The Wolff-Parkinson-White syndrome (WPW syndrome) and its variants are called the preexcitation syndrome. Anesthetic management of the patient with WPW syndrome requires the minimizing or avoidance of tachyarrythmias. Various anesthetic plans are employed for this purpose. For example, N2O, oxygen and narcotic technique, neuroleptanalgesia, deep inhalation anesthesia are included in this category. We have recently anesthetized a patient with preexcitation syndrome, performing continuous epidural anesthesia with 2% lidocaine and single bolus injection of Innovar followed by general endotracheal inhalation anesthesia with enflurane, and our experience suggested that this anesthetic method might be useful for the patients with WPW syndrome and below-lower abdomen operation.
Abdomen ; Anesthesia, Epidural ; Anesthesia, Inhalation* ; Enflurane ; Humans ; Inhalation* ; Lidocaine ; Neuroleptanalgesia ; Oxygen ; Pre-Excitation Syndromes ; Tachycardia ; Wolff-Parkinson-White Syndrome*

Adolescent ; Adult ; Debridement ; methods ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Neuroleptanalgesia ; methods ; Nose ; surgery ; Postoperative Period ; Young Adult

Since 1959 neuroleptanalgesia has been used for poor risk patients and open heart surgery. From august 1973 we have used a modified neuroleptanalgesia and anesthesia with droperidol-pentazocine- N2O in 40 cases. Age ranged 10 to 69 years; 22 were male and 18 female. Physical status was. Class I and II except for 4 patients in Class III and IV. In Group I (20 patients) for induction of neuroleptanalgesia, a mixture combining droperidol, 0.25mg/kg, and pentaocine, 1.0~1.2 mg/kg, was administered intravenously. In Group II (20 patients) for induction initially droperidol only, 0.25 mg/kg, was injected intravenously and 5~10 minutes later pentazocine, 1.0~1.2mg/kg, was given intravenously. Endotracheal intubation following a sleep dose of thiopental, 75~100 mg, and succinycholine, 40~60 mg, was performed in 36 cases. During the operation anesthesia was maintained with N2O-O2, supplemented with muscle relaxants. Neuroleptanalgesia without thiopentaJ, relaxants, intubat- ion or N2O, to four patients (laryngeal suspension-2 cases, and percutaneous cordotomy 2 cases). An additional quarter of the initial dose of droperidol was given,if anesthesia time exceeded .3 4 hours. Pentazocine, half the initial dose was also repeated when the patient showed signs of inadequate anesthesia, as body movement, tachycardia, increased blood pressure and lacrimation. The patients were deeply tranquilized but did not sleep with only droperidol and pentazocine. However when N2O inhalation was given, the corneal reflex was lost and the patient quickly went to sleep. The pupils persisted in miosis after pentazocine was given. The course of induction was smooth and there was no sweating, bradycardia or generalized muscular contractions seen at that time. Nausea and vomiting 12 hrs after anesthesia appeared in only 10% of cases. Blood pressure in Group I remained stable after the mixture but in Group II fell somewhat after the droperidol injection. Pulse rates was stable in both groups. Moderate respiratory depression was observed in Group I as soon as the mixture was administered, however during anesthesia and operation, the respiratory rate, tidal volume and minute volume gradually increased and were normal postoperatively. In Group II after pentazocine administration, respiratory depression increased significantly to about the same level in Group I but persisted after the end of the operation. In neither group was there any statistically significant change in pH and Base-Excess values. Recovery from anesthesia was very rapid and patients opened their eyes on command in 2~3 minutes after N2O was stopped and awakened within 5~6 minutes. The analgesic effect of pentazocine as excellent, persisting for 12 hours postoperatively. In conclusion the circulatory and respiratory response to the administration of the droperidol and pentazocine mixture were more stable than when they were administered seperatedly.
Anesthesia* ; Blood Pressure ; Bradycardia ; Clinical Study* ; Cordotomy ; Droperidol ; Female ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Inhalation ; Intubation, Intratracheal ; Male ; Miosis ; Muscle Contraction ; Nausea ; Neuroleptanalgesia* ; Pentazocine ; Pupil ; Reflex ; Respiratory Insufficiency ; Respiratory Rate ; Sweat ; Sweating ; Tachycardia ; Thiopental ; Thoracic Surgery ; Tidal Volume ; Vomiting