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

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

It is known that the cardiovascular system is extremely sensitive to the effect of both exogenous and endogenous opiates. In rabbits, less than 1% of the usual morphine dose necessary to produce antinociception results in significant hypotension and bradycardia. The endozenous opiate, beta-endorphin, is stored along with pitulatary adrenocorticotorphin(ACTH), and the action of stressors seems to result in the release of both peptides. Therefore it seems likely that beta-endorphin is released during stress such as shock and that it might contribute to the hypotension. In order to probe this hypothesis, hypovolemic and endotoxin shock model were produced in rabbits. If these hemorrhage and endotoxin induced hypotension were mediated through the beta-endorphin release, the blockade of beta-endorphin should reverse such hypotension. Using the specific opiate antagonist, Naloxone-HCl, these hypotensions could be reversed and prevented as following results show, 1) As compared with the saline control, the hypovolemic shock experiment had a 36.49+/-14.44% increase in mean arterial pressure(MAP) within 2 to 3 minutes and the endotoxin shock had a 52.43+/-23.66% increase in MAP within 5 to 6 minutes after naloxone treatment (0.4mg/kg). 2) AS compared with the saline control, in both hypovolemic and endotoxin shock naloxone pretreatment(0.4mg/kg) could prevent the decrease of MAP significantly. 3) No significant difference were seen in heart rate between the control and both experimental groups. And plasma bets-endorphin was measured by radioimmunoassay(RIA), using beta-endorphin kit(Immunonucler corportion, Stillwater, Minnesota, USA) and Beckman 8,000 tau-Counter, in these shock model with following results. 1) Hemorrhage and endotoxin induced shock produced a significant increase in plasma beta-endorphin to about 3 times control and reversed by naloxone treatment(0.4mg/kg) significantly as compared with saline control. 2) AS compared with the saline control, in both hypovolemic and endotoxin experiments naloxone pretreatment(0.4mg/kg) could prevent the increase of plasma beta-endorphin significantly.
Rabbits ; Animals

Since the first report by Drury and Szent-Gyorgyi in 1929, the inhibitory influences of adenosine on the heart have repeatedly been described by many investigators. A lot of investigations on the working mechanisms of adenosine have been focused mainly on the effects on the coronary blood flow. However, the cellular mechanisms underlyiag the inhibitory action of adenosine on the SA node are not well understood yet. Furthe-rmore, the physiological role of adenosine in the regulation of the heart beat remains still to be explored. Thus, this study was undertaken to examine the behavior of the rabbit SA node ander the influence of adenosine, and the interactions between adenosine and aminophylline on the SA node, and then to compare these results with those of acetylcholine. At the same dosage range, adenosine suppressed the sinus rate and atrial contractility even in the reserpinized preparation. The spontaneous firing rate of the SA node at 35degrees C (mean+/-SEM, n=16) was 154+/-3.3 beats/min. The parameters of action potential were: maximum diastolic potential(MDP), -73+/-1,7 mV; overshoot(OS), 9+/-1.4 mV; slope of pacemaker potential(SPP), 94+/-3.0 mV/sec. Adenosine suppressed the firing rate of the SA node in a dose-dependent manner. This inhibitory effect appeared at the concentration of 10(-4)M and was potentiated in parallel with the increase in adenosine concentration. Changes in the action potential by adenosine were dose-dependent as show by the increase of MDP and the decrease of SPP until 10(-4)M. Above this concentration, however, the amplitude of the action potential decreased markedly due to the simultaneous decrease of both MDP and OS. Dipyridamole, which is known to block the adenosine transport aross the cell membrane, definately potentiated the action of adenosine. The effects of adenosine on the SA node were inhibited by aminophylline. However, the similar effects of acetylcholine to those of adenosine were not reversed by aminophylline. These results suggest that adenosine suppressed the pacemaker activity by acting dire-ctly on the membrane of the SA node, and the effects of adenosine on SA node are sele-ctively inhibited by aminophylline.
Acetylcholine ; Action Potentials ; Adenosine ; Aminophylline ; Cell Membrane ; Dipyridamole ; Fires ; Heart ; Humans ; Membranes ; Research Personnel

Glycogen storage disease is a rare metabolic disorder of significant to the anesthesiologist. The term "glycogen storage disease" is applied to a group of congenital and familial disorders characterised by depostion of abnormally large or small quantities of glycogen in the tissues. 13 types of glycogen storage diseases have been described, classified on the basis of enzyme deficiencies. Type l glycogen storage disease (von Gierke's Disease) is the most common of this constellation of syndromes. The basic defect is a deficiency of enzyme, glucose-6-phosphatase. The patient has hepatomegaly, renomegaly, stunted growth, a tend toward severe hypoglycemia and acidoais. The adverse effect of the combined anesthetic and surgical procedure during operation was reflected in a deterioration of the patients's biochemical parameters. A cardiac arrest after tonsillectomy of the patient with Von Gierke's disease was reported and this fact cmphasizes serious anesthetic problems during operation. Anesthetic management of these patients should focus on prevention of hypoglycemia and lactic acidosis. The careful frequent measuring of the acid-base status is highly recommended and is essential prior to and during andy surgical procedure. We report a case of anesthetic management for a patient with Von Gierke's desease ane review anesthetic problems for these patients.
Acidosis, Lactic ; Glucose-6-Phosphatase ; Glycogen ; Glycogen Storage Disease ; Glycogen Storage Disease Type I ; Heart Arrest ; Hepatomegaly ; Humans ; Hypoglycemia ; Tonsillectomy

In order to determine the enzyme activity, as expressed in Reitman-Frankel unit, of GOT isozyme present in whole homogenate, mitochondrial fraction and supernatant fraction were prepared from brain tissues of normal adult rabbit, by a differential centrifugal method. The effect of thiopental on the GOT isozyme activity in each fraction was determined and the following results were obtained. 1) The activity of GOT isozyme in whole homogenate of normal rabbit brain tissues was found to be 545+/-2.608 units/mg of wet weight whereas the corresponding figure for the supernatant GOT isozyme was 512+/-3.081 and the value for the mitochondrial GOT isozyme was found to be 34.9+/-1.224. 2) The supernatant GOT isozyme existing in a floating status within the cytoplasm accounted for 94 percent followed by 6.35 percent of mitochondrial GOT isozyme. 3) The activated-peak of mitochondrial GOT isozyme contained in the whole homogenate of adult rabbit brain tissues was found to be at #15 on the tube of elution in comparison to that of #73 for supernatant GOT isozyme, as analyzed by the DEAE-Cellulose column chromasography. 4) The supernant GOT isozyme from the thiopentaltreated brain was proportionaly distorted while mitochondrial GOT isozyme was not influenced. Fro example, treated with thiopental, the supernatant GOT isozyme was divided to be #63 & #73 on the tube in comparison to #15 for the mitochondrial GOT isozyme. 5) The activity of supernatant isozyme was proportionaly reduced as the concentration of thiopental. 6) Fifty percent inhibition dose(1se) of thiopental on the supernatant GOT isozyme was found to be 0.63mM. 7) The inhibitory effect of thiopental on the supernatant GOT isozyme was very high significantly by the statistics. 8) The mchanism by which thiopental inhibits the supernatant GOT isozyme in the adult rabbit brain was found to bh uncompetitive inhibition as its Michaelis-Menten constant Km=58.07mM demonstrated. In view of the above finding it is suggested that the thiopental inhibited selectively the activity of supernatant GOT isozyme of the adult rabbit brain tissues while it did not inhibitnificantly by the statistics. 8) The mechanism by which thiopental inhibits the supernatant GOT isozyme in the adult rabbit brain was found to bh uncompetitive inhibition as it Michaelis-Menten constant of Km=58.07 mM demonstrated. In view of the above findings it is suggested that the thiopental inhibited selectively the activity of supernatant GOT isozyme of the adult rabbit brain tissues while it did not inhibit that of mitochondrial GOT isozyme. The GOT isozyme of adult rabbit brain tissues was divided into thiopental-sensitive GOT isozyme(supernatant GOT isozyme) and thiopental insensitive GOT isozyme(mitochondrial GOT isozyme) Furthermore, it is suggested that the cellular function of the brain can be somewhat hindered, when thiopental is injected into the brain cell, while mitosis of the brain cell is not influenced.
Adult* ; Aspartate Aminotransferases* ; Brain* ; Cytoplasm ; DEAE-Cellulose ; Humans ; Mitosis ; Thiopental*

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

Cannulation of the arterial system is an invasive monitoring technique that readily is justified by its high information yield and minimal discomfort and risk to the patient and is commonly performed in the ICU and operating room, allowing continuous monitoring and graphic display of the systemic arterial blood pressure, and repeated analysis of arterial blood gases. The major complications subsequent to cannulation are thrombosis and occlusion pain at the puncture site, hematoms and infection. We performed a clinical study on complications following percutaneous arterial cannulation in 378 patients with radial artery cannulation and 172 patients with dorsalis pedis artery cannulation who had undergone surgery at Kyung Hee University Hospital from April to September, 1987. The patients were examined to confirm the patency of the collateral circulation of the hand and foot before cannulation and the frequency of complication was studied by physical examination and the Doppier technique on the 1st, 7th and 10th days after decannulation. The results were as follows: 1) The most common complication of radial artery cannulation was ecchymosis(41.8%) and the next common complications were abnormal blood flow(17.5%), abnormal pulse (13.2%), sensory change(1.3%) and infection(0.3%). 2) The most common complication of dorsalis pedis artery cannulation was ecchymosis(34.9%) and the next common complications were abnormal blood flow(19.8%), abnormal pulse(12.8%), sensory chang(1.7%) and infection(0.6%). 3) The crrelation of sex, duration of cannulation, number of punctures and age to the incidence of abnormal flow was studied in both arteries. Abnormal flow was only significantly related to females(p<0.05) in both arteries. 4) The correlation of both arteries to the incidence of abnormal flow under several circumstances was studied. But neither artery did not revealed a significant difference to the incidence of abnormal flow. 5) No permanent ischemic damage to the hand or foot occurred in any patient in this study. Therefore, we concluded that radial artery cannulation is a low-risk highly beneficial monitoring technique and careful dorsalis pedis artery cannulation provides a relatively safe, reliable and available to the radial artery with caution.
Arterial Pressure ; Arteries ; Catheterization ; Collateral Circulation ; Foot ; Gases ; Hand ; Humans ; Incidence ; Operating Rooms ; Physical Examination ; Punctures ; Radial Artery ; Thrombosis