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

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

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

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

A case of anesthesia for a patient of "pulaeless disease" (Takayasu's disease) was reported. During her general anesthesia, blood pressure was measured at the femoral artery by auscultatory method. There are numerous problems to evaluate the result of indrect measurements of arterial blood pressure obtained by auscultatory method. For accurate measurements of blood pressure, the relationship between the circumference of the arm and the blood pressure should be considered, which was emphasized by Ragan and Bordley. The auscultatory method of blood pressure measurement was reviewed.
Anesthesia* ; Anesthesia, General ; Arm ; Arterial Pressure ; Blood Pressure ; Femoral Artery ; Humans ; Takayasu Arteritis*

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