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*

A postanesthetic recovery score to provide objective information on the phsical condition of patients arriving in the recovery room after anesthesia. The status of the patients was judged after arriving in the recovery room and every 30minutes thereafter, until their discharge to the ward or Intensive Care Unit. To study this method, 324 patients were selected at random to include as many variants of anesthesia as possible. The patients were transported to the recovery room within 10 minutes of the completion of the anesthesia; Once there, the first score was made by the anesthesiologist. Thereafter, the evaluation was made by the same anesthesiologist. Depending on the length of stay in recovery room, this evaluation was repeated 30, 60, and 90 minutes after the patients arrival. The various signs were evaluated. The independent variables such as age, sex, physical status, anesthetic agents or technics, type of surgery, use of muscle relaxants, duration of anesthesia were correlated with the proportional number of patients receiving top or safe score 10, 9 or 8, and those given 7 or less, which were considered low or dangerous.
Anesthesia ; Anesthetics ; Humans ; Intensive Care Units ; Length of Stay ; Recovery Room*

Hypotension immediately after spinal anesthesia has been considered as the result of pre-ganglionic sympathetic paralysis and secondarily due to changes in cardiac output. And also the increase of vascular bed space about 20~25% was pointed ont during spinal anesthesia which was another cause of spinal hypotension. Same degree of increased vascular bed space was produced by vasodilators such as Dibenzyline and Arfonad. Therefore, vasopressors have been used as the drug of choice to prevent and treat this spinal hypotension. This study was attempted to combat the hypotension during spinal anesthesia by filling this increased vascular bed space with Lactated-Ringer's or Dextrose solution instead of giving vasopressors. Lactated-Ringer's or Dextrose solution was administered to 141 cases, before and immediately after. spinal anesthesia was performed. The given amount of fluid was about 12.5~15% of estimated total blood volume (Group A). And no intravenous fluid was given to 101 cases as control (Group B). Changes of the systolic, diastolic blood pressure and pulse rate were observed. In the Group A, significant changes of the systolic (t=2.52, p<0.02) and diastolic blood pressure (t=1.98, p<0. 05) was observed. The changes of pulse rate were found not significant in the both group series.
Anesthesia, Spinal* ; Blood Pressure ; Blood Volume ; Cardiac Output ; Glucose ; Heart Rate ; Hypotension ; Paralysis ; Phenoxybenzamine ; Vasodilator Agents

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

Anesthesiologists are often encountered arrhythmia during general anesthesia. Sometimes, ventricular arrhythmia may threaten patient condition to be fatal. On the other hand, anesthesiologists experience that an arrhythmia which existed pre-operatively may disappear during general anesthesia. And after anesthesia, in most of the cases, the former arrhythmia may reappear. The authors experienced one such patient who had arrhythmia pre-operatively and normal rhythm during and after general anesthesia until the 7th post-operative day. At the moment, the mechanism of disappearance of arrhythmia during general anesthesia is not clearly known, but we like to use the medical term Cardio-Anesthesia Restoration for a case who had pre-operative arrhythmia which was abolished during and after general anesthesia.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Hand ; Humans

This is an analysis of 75 cases of written interdepartmental consultations submitted to our department during January 1973 to December 1973. In all, 67 cases were surgical, 8 cases were non-surgical and, of which, 66 cases were for elective cases and 6 cases were for emergency cases, including 5 non-operative cases, and post-operative consultations were 3 cases. Among the 67 surgical cases, 4 cases of surgery were postponed according to our advice. The analysis was as follows; 1 Age; 58.6% were over 40 years old, which included 25.3% over 60 pears old. 2. Sex; male was 49.3% and female was 50.7%. 3. The consultation rate was 2.9% (consultation cases 75; total operation cases 2583). The number of monthly consultations was 7 cases on average. 4. The highest number of departmental consulations were requested from general surgery (42.7%), then from orthopedic department (30.7%), from internal medicine (8.0%), and from eye department (8.0%) respectively. 5. In pre-operative diagnosis of the consultations, around 45 diseases were encountered. 6. The problems of the consultations were varied in 153 subjects; 30.1% of the consulted problems were cardiovascular origins, including hypertension (8.5%), severe anemia (7.1%), and ECG abnormalities (5.9%). 23.5% of the consulted problems were respiratory dysfunction and 21.6% of the problems were endocrinological and metabolic disorders. 7. 3.9% of the problems were therapeutic pain control and/or block. Pain clinics were recently started in our country, in this regards, a joint clinic staff may help to operate the pain clinic efficiently. 8. There were 67 pre-operative surgical consultations (95.5%) and 3 post-operative consulations (4.5%). 9. Through this study, anesthesiologists are requested to have a much broad medical and surgical knowledge to keep their high standard of the speciality.
Anemia ; Diagnosis ; Electrocardiography ; Emergencies ; Female ; Humans ; Hypertension ; Internal Medicine ; Joints ; Male ; Orthopedics ; Pain Clinics ; Pyrus ; Referral and Consultation

It is known that changes in body temperature occur during surgical operations with the patient under general anesthesia. Body temperature who has had elective surgery on St. Mary's Hospital at spring time (February to April) was measured by rectal thermometer. Body temperature was checked at before surgery and immediate postoperatively. Measured body temperature was analysed for sex, comparison of abdorninal surgery, skin graft or cranial surgery (who had exposed room temperature (20~23 degrees C) as almost naked), duration of operation, types of anesthetic system and operating room temperature. Results were as follows; 1. In abdominal surgery, body temperature change in man was decreased 0.64 degrees C postoperatively, in woman decreased 0.35 degrees C pastoperatively. But no statistical significance was obtained(p>0.05). 2. In abdominal surgery, body temperature change was decreased 0.25 degrees C postoperatively but room temperature was increased 0.51 degrees C significantly(p<0.01) postoperatively. Correlation coefficient between body temperature and room temperature was not observed (gamma=0.37, 0.04). 3. In skin graft and cranial surgery, body temperature was decreased 1.3 degrees C postoperatively and room temperature was increased 0.4 degrees C, respectively. But no statistical significance and no correlation coefficient were observed. 4. In duration of surgery (in abdominal surgery), body temperature was decreased 0.75 degrees C within 2 hours and over 3 hours duration, each. 5. In duration of surgery (in skin graft and cranial surgery), body temperature was significantly decreased 0.51 degrees C within 2 hours and significantly decreased 1.17degrees C over 3 hours duration(p<0.001). 6. In vaporizer inside the circuit (Air-Med anesthetic machine), body temperature was increased 0.3 degrees C postoperatively and was significant(p<0.001). Room temperature change was significantly increased 1.17 degrees C postoperatively and was significant(p<0.001).
Anesthesia, General* ; Body Temperature Changes* ; Body Temperature* ; Dermatologic Surgical Procedures ; Female ; Humans ; Nebulizers and Vaporizers ; Operating Rooms ; Skin ; Thermometers ; Transplants

Transient hyperkalemia is well known to occur in man following intravenous administration of succinylcholine chloride (Anectine). Furthermore, massive hyperkalemia following succinylcholine chloride administration is a recognized danger in patients with severe burns, massive trauma, muscle dystrophy, and peripheral nerve injury or lesions on central nervous system with skeletal muscle paralysis. Increased serum potassium may lead to severe cardiac arrhythmia or cardiac arrest. Reported mary literatures, this was shown for succinylcholine chloride but not for succinylcholine iodide. The authors studied succinylcholine iodide intravenous administration for burned patient as to whether serum potassium changes or not. Effects of intravenous succinylcholine iodide on serum potassium, ECG and fasciculation were studied in fifteen burned patients. For serum potassium change, venous blood sample was drawn at preoperative period and at 10 minutes after succinylcholine iodide administration. Results were as follows; 1. Serum potassium was increased at 10 minutes after succinylcholine administration (4.47+/-0.65 mEq/L) than the preoperative value (4.17+/-0.51 mEq/L). Mean increase was 0.30 mEq/L. 2. In ECG change, only one patient showed transient premature ventricular contraction during induction of anesthesia. In this case serum potassium was increased 0.8 mEq/L (delta K). Occurance of this arrhythmia, it was not confirmed whetner it was due to increased serum potassium(delta K=0.8 mEq/L) or other factors. 3. Surprisingly, fasciculation was minimal level in all cases. 4. Significance in statistical analysis did not correspond with clinical signs. 5. Succinylcholine iodide intravenous administration was not contraindicated for intubation in. burned patient.
Administration, Intravenous ; Anesthesia ; Arrhythmias, Cardiac ; Burns* ; Central Nervous System ; Electrocardiography ; Fasciculation ; Heart Arrest ; Humans ; Hyperkalemia ; Intubation ; Muscle, Skeletal ; Paralysis ; Peripheral Nerve Injuries ; Potassium* ; Preoperative Period ; Succinylcholine ; Ventricular Premature Complexes

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