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*

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

Non-depolarizing muscle relaxant; d-tubocurarine was introduced clinically in 1942. Thereafter depolarizing muscle relaxant; succinylcholine was introduced in 1951. Those muscle relaxants were highly contributed in modern anesthesia practice today. But, since many years ago complications of succinylcholine were reported clearly so many anesthesia practice. Complications were such as ventricular arrythmia(cardiac arrest), fasciculation, hyperkalemia, muscle pain, elevation of intragastric, intraocular & intracranial pressure, prolonged apnea, generalized muscle clonus, masseter muscle rigidity and malignant hyperthermia etc. Succinylcholine was still used in clinical practice despite of many complications reported as long as more than 45 years. Finally, FDA(USA) decleared the routine use of succinylcholine was contraindicated in children and adolescents. Many textbooks of anesthesiology shows that use of succinylcholine was contraindicated in children and adolescents those were published recently since 1994. What is the current status of succinylcholine in despite of changing current concept of succinylcholine use in Korea? Succinylcholine is still inadvertently used in Korea over 79% of resident training hospital. Intravenous dantrolene reserve was only one hospital(1.4%). Undoubtedly, amazing things were going on in Korea. Seventeen cases of malignant hyperthermia had been reported from 1971 to 1996 on Korean medical journals. It's mortality was 70.6%. Not only the reported malignant hyperthermia, there are many cardiac arrest during anesthesia reported on Korean medical journals. Etiological analysis of cardiac arrest was reviewed some of them, there are certain numbers of cardiac arrest cases confirmed by succinylcholine was guilty. What is the counterplan? Change the current concept of succinylcholine is important. Conclusions ; 1. Non-depolarizing mucle relaxant should be used for intubation &/or muscle relaxation. 2. Hot line for malignant hyperthermia should be established.. 3. Intravenous dantrolene reserve is necessary. 4. Routine monitoring during anesthesia should be blood pressure, ECG, SPO2, ETCO2, body temperature and peripheral nerve stimulator.
Adolescent ; Anesthesia ; Anesthesiology ; Apnea ; Blood Pressure ; Body Temperature ; Child ; Cognition* ; Dantrolene ; Electrocardiography ; Fasciculation ; Heart Arrest ; Humans ; Hyperkalemia ; Intracranial Pressure ; Intubation ; Korea ; Malignant Hyperthermia ; Masseter Muscle ; Mortality ; Muscle Relaxation ; Myalgia ; Peripheral Nerves ; Succinylcholine* ; Tubocurarine

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

Patients vary markedly in their responses to d-tubocurarine chloride. Despite an attempt to diminish the variation in responses to relaxants by standardizing experimental techniques, anesthetic concentration kept constant, acid-base status kept constant, premedication omitted, dosage calculated in terms of mg/sq meter body surface, the marked variation was found to persist. The dose related neuromuscular blocking effect of d-tubocurarine chloride was investigated using a rabbit common peroneal nerve anterior tibial muscle preparation. All experimental rabbits tracheas were intubated through tracheostomy under general anesthesia with Nembutal 40 mg/kg intravenously. Reapiration was controlled by a Harvard animal respirator. The body temperature was kept at 35-37 degrees C by a thermoblanket. The degree of neuromuscular block following intravenous d-tubocurarine chloride was measured by single twitch response. The common peroneal nerve was stimulated supramaximally using a square waves of 0. 2 msec duration at a frequency of 0.1 Hz, and each stimulus was repeated once every 10 seconds. The ratio of the twitch height was calculated. The results were as follows: 1) No neuromuscular blocking effect was observed with 0.1 mg/kg of intravenous d-tubocu- rarine chloride. 2) 100% of neuromuscular blocking effect was observed with more than 1mg/kg of intravenous d-tubocurarine chloride. This is 5 to 10 times higher than the human dose. 3) Dose related prolonged neuromuscular blocking effect was observed from d-tubocurarine chloride in rabbits.
Anesthesia, General ; Animals ; Body Temperature ; Humans ; Muscle, Skeletal ; Neuromuscular Blockade* ; Pentobarbital ; Peroneal Nerve ; Premedication ; Rabbits* ; Trachea ; Tracheostomy ; Tubocurarine ; Ventilators, Mechanical

Succinylcholine chloride is the most commonly used muscle relaxant. Its rapid onset of action and relatively brief duration are unique Despite its wide use, certain pharmacologic aspects of auccinylcholine chloride are not as widely appreciated as they should be. There is marked variation in the responses of patients to clinically used doses. Large doses demonstrate that recovery from succinylcholine chloride is slower than is generally appreciated in man. The dose related neuromuscular blocking effect of succinylcholine chloride in cats was investigated using a cat common peroneal nerve anterior tibial muscle preparation. All experimental cats tracheas were intubated through a tracheostomy under general anesthesia with Nembutal 40 mg/kg intravenously. Respiration was controlled by a Harvard animal respirator. The body temperature was kept at 35~37 degrees C by a thermoblanket. The degree of neuromuscular block following intravenous succinylcholine chloride, 0.5 mg/kg and 1 mg/kg, were measured by single twitch response. The common peroneal nerve was stimulated supramaximally by a single stimulus with square waves, 0. 2 msec duration and at a frequency of 0.1 Hz. The ratio of the twitch height was calculated. The results were as follows: 1) The time of neuromuscular blokade to 100% depression was 30.7 sec and to l00% spontaneous recovery was 1,260 sec (21 min.) in the succinylcholine chloride 0.5 mg/kg intravenous group. The recovery index was 258. 5 sec (4. 3 min.). 2) The time of neuromuscular blockade to 100% depression was 30 sec and to 100% spontaneous recovery was 2,004 sec (33. 4 min.) in the succinylcholine chloride I mg/kg intravenous group. No significant time difference was observed in neuromuscular depression in both groups but spontaneous recovery time was markedly prolonged to 744 sec (59% prolongation). The recovery index was also prolonged to 474 sec (83% prolongation).
Anesthesia, General ; Animals ; Body Temperature ; Cats* ; Depression ; Humans ; Muscle, Skeletal ; Neuromuscular Blockade* ; Pentobarbital ; Peroneal Nerve ; Respiration ; Succinylcholine* ; Trachea ; Tracheostomy ; Ventilators, Mechanical

Cardiopulmonary dysfunction in deformity of the spine had been recognized and complicated with surgical risk. The deformity of the bony thoracic cage reduces its capacity and also impairs the action of the inspiratory muscles will increase work of breathing. Progression of the deformity, the work of breathing and arterial desaturation were further increased. Primary alveolar hypoventilation will produce hypoxemia and resulting in polycythemia and increased pulmonary vascular resistance, and causespulmonary hypertension and congestive heart failure. The end result is similar to the cardiopulmonary failure of primary alveolar hypoventilation and of chronic obstructive bronchitis. Two cases of severe kyphoscoliosis were anesthetised for appendectomy and caesarean section. Anesthetic management of the severe kyphoscoliosis should be focused on the cardiopulmonary dysfunction. In this respect, for the surgical patient with kyphoscoliosis, it is very important to detect the reduced cardiopulmonary function and to consider the prevention or treatment of postoperative pulmonary complication by use an antibiotics, IPPB with oxygen, tracheobronchial toilet, venesection, digitalization and diuretics.
Anoxia ; Anti-Bacterial Agents ; Appendectomy ; Bronchitis ; Cesarean Section ; Congenital Abnormalities ; Diuretics ; Female ; Heart Failure ; Humans ; Hypertension ; Hypoventilation ; Intermittent Positive-Pressure Breathing ; Muscles ; Oxygen ; Phlebotomy ; Polycythemia ; Pregnancy ; Spine ; Vascular Resistance ; Work of Breathing

Cardiac arrest is the most serious complication during anesthesia and surgery. Once cardiac arrest is diagnosed, whether the heart is in standstill or in ventricullar fibrillation and whatever is the initial cause, the immediate treatment must be aimed at providing an artificial circulation of oxygenated blood to the vital organs. Authors have experienced cardiac arrest due to ventricular fibrillation during general anesthesia with hypotensive technique. When the diagnosis was established, immediate closed chest cardiac massage was carried out with drug therapy and D.C. defibrillator. Cardiac rhythm was restored immediately after the 100 joules of electric shock was given. The duration of closed chest cardiac massage was 18 minutes. The patient recovered completely without complications.
Anesthesia ; Anesthesia, General ; Defibrillators ; Diagnosis ; Drug Therapy ; Heart ; Heart Arrest* ; Heart Massage ; Humans ; Oxygen ; Shock ; Thorax ; Ventricular Fibrillation*

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