No abstract available.
Gastroschisis*

BACKGROUND: Epidural morphine has side effects, especially pruritus, nausea, and vomiting. Butorphanol has been added in studies to reduce these side effects in post cesarean patients. The purpose of this study was to evaluate the side effects and analgesic efficacy when a combination of epidural morphine and butorphanol was administered in patients having combined local anesthetic and opioid epidural infusion. METHODS: Sixty patients having epidural anesthesia for cesarean section were randomly divided into two groups. Group M (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and saline 0.75 ml, whereas group B (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and butorphanol 1.5 mg (0.75 ml). Continuous epidural infusion was done by Two-day Infusor containing either 0.25% bupivacaine 75 ml, morphine 5 mg, and saline 20 ml in group M or 0.25% bupivacaine 75 ml, morphine 5 mg, butorphanol 4 mg (2 ml), and saline 18 ml in group B. We compared the side effect and analgesic effect of group M to those of group B for 2 days. RESULTS: The incidence of pruritus and vomiting were reduced significantly in group B (p<0.05). There were no significant differences between both groups in the incidence of nausea or other side effects as well as no differences in analgesic effect. CONCLUSIONS: We conclude that the addition of butorphanol to morphine in combined local anesthetic and opioid epidural infusion for postoperative analgesia decreases the occurrence of pruritus and vomiting without significant increase of other side effects and adverse effect on analgesia.
Analgesia ; Anesthesia, Epidural ; Bupivacaine ; Butorphanol* ; Cesarean Section* ; Female ; Humans ; Incidence ; Infusion Pumps ; Morphine* ; Nausea ; Pregnancy ; Pruritus ; Vomiting

No abstract available.

No abstract available.
Female ; Mammaplasty*

This study was done to see the changes in the serum transaminase and LDH levels after general anesthesia in open heart surgery. We selected at random 60 patients who had received open heart surgery under cardiopulmonary bypass with mild to moderated hypothermia. They were divided into 3 groups depending on the anesthetic agents, halothane, penthrane and morphine group. Serum transaminase and LDH levels were checked before operation and also about 24 hours after operation; SGOP; spectrophotometirc assay by end-point method with Sequential Multiple Autoanalyser(SMA), SGPT; Spectrophotometric assay by kinetic method with SMA, LDH; Spectrophotometric assay by kinetic method. The results were as follows: 1) Serum transaminase and LDH levels were not significantly influenced by anesthetic agents after open heart surgery. 2) Serum transaminase and LDH levels were not significantly influenced by anesthetic agents in congental heart disease. 3) Serum transaminase and LDH levels were not significantly influenced by anesthetic agents in acquired heart disease.
Alanine Transaminase ; Anesthesia, General ; Anesthetics ; Cardiopulmonary Bypass ; Halothane ; Heart Diseases ; Heart* ; Humans ; Hypothermia ; Methoxyflurane ; Morphine ; Thoracic Surgery*

Recent studies(Rorke et al., 1968: Moir 1970: Baraka, 1970: Fox and Houle, 1971) have demonstrated that the maternal arterial oxygen tension during Cesarean section is an important determinant of fetal oxygenation and consequently of the clinical condition of the infant at birth for oxygen is transferred by simple diffusion across the placenta to the fetus. Fetal blood oxygen tension is affected by the arteiral oxygen tension and concentration of the mother, and also is affected by uterine blood flow(Fox and Houle, 1971). The enlarged uterus pushes the diaphragm upwards. This results in a change in position of the heart which is lifted upwards, shifted to the left and anteriorly, and a change in the thoracic cage, and heart rate is increased about 10~12 beats above normal. There is a significant increase in cardiac output which reaches a peak 30~50% above normal until term, and in respiratory rate, so that it follows that oxygen consumption increases but its direct cause is the metabolic need of the uterus, placenta and fetus(Atkinson et al., 1977). As well as increased oxygen consumption in parturients hypoxia may occur in situations of difficult intubation, laryngoscopy for intubation, extubation and during endotracheal suctioning. Because of the markedly decreased oxygen tension, these procedures are more dangerous than for non-parturients. Therefore sufficient oxygenation is recommanded(Archer and Marx, 1974). We selected at random 78 adult female patients who had received Cesarean section and other surgical procedures under general anesthesia with intubation at Severance Hospital from September to November, 1980. They were divided into 3 groups. Group 1 was ventilated with 100% oxygen for 5 minutes followed by 1 minute of apnea. Group 2 was ventilated with 50% oxygen for 5 minutes followed by 1 minute of apnea. Group 3 was ventilated with 50% oxygen for 5 minutes followed by 1 minute of apnea with endotracheal suction. We analysed the decrease in oxygen tension between parturients and onoparturients. The results were as follows: 1) During apnes, the decreases in arterial blood oxygen tension were significantly greater (p<0.05) in parturients than in non-parturients in the 100% oxygen group. 2) During apnea, the decreases in arterial blood oxygen tension were significantly greater(p<0.05) in parturients than in non-parturients in the 50% oxygen group. 3) During apnea, the decreases in oxygen tension were significantly greater(p<0.05) in paturients than in non-paturients in the 50% oxygen and endotracheal suction group. These results indicate the importance of preoxygenation prior to endotracheal intubation and endotracheal suction and also of prompt reoxygenation following endotracheal intubation, extubation and endotracheal suction.
Adult ; Anesthesia, General ; Anoxia ; Apnea* ; Cardiac Output ; Cesarean Section ; Diaphragm ; Diffusion ; Female ; Fetal Blood ; Fetus ; Heart ; Heart Rate ; Humans ; Infant ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Mothers ; Oxygen Consumption ; Oxygen* ; Parturition ; Placenta ; Pregnancy ; Respiratory Rate ; Suction ; Uterus

No abstract available.
Breast Implants* ; Breast* ; Contracture* ; Pregnancy*

No abstract available.
Adult* ; Humans ; Purpura, Thrombocytopenic, Idiopathic* ; Splenectomy*

The brachial plexus block by interscalene approach is useful for any procedure on upper extremity, including the shoulder. Complications such as phrenic nerve block, Horner's syndrome, permanent neurologic damage, high epidural block, total spinal anesthesia, pneumothorax and cardiac arrest etc. were reported. We experienced a case of 56-year old male patient with ankylosing spondylitis who developed cervical spinal cord injury following the turning of head for brachial plexus block by interscalene approach. The patient developed quadriplegia and finally died after 28 days.
Anesthesia, Spinal ; Brachial Plexus* ; Head ; Heart Arrest ; Horner Syndrome ; Humans ; Male ; Middle Aged ; Phrenic Nerve ; Pneumothorax ; Quadriplegia ; Shoulder ; Spinal Cord Injuries* ; Spinal Cord* ; Spondylitis, Ankylosing ; Upper Extremity

BACKGROUND: The effect of spinal anesthesia with hyperbaric tetracaine and bupivacaine, with and without 1:1000 epinephrine were studied in 60 patients having perianal operation in the horizontal lithotomy position. METHODS: The 60 patients were divided into four groups(n=15 in each group). Patients in group I and II received 0.5% hyperbaric tetracaine 7 mg(1.4 ml) and normal saline 0.2 ml (group I) or epinephrine 0.2 mg (0.2 ml) (group II) and patients in group III and IV received 0.5% hyperbaric bupivacaine 7 mg (1.4 ml) and normal saline 0.2 ml (group III) or epinephrine 0.2 mg (0.2 ml) (group IV). After intrathecal injection, changes and durations of sensory block, motor block and anal tone block were checked. RESULTS: The sensory block level was similar in four groups and the duration of analgesia was significantly longer in bupivacaine groups (III and IV) than in tetracaine groups (I and II) (in turn, group IV, II, III and I). Tetracaine groups were earlier onset of motor block, a larger number of patients with motor block and significantly longer duration of motor block than bupivacaine groups (in turn, group II, I, IV and III). The onset of anal tone block was earlier in tetracaine groups as the onset of motor block, but the duration of anal tone block was significantly longer in bupivacaine groups as the duration of analgesia (in turn, group IV, II, III and I). Epinephrine 0.2 mg produced significant prolongation of durations of analgesia, motor block and anal tone block of the hyperbaric tetracaine and bupivacaine. Cardiovascular change was similar in four groups and most common complication in all groups after spinal anesthesia was urinary retention. CONCLUSIONS: We conclude that the hyperbaric tetracaine and bupivacaine are appropriate anesthetic agents for perianal surgery and epinephrine produce a significant prolongation of the postoperative analgesic duration in both anesthetic agents.
Analgesia ; Anesthesia, Spinal ; Anesthetics ; Bupivacaine* ; Epinephrine ; Humans ; Injections, Spinal ; Tetracaine* ; Urinary Retention