During massive transfusions especially under pressure, considerable hemolysis has been expected. It had been assumed that hernolysis would increase with increasing age of the bank blood, increasing pressure and with decreasing bore of the needle. Moss and Stauntan, however, found that hemolysis actually increased when blood was forced through larger bore needles. The authors have studied the magnitude of hemolysis according to various needle sizes under ordinary clinical transfusion conditions, and concluded as follows: 1) Hemolysis was maximum when a 18G needle was used and minimum with use of a 22G. needle regardless of the age and temperature of the bank blood, 2) Hemolysis increased with increasing age of the bank blood. 3) When the needle size was constant, hemolysis was not affected by warming of the bank blood.
Clinical Study* ; Hemolysis* ; Needles

Vasopressor effects of epinephrine, norepinephrine, ephedrine, phenylephrine, methoxamine and of mephentermine were compared in resrpinized dogs with or without nitrous oxide-oxygen-halothane anesthesia. The results are as follows: (1) Epinephrine and norepinephrine were shown to have the most potent pressor effect in reserpinized and nitrous oxide-oxygen-halothane-anesthetized dogs. Phenylephrine, methoxamine, mephen-termine and ephedrine were less potent in decreasing order. (2) Decrease in mean arterial pressure was less marked in dogs reserpinized and anesthetized with nitrous oxide-oxygen-halothane than in reserpinized but unanesthetized dogs. (3) It revealed that nitrous oxide-oxygen-halothane anesthesia potentiated the vasopressor effects of the sympathomimetic amines studied. Nitrous oxide-oxygen-halothane anesthesia is implicated to exert an sympathomimetic effect.
Anesthesia* ; Animals ; Arterial Pressure ; Dogs* ; Ephedrine ; Epinephrine ; Mephentermine ; Methoxamine ; Norepinephrine ; Phenylephrine ; Sympathomimetics*

To determine the effects of hydrcxyethyl starch upon liver, kidney, serm electrolytes and particularly upon blood coagulation, 500 ml of 6% HES in saline solution was administered intravenously to 15 patients during elective minor surgery. In all cases weighted blood loss was less than 600 ml without replacement. The following laboratory tests were performed immediately before infusion and again 1 hour, 24 hours, 48 hours, and 1 week after the infusion: RBC, WBC, hemoglobin, hematocrit, ESR, platelet, bleeding time, coagulation time, prothrombin time, total protein, albumin, total bilirubin, direct bilirubin, SGOT, SGPT, alkaline phosphatase, BUN, sodium, potassium, and chloride. The results are as follows: 1) No anaphylactic shock or bleeding tendency characteristic of colloids was encountered. 2) No functional disturbance of liver or kidney directly attributable to HES was identified. 3) All laboratory parameters except WBC and ESR decreased after infusion. The decrease was, however, within the normal range and believed secondary to dilational effect of infusion. WBC increased somewhat, but returned to the preinfusion level in a week. 4) Exceptionally erythrocyte sedimentation rate increased notably during the 24 hour period following infusion. As with dextran, this was interpreted not due to direct effect of HES, but due to increased adsorption of fibrinogen, alpha-beta-gamma-glcbulin to red cell surface with changes in electric charge between red cells. 5) Clinical applicability, metabolic aspect, degree of subtitution of hydroxyethyl group and safety with multiple infusion of HES must be carefully determined.
Adsorption ; Alanine Transaminase ; Alkaline Phosphatase ; Anaphylaxis ; Aspartate Aminotransferases ; Bilirubin ; Bleeding Time ; Blood Coagulation ; Blood Platelets ; Blood Sedimentation ; Colloids ; Dextrans ; Electrolytes ; Fibrinogen ; Hematocrit ; Hemorrhage ; Humans ; Kidney ; Liver ; Potassium ; Prothrombin Time ; Reference Values ; Selective Estrogen Receptor Modulators ; Sodium ; Sodium Chloride ; Starch* ; Surgical Procedures, Minor

Anesthetic experience with thymectomies for two patients with myasthenia gravis has been reported. Both of them talerated the surgical procedures under endotracheal nitrous oxide-oxygen-halothane anesthesia well, but one of tbem expired from cholinergic crisis on the 3rd postoperative day. Chemical diagnosis of myasthenia gravis and the salient clinical features including choice of preanesthetic medication, anesthetic agents, techniques and of neuromuscular blocking agents for myasthenic patients have been discussed. Paramount importance of rigid attention to ventilation, the maintenance of a patent airway and the removal of secretions by bronchoscopy or tracheostomy whenever necessary for the patient safety throughout operative and postoperative period has been stressed. Frequent determinations of pulmonary function and the use of edrophonium test in avoiding cholinergic crisis are advocated.
Anesthesia ; Anesthetics ; Bronchoscopy ; Diagnosis ; Edrophonium ; Humans ; Myasthenia Gravis ; Neuromuscular Blocking Agents ; Patient Safety ; Postoperative Period ; Preanesthetic Medication ; Thymectomy ; Tracheostomy ; Ventilation

An anesthetic experience with right adrenalectomy for pheochromocytoma in a 24 year-old woman has been reported. Thiopental was used for induction followed by nitrous oxide-oxygen-fluothane supplemented with fractional doses of morphine for analgesia and succinylcholine (0.1 per cent intravenous drip) for muscular relaxation. An endotracheal semi-closed circle absorption technique with controlled ventilation was employed. The patient tolerated the ansthesia and surgery well with appropriate cardiovascular control using Regitine to suppress excessive hypertension and Levophed, whole blood and cortisone to combat hypotension after removal of the tumor. Importance of preoperative preparation, sufficient sedation, smooth induction, complete analgesia, good muscular relaxation, adequate alveoiar ventilation and proper cardiovascular control has been stressed and discussed together with the choice of anesthetic agent and technique.
Absorption ; Adrenalectomy ; Analgesia ; Cortisone ; Female ; Humans ; Hypertension ; Hypotension ; Morphine ; Norepinephrine ; Phentolamine ; Pheochromocytoma ; Relaxation ; Succinylcholine ; Thiopental ; Ventilation ; Young Adult

Sixty-six patients with squamous cell carcinoma of the supraglottic larynx received irradiation with curative intent between 1979 and 1985 were retrospectively analysed. All patients had a minimum follow-up of 4 years. Of the entire group consisting of 73% T3 and T4 lesions and 58% lymph node metastases, a 5-year acturial survival rate was 31.3%. A 5-year acturial survival rates for stage II, III andIV were 60.7%, 46.7% and 13.5% respectively (p<0.05). Patients without lymphnode metastases had better survival rate than those with costive lymphnode metastases(54.8% vs 12.2%) (p<0.005). Surgical salvage rate was 4/7 (57%). Three patients developed distant metastases. Major complications requiring surgery were seen in 11% Radiation therapy alone with surgical salvage was an effective, voice preserving treatment for stage I, II and selected III carcinoma of the supraglottic carcinoma, however planned combined treatment with surgery and radiation therapy is advised for stage III andIV carcinoma of the supraglottic larynx with resectable neck disease.
Carcinoma, Squamous Cell* ; Follow-Up Studies ; Humans ; Larynx* ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Retrospective Studies ; Survival Rate ; Voice

The effects of unilateral hypoxic ventilation on pulmonary hemodynamics, alveolar-arterial oxygen tension difference (A-aDO2) and intrapulmonary shunt in 10 dogs were studied under unilateral hypoxic ventilation using nitrogen. Hear rate, mean arterial pressure, central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac output, blood gases and hemoglobin were measured during controlled ventilation with 100% oxygen and unilateral hypoxic ventilation. Using the above steps pulmonary hemodynamics, (A-a)DO2 and intrapulmonary shunt were calculated and the following results were obtained. 1) Mean pulmonry arterial pressure significantly increased (20%) from 20.6+/-2.60mmHg to 24.8+/-2.46mmHg(p<0.005) and pulmonary vascular resistance also significantly increased(43%) from 434+/-68.4 dynee. sec/cm(2) to 605+/-81.0 dynes. sec/cm(2)(p<0.005), whereas the cardiac output decreased (8%) from 1.92+/-0.23 l/min to 1.76+/-0.21 l/min(p<0.05) after unilateral hypoxic ventilation. 2) Alveolar-arterial oxygen tension difference significantly increased from 180+/-23.2mmHg to 470+/-31.9mmHg(p<0.005) after unilateral hypoxic ventilation. 3) Intrapulmonary shunt significantly increased from 9.5+/-1.40% to 24.8+/-2.02%(p<0.005) after unilateral hypoxic ventilation, but it was much lower than the mathematically expected value(40% over). The above findings suggest the operation of a protective mechanism, which causes hypoxic pulmonary vasoconstriction in the unilateral hypoxic lung, and diverts blood flow from the hypoxic to the non-hypoxic lung and so minimizes the hypoxic effect on the arterial blood.
Animals ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Dogs* ; Gases ; Hemodynamics* ; Lung ; Nitrogen ; Oxygen ; Pulmonary Wedge Pressure ; Vascular Resistance ; Vasoconstriction ; Ventilation*

The required doses of gallamine (nondepolarizing neuromuscular bloeker) were measured in twelve patients under one MAC anesthesia of nitrous oxide-oxygen(50%)-enflurane with inductions of sodium pentothal (sleeping doses) and succinylcholine(1mg/kg). It was observed that the required dose of gallamine in nitrous oxide-oxygen(50%)-halothane (36. 5+/-3.54mg/hr/M2) is much higher than that in nitrous oxide-oxygen(50%)-enflurane (18.0+/-2.48mg/hr/M2) (p<0.01) and reviewed literaturea on the above result.
Anesthesia ; Enflurane* ; Gallamine Triethiodide ; Halothane* ; Humans ; Muscle Relaxation* ; Sodium ; Thiopental

It has been emphasized that continuous monitorings of arterial pressure, central venous pressure, electrocardiogram, blood gas analysis, serum electrolytes, body temperature, hematacrit and urinary output are mandatory for the anesthetic management of pheochromocytoma. In addition, it is necessary for the anesthetists to understand pharmacologic effects of drugs which influence the peripheral vascular tone and cardiac excitability. We experienced recently anesthetic management of two cases of pheochromocytoma; one raised problems of ventricular arrhythmias and hypertension that aggravated nature of arrhythrmias by increasing blood pressure and responded favorably to treatment with propranolol and trimetaphan. Tumor of this case originated from abdominal aortic wall. The other was managed by injection of d-tubocurarine which induced narrowing of pulse pressure by depletion of increasing systolic pressure and accompanied tachycardia without cardiac decompensation. We have reported proper anesthetic managements of two cases of pheochromocytoma with N2O O2-halothane anesthesia and reviewed literatures in discussion.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Body Temperature ; Central Venous Pressure ; Electrocardiography ; Electrolytes ; Hypertension ; Pheochromocytoma* ; Propranolol ; Tachycardia ; Trimethaphan ; Tubocurarine

Blood pressures and heart rates were recorded with Twin-Viso (Sanborn, USA) for comparative estimations of cardiovascular responses by injection of intravenous anesthetic agents-2.5% solution of Pentothal Sodium (Abbott Laboratory, USA) and Thiotal (Samsung Pharmaceutical Co., ROK) mongrel dogs. Dogs were evaluated the hepatic function by biochemical studies of blood such as total protein, albumin, total bilirubin, direct bilirubin, thymol turbidity test, alkaline phosphatase, serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGOT). Liver biopsies were performed in dogs for identifications of hepatic darnages by injection of the above barbiturates, The following results were observed: 1) It was observed the remarkable negative inotropic effect in myocardium of the mongrel dogs intravenously injected with 20 mg/kg of the above barbiturates for three minutes (Table 7, Fig. 8) 2) It was noted slight negative inotropic effect in mongrel dogs intravenously injected with 10 mg/ kg of the above barbiturates for thirty seconds (Table 8, Fig. 8). 3) It was more shorter recovery time from negative inotropic effects in mongrel dogs injected with Thiotal than in the dogs injected with Pentothal Sodium. 4) It was noted no significant changes in pathological studies of Hematoxylin-Eosin stained liver specimen and liver function studies of the blood by biochemical analysis in mongrel dogs intravenously injected everyday with 10 mg/kg of the above barbiturates. 5) It was noted slight changes in mongrel dogs injected with 20 mg/kg of the above barbiturates on TTT, Alkaline Phosphatase, SGOT and SGPT as biochemical analysis in comparing with controI values. These values, however, were not concided with the pathological findings of HematoxyIin-Eosin stained liver biopsy specimen. The facts explain to be inquired into further investigations in the pathological and biochemical aspect.
Alanine Transaminase ; Alkaline Phosphatase ; Animals ; Aspartate Aminotransferases ; Barbiturates ; Bilirubin ; Biopsy ; Dogs ; Heart Rate ; Liver ; Myocardium ; Sodium ; Thiopental* ; Thymol