BACKGROUND: As undergoing general anesthesia for Cesarean Section, we usually maintain a light anesthesia until delivery. It provokes the high incidence of waketulness for the mothers. We surveyed the incidence of maternal wakefulness when thiopental was used as an induction agent. METHODS: Forty pregnant women (ASA class I or II) at term who underwent general anesthesia and cesarean section received thiopental, 4mg/kg. As the 'isolated forearm technique', a pressure cuff was inflated to isolate one arm from the the effects of succinylcholine so that wakefulness during anesthesia could be assessed by asking the patient to move her hand. To assess wakefulness,the patient was commanded to squeeze the investigator's hand a specified number of times. If the patient promptly squeezed the investigator's hand the appropriate number of times, the command was repeated but a different number of times specified. Only if the patient responded correctly both times, then we noted as a positive response. This test was repeated at 1 minute intervals beginning 1 minute after thiopental injection through the delivery. RESULTS: Five of the forty patients (12.5%) showed wakefulness. Twenty nine of the forty patients showed 'reaching movements'. One patient showed both wakefulness and 'reaching movements'. CONCLUSIONS: When we undergo general anesthesia for Cesarean Section, especially using thiopental as an induction agent, we should consider the maternal wakefulness seriously.
Anesthesia ; Anesthesia, General ; Anesthesia, Obstetrical ; Arm ; Cesarean Section* ; Female ; Forearm* ; Hand ; Humans ; Incidence ; Mothers ; Pregnancy ; Pregnant Women ; Succinylcholine ; Thiopental ; Wakefulness*

No abstract available.
Resuscitation* ; Shock, Hemorrhagic*

Premature infants are at high-risk of apnea after surgery. General anesthesia increases the risk of apnea. A 3-day-old male was scheduled for an anoplasty because of a low-type imperforated anus with a anoperineal fistula. The medical history was significant for premature birth at 345 weeks of gestation with a birth weight of 2,610 g. He had an irregular breathing pattern and self-limiting apnea. He also had bilateral 12th rib defect with substernal retraction. After an intravenous injection of ketamine 1 mg/kg and atropine 0.15 mg, a mask was positioned. A caudal block was performed via a 23 G angiocatheter using a single bolus dose of 0.8 ml/kg of 0.25% bupivacaine in the lateral position. He was immediately turned to a supine position and lithotomy position after slow injection of the drug. Anesthesia was maintained with isoflurane 0.2 0.6 vol.% in 50% O2 during preparation and operation under the masking. During 15 minutes of uneventful surgery, the infant remained comfortable but the breathing pattern was still irregular. No increase in the frequency of apnea was observed during the first postoperative day. A caudal block with light inhalational anesthesia was a successful method in a premature infant for anoplasty.
Anal Canal ; Anesthesia* ; Anesthesia, Caudal* ; Anesthesia, General ; Anesthetics ; Apnea ; Atropine ; Birth Weight ; Bupivacaine ; Fistula ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Injections, Intravenous ; Isoflurane ; Ketamine ; Male ; Masks ; Pregnancy ; Premature Birth ; Respiration ; Ribs ; Supine Position

BACKGROUND: The purpose of this study was to measure the magnitude of the hypoxic pulmonary vasoconstriction(HPV) response to hypoxia of left lung and the effect of positive end-expira pressure(PEEP) of right lung on the regional HPV of left lung. METHODS: Left thoracotomy was performed in eight female mongrel dogs. Left pulmonary blood flow(Q) was measured with electromagnetic blood flow probe and cardiac output with tliermodilution technique in triplicate. Systemic and pulmonary hemodynamics were measured via Swan-Ganz and indwelling catheters. Q was shown as percent of cardiac output(Q%). Total, right and left pulmonary v.ascular resistance(PVRt, PVRr and PVR1) and pulmonary shunt(Qg/Qt) were calculated. Through the study, the right lung was ventilated continuously with 100% O2, while the left lung was either ventilated with 100% O2(control: phased 1)and a gas mixture containing 4% O2, 3% CO2 and 93% N2 (hypoxic: phase2I and 3). In phase 3 10 cmH2O PEET was applied to the light lung. RESULTS: Left lung hypoxia in phase 2 results in a reduction of Ql% and PaO2 and a elevation of PVRl without any changes of PVRt, Qs/Qt, MPAP and pulmonary perfusion pressure(PPP). With a 10 cm H2O PEEP on the light lung in phase 3, Ql% returned to the control level, but PVRl was still higher as compared to control . PaO2 and Qs/Qt were further aggravated. PVRt and PVRr were elevated in phase 3 as compared to phase 1and 2. CONCLUSION: It is concluded that contra-lateral PEET during unilateral HPV may aggravate systemic hypoxemia via blood flow diversion away from the PEETed area to the hypoxic area, but not abolish hypoxic pressor respone of hypoxic area.
Animals ; Anoxia ; Cardiac Output ; Catheters, Indwelling ; Dogs ; Female ; Hemodynamics ; Humans ; Lung ; Magnets ; Perfusion ; Positive-Pressure Respiration ; Thoracotomy ; Ventilation

A small but significant rise in serum potassium level following succinylcholine administration has been observed in normal anesthetized patients. A dangerous increase in serum potassium concentrations after the administration of succinylcholine chloride has been reported in an increasing number of clinical conditions including burns, massive muscle trauma, tetanus and uremia. The hyperkalemia can be of sufficient degree to cause ventricular tachycardia and fibrillation. Serum electrolytes levels were measured in 40 healthy children during induction of anesthesia. They were less than 10 years old and were divided into 4 groups of 10 children each. Group l: Ketamine 2 mg/kg and succinylcholine 2 mg/kg Group llI: Thiopental 5 mg/kg and succinylcholine 2 mg/kg Group lll: Pretreatment with pancuronium 20 ug/kg followed in 3 min by ketamine 2 mg/kg and succinylcholine 2 mg/kg Group lV: Pretreatment with pancuronium 20 ug/kg followed in 3 min. by thiopental 5 mg/kg and succinylcholine 2 mg/kg. Venous blood samples for serum electrolyte estimation were obtained using a catheter placed in an antecubital vein. The following results were obtained: 1) Serum potassium concentration following administration of succinylcholine was significantly increased in group l (p<0.05), but not in group ll, lll, lV. 2) Peak changes of serum potassium concentration were much higher in group l than group ll and lll, and the peak change in group lV was decreased below control values. Variance analysis indicate a significant difference between group I and the others(pp<0.05). 3) The peak change in serum potassium concentration in group I was from 1 min. to 3 min. after succinylcholine. 4) Serum Na+, Cl- and CO2, content were not significantly changed after succinylcholine and statistically not significant in all the groups.
Anesthesia ; Burns ; Catheters ; Child* ; Electrolytes* ; Humans ; Hyperkalemia ; Ketamine* ; Pancuronium* ; Potassium ; Succinylcholine* ; Tachycardia, Ventricular ; Tetanus ; Thiopental* ; Uremia ; Veins

Voice changes developing after endotracheal intubation during right hemicolectomy with endotracheal intubation have been found to be due to a right recurrent laryngeal nerve palsy in 43-years-old male patient. It was likely that the inflated cuffed tube rode up to the level of the cricoid cartilage during the course of surgery as traction was placed on the endotracheal tube because the condenser humidifier and breathing circuit weighed heavy. Cuff overexpansion, in addition to muscle relaxation and decreased tracheal elasticity were considered as contributing factors of vocal cord palsy. We believe that tube traction and cuff overexpansion were the mechanism of vocal cord palsy in our patient. So we recommend the routine use of tube stand so that weigh of the breathing circuit does not transmit traction to the endotracheal tube. Concurrently, filling the cuff with a sample of the inspired mixture of gases, saline and 4% lidocaine in special cases or regular deflation of the cuff must be considered.
Cricoid Cartilage ; Elasticity ; Gases ; Humans ; Intubation, Intratracheal* ; Lidocaine ; Male ; Muscle Relaxation ; Respiration ; Traction ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

In 1868 Charcot described the joint in tabes dorsalis, which since then has been designated as Charcot neuroarthrophathy. It is characterized by painless swelling and abnormal mobility of the affected joint. Arthrophthy of the type described by Charcot has been associated with various other conditions, such as diabetes mellitus, syringomyelia, injury to nerve root, congenital indifference of pain, leprosy, and intra articular use of steroid, etc. Authors present a case of Charcot spine due to tabes dorsalis.
Diabetes Mellitus ; Joints ; Leprosy ; Spine ; Syringomyelia ; Tabes Dorsalis

The authors has been reviewed the 123 cases, 119 patients of ankle fracture that were treated through the admission and outpatient Department of Orthopedic Surgery, Chungnam National University, from September, 1974 to January, 1982. The summary of the' results were follows: l. Among the 123 cases, male was 94 cases(76.4%), female was 29 cases, and the average age of the patients was 34.9 years. 2. The causes of the injury was traffic accidents, fall or slip downs and sports injuries in orders. 3. By the Lauge-Hansens classification, pronation-external rotation ty'pe and supination-adduction type were more common than the others. 4. Open reduction and internal fixation were more commonly used in its treatment than that of the closed method. 5. The better radiological assessment could be achieved by. obtaining the anatomical reduction and the reduction was more satisfactorily by the use of the key role of the lateral malleolus. 6. The overall results were more supported by the radiological results than the clinical results.
Accidents, Traffic ; Ankle Fractures ; Ankle ; Athletic Injuries ; Chungcheongnam-do ; Classification ; Clinical Study ; Female ; Humans ; Male ; Methods ; Orthopedics ; Outpatients

BACKGROUND: Recently, laparoscopic cholecystectomy becomes more favorite method than traditional open cholecystectomy. But postoperative pain control is still remaining problem. METHOD: Patients scheduled for elective laparoscopic cholecystectomy were assigned to two groups by simple randomization (15 patients per group). Group C (control) had no specific treatment and group B (bupivacaine) received 20 ml of 0.5% bupivacaine with epinephrine 1:200,000 before surgery. Immediately after the creation of a pneumoperitoneum, the surgeon sprayed the bupivacaine near and above the operation field. Operation was started 10 minutes after then. We attempted to investigate that the degree of postoperative pain which was assessed using the visual analogue scale (VAS) and the verbal rating scale (VRS) in the recovery room at postoperative 1 h., as well as the analgesic requirements during the first 24 h. postoperatively. RESULT: VRS of group B was significantly lower than group C (p<0.05), but VAS was not significantly different. Six patients in group B and only one in group C requested no analgesics. Group C had statistically more frequent request for analgesics than group B (p<0.05). CONCLUSION: The topical intraperitoneal anesthesia of 20 ml of 0.5% bupivacaine with epinephrine 1 : 200,000 before laparoscopic cholecystectomy is effective on the postoperative pain control. So, we recommmend that this simple and effective management is routinely treated in patients undergoing laparoscopic cholecystectomy.
Analgesics ; Anesthesia* ; Bupivacaine* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Epinephrine ; Humans ; Pain, Postoperative* ; Pneumoperitoneum ; Random Allocation ; Recovery Room

Adequate relaxation of the laryngeal adductor muscle is required to obtain good tracheal intubating condition. But we couldnt check rountinely laryngeal adductor muscle response, so we quantify the effects of succinylcholine and vecuronium at the laryngeal adductor muscles and the adductor pollicis. Twenty adult patients of ASA physical status 1-2 were studied during propofol-fentanyl anesthesia. The trachea was intubated without the use of muscle relaxants and the tube cuff placed between the vocal cords. Succinylcholine 1.5 mg/kg or vecuronium 0.1 mg/kg was given as a single bolus by random allocation. Muscular activity was evoked with supramaximal stimuli in a train-of-four sequence every 12 sec to the ulnar nerve and the anterior branch of the recurrent laryngeal nerve at the notch of the thyroid cartilage and forehead. Neuromuscular transmission was monitored at wrist by mechano-myography and laryngeal response was measured as pressure changes in the cuff of the tracheal tube positioned between the vocal cords. Pressure inside the cuff was measured with an air-filled transducer. TOF responses of both sites were continuously recorded on strip chart. Lag time and onset time were no statistically significant differences at the laryngeal adductor and adductor pollicis after succinylcholine or vecuronium bolus injection. Clinical durations were significantly shorter at the laryngeal adductor than at the adductor pollicis after succinylcholine and vecuronium injection. In one patient, onset of neuromuscular blocking effect with vecuronium was 125 sec slower at the laryngeal adductor than at the adductor pollicis. We recommand that if vecuronium is selected for gentle and smooth tracheal intubation, intubation will be delayed sufficient time after adductor pollicis relaxation.
Adult ; Anesthesia ; Forehead ; Humans ; Intubation ; Muscles* ; Neuromuscular Blockade* ; Random Allocation ; Recurrent Laryngeal Nerve ; Relaxation ; Succinylcholine* ; Thyroid Cartilage ; Trachea ; Transducers ; Ulnar Nerve ; Vecuronium Bromide* ; Vocal Cords ; Wrist