group I (Fig. 1) and the critical volume which is designated as the volume at the point where the pressure of the bladder increased sharply in cystometry, was about 700ml which was larger than Group I. 3) In the 3 rd group of 16 cases, the cystornetry showed on the average pressure tension curve that the increase of the pressure was proportional to the volume in the bladder and no critical volume seems to be observed. It means that there is no contraction of the bladder muscle due to the paralysis of the sacral parasympathetic nerves which innervate the detrusor muacle of bladder. As a result of this study, we came to the conclusion that a cause of post-spinal urinary retension is the residual effect of local anesthetics prolonging the depression of the autonomic parasympathetic innervation system. These fibers from S2-S4 are very susceptible to analgesic solutions.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Anesthetics, Local ; Depression ; Female ; Humans ; Paralysis ; Premedication ; Urinary Bladder

Total spinal anesthesia is a serious life threatening complication of spinaI and epidural anesthesia and paravertebral block etc. We had 2 cases of accidental total spinal anesthesia associated with cranial nerve paralysis and eventual unconsciousness. Thereafter we have attempted to observe the clear physiologic changes resulting from total spinal anesthesia. Deliberate total spinal anesthesia was induced in 11 elective cases(Table I) for various proposed surgeries such as tonsillectomy, mastectomy and a variety of abdominal operations. Lumbar tapping for total spinal anesthesia was performed in a sitting position at a level between L 2-5, using a 22 gauze Whitacre pencil point needle, then 300 to 750 mg of 2% or 5% lidocaine solution was injected into the subarachnoid space, followed by the patient lying down in a steep Trandelenburg position. Shortly after the spinal injection of lidocaine, many physiologic ehangea from total spinal anesthesia could be clearly observed. We have described the results of our observation as well as the general physiology of spinal anesthesia according to the following classification, the nervous system, csrdiovascular system, gastrointestinal system, genitourinary system, levels of seeing, hearing and consciousness. Note that this study was done according to the studies which Koster, HK had performed on 3500 cases in 1928.
Anesthesia, Epidural ; Anesthesia, Spinal* ; Classification ; Consciousness ; Cranial Nerves ; Deception ; Hearing ; Humans ; Injections, Spinal ; Lidocaine ; Mastectomy ; Needles ; Nervous System ; Paralysis ; Physiology* ; Subarachnoid Space ; Tonsillectomy ; Unconsciousness ; Urogenital System