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*

Autoclaving the local anesthetic ampuls has been suggested as a safer method of sterilization. However the method and time necessary to sterilize the ampul has not been standardizzed, and the amount of deterioration of anesthetic agents by this method is unknown, and the effect of injection of the caramelized dextrose has not been determined. If ampuls are autoclaved with the spinal tray or set up, the ampuls are subjected to sterilization for a prolonged time which in turn causes caramelization of dextrose and possible deterioration. We have studied the effect of multiple autoclavings on pH of the drugs whichart used in spinal anesthesia, 1% tetracaine, 10% dextrose, 2% xylocaine and epinephrine at 134C, 36 psi for 5 minutes. Statistieal significance of the pH changes were observed by multiple autoclavings.
Anesthesia, Spinal ; Anesthetics ; Anesthetics, Local* ; Epinephrine ; Glucose ; Hydrogen-Ion Concentration* ; Lidocaine ; Methods ; Sterilization ; Tetracaine

The relationship between the Ledig cell of testis and the tropic hormones of the anterior pituitary gland has been ineddquately expiored in man because of methodological difficulties levels in human serum. As testosterone in one of the most important anabolie hormones, it would therefore serve as an index to hormanal response to stress in man. This study was performed to inveatigate the effect of thalamonal-N2O-O2 anesthesia and surgery on human sex hormone by radioimmunoassay method. Measured serum testosterone lexels in the preanesthetic period, 60 minutes after anesthesia and surgery, and at full rectxary from anesthesia were 5.64ng/ml 4.40ng/ml and 5.02ng/ml, respectively.
Anesthesia* ; Humans ; Methods ; Pituitary Gland, Anterior ; Radioimmunoassay ; Testis ; Testosterone*

The effect of nitrous oxide on endotracheal tube cuff pressure was measured during N2O-O2-halothane anesthesia. Intracuff pressure was increased in a time-related fashion up to 150 minutes. Thereafter no significant increase was observed, The other hand, there is no endotracheal tube cuff pressure change during O2-halothane anesthesia. These findings demonstrate that nitrous oxide has the capacity to diffuse into Portex endotracheal tube cuffs in significant volumes and may result in increased intracuff pressure, and in O2-halothane anesthesia, the nitrogea in the cuff was diffused out from the cuffs.
Anesthesia ; Anesthesia, Inhalation* ; Hand ; Inhalation* ; Nitrous Oxide

The tetralogy of Fallot is the commonest cyanotic congenital heart disease and is not a single entity but is classified according to variations in clinical and hemodynamic findings based primarily on the degree of pulmonary stenosis and the size of the ventricular septal defect. Total surgical correction was performed with Sarns 500 pump oxygenator, hypothermia 28 to 30 C and perfusion flow rates of 2. 4 L/min/m2. A successfully performed tetralogy of Fallot discussed mainly fromthe pathophysiological view.
Anesthesia* ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Hemodynamics ; Hypothermia ; Oxygen ; Oxygenators ; Perfusion ; Pulmonary Valve Stenosis ; Tetralogy of Fallot*

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

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

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

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