Hypothermia and/or hypotensive anesthesia are well known technics for surgery of cerebral aneurysm. This study was performed to compare the Iaboratory data from hypotensive anesthesia with trimetaphan (Arfonad) to hypothermic anesthesia without trimetaphan for surgery of cerebral aneurysm For this purpose, the author performed hypotensive anesthesia with trimetaphan. Laboratory data studied were blood gases, hemoglobin, hematocrit, blood chemistry, urine output, specific gravity of urine, dose of trimetaphan, period of hypotensive state and dose of mannitol, etc. Laboratory data were obtained before surgery (Group A), hypotensive period (systolic blood pressure; 50~60 mmHg) (Group B) and immediately after the surgery (Group C) and were analysed. The results of analysis were as follows; 1. In gas studies, metabolic alkalosis and respiratory alkalosis were shown before surgery and the hypotensive period. Metabolic alkalosis and respiratory acidosis were shown after surgery. It is hard to imagine an explanation for the data. Metabolic acidosis and compensatory respiratory alkalosis should be expected due to decreased tissue perfusion by hypotension, presumably. 2. In Hb. and Hct. studies, among the 3 groups shown there was statistical significance (p( 0.001), but no clinical significance was noticed. 3. In blood chemistry; Serum K showed significant decrease (p<0.001) in the hypotensive period and immediate postoperative period compared with before surgery. Serum Na showed significant decrease (p<0.05) in the hypotensive period and significant increase (p<0.001) in the immediate postoperative period. Serum creatinine showed significant increase (p< 0.001) in the hypotensive and immediate postoperative period. Serum NPN showed significant decrease (p<0.001) in the hypotensive period compared with before surgery and the immediate postoperative period, but statistical significance was noticed in the hypotensive period only. There was no clinical significance among the 3 groups. 4. In urine output, significant decrease was noticed in the hypotensive and postoperative periods: but no statistical significance was found. 5. In specific gravity of urine, progressiv increase was found in the hypotensive and postoperative period than before surgery. 6. In ECG study, no significance change was noticed except one atrial premature contraction during hypotensive period. 7. All the above data were suggested no cerebral hypoxia and/or renal failure were encountered. 8. The mean trimetaphan dose was 189.50+/-172.73 mg, the mean mannitol dose was 53.75+/-13.75 g and the mean hypotensive period was 40.50+/-20.91 minutes respectively. In the statistical significance, unreasonable explanations were encountered. And also, clinically significant results were encountered among the non-statistical significance. To conclude through this study, when we present to give a results of statistical significance, there must be needed more careful analysis not only of obtained data but also analysis with more variable aspects, so further study is indicated.
Acidosis ; Acidosis, Respiratory ; Alkalosis ; Alkalosis, Respiratory ; Anesthesia ; Blood Pressure ; Chemistry ; Creatinine ; Electrocardiography ; Gases ; Hematocrit ; Hypotension* ; Hypothermia ; Hypoxia, Brain ; Intracranial Aneurysm* ; Mannitol ; Perfusion ; Postoperative Period ; Renal Insufficiency ; Specific Gravity ; Trimethaphan*

Stimulation of ulnar nerve and. measurement of adductor pollicis response have been used for many years in clinical practice and research, but different muscles respond differently to relaxants, both in terms of onset and duration of blockade. The onset time of neuromuscular blockade at the vocal cords and at the orbicularis oculi muscle(OO) was similar, and was shorter than at the adductor pollicis muscle(AP). The purpose of this study was to examine which will be the best stimulus among double burst stimulation(DBS), train of four(TOF) and single twitch stimulation(STS) on OO or AP for an indicator of the optimal tiime for tracheal intubation. Two hundreds and thirty six healthy patients were randomly allocated to six groups in which DBS(n=34), TOF(n=36) and STS(n=37) group in OO group, and DBS(n=43), TOF(n=43) and STS(n=43) group in AP grouy. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained with 1% enfluraae until intubation. Neuromuscular block was induced by intravenous vecuronium 0.1 mg/kg and applied facial nerve or ulnar nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher & Paykel Co.) continuously. The complete relaxation time of OO group was closely observed with authors naked eyes, but the time of AP group were measured by tactile response of thumb. Tracheal intubation was tried immediately by the author after complete disappearance of the muscle contraction. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cord opening, coughing reflex and response to laryngoscopy attempts. The results were as follows: 1) The intubation time of OO group was 195.97+/-12.82 sec. in DBS group, 182+/-8.46 sec. in TOF group and 167.73+/-6.24sec. in STS group, respectively and there were no significance among groups. 2) The intubation time of AP group was 290.56+/-12.1sec. in DBS group, 276.79+/-10.32sec. in TOF group and 230.16+/-9.88sec, in STS group, respectively and there were no significance among groups. But the intubation time of AP group was significantly prolonged more than that of OO group. as much as 95 sec. of DBS group, 94 sec. of TOF group and 63 sec. of STS group, respectively(p<0.05). 3) There were no significance of vocal cords opening and response to laryngoscopy attempts in three groups, but DBS group(6%) was statistically less cough reflex than TOF(37%) and STS group(33%) in OO group(p<0.05). There were no significance of the intubation responses among three groups in AP group. 4) Coughing reflex ratio(positive cough cases/total cases X 100) of OO group(36%) was significantly more than that of AP group(12%) in TOF group, and coughing reflex ratio of OO group (32%) was significantly more than that of AP group(12%) in STS group, but there were no significance of coughing reflex ratio between OO and AP group in DBS group. With the above results the authors concluded that DBS on facial nerve observed orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation, and facial nerve stimuli was more sensitive than ulnar nerve stimuli due to reduce 95 sec. of intubation time. The optimal intubation time was about 196 sec. after vecuronium(0.1 mg/kg).
Anesthesia ; Cough ; Facial Nerve* ; Humans ; Injections, Intravenous ; Intubation* ; Laryngoscopy ; Muscle Contraction ; Muscle, Skeletal ; Muscles ; Neuromuscular Blockade ; Reflex ; Relaxation ; Thiopental ; Thumb ; Ulnar Nerve* ; Vecuronium Bromide ; Vocal Cords

The relationship between the Leydig cell of testis and the tropic hormones of the anterior pituitary gland has been inadequately explored in man because of methodological difficulties. A report has appeared on the effect of anesthesia per se on sex hormone levels in human serum. As testosterone is one of the most important anabolic hormones, it would therefore serve as an index to hormonal response to stress in man. Tcsticular blood level of testcsterone in man was increased by ether anesthesia but plasma testcsterone one in man was decreased by halothane anesthesia. Plasma testostercne levels were measured by others. by a competitive protein binding method. This study was performed to investigate the effect of methoxyflurane anesthesia and surgery on human sex hormone by a radioimmunoassay method. Serum testosterone levels measured in the pre-anesthetic period, (60 minutes after anesthesia and surgery, and at full recovery from. anesthesia were 3.80+/-1. 75 ng/ml, 0. 58+/-1. 22 ng/ml and 3. 55+/-1. 85 ng/ml, respectively. No statistical significance was observed. The obtained value of testostercne was the lowest when compared with the values reported by others.
Anesthesia* ; Ether ; Halothane ; Humans ; Methods ; Methoxyflurane* ; Pituitary Gland, Anterior ; Plasma ; Protein Binding ; Radioimmunoassay ; Testis ; Testosterone*

Acute pulmonary edema was experienced during the mass excision of a nasopharyngeal angiofibroma clue to massive transfusion (8,000ml of blood within 3 hours). High FIoz with manual PEEP, diuretics, steroid and digitalis were given immediately. Full recovery was observed after 18 hours of ICU care.
Angiofibroma* ; Digitalis ; Diuretics ; Edema* ; Pulmonary Edema

Laryngospasm is a serious complication which may be seen following extubation in children. During laryngospasm either the true vocal cords or the true and false cords become opposed in the midline and close the gllotis. Intravenous lidocaine has been used in adult patients to prevent cough following extubation. The present study was made to see if intravenous 1% lidocaine, 2mg/kg of body weight, can be safely used to prevent or control extubation laryngospasm in children. Anesthesia was maintained with halothane-N2O-O2, in a semiclosed circuit. In 20 children, a bolus of 1% lidocaine 2mg/kg was injected intravenously two to three minutes prior to extubation; in the other 20 children, extubation was carried out without prior injection of lidocaine. The incidence of laryngospasm, coughing, respiratory depression, and changes of blood pressure, pulse rate were measured. The results were as follows: 1) Two cases of laryngospasm (10%), 11 cases of coughing (55%) and 2 cases of stridor (10%) were observed following extubation in the control group. Blood pressure and pulse rate showed a tendency to increase about 20%, in the control group. 2) One case of laryngospasm (5%) and 4 cases of coughing (20%) were observed following extubation in the lidocaine pretreated group. Incidence of trouble following extubation was markedly reduced (75 to 25%) in the lidocaine pretreated group. Blood pressure and pulse rate showed a tendency to decrease about 15% in the lidocaine pretreated group.
Adult ; Anesthesia ; Blood Pressure ; Body Weight ; Child* ; Cough ; Heart Rate ; Humans ; Incidence ; Laryngismus* ; Lidocaine* ; Respiratory Insufficiency ; Respiratory Sounds ; Vocal Cords

Central to the question of anesthetic risk is the definition of an anesthetic death. This is yet to be defined within any reasonable limits. A number of factusl and philosophical considerations complicate attempts to derive a precise definition. Since anesthesia is usually administered only to permit or facilitate a diagnostic or therapeutic procedure, anesthesia risk is largely confounded with surgical risk and a second set of persons and procedures. For most death, assignment of the relative roles of anesthesia, surgery and patient disease is based on retrospective assumptions, hindsight judgment, bias, and incomplete information. We would like to make a plea for a more widespread use of death reports and more detailed discussion of fatalities occurring in patients who have received anesthesia. Therefore, we have evaluated cardiac arrest during peri-anesthesia this ten-year period (1969~1979) in St. Mary's hospital: 28, 124 anesthetics were administered. On the other hand, recently the developments that led, to widespread organization of hospital based cardiac resuscitation programs in the early sixties were direct mechanical ventilation of the lungs, external cardiac compression, external cardiac electrical defibrillation and conduct a intensive care unit. Obviously, the concept of anesthetic death must contain a judgment of the relative roles of error and toxicity, also. Evaluated results were as follows; 1) Incidence of cardiac arrest was 1: 55. 2) Forty six percent of cardiac arrest was encountered in the thirty to forty age group. 3) Increasing incidence of cardiae arrest was encountered in poor physical status. 4) Etiological factors in cardisc arrest were overdose of anesthetic drags, hypovolemia, electrolyte imbalance and a disease focus in the central nervous system. 5) Cardiac arrest due to the patient's disease itself was 47%, contributed surgical stress was 22% and contributed anesthetic stress was 31%. 6) Highest incidence of cardiac arrest was encountered in hepatobiliary tract diseases.
Anesthesia ; Anesthetics ; Bias (Epidemiology) ; Cardia ; Central Nervous System ; Hand ; Heart Arrest* ; Humans ; Hypovolemia ; Incidence ; Intensive Care Units ; Judgment ; Lung ; Respiration, Artificial ; Resuscitation ; Retrospective Studies

Central to the question of anesthetic risk is the definition of an anesthetic death. This is yet to be defined within any reasonable limits. A number of factusl and philosophical considerations complicate attempts to derive a precise definition. Since anesthesia is usually administered only to permit or facilitate a diagnostic or therapeutic procedure, anesthesia risk is largely confounded with surgical risk and a second set of persons and procedures. For most death, assignment of the relative roles of anesthesia, surgery and patient disease is based on retrospective assumptions, hindsight judgment, bias, and incomplete information. We would like to make a plea for a more widespread use of death reports and more detailed discussion of fatalities occurring in patients who have received anesthesia. Therefore, we have evaluated cardiac arrest during peri-anesthesia this ten-year period (1969~1979) in St. Mary's hospital: 28, 124 anesthetics were administered. On the other hand, recently the developments that led, to widespread organization of hospital based cardiac resuscitation programs in the early sixties were direct mechanical ventilation of the lungs, external cardiac compression, external cardiac electrical defibrillation and conduct a intensive care unit. Obviously, the concept of anesthetic death must contain a judgment of the relative roles of error and toxicity, also. Evaluated results were as follows; 1) Incidence of cardiac arrest was 1: 55. 2) Forty six percent of cardiac arrest was encountered in the thirty to forty age group. 3) Increasing incidence of cardiae arrest was encountered in poor physical status. 4) Etiological factors in cardisc arrest were overdose of anesthetic drags, hypovolemia, electrolyte imbalance and a disease focus in the central nervous system. 5) Cardiac arrest due to the patient's disease itself was 47%, contributed surgical stress was 22% and contributed anesthetic stress was 31%. 6) Highest incidence of cardiac arrest was encountered in hepatobiliary tract diseases.
Anesthesia ; Anesthetics ; Bias (Epidemiology) ; Cardia ; Central Nervous System ; Hand ; Heart Arrest* ; Humans ; Hypovolemia ; Incidence ; Intensive Care Units ; Judgment ; Lung ; Respiration, Artificial ; Resuscitation ; Retrospective Studies

It is a fallacy on the part of the anesthesiologist and surgeon to think that the same principles of anesthesia and surgery apply in the younger patient as in the aged who have a multiplicity of preoperative pathologic and physiologic states which may affect them during surgery and postoperatively and which must be considered in their preoperative preparation. Changes of importance are related to diminished cardiac, pulmonary, renal and hepatic reserves. With this steady increase of candidates for geriatric anesthesia, it is necessary that periodic reviews be presented so that the problems associated with the management of this enlarging group of patients may be elucidated. In this paper presented 1, 208 cases of geriatric anesthesia during 1964~1973 (10 years) at St. Mary's hospital and were analysed. Results were as follows; 1. Number of the total operative cases were 24, 970, among them over 60 years of age were 1,208 cases. Incidence was 4.9%. 2. Among the 1,208 cases, 967 cases were over 60~69 years of age (80%), 210 cases were over 70~79 years of age (17.4%) and 31 cases were over 80 years of age (2.6%). 3. Emergency versus elective surgical cases re 29.1% versus 78.9% 4. Among the 1,208 cases, 726 cases were general surgery(60.1%), each of 138 cases were orthopedics and urological ones(11.4%). 5. Inhalation anesthesia was performed 1,127 cases(90.4%) and spinal anesthesia was 29 cases(2.3%). 6. Halothane and methoxyflurane anesthesia were markedly increased after 1970 instead of diethyl ether anesthesia. 7. ECG was checked 42.2% of the cases preoperatively. 8. Post-anesthetic related death was not evaluated because of the insufficient record.
Anesthesia* ; Anesthesia, Inhalation ; Anesthesia, Spinal ; Electrocardiography ; Emergencies ; Ether ; Halothane ; Humans ; Incidence ; Methoxyflurane ; Orthopedics

Anesthesiologists may have close relationship with muscle relaxants in clinical practice fortunately, few of the new muscle relaxants were discovered and used in clinic recently. In this moment we have to look back the old muscle relaxants. Undesirable side effects of thIn old ones are less common, but encountered often enough to be troublesome. For example, succinylcholine(depolarizer) mar enhance drsrhythmia, rise in plasma pot-assium, increase in intraocular pressure, rise in intragastric pressure, triggering malignant hrperpyrexia Trestle Pain and dual block etc. Is there a simple screen test for the atypical cholinesterase? Unfortunately it's not available now. Nevertheless depolarizer was still used in many decades. That's the matter? Muscle relaxants are also affected by many factors those are renal excretion, metabolism of the drug, lilver or disease, effect of jaundice, muscle blood flow, production and release of acetylcholine, bod)'temperature, antibiotics, other drug interactions, electrolyte imbalance, pathological status, individual differences and species differences etc. Sometimes it will make a trouble for the anesthesia practice. So anesthesiologists must be familiar with the use of muscle relaxants. And also we have to think twice about it's clinical use before given to the patients. What Is the right methods of rational use of muscle relaxants? What is the right way to reverse muscle relaxation? Obviously, return of normal muscle function followin? muscle relaxant administration is of prime importance to restoration of adequate spontaneous ventilation because it is clini-call velr i rnportant. In human study; supramaximal ulnar nerve stimulation was delitrered br a Peripheral nerIFe stimulatur(Ml'oftest, Biometer MK II) through electrode at the wrist. Stimuli were detail erect continuousl) by either 7 TOF or sin 91e twitch stimuli. The resultant force of thumb adduction was measured and recorded by Biophysiograph(San Ei, Japan) through the force displacoment transducer. In animal study: all animals were intubated through a tracheostomr under the intraper-itoneal urethane anesthesia with nembutal given intravenously. Respiration was controlled by means of Shinano animal respirator. The body temperature 7as kept at 35 degrees C with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and nerve stimulator was applied to the nerve-muscle preparation. The twitch height of the muscle contraction was recorded on a Biophrsiograph through the force displacement Ira-nsfucer. The common peroneal nerve was stimulated supramaximally using a peripheral nerve stimulator with a "TOF" stimulation or single twitch stimulation. Obviously, newly introduced muscle relaxants are certainly have advantage over the old ones but we should hatre further studies on them. Conclusions ; 1) Minimal dose of muscle relaxant which may produce 90~100% of twitch depression may use depend on the types of surgery. 2) To evaluate the type and degree of muscle relaxation intermittently by use of the peripheral nerve stimulator is essential. 3) Best choice of the muscle relaxants are should be non-depolarizers those mar promp-tly reversed by anticholinesterases.
Acetylcholine ; Anesthesia ; Animals ; Anti-Bacterial Agents ; Body Temperature ; Cholinesterase Inhibitors ; Cholinesterases ; Cimetidine ; Depression ; Drug Interactions ; Electrodes ; Humans ; Individuality ; Intraocular Pressure ; Jaundice ; Metabolism ; Muscle Contraction ; Muscle Relaxation ; Muscle, Skeletal ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents* ; Neuromuscular Junction ; Pentobarbital ; Peripheral Nerves ; Peroneal Nerve ; Plasma ; Respiration ; Thumb ; Transducers ; Ulnar Nerve ; Urethane ; Ventilation ; Ventilators, Mechanical ; Wrist

Ketamine, a phencyclidine derivative, has been used as an anesthetic agent since 1965 and it has received much attention as an anesthetic for minor surgical procedures, in some diagnostic procedures in children or as an induction agent for poor risk patients. A troublesome problem has been psychic disturbance on emergence. There are many reports on ketamine anesthesia but some cases describing the failure of recommended doses of ketamine to produce adequate analgesia have been reported with cerebral cortical disease or massive craniocerebral trauma. In this case, we experienced a failure to produce adequate analgesia with intramuscular ketamine (11 mg/kg). It was not confirmed in this case whether the patient had suffered any cerebral cortcial disease or not.
Analgesia* ; Anesthesia ; Child ; Craniocerebral Trauma ; Humans ; Ketamine* ; Minor Surgical Procedures ; Phencyclidine