BACKGROUND: To evaluate the effects of pneumoperitoneum and posture on total respiratory compliance, peak inspiratory airway pressure and inspiratory minute ventilation during laparoscopic pneumoperitoneum and pelviscopic surgery we monitored continuously with continuous spirometry. METHODS: 20 patients were anesthetized and paralyzed, tracheally intubated and mechanically ventilated at te rate of 12/min and at a tidal volume of 10 ml/kg. Measurements were made before surgery, just before insufflation and 5, 10, 20, 30, 60 min after insufflation under position changed (10o reverse Trendelenburg position in laparoscopic cholecystectomy; group C, 10o Trendelenburg and lithotomy position in pelviscopic surgery; group P), and 5, 10 min after deflation under horizontal position. Compliance, peak inspiratory airway pressure and inspiratory minute volume were monitored continuously with side stream spirometry. RESULTS: Compliance of respiratory system decreased 39.8% and 39.1%, peak inspiratory pressure increased 43.5% and 61.3%, inspiratory minute volume decreased 10.9% and 9.1% under pneumoperitoneum in group C and group P. CONCLUSION: Increased intrabdominal pressure and posture during laparoscopic cholecystectomy and pelviscopic surgery cause significant decreased respiratory compliance and inspiratory minute volume and a significant increased airway pressure. On-line monitoring of respiratory volume, pressure and compliance may be helpful during general anesthesia to avoid the potential harmful effects of increased airway pressure occurring with increased intra-abdominal pressure.
Anesthesia, General* ; Cholecystectomy, Laparoscopic ; Compliance ; Head-Down Tilt ; Humans ; Insufflation ; Pneumoperitoneum* ; Posture* ; Respiratory System ; Rivers ; Spirometry* ; Tidal Volume ; Ventilation*

BACKGROUND: The manufacturer has recommended that 6-7 ml of air be used to seal the bronchial blocker cuff of Univent tubes high pressure type. However overinflation of the cuff might result in pressure damage to mucosa. This study was performed to evaluate the appropriate sealing volume and pressure of the bronchial blocker cuff. METHODS: Univents were inserted in 26 patients. The bronchial blocker was connected to a pressure gauge and the cuff was inflated by 0.5 ml increment until the bronchus was sealed in supine and lateral positions under 20-25 mmHg airway pressure. The sealing volume and pressure were recorded. RESULTS: In males, the sealing volume for the left bronchus (3.8 +/- 0.4 ml) was smaller than for the right bronchus (5.4 +/- 1.0 ml) in both positions significantly (p < 0.05). In females, the sealing volume for the left bronchus (2.8 +/- 0.4 ml in both positions) was smaller than the volume for the right bronchus (3.7 +/- 0.8 ml in supine position, 3.9 +/- 0.9 ml in lateral position) significantly (p < 0.05). The sealing volume for females was smaller than for males significantly (p < 0.05), for all sealing pressures, there were no significant differences statistically. CONCLUSIONS: The bronchial blocker of Univent is a high pressure type and the sealing volume is higher for the right bronchus than for the left bronchus. Furthermore the sealing volume is less than the volume which is recommended by the manufacturer.
Bronchi ; Female ; Humans ; Male ; Mucous Membrane ; Supine Position

Spinal reflex activity that remains after insult to the spinal cord brings with it significant functional impairment. Our patient had suffered from general spasticity and hyperreflexic neurogenic bladder caused by sixth cervical cord injury. Unfortunately, the use of oral medication (baclofen) was limited by an inadequate effect. So we performed two times of subarachnoid block with 0.5% heavy bupivacaine, the patient experienced improvement in bladder and sphincter function. We concluded that subarachnoid block with 0.5% heavy bupivacaine is an effective and safe modality for spasticity control in patients who are refractory to oral medication before neurolytic block.
Bupivacaine ; Humans ; Muscle Spasticity ; Reflex ; Spinal Cord ; Urinary Bladder ; Urinary Bladder, Neurogenic*

BACKGROUND: The reduction is cerebral blood flow (CBF) caused by hypocapnia is an important element of anesthetic techniques for neurosurgery as well as for nonneurologic surgery in patients with reduced intracranial compliance. Accordingly, the impact of anesthetic agents on the CO2 responsiveness of the cerebral circulation has important implications with regard to anesthetic selection. The purpose of this study was to investigate the effects of isoflurane-N2O and propofol-N2O anesthesia on the CBF response to changes in end-tidal CO2 in healthy patients. METHODS: 19 healthy patients with nonneurological operation were selected. In group 1, anesthesia was induced with thiopental sodium 4 mg/kg, fentanyl 1 g/kg, succinylcholine 1~1.5 mg/kg and was maintained with isoflurane 0.5~1.5 vol%. In group 2, anesthesia was induced with propofol 2~2.5 mg/kg, fentanyl 1 g/kg, succinylcholine 1~1.5 mg/kg and was maintained with a propofol infusion of 10 mg/kg/h for 10 min and then 8 mg/kg/h for 10 min and then was reduced 3~6 mg/kg/h of the remainder of the study. All patients were ventilated with N2O in O2 (FIO2 0.5) and measured end-tidal CO2 (PETCO2). Mean blood flow velocity of middle cerebral artery was measured using transcranial Doppler in PETCO2 45, 40, 35, 30, 25, 20 mmHg. RESULT: CO2 reactivity of MCA flow velocity during isoflurane-N2O and propofol-N2O anesthesia was 5.1 +/- 1.8 %/mmHg, 4.4 +/- 1.0 %/mmHg respectively. CONCLUSION: The cerebral vasculature in healthy patients remains responsive to changes in PETCO2 during isoflurane-N2O and propofol-N2O anesthesia.
Anesthesia* ; Anesthetics ; Blood Flow Velocity* ; Carbon Dioxide* ; Carbon* ; Compliance ; Fentanyl ; Humans ; Hypocapnia ; Isoflurane ; Middle Cerebral Artery* ; Neurosurgery ; Propofol ; Succinylcholine ; Thiopental

BACKGROUND: Etomidate is frequently used as an induction agent in the elderly patients. We compared the induction dose of etomidate in the elderly patients. METHODS: Sixty ASA 1-2 patients were randomly allocated to four groups. They were Group 1 (age < 65, receiving 0.2 mg/kg of etomidate, n = 15), Group 2 (age < 65, receiving 0.3 mg/kg of etomidate, n = 15), Group 3 (age > or = 65, receiving 0.2 mg/kg of etomidate, n = 15), and Group 4 (age > or = 65, receiving 0.3 mg/kg of etomidate, n = 15). The time interval from etomidate infusion to loss of verbal response and eyelash reflex, to decrease BIS 50, to return of bispectral index (BIS) 50 were measured. Mean arterial pressure (MAP), heart rate (HR), responses to isolated forearm test and postoperative recall were recorded. RESULTS: Time interval were not significantly different between groups. BIS value did not show statistical differences between groups, though value of group 1 at 1 min after intubation was higher than that of group 2. MAP and HR were increased after intubation in 4 groups. The changes in MAP were significantly different between group 1 and 2. Isolated forearm test was positive in 10, 6, 4, 3 patients in groups 1, 2, 3 and 4, respectively. Only 1 patient in group 1 showed postoperative recall. CONCLUSIONS: Age does not influence the BIS value in these etomidate doses. Loss of consciousness and hemodynamic changes during induction with 0.2 mg/kg of etomidate were inappropriate in younger patients, whereas they were appropriate with 0.2 and 0.3 mg/kg of etomidate in the elderly patients.
Aged* ; Anesthesia, General* ; Arterial Pressure ; Etomidate* ; Forearm ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Reflex ; Unconsciousness

Anomalous right upper lobe bronchus takeoff from the trachea has been reported to occur in 1 of 250 otherwise normal patients. Difficulty with double-lumen tube(DLT) placement has been described previously and there are problems with Univent tube with the intention of using the bronchial blocker to achieve right lung collapse in this patient. In two cases, the fiberoptic bronchoscopic examination through Univent tube revealed a trifurcation, rather than the usual bifurcation, at the carina and revealed that the most rightward lumen was the right upper lobe bronchus and the middle lumen was the right middle and lower lobe bronchus. The left lumen was the left main bronchus. So in one case, the Univent tube was withdrawn and DLT was reinserted. In the other case right lung collpase achieved with the inflation of cuff of bronchial blocker. One lung anesthesia was performed without any problem in these two cases.
Anesthesia ; Bronchi ; Humans ; Inflation, Economic ; Intention ; Lung ; One-Lung Ventilation* ; Pulmonary Atelectasis ; Trachea

BACKGROUND: Although the incidence of postoperative residual curarization (PORC) following the use of intermediate-acting neuromuscular blocking agents is lower than that of longer-acting neuromuscular blocking agents, it has been reported in many studies. We compared the incidence of PORC following either rocuronium or vecuronium given by intermittent bolus or continuous infusion dosing. METHODS: Ninety-eight patients were included in this study. Neuromuscular blocking drugs were administered based solely on clinical criteria, and the reversal agent pyridostigmine was given to all patients. Residual block following rocuronium infusion (Group R-I), rocuronium bolus (Group R-B), vecuronium infusion (Group V-I), or vecuronium bolus dosing (Group V-B) was evaluated on arrival in the postanesthesia care unit. Neuromuscular function was assessed acceleromyographically (using TOF-Watch(R) to measure the train-of-four (TOF) ratio) and also clinically. PORC was defined as a TOF ratio of < 0.8. RESULTS: The incidence of PORC on arrival in the postanesthesia care unit was 20% in Group R-I, 23% in Group R-B, 42% in Group V-I, and 19% in Group V-B. Mean TOF ratio in Group V-I was less than those of the other groups (P < 0.05). CONCLUSIONS: PORC is still common following vecuronium or rocuronium, even after the block is antagonized, if neuromuscular blocking agents are administered according to clinical criteria alone.
Anesthesia Recovery Period ; Humans ; Incidence ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pyridostigmine Bromide ; Vecuronium Bromide*

The authors analyzed statistically, 223 cases of anethesia for operations after traffic accidents at the Department of Anesthesiology, Ewha Woman University Hospital from January 1978 to December 1982. The results were as follows: 1) There was a upward trend in the numbers of patients undergoing surgery. 2) The ratio of male to female was 3.5:1. 3) In the distribution by age, the 4th decade numbered 49cases (22.2%), the 3rd decade numbered 48 cases (21.1%), and the 6th decade was 44cases(19.7%). 4) in the physical status by the American Society of Anesthesiologists, there were 63 cases (28.3%) in class 1, 54 cases (24.2%) in class 2, 27 cases (12.4%) in class 4E and 25 cases (11.2%) in class 3E. 5) There were 128 cases of elective surgery (57.4%) and 95% cases (42.6%) of emergency surgery. 6) Among 191 cases of general endotracheal anesthesia, 22 cases (11.5%) were already intubated or had a tracheostomy before the general anesthesia. 7) The premedicants(atropine sulfate, opioid and tranquilizer) were administrated in 143 cases(54.1%). 8) The head injuries numbered 153 cases. The extremities 124 cases and abdominal injuries numbered 9 cases. 9) 121 cases (54.3%) were done by orthopedic surgery, 80 cases(35.9%) by neurosurgery and 8 cases(3.6%) done by the dental surgery department. 10) In the anesthetic techniquie, general endotracheal anesthesia was used in 191 cases (85.7%): regional anesthesia in 32 cases which included 22cases(9.9%) of spinal anesthesis, and 8 cases (8.6%) of epidural anesthesia. 11) For the main anesthetic of the general endotracheal anesthesis halothane was used in 41 cases (18.4%) and balanced anesthesia (opioid, tranquilizer, neuromuscular blocking agent with nitrous oxide) was used in 138 cases (61.9%). 12) Fro the anesthetic period there were 90 cases (40.4%) which ran 1~2 hours: 47 cases (21.8%) ran less than 1 hour or ran 2~3 hours: 26 cases (11.7%) ran 3~$ hours and 13 cases (5.8%) ran more than 4 hours.
Abdominal Injuries ; Accidents, Traffic ; Anesthesia* ; Anesthesia, Conduction ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesiology ; Balanced Anesthesia ; Craniocerebral Trauma ; Emergencies ; Extremities ; Female ; Halothane ; Humans ; Male ; Neuromuscular Blockade ; Neurosurgery ; Orthopedics ; Tracheostomy

BACKGROUND: Oxytocin is used for uterine contraction after delivery in cesarean sections. Doses of oxytocin vary widely, ranging from 5 20 IU by slow IV infusion. The aim of this study was to compare the effect of three different doses of oxytocin (5, 15, 25 IU) during elective cesarean section. METHODS: Thirty patients (ASA 1 and 2) undergoing elective repeated cesarean section were assigned to one of three groups. Group I received 5 IU, group II 15 IU, and Group III 25 IU of oxytocin after clamping of the umbilical cord. Linear analog scale (LAS) of 0 to 10 assessed by the surgeon for degree of uterine contraction was used at 5, 10, 15, 20, 25 and 30 min after delivery. Blood pressure (BP) and pulse rate (PR) of the patients, volume of blood mixed with amniotic fluid in suction jars (Vol in S.J.), weight of all gauzes soaked with blood (Wt of gauzes), difference in pre- and postoperative hematocrit (Change in Hct), induction to delivery (I-D) and delivery to closure of uterus (D-C) interval were also recorded. RESULTS: There were no significant differences in the degree of uterus contraction, BP and PR of the patients, Vol in S.J., Wt of gauzes, Change in Hct, I-D and D-C interval, in the three groups. CONCLUSIONS: Five IU of oxytocin is as effective as more doses in healthy parturients undergoing elective cesarean section with general anesthesia.
Amniotic Fluid ; Anesthesia, General ; Blood Pressure ; Cesarean Section* ; Constriction ; Female ; Heart Rate ; Hematocrit ; Humans ; Oxytocin* ; Pregnancy ; Suction ; Umbilical Cord ; Uterine Contraction ; Uterus

BACKGROUND: Endoscopic urologic surgery including transurethral resection of prostate (TURP) requires adequate sacral analgesia for insertion of resectoscope. But epidurally administered local anesthetic does not produce anesthetic effects uniformly. Failure to completely block S1 during epidural anesthesia because of the large size of nerve root has been noted. The purpose of this study to compare the relation between catheter direction and sensory anesthesia. METHODS: Thirty patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L3-4 using a standard 18 gauge Tuohy needle. In group A (n=15), the Tuohy needle with bevel pointed in a cephalad direction during catheter insertion. In group B (n=15), it pointed caudally. And the catheter was introduced 3 cm into the epidural space. After test dose, 2% lidocaine 5 cc, 0.5% bupivacaine 5 cc and 2% lidocaine 3 cc were administered with fractionate dose through it. The extent of the sensory anesthesia to loss of cold sensation and pin prick test was measured every 5minute for 30 minutes. RESULTS: Analgesia spread to loss of cold sensation and pin prick test was no significant statistical difference between the two groups. In 15 minutes after injection of surgical dose, complete blockade in L5, S1 dermatome was present in both groups. CONCLUSION: Our results conclude that epidural catheter direction is not significantly influence the epidural anesthetic spread including sacral area in continuous lumbar epidural anesthesia in elderly patients.
Aged ; Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Anesthetics ; Bupivacaine ; Catheters* ; Epidural Space ; Humans ; Lidocaine ; Needles ; Sensation ; Transurethral Resection of Prostate