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*

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

Central to the question of anesthetic risk is the definition of an anesthetic death. This has yet to be defined within any reasonable limits. A number of factual and philosophical considerations have complicated attempts to derive a precise definition. Anesthetic risk is largely confused with surgical risk, involving a second set of persons and procedures. Only events between induction of anesthesia and onset of operation clearly relate the risk of anesthesia to patient diseases and the causes of deaths during and after operation are usually speculative. Among those factors which relate to anesthetic risk; age, physical status, surgical area, anesthetic method, selection of anesthetic agent, inadequate preoperative preparation, improper decision and skill of anesthesiologist himself, and elective vs emergency operations are most important in minimizing the anesthetic risk. Furthermore, elective vs emergency operations relate more to anesthetic mortality than to other factors. Many emergency operations were practiced in our hospital, more than in other institutions. Thus, our anesthesiologists are faced with a higher incidence of anesthetic risks. Evaluated results were as follows; 1) The percentage of emergency operations was 57.4% of the total performed operations. 2) The mortality rate is significantly higher in emergency surgical procedures than in elective surgical procedures, 3) Frequent changing of the operation schedule may cause confusion in the anesthesiologist's decision on preparation and selection of the anesthetic agent and technique, and may also cause an increased workload.
Anesthesia ; Appointments and Schedules* ; Cause of Death ; Elective Surgical Procedures ; Emergencies ; Humans ; Incidence ; Methods ; Mortality

Anesthesia consent was requested by our anesthesiology department when the patient condition was found to be critical during the preanesthetic visit. To evaluate the trend, one hundred and five anesthesia consent cases among the 6,430 anesthetics from January 1977 to December 1978 at the department of anesthesiology, St. Mary's hospital, Catholie Medical College, were analyzed according to the anesthetic method, age, sex, surgical department, anesthetic agent, physical status, site of operation, diagnosis, preanesthetic problem and cause of death. The results were as follows; 1) Fifteen cases(14%) died among the 105 cases of anesthesia consent during and/or after .surgery, within the first 7 days. 2) Physical status was class ll E in 43% and the ratio of elective to emergency surgery was 1 to 1.4. 3) Upper abdominal surgery was performed in 52 cases(50%), urogenital surgery in 21 cases (20%), head and neck surgery in 18 cases(17%), surgery on extremities in 12 cases(11%) and thoracic surgery in 2 cases(2%), accordingly. 4) Cardiovascular problems were found in 27 cases(26%), hematologic disorders in 13 cases (12%), respiratory problems in 13 cases(12%), sepsis in 9 cases (9%), problems of central nervous system in 9 cases(9%), hepato-renal disorders in 8 cases(8%) and endocrine disorders in 5 cases(5%), respectively, 5) Postanesthetic cause of death was cardiopulmonary disturbance(33%), sepsis(27%) cerebral edema(20%) and hemorrhage(13%).
Anesthesia* ; Anesthesiology ; Anesthetics ; Cause of Death ; Central Nervous System ; Diagnosis ; Emergencies ; Extremities ; Head ; Humans ; Methods ; Neck ; Sepsis ; Thoracic Surgery

Recently, with the help of medical development which is able artificially to control respiration, circulation, nutrition and excretion, human beings may still survive in spite of brain death. We have had experience with the first case of cadaveric kidney transplantation in Korea. Because the prognosis of kidney transplantation is relatively good in comparison to the five-year survival rate of cancer patients and because postoperative rehabilitation is fair, nowadays kidney transplantation is popular. With the limitations of confluent acceptance and supplimental functioning together of the living kidney, cadaveric kidney transplantation has been preferred, although several problems still exist. We have used the conventional method to maintain the cadaver donor's life after clarification of death. As soon as brain death was confirmed on EEG monitoring, then an artificial respirator was applied to the tracheotomy site, adequate urinary excretion was maintained and infection prevented. At the same time, the HL-A(human lymphocyte-antigen) compatibility test and ABO blood matching had to be performed before anesthesia. The patient's intraoperative and postoperative course was satisfactory and he now has no problems of physical or social activity. However cadaveric kidney transplantation is in the early phase in Korea, and therefore further improvement is needed, and several problems should be solved. We hope many cadaveric kidney transplantations will be performed.
Anesthesia ; Brain Death ; Cadaver* ; Electroencephalography ; Hope ; Humans ; Kidney Transplantation* ; Kidney* ; Korea ; Methods ; Prognosis ; Rehabilitation ; Respiration ; Survival Rate ; Tracheotomy ; Ventilators, Mechanical

The history of muscle relaxants is fascinating, and their use for clinical applications has been accepted. Depolarizing drugs can produce a non-depolarizing type of neuromuscular block. Decamethonium produces a nondepolarizing block in the isolated rabbit lumbrical muscle. Electromyographic studies of the hand muscles in man have demonstrated that a dual block will be produced with doses of succinylcholine varying from 500 to 1,500 mg (initially a delpolarizing block and subsequently a non-depolarizing block exists). The common peroneal nerve in the rabbit knee was stimulated by a "train of four" method (Ali et al) repeated intermittently. The muscle response with the "train of four" method to intravenous succinylcholine chloride (1 mg/kg) in the rabbit was recorded and analysed after a single injection and repeated intravenous injections of succinylcholine chloride 1 mg/kg. Result were as follows: 1) Time after the "train of four" to depression of muscle twiteh of 25, 50, 75 & 100% was 128. 2, 135. 3, 142. 8 and 159 seconds respectively. 2) Recovery index of a single intravenous injection of succinylcholine chloride 1 mg/kg was observed as 3 minutes and 14 seconds. 3) A depolarizing form of "train of four" response to the first succinylcholine chloride injection 1 mg/kg was observed and, a non-depolarizing form of "train of four" response to the second dose of succinylcholine chloride 1 mg/kg was observed definitely.
Depression ; Hand ; Injections, Intravenous ; Knee ; Methods ; Muscles ; Neuromuscular Blockade ; Peroneal Nerve ; Rabbits* ; Succinylcholine

There are many reports that d-tubocurarine has marked species and individual variations in the matter of muscle relaxation. Therefore the dose-related neuromuscular blocking effect of d-tubocurarine was studied in anesthetized patients. Eighty adult patients were studied during halothane-N2O-O2 anesthesia for various kinds of surgery. These patients were in good physical shape, without known or suspected liver, kidney, neuromuscular or hormonal disease, and were not taking medication known to influence the action of relaxants. Preanesthetic medication consisted of atropine 0.01mg/kg and valium 0.18 mg/kg intramuscularly 60 minutes before anesthesia. Anesthesia was induced with thiopental 4~5mg/kg. Succinylcholine 1mg/kg was used to faciliate tracheal intubation. Moderate hyperventilation was maintained throughout by a mechanical ventilator and patient temperature was maintained at 35~36 degrees C during the study. Forty patients received a single intravenous d-tubocurarine 0.1mg/kg(group A) after the succinylcholine effect had worn off and the other forty patients received a single intravenous d-tubocurarine 0.2mg/kg(group B) after the succinylcholine effect had disappered. Prior to the administration of d-tubocurarine, the patient's forearm and hand were firmly fixed to a specially constructed metal armboard. The thumb was abducted, fixed and connected to a electrical kymograph, Harvard apparatus. The ulnar nerve was stimulated at the wrist subcutaneous needle electrodes by means of supramaximal stimull from a peripheral nerve stimulator(model 91-M3, Emerson, USA). Square wave of "Train of Four" stimuli of 0.2msec duration were delivered at a frequency of 0.1Hz. The evoked twitch and tracing of the adductor muscle of the thumb was recorded continuously on a electrical kymograph. Upon recovery from the initial dose of succinylcholine, a stable baseline twitch tension was recorded for 15 minuts. At this point a single intravenous injection of d-tubocurarine, either 0.1mg/kg or 0.2mg/kg, was given. The data were plotted as onset time of twitch depression and percentage depression of twitch height and the recovery time of "Train of four" response were analysed in each group. The results were as follows: 1) In d-tubocurarine 0.1mg/kg group: the effect of d-tubocurarine was variable, ranging from no effect on twitch tension to abolition of the twitch response. Mean maximal twitch depression was 59.4%. Recovery index which showed more than 75% twitch depression was 39.9minutes. 2) In d-tubocurarine 0.2mg/kg group: the effect of d-tubocurarine obtained consistent and solid neuromuscular relaxation. Mean maximal twitch depression was 95.2%. Recovery index was 58.1 minutes.
Adult ; Male ; Female ; Humans

Ketamine hydrochloride(ketamine) is a non-barbiturate anesthetic agent chemically designated as dl-2-(0-chlorophenyl)2-(methylamino)-cyclohexanone hydrochloride. Ketamine anesthesia has been found distinctively different from that induced by conventional anesthetic agents, as it provides profound analgesia without significant impairment of respiratory function or stimulation of cardiovascular activities thus avoiding hypotension and are preserved the protective pharyngeal and laryngeal reflexes. In addition, ketamine appears to have muscle relaxation properties. This latter clinical finding, however has not been experimentally substantiated since few reports have appeared on the effect of ketamine on muscle relaxation. The present study therefore, was undertaken to determine whether this agent affects the muscle activity during d-tubocurarine block. The experiment was performed on sixteen rabbits weighing 1.8 to 2.5kg and these were divided into two groups; eight rabbits for control and eight for th study group. All animals were intubated through a tracheostomy under general anesthesia with nembutal 40mg/kg given intravenously. Respiration was controlled by means of a Harvard animal respirator. The body temperature was kept at 35 degrees C to 36 degrees C with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and the nerve stimulator was applied to the nerve muscle preparation. The twhitch height of the muscle contraction was recorded on a biophysiograph through the force displacement transducer. The common peroneal nerve was stimulated supramaximally using a single twitch, square wave of 0.2 msec duration at a frequency of 0.1Hz once every 10 seconds. The degree of neuromuscular block following intravenous injection of d-tubocurarine 1mg/kg was measured in the control group. And in the study group ketamine 5mg/kg was administered intravenously when 25% of twitch height of muscle contraction was obtained spontaneously after the intravenous injection of d-tubocurarine 1mg/kg. The changes of the twitch height of muscle contraction and the time of spontaneous recovery in the study group were compared with those of the control group. The results were as follows: 1) The times and degree of maximal single twitch depression were obtained at 194.8sec and 87.3% in the control group and were at 197.5 sec and 87.8% in study group. No significant difference was observed. 2) Recovery index of the control group was 1,560.0 sec and recovery index of the study group was markedly prolonged to 2,387.5 sec(53.0% prolongation). 3) Mean decrease of single twitch height was 8.8% soon after the intravenous ketamine 5mg/kg when 25% of twitch height was obtained after the intravenous d-tubocurarine 1mg/kg in the study group.
Rabbits ; Animals

Why anesthesiologists use the muscle relaxants? Because muscle relaxants are an adjunct to modem anesthesia practice today. What should be pepared whenever using a muscle relaxant? Of course, its necessary for artificial respiration. Why should be anesthesiologists monitor the neuromuscular blockade? There are so many factors affecting neuromuscular blockade. Factors are ; individual difference, age, sex, bady fluid, drug interactions including muscle relaxants themself and more than 250 drugs including anesthetics and antibiotics, disease states, hypothermia etc. That why anesthesiologists should know the degree of neuromuscular blockade. Whenever assurance on the degree of neuromuscular blockade is essential to the modern anesthetic practice. Observation of the motor response to peripheral nerve stimulation is helpful. Use of the peripheral nerve stimulator for monitoring of the neuromuscular blockade must be made mandatory whenever muscle relaxants are used. This study was performed 50 healthy patients. Ulnar nerve-adductor pollicis was stimulated simultaneously both hand by TOF and DBS3,3 each, during intubation dose of vecuronium 0.1 mg/kg and same stimulation was given both hand during anesthetic maintenance by intermittent bolus of vecuronium 1-2 mg during surgery. Number of twitch was counted by each TOF and DBS3,3 in the same time and onset time (TOF, TO) and time for reappearance of TOF, Tl was measured. Results were as follows ; 1) Simple, by use of peripheral nerve stimulator. 2) During onset time ; TOF twitch was disapperared earlier than DBS3,3. 3) During recovery phase ; DBS3,3 twitch was appeared earlier than TOF. 4) Onset time was 215.4+/-54.04 sec. and TOF, Tl reappearance was 1,793.4+/-487.61 sec. 5) Clinical evaluation of neuromuscular function was more reliable by number of twitch count with ulnar nerve-adductor pollicis on TOF than DBS3,3.
Anesthesia ; Anesthetics ; Anti-Bacterial Agents ; Drug Interactions ; Hand ; Humans ; Hypothermia ; Individuality ; Intubation ; Modems ; Neuromuscular Blockade ; Neuromuscular Monitoring* ; Peripheral Nerves ; Respiration, Artificial ; Vecuronium Bromide

Transfusion therapy has changed in the past several years, largely as a result of improved knowledge of the physIology of hypovolemia, development of plasma expenders and plastic blood-collection equipment, the possibility of blood mediated infection and also shortage of whole blood Supply. In Korea, the difficulty of getting blood is remarkably increasing recently. According to recent studies, the patient seems can undergo rapid loss of 1000 to 2000mL, or up to 40 percent of their blood volume without developing irreversible shock, and that blood pressure can be maintained by the administration of saline fluids, lactated Ringer solution being presently most in vogue. If there is further blood loss, it may be necessary to augument the bodys circulating hemoglobin, but this can be done by the administration of packed cells. During 1968 and 1970 at St. Mary's Hospital took place 6904 general anesthesia. Blood transfusion or these cases were analysed. In the past several years, we have tried to reduce the whole blood transfusion during surgery and to use lactated Ringer's solution and plasma expanders like hemaccel and macrodex, etc. In this review there was significant change in intraoperative blood and fluid replacement and the trend of decreasing blood transfusion and increasing lactated Ringers solution and plasma expander was noticed. Supply of packed cell is required to improve the transfusion technique in future.
Anesthesia, General ; Blood Pressure ; Blood Transfusion ; Blood Volume ; Dextrans ; Humans ; Hypovolemia ; Korea ; Physiology ; Plasma ; Plastics ; Shock