The authors experienced a case of myoglobinuria accompanied by generalized myalgia and mild fever that developed 3 hours 30 minutes after general anesthesia. Tracheal intubation was done smoothly 5 minutes after injection of thiopental sodium(275 mg) and pancuronium bromide(6 mg), and anesthesia was maintained with ethrane/N2O/O2(1.5-2%/21/21/min). There was no specific event except tachycardia and fluctuation of blood pressure throughout operation. In this case, we assume that the myoglobinuria is a presentation of the sign of an abortive type of malignant hyperthermia. However, it was not confirmed. We had good patient outeome with the supportive measures of hydration and diuresis. The patient was discharged twenty three days after operation without any complication.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Diuresis ; Fever ; Humans ; Intubation ; Malignant Hyperthermia ; Myalgia ; Myoglobinuria* ; Pancuronium ; Tachycardia ; Thiopental

We observed one patient who developed sudden unilateral blindness following general anesthesia. After genera1 anesthesia with the prone position of the patient, the affected eye had no perception of light. Three days after, funduscopic features revealed narrowing of retinal artery, whitening or opacification of the retinal and a cherry-red spot. Central retinal artery occlusion can occur after surgery, possible etiologic factors being hypotension, extrinsic pressure on the eyeball. Proper positioning of the head on an adequate headrest and avoidance of an ocular compression will prevent the extrinsic pressure on the eyeball.
Anesthesia* ; Anesthesia, General ; Blindness ; Head ; Humans ; Hypotension ; Prone Position ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinaldehyde

Pneumothorax and pulmomary edema can be produced as a complication during general anesthesia. The former which occurs during pressure ventilation is highly dangerous. It is characterized by a dramatic onset which is readily recongnized and demands immediate management. The latter may be developed after the upper airway obstruction has been relived due to the reduction of the intersitial hydrostatic pressure and increased capilary permeability. We experienced a case of pneumothorax and pulmonary edema that occurred after treatment for upper airway obstruction.
Airway Obstruction* ; Anesthesia, General ; Edema ; Hydrostatic Pressure ; Permeability ; Pneumothorax* ; Pulmonary Edema* ; Ventilation

Nausea and vomiting are common problems after strabismus surgery in pediatric patients. We compared the effects of droperidol and ephedrine with conventional regimen consisting of halothane-N2O to the effects of conventional regimen itself, 69 children. ASA physical status l, ages 1-12yrs, were studied. Each child was randomly assigned to receive droperidol 0.04mg/kg., ephedrine 0.5mg/kg or normal saline 2ml intramuscularly, 10 minutes before the end of surgery. The incidence of postanesthetic nausea and vomiting was 17% in the droperidol group(p<0.05)., 13% in the ephedrine group(p<0.05), which were significantly less than the control group(43%). But there was no significant difference between droperidol group and ephedrine group. We concluded that droperidol and ephedrine have significant postoperative antiemetic effect in patients undergoing strabismus surgery.
Antiemetics ; Child* ; Droperidol ; Ephedrine ; Humans ; Incidence ; Nausea ; Postoperative Nausea and Vomiting* ; Strabismus* ; Vomiting

The purpose of a conculation is to seek the opinions and advice of those whom we recognize to be more expert in a particular field of medicine than we are. Most surgeons regard the anesthesiolgist as a conculatant. Thus we analyzed 308 cases of interdepartmental consulatation submitted to our department from June 1991 to Novermber 1991. All case were elective ones and emergent cases were excluded. The analysis were as follow. 1) The overall conculation rate were 11.5%. 2) The highest rate of consultation were requested from orthopedic surgery department(29.9%) followed by ophthalmology department(25.0%), neurosurgery department(24.6%) and urology department(13.4%). 3) Male was 42.8% and female was 57.2%. 4) Most requestered problem was hepatic diseases including elevated transaminase, hepatitis and liver cirrhosis(35.1%) and then cardiovascular problem was 20.5%. 5) Because of our opinion, 22 cases were postponed. 6) Consultation rate increased according to advancing of age.
Female ; Hepatitis ; Humans ; Liver ; Male ; Neurosurgery ; Ophthalmology ; Orthopedics ; Urology

The isolation arm test at upper limb for the study of muscle relaxants sensitivity of human muscle is described. In the healthy adults, succinylcholine 100ug/kg or vecuronium 5~6ug/kg combined with 20ml saline is given intravenously at various sites of injection while the circulation to the arm is occluded with upper arm pneumatic tournique. After injection of muscle relaxants, neuromuscular transmission is then studied by TOF stimulation to ulnar nerve with EMG monitor(ABM, Dates) and changes of twitch response in evoked muscle action potential amplitude from hypothenar muscle are recorded. In the results, twitch height is depressed weakly and slowly but incompletely after muscle relaxant is injected intravenously at cubital fossa, and declines further depression following recovery after the release of upper arm tourniquet occiuded systemic circulation(two stage response). There are not any changes of twitch response while muscle relaxants are given intravenously between upper arm and forearm pneumatic tourniquet. But twitch height is depressed rapidely and completely after muscle relaxants are given intravenously at doris hand under the upper arm or forearm pneumatic tourniquet. Conclusively, twitch response under the isolation arm test is influenced from the site of injection, and in order to obtain the correct assessment of neuromuscular blockade, muscle relaxants will be given intravenously at dorsi hand with forearm pneumatic tourniquet.
Action Potentials ; Adult ; Arm* ; Depression ; Forearm ; Hand ; Humans ; Neuromuscular Blockade ; Succinylcholine ; Tourniquets ; Ulnar Nerve ; Upper Extremity ; Vecuronium Bromide

This study investigated the comparison of electromyographic change of neuromuscular blocking effect induced vecuronium between the ulnar, facial and tibial nerve in 24 healthy adult patients anesthetized with thiopental, N2O and enflurane. Neuromuscular monitoring commenced immediately after administration of thiopental. After supramaximal stimulation was achieved, a bolus of vecuronlum 0.08mg/kg was injected intravenously. And then single twitch nerve stimulation(T1) was applied to the nerves using surface electrodes and the electrical response of muscles recorded using the RELAXOGRAPH(Dates Co.). The patients were allocated randomly to 3 groups of 8 patients respectively: the ulnar nerve troup was the control, and the facial nerve group and the tibial nerve group were the studing group. We assessed electromyographic responses from abductor digiti minimi muscle in the ulnar nerve, orbicularis oris muscle in the facial nerve and flexor hallucis brevis muscle in the tibial nerve to single twitch nerve stimulation respectively. And the onset time, the time from injection of vecuronium to 25% and 75% recovery to T1, and recovery index of the ulnar, facial and tibial nerve groups were measured. The obtained results were as follos: 1) The onset time was faster in the facial nerve group compared with the ulnar nerve group. 2) The time from injection of vecuronium to 25% recovery of T1 was more prolonged in the facial nerve group compared with the ulnar nerve group. 3) The time from injection of vecuronium to 75% recovery of T1 and recovery index were more shorter in the tibial nerve group compared with ulnar nerve group.
Adult ; Electrodes ; Enflurane ; Facial Nerve ; Humans ; Muscles ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Thiopental ; Tibial Nerve* ; Ulnar Nerve ; Vecuronium Bromide*

Several investigators have described an interaction between muscle relaxants and hydrocortisones which have showed different results. The exact mechanism of this action is not clear and ther conflicting results have further confusion. The experimental methods were two ways. In the one of method, a group that vecuronium 0.1mg/kg was given intravenously is control and a group that hydrocortisones of various doses(0.3, 0.5 and 1 mg/kg) were administered into vein when T1 was appeared is compared. In the another of method, a control group was anticholinesterase(pyridostigmine 0.12 mg/kg, robinul 0.004mg/kg) were given at the time when T1 reached 25% and a group treated with hydrocortisone 0.5 mg/kg when T1 was appeared is compared. Neuromuscular blockade was measured by recording the twitch response following ulnar nerve stimulation by EMG(ABM, Datex Co. 2Hz 30mA supramaximal voltage). The recovery time from 25% to 75% recovery of twitch height was measured according to recovery index(RI). The results obtained were as follows: `) The RI of control group treated with vecuronium 0.1mg/kg alone was 40.32+/-20.24 minutes and the group which hydrocortisone 0.5mg/kg was combined, was shorten to 18.79+/-5.17 minutes, but in the group combined with hydrocortisone 1.0mg/kg and 0.3mg/kg, the RI was also tended to short, but not significant. 2) In the RI of vecuronium 0.1mg/kg, anticholinesterases were given, was 8.46+/-5.06 minutes and the group combined with hydrocortisone 0.5mg/kg was shorten to 4.77+/-1.82 minutes significantly. Conclusively, in the small doses of hydrocortisone, there is a effect of antagonism to the vecuronium induced blockade and a potentiated effect to the anticholinesterase activity to the vecuronium.
Cholinesterase Inhibitors ; Humans ; Hydrocortisone* ; Neuromuscular Blockade* ; Research Personnel ; Ulnar Nerve ; Vecuronium Bromide* ; Veins

Leventhal, et al. described a preoperative scoring system for myasthenic patients undergoing transsternal thymectomy, which includes four key risk factors. There were : 1) duration of myasthenia gravis greater than 6 years (12 points); 2) a history of chronic respiratory disease not due to myasthenia gravis(10 points); 3) a dose of pyridostigmine greater than 750mg per day 48 hours before operation (8 points); 4) a preoperative vital capacity less than 2.9L(4 points). Thirty-seven patients with myasthenia gravis undergoing transsternal thymectomy under general inhalation anesthesia with or without muscle relaxants were applied to scoring system by leventhal, et al. retrospectively. The predicitive score was assessed for each patient and the duration of postoperative mechanical ventilation was also noted for each patient. in this study, there was correct in 23/37(62.2%) of the cases, with 9 out of 27 being incorrectly predicted to be ready for tracheal extubation(false positive) and 5 out of 10 being incorrectly predicted to need ventilation(false positve). In conclusion, the scoring system proposed by leventhal, et al. may be some value in predicting whether or not a particular myasthenic patient was likely to need mechanical ventilation following transsternal thymectomy.
Anesthesia, Inhalation ; Humans ; Myasthenia Gravis* ; Pyridostigmine Bromide ; Respiration, Artificial* ; Retrospective Studies ; Risk Factors ; Thymectomy* ; Ventilation ; Vital Capacity

When we perform the regional blockade, we usually addit epinephrine to the local anesthetics for the purpose of lengthening anesthesia time and preventing the systemic reaction of local anesthetics. In that situation, epinephrine produces decrease in serum potassium concentration and changes in electrocardiogram. We investigated the influence of propranolol on changes in serum potassium and ECG induced by brachial plexus block with 30ml of mixture of local anesthetic (2% lidocaine +0.5% bupivacaine) which contains 1:200,000 epinephrine. The subjects classified as following two groups: Group l : Brachial plexus block with mixture of local anesthetic and 1:200,000 epinephrine(n=20). Group ll : Pretreated with 2 mg of propranolol(slow intravenous injection for 5 min. before block) and performed as Group l. The results were as follows: 1) Group l showed statistically significant decrease of serum potassium after 10, 20, 30 min. of block(p<0.05). Group ll did not show any significant change. 2) Group l showed progressive flattening of T wave and appearance of U wave (25% of pts) in ECG as the serum-potassium decreased progressively, but Group ll did not sho any significant change. 3) The epinephrine mediated beta-adrenergic stimulation may be considered as the cause of epinephrine induced hypokalemia during brachial plexus block.
Anesthesia ; Anesthetics, Local ; Brachial Plexus* ; Electrocardiography ; Epinephrine ; Hypokalemia ; Injections, Intravenous ; Lidocaine ; Potassium ; Propranolol*