BACKGROUND: Because desflurane can cause airway irritability when used to induce anesthesia, drugs aimed at reducing airway irritability. This study investigated the possible differences between lidocaine and alfentanil on the decrease in the airway irritability during desflurane inhaled induction. METHODS: 75 patients (25 in each groups) were assigned randomly to induce anesthesia with inhaled desflurane. The breathing circuit was primed with desflurane 6% in 50% O2 and 50% N2O. After pretreatment with 2% lidocaine (1 mg/kg), or alfentanil (10microgram/kg), or saline (7 ml) intravenously 2 minutes before inducing anesthesia, each patient breathed the gas mixture through a tight fitting facemask. The time to loss of consciousness, cough, laryngospasm, excitatory movement and hemodynamics were checked before and after inhalation. RESULTS: The time to loss of consciousness, cough and excitatory movement were lower significantly between in the control group and other groups, but there was no difference between the 2% lidocaine and alfentanil groups. The blood pressure and heart rate were lower in the alfentanil group, but the heart rate was similar. CONCLUSIONS: These results explain that intravenous 2% lidocaine appears to be useful. However, Intravenous alfentanil can also reduce the airway irritability and stabilize the hemodynamics significantly when desflurane is used to induce anesthesia.
Alfentanil* ; Anesthesia ; Blood Pressure ; Cough ; Heart Rate ; Hemodynamics* ; Humans ; Inhalation ; Laryngismus ; Lidocaine* ; Respiration ; Unconsciousness

BACKGROUND: Propofol increases the risk of bradycardia compared with other anesthetics. This paper reports the heart rate response to intravenous atropine during propofol and enflurane anesthesia. METHODS: Sixty patients undergoing a transabdominal hysterectomy under general anesthesia were randomly assigned to two groups: the propofol group and the enflurane group. All the patients received midazolam 2 mg intramuscularly and were then anesthetized with propofol or enflurane. The blood pressure and heart rate were taken at 1 min intervals for 10 min after a bolus injection of atropine 5microgram/kg. RESULTS: In the enflurane group, the systolic blood pressure and heart rate were increased significantly at 1, 2 and 3 min after the atropine injection (P<0.05). When the two groups were compared, the heart rate in the enflurane group was significantly higher at 1, 2 and 3 min after atropine injection than in the propofol group (P<0.05). CONCLUSIONS: The heart rate response to intravenous atropine during propofol anesthesia is attenuated compared with enflurane anesthesia.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Atropine* ; Blood Pressure ; Bradycardia ; Enflurane* ; Heart Rate* ; Heart* ; Humans ; Hysterectomy ; Midazolam ; Propofol*

BACKGROUND: This study assessed the changes in the heart rate variability (HRV) indices, which are used to measure the autonomic nervous system function during general anesthesia (GA), and compared the result of the awake state. METHODS: Patients undergoing an explo-laparotomy were anesthetized with either isoflurane (Group I, n = 20) or sevoflurane (Group S, n = 20) added to a mixture of nitrous oxide and oxygen. Frequency-domain analysis of the HRV indices using fast Fourier transformation (FFT) resulted in a power spectrum with a very low (VLF), low (LF), and high frequency (HF) and calculated normalized LF (nuLF), normalized HF (nuHF), and LF/HF ratios before and after GA. Time-domain analysis was performed and the pNN50 (proportion of successive RR intervals [RRI] > 50 ms in relation to the total RRI), RMSSD (root mean square of the successive differences in the RRI), standard deviation 1 (SD1) and standard deviation 2 (SD2) from the Poincare plots, HRV triangular index, and TINN (triangular interpolation of NN interval histogram) were also calculated before and after GA. RESULTS: The VLF, LF, HF, nuLF, and LF/HF ratio during GA decreased by 45.2, 95.1, 83.1, 27.3, and 17.4%, respectively, compared with the awake state. However, the nuHF significantly increased. The RMSSD, pNN50, SD1, SD2, HRV triangular index, and TINN also decreased 62.0, 69.2, 62.0, 61.7, 62.4, and 52.4%, respectively. Groups I and S produced similar alterations in the studied parameters during GA. CONCLUSIONS: GA reduced all the HRV indices studied except for the nuHF.
Anesthesia, General* ; Autonomic Nervous System ; Fourier Analysis ; Heart Rate* ; Heart* ; Humans ; Isoflurane ; Nitrous Oxide ; Oxygen

The incidence of myocardial ischemia and silent myocardial infarction are higer in diabetic than in nondiabetic patients. We had a case of a disbetic, myocardial ischemic female patient, 54years old, who had cardiac arrest during an emergency surgery. The patient was admitted via emergency room with the diagnosis of rupture of basilar artery aneurysm. During the dissection for the exposure of the artery. The aneurysm ruptured. causing massive hemorrhage. At this time, cardiac arrest was revealed at the monitoring EKG, cardiopulmonary resuscitation with DC shock were performed to reverse venticular fibriliation but the EKG monitor showed T wave inversion and sinus tachycardia in several leads. And the blood pressure was hardly audible with systolic of about 50mmHg. So nitroglycerin 0.05mg, intravenous bolus injection was given twice and the systolic went up to 110mmHg with a diastolic of 80mmHg. So the operation proceeded and finished. The patient was sent to the ICU. On the third postoperative day, the patient again had cardiac arrest but this time could not be resuscitated. We experienced the dramatic effect of nitroglycerin on this ischemic patient during cardio pulmonary resuscitation and we would like to share this experience with our colleagues.
Aneurysm ; Arteries ; Blood Pressure ; Cardiopulmonary Resuscitation* ; Diagnosis ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Heart Arrest ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin* ; Rupture ; Shock ; Tachycardia, Sinus

Differential independent lung ventilation is gaining growing attention for management of patients with unilateral pulmonary pathology. This case presents the method for the intraoperative anesthetic management of a patient with empyema and bronchopleural fistula of the left lung which could be controlled by the use of dual-mode asynchronous lung ventilation. The healthy right lung was ventilated by a conventional mechanical ventilator and disessde left lung by a high frequency jet ventilator. The use of endotracheal anesthesia and high frequency ventilation were necessary to prevent drainage of infected secretions into the right side healthy lung and to achieve good gas exchange in the presence of a bronchoplsural fistula. The method used by us, high frequency ventilation for the diseased lung a conventional mechanical ventilation for the other, demonstrated that differential independent lung ventilation using double lumen tube as in this case was suited for handling the problem of a bronchopleural fistula and empyema, further extending the indication for a giant lung bulls, lung cyst, major tracheobronchial disruption and one lung contaminating the other lung with either infected material or blood.
Anesthesia ; Drainage ; Empyema ; Fistula ; High-Frequency Ventilation ; Humans ; Lung* ; Pathology ; Respiration, Artificial ; Ventilation* ; Ventilators, Mechanical

Toxic methemoglobulinemia is a rare disease and poses great risks in anesthesia because the oxygen carring capacity of the blood is reduced. This condition may be idiopathic or result from exposure to grugs or chemical agents and is treasted by the intravenous injection of methylene blue. This 17 year-old male was admitted to St. Mary Hospital for right nephrectomy because of rupture of the right kidney after accidental ingestion of Diaminodiphenyl sulfate and then falling down. The patient appeared cyanosed and dark brown tinged blood was ween at the site of skin incision. The result of arterial blood gas analysis was relatively normal and no specific problem was detected during anesthesia. This patient was successfully trated with ascorbic acid, methylene blue and oxygenation.
Adolescent ; Anesthesia ; Ascorbic Acid ; Blood Gas Analysis ; Eating ; Humans ; Injections, Intravenous ; Kidney ; Male ; Methemoglobinemia* ; Methylene Blue ; Nephrectomy ; Oxygen ; Rare Diseases ; Rupture ; Skin ; Tolnaftate

A 18 year old male with myesthenia gravis. Osserman Adult B type, underwent thymectany under general anesthesia combining the use of the new competitive muscle relaxant. Vecuronium, with initial dose of 0.08mg/kg. Neuromuscular blockade of Vecuronium in this myasthenic patient was monitored carefully from induction to postanesthetic period and it was compared with neuromuscular blockade of vecuronium(0.08mg/kg) and pancuronium(0.08mg/kg) in non-myasthenic patient. In this dose of Vecuronium in myasthenic patient, easy to achive endotracheal intubation, it's duration action and recovery were makedly prolonged and delayed than those of non-myasthenic patient and weakly approximated to those of pancuronium in non-myasthenic patients. Conclusively, the reduced dosage of vecuronium with careful neuromuscular monitering in myasthenic patient should be more effective and safe without any difficulties of anesthetic management and ventilatory support on post-operative period.
Adolescent ; Adult ; Anesthesia, General ; Humans ; Intubation, Intratracheal ; Male ; Myasthenia Gravis* ; Neuromuscular Blockade ; Pancuronium ; Thymectomy* ; Vecuronium Bromide*

The intensive care unit(ICU) of our hospital is a 12 bed multidisciplinary ICU which is under the auspices of the Department of Anesthesiology. The ICU is essentially a respiratory ICU in which all hospital patients requiring ventilatory support are cared for. The patient population encompasses all causes of respiratory failure, medical and surgical. Another source of referral (surgical and medical) is a large group of critically ill patients with multiorgan failure, especially due to traums. Our experience of intensive care therapy began in the recovery room starting in 1959. Since that time the size and facilities of the ICU have been enlarged. We analyzed 4,514ICU patients admitted between Mar. 1980 and Feb. 1984, to obtain better guidance and management in the ICU. The results of patients was 4,514; 874 patients in 1980, 832 patients in 1981, 895 patients in 1982, 862 patients in 1983 and 1,051 patients in 1984. The ratio of male to female patients was nearly 2:1/ 2) Total Total admission time in the ICU was 17.473 days. The average patient stay was 3.9 days. The number of patients staying in the ICU more than 9 days increased from 54 cases(6%) in 1980 to 101 cases(10%) in 1984. 3) The forty year age group outrumbered the order age group and was 20.5%. The mortality rate of the pre-teen age group was the hightest(19.7%) and the overall mortality was 14.2%(640 cases) during these 5 years. 4) The number of patients admitted to the ICU from the Department of Neurosurgery was 1,218(27%) being the highest among all departments. Oct of 232 patients who died, the Department of Neurosurgery had the highest mortality rate, 19.1%. From the above results, it can be seen that the number of patients admitted to the ICU. the mortality rate and the patients staying more than 9 days in the ICU has increased annually it is claimed that more facilities allowing for monitoring and support, special qualified staffs and a co-ordinated organization will reduce the mortality rate, particularly in the pre-teen age group.
Anesthesiology ; Critical Illness ; Female ; Gangwon-do* ; Humans ; Intensive Care Units* ; Critical Care* ; Male ; Mortality ; Neurosurgery ; Recovery Room ; Referral and Consultation ; Respiratory Insufficiency

Fourty one cases with coronary occlusive disease were anesthetised for aortocoronary bypass graft from May 1977 to December 1983 st Severance Hospital, Yonsei University Medical Center. The main anesthetic agents were diazepam-morphine-pancuronium-O2-N2O in most cases, and supplemented with halothane, enflurane of methoxyflurane in some cases. Nitroglycerin, nitroprusside, triflupromasine, and dopamine were used for keeping the hemodynamic stability before, during and after anesthesia depending on the needs. Two operative death occured in our early years. The mortality rate was 4.87% and no late deaths. The overall anesthetic management for aortocoronary bypass graft surgery is disscussed.
Academic Medical Centers ; Anesthesia* ; Anesthetics ; Coronary Artery Bypass ; Dopamine ; Enflurane ; Halothane ; Hemodynamics ; Methoxyflurane ; Mortality ; Nitroglycerin ; Nitroprusside ; Transplants*

Maternal hyperventilation may cause neonatal depression. For the evaluation of relationship between maternal acid-base status and neonatal state in elective cesarean section, we observed maternal arterial blood gases and umbilical venous blood gases, and compared them according to maternal pH. Umbilical venous PO2 in group ll(maternal pH between 7.35 and 7.45) and group lll(maternal pH more than 7.45)were significantly low, compared to group l (maternal pH less than 7.35). However, Apgar score at 1 minute and 5 minute didn't show any significant differences in each group.
Apgar Score ; Cesarean Section ; Depression ; Female ; Gases ; Hydrogen-Ion Concentration ; Hyperventilation ; Pregnancy