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: Propofol has gained widespread popularity but it should at least be questioned in the presence of heart rate lowering medications such as beta-blockers. Esmolol, due to its ultrashort action and cardioselective properties, has been shown to be safe and effective for use in intraoprative tachycardia and hypertension. The purpose of this study is to evaluate the hemodynamic effects of esmolol and propofol under isoflurane anesthesia in dogs. METHODS: Six-mongrel dogs were induced with thiopental, intubated and ventilated with a mixture of isoflurane (1-1.5 vol%) and oxygen. A pulmonary artery catheter was placed via femoral vein and the femoral artery was cannulated. After stabilization, baseline hemodynamic measurements (HR, MAP, CO, SVR) were obtained. Measurements were repeated 5 and 15 minutes after injection of propofol (2 mg/kg), esmolol (1 mg/kg), and additional esmolol (1 mg/kg) for 30 seconds. Data was analyzed by repeated measurement of ANOVA. P < 0.05 was considered significant. RESULTS: Propofol produced no change in heart rate, MAP, CO and SVR. Heart rate decreased significantly during esmolol administration and remained decreased up to 15 minutes after the injection whereas the MAP, CO and SVR showed no significant changes. CONCLUSIONS: We have demonstrated that the decrease in heart rate continued up to 15 minutes after esmolol administration. These findings suggest that concomittent administration of propofol and esmolol requires monitoring of the heart rate after a bolus intravenous injection of esmolol.
Anesthesia* ; Animals ; Catheters ; Dogs* ; Femoral Artery ; Femoral Vein ; Heart Rate ; Hemodynamics* ; Hypertension ; Injections, Intravenous ; Isoflurane* ; Oxygen ; Propofol* ; Pulmonary Artery ; Tachycardia ; Thiopental

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: 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

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: 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: There are few preoperative assessments focused on elderly surgical patients in Korea. Current study suggest that preoperative tests should be ordered only when the history or finding on physical examination have indicated for test. We performed a study to evaluate the preoperative assessment and to determine the need for routine preoperative laboratory test in elderly patients. METHODS: Three hundred forty-five patients aged 65 yrs or older presenting for elective surgery requiring general or regional anesthesia were divided into three groups according to age. Data was obtained from chart review and anesthesia preoperative records. Demographic information included age, sex, body mass index, coexisting disease, type of surgery and ASA classification. Clinically obtained preoperative laboratory test results (hemoglobin, platelet, chest X-ray, ECG, BUN, creatinine, ALT, AST, arterial blood gas analysis, pulmonary function test, PT, PTT, echocardiography) were measured. RESULTS: Fifty-seven percent were women. The most frequently performed procedures were general surgery followed by orthopedic surgery. In 345 patients, 47.5% of the patients had a coexisting disease. The most frequently coexisting disease was hypertension. 78.6% of the patients were classified as ASA class 2 and 3. The abnormal findings on ECG, pulmonary function test, and chest X-ray were 46.4%, 48.3%, and 42.6% respectively. 48 patients without any clinical history and symptoms had abnormalities on the routine laboratory test. CONCLUSIONS: We demonstrated that 47.5% of the patients had a coexisting disease and the majority of the patients were classified as ASA class 2 and 3. Changes in the cardiovascular and respiratory function were greater than other functions. We concluded that routine preoperative laboratory test in elderly is useful as a part of preoperative assessment.
Aged* ; Anesthesia ; Anesthesia, Conduction ; Blood Gas Analysis ; Blood Platelets ; Body Mass Index ; Classification ; Creatinine ; Electrocardiography ; Female ; Humans ; Hypertension ; Korea ; Orthopedics ; Physical Examination ; Respiratory Function Tests ; Thorax

Peripartum cardiomyopathy(PPCM) is a relatively rare form of acute heart failure, which may result in severe cardiac failure and death. In part this may be due to late diagnosis and inappropriate treatment. Also diagnosis in the last trimester is complicated by the fact that the early symptoms of this disorder may mimic the symptoms of normal pregnancy. We experienced and reported a 35-year-old primigravida who was diagnosed with PPCM and undertaken emergency cesarean section with epidural anesthesia. PPCM must be considered in any patient who presents with newly onset of peripheral edema, dyspnea on exertion, or paroxysmal nocturnal dyspnea during late pregnancy or up to 5 months postpartum. We suggest that early and precise diagnosis is associated with a better outcome.
Adult ; Anesthesia* ; Anesthesia, Epidural ; Cardiomyopathies* ; Cesarean Section* ; Delayed Diagnosis ; Diagnosis ; Dyspnea ; Edema ; Emergencies ; Female ; Heart Failure ; Humans ; Peripartum Period* ; Postpartum Period ; Pregnancy ; Pregnancy Trimester, Third ; Pregnant Women*

BACKGROUND: Laryngoscopic and tracheal intubation often causes an increase in blood pressure and heart rate. The purpose of this study was to evaluate the influence of the duration of laryngoscopy and tracheal intubation on hemodynamic response. METHODS: We studied 110 patients undergoing elective surgery. Anesthesia was induced with fentanyl 1microgram/kg and thiopental 5 mg/kg, and rocuronium 0.6 mg/kg was administrated prior to intubation. The duration of laryngoscopy and tracheal intubation was defined as the interval between the insertion of a laryngoscope into a patient's mouth and its removal after successful tracheal intubation. Patients were divided into three groups according to the duration of intubation: Group 1 (duration < or = 15 seconds); Group 2 (15 < duration < or = 30 seconds); Group 3 (duration > 30 seconds). Systolic blood pressure, diastolic blood pressure and heart rate were measured before intubation, after induction, immediately after intubation, and 1 min and 3 min after intubation. RESULTS: Systolic blood pressure at 1 min after intubation was significantly higher in Group 3 than in Group 1, but no significant differences were observed in diastolic blood pressure or heart rate. Regarding the correlation between systolic blood pressure and the duration of laryngoscopy and tracheal intubation, the linear regression r2 value was 0.03. CONCLUSION: This study suggests that the duration of laryngoscopy and tracheal intubation is not significantly correlated with blood pressure. However, it also shows that when the time to intubation exceeds 30 seconds, that the systolic blood pressure is significantly increased. Thus, when the duration of tracheal intubation is anticipated to be prolonged, attempts to attenuate hemodynamic response to tracheal intubation are necessary.
Anesthesia ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Laryngoscopes ; Laryngoscopy ; Linear Models ; Mouth ; Thiopental*

A 74-year-old woman underwent posterior lumbar decompressive fusion at L4-5 for treating spondylolisthesis, with the patient under general anesthesia and she was in the prone position. Following attempts to transfuse blood using a pressurized bag, the intravenous infusion site of the left hand along with the noninvasive blood pressure cuff was changed. Swelling and several bullae on the left forearm and hand were visible. Removal of intravenous catheter, hyaluronidase injection, wet dressing were subsequently performed. In postanesthesia recovery unit, the patient did not complain of pain, and the radial pulse and oxygen saturation of the left appeared normal. Three days after the incident, the edema on the patient's forearm and hand subsided, and the patient was discharged without any complications two weeks afterwards. Impending compartment syndrome should be given close attention, and particularly when performing pressurized infusion in patients who are unable to express pain because they are under general anesthesia.
Aged ; Anesthesia, General ; Bandages ; Blister ; Blood Pressure ; Catheters ; Compartment Syndromes ; Edema ; Female ; Forearm ; Hand ; Humans ; Hyaluronoglucosaminidase ; Infusions, Intravenous ; Oxygen ; Prone Position ; Spondylolisthesis