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*

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 So in one case, the Univent tube was withdrawn and DLT was reinserted.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

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: 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

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: 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

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

Ritodrine hydrochloride is widely used for the treatment of premature uterine contraction because the drug has beta2-sympathomimetic effect on the uterus. Hypokalemia is one of the most common side effects of ritodrine. We experienced a case of hyperkalemia without ECG change that occurred during cesarean section in a healthy parturient, associated with low-dose ritodrine pretreatment for six and half hours to stop preterm labor. We treated the patient with potassium-free fluid and calcium chloride. Plasma potassium level returned to normal four hours after the ritodrine had been terminated.
Calcium Chloride ; Cesarean Section ; Electrocardiography ; Female ; Humans ; Hyperkalemia ; Hypokalemia ; Obstetric Labor, Premature ; Plasma ; Potassium ; Pregnancy ; Ritodrine ; Uterine Contraction ; Uterus

BACKGROUND: The combined induction using two or more agents has a potential benefit that anesthesia could be induced with smaller anesthetic agents with fewer side effects. We studied the effects of co-administration with midazolam and remifentanil on the dose of propofol, the time to loss of consciousness (LOC) and hemodynamics during tracheal intubation. METHODS: Sixty patients were randomly assigned to three groups. Group 1 was induced with target-controlled propofol alone. Group 2 received midazolam (0.05 mg/kg) and target-controlled propofol. Group 3 received midazolam (0.025 mg/kg), remifentanil (2 ng/ml) and target-controlled propofol. The time to LOC, the infused propofol dose and the effect site concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was given and tracheal intubation was performed. The noninvasive blood pressure, heart rate (HR) and bispectral index were recorded. RESULTS: The time and the dose of propofol to LOC were significantly reduced in group 2, 3 than in group 1 (P < 0.05). Compared with pre-induction values, mean blood pressure at immediately after intubation was increased in group 1, 2 with no change in group 3. The HR immediately after intubation was significantly increased in all groups compared to the pre-induction values, but the rate of increase of HR in group 3 were significantly lower than those group 1, 2 (P < 0.05). CONCLUSIONS: The co-administration with midazolam and remifentanil reduces the time to LOC and the dose of propofol. That also attenuates hemodynamics during tracheal intubation under target-controlled infusion of propofol.
Androstanols ; Anesthesia ; Anesthetics ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam ; Piperidines ; Propofol ; Unconsciousness

Routine use of supplemental oxygen(O2) in the recovery room traditionslly has been used to minimize the incidence of hypoxemia. However with the advent of continuous noninvasive monitoring by pulse oximetry is routine administration of O2 necessary? We hypothesized that administration O2 as needed based on pulse oximetry dats, would effect without compromieing patient care. And factors that might influence the incidence of post-operative hypoxemia were analyzed. On hundred thirty eight adult (> or = 18yrs) patients were enrolled in the study. During recovery room care, when O2 saturation(SpO2) was continuously more than 94%, no supplemental O2 was given. When SpO2 was less than 94%, supplemental O2 was given by face mask(O2 51/min). SpO2 and Aldrete score(AS) were measured at preoperatively, at the end of anesthesia, on arrival in the recovery room, at 10 min, 20 min and 30 min after arrival in the RR and at discharge. The results are as follows: 1) Supplemental O2 was unneeessary in the 55.8% of patient for the duration of the recovery room stay. 2) A significant multiple correlation was found between low SaO2 level, while breathing room air on arrivsl in the recovery room and preoperative SpO2, weight and Aldrete score on arrival in the recovery room. With the above results the authors concluded that in as much as pulse oximetry monitoring is now standard in the recovery room, administration O2 as need based on the pulse oximetry data would effect without compromising patient care, and that preoperative oxygen saturation and weight are the main factors influencing early postopertative hypoxemia in this study.
Adult ; Anesthesia ; Anoxia* ; Humans ; Incidence ; Oximetry ; Oxygen* ; Patient Care ; Recovery Room ; Respiration