No abstract available.
Diazepam* ; Hemodynamics* ; Morphine* ; Pancuronium* ; Respiration, Artificial*

Coronary artery disease is an ever-increasing problem to anesthesiologists as more patients with severe coronary artery are being accepted for surgery. Four cases of aortocoronary bypass graft procedure were done at Severance hospital. The procedure itself can result in perioperative myocardial infarction leading to death. Greater understanding of and constant attention to the myocardial oxygen supply and demand may reduce the incidence of perioperative myocardial infarction. Among the four patients, three tolerated the anesthesia and surgery well without gross pre and postoperative complications. However one patient developed hypotension in the recovery room and died 6 hours postoperatively, in spite of an intensive efforts at resuscitation. The problems, complications and precautions for anesthesia are discussed.
Anesthesia* ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Hypotension ; Incidence ; Myocardial Infarction ; Oxygen ; Postoperative Complications ; Recovery Room ; Resuscitation ; Transplants

Midazolam, a water-soluble benzodiazepine that is shorter-acting, more potent, and less irritating to veins than diazepam, has been suggested for use for induction of anesthesia. The cardiovascular effects of an induction dose(0.2~0.3mg/kg) of midazolam in ASA class lll cardiac surgical patients (N=15) were compared in a couble-blind fashion with a similar group of patients (N=15) receiving thiopental (5.0mg/kg). The patients were premedicated by triflupromasine, pethidine, hydroxyzine, atropine and diazepam. The results were summarized as follows. 1) The thiopental group were more decreased in blood pressure and increase in heart rates than midazolam group. 2) Spontaneous eye closing time and loss of eyelash reflexes were observed. But those were a poor sign of adequate induction became of heavy preanesthetic sedation. 3) The changes of blood pressure and pulse rate after induction and intubation were almost similar in the two groups, but greater individual variation was seen in midazolam groups, depends on preload state before induction. From the above results, midazolam was sufficient as an induction agent for open heart cases. But a hypovolemic patients and completely beta blocked patients should be used cautiously because they may be developed severe hypotension and tachycardia.
Anesthesia ; Atropine ; Benzodiazepines ; Blood Pressure ; Diazepam ; Heart Rate ; Heart* ; Humans ; Hydroxyzine ; Hypotension ; Hypovolemia ; Intubation ; Meperidine ; Midazolam* ; Reflex ; Tachycardia ; Thiopental ; Thoracic Surgery* ; Veins

Introduction: Oxygen delivery to tissue is of major clinical interest in patients with cyanotic congenital heart disease (CHD). The use of pulse oximeter to monitor arterial oxygen saturation (SaO2) is considered accurate and reliable in the range of 90% to 100%. However with desaturation, the accuracy remains controversial below 90%. The aim of this study was to evaluate the accuracy of pulse oximetry in severe hypoxemia. METHOD: In 110 children with cyanotic CHD, pulse oximeter (N-200, Nellcor, USA) readings were compared with the direct measurement of SaO2 by blood gas analyser (Profile10, Stat, USA). All measurements were carried out after induction of anesthesia and devided into 4 groups according to saturation measured by pulse oximeter (SpO2). SpO2 in group I was higher than 90% (n=90), in group II between 80% and 89% (n=75), in group III between 70% and 79% (n=41), in group IV lower than 69% (n=18). Statistical analysis of paired SpO2 and SaO2 values was performed using correlation analysis and paired t-test. The other comparisons were perfomed with ANOVA. p<0.05 was considered statistically significant. RESULTS: Correlation coefficient of group I was 0.89 (p<0.01), group II was 0.67 (p<0.01), group III was 0.63 (p<0.01) and group IV was 0.41. The study demonstrate that SpO2 seems to have good correlation with SaO2 when SpO2 is higher than 70%. This results are contrary to other studies which show that SpO2 is not reliable when SpO2 is below 90%. However, the correlation value r seems to decrease with desaturation. CONCLUSION: The use of pulse oximeter in severe hypoxemic children with CHD is efficient in monitoring oxygenation, even though there is decrease in accuracy of the SpO2.
Anesthesia ; Anoxia ; Child* ; Heart Defects, Congenital* ; Humans ; Oximetry* ; Oxygen ; Reading

As the mitral valve disease becomes long-standing, the patient may develop pulmonary hypertension. It was reported that after surgical correction, the elevated pulmonary vascular resistance(PVR) would fall quickly in association with the fall in left atrial pressure(LAP). This study was performed to evaluate the changes in mean pulmonary artery pressure(PAP) and PVR immediately after mitral valve replacement(MVR). Fifty six patients undergoing mitral valve replacement(MVR) were divided into two groups on the basis of the presence or absence of significant pulmonary hypertension, defined as a resting mean pulmonary arterial pressure greater than 30mmHg. After induction of anesthesia, PAP, PVR, cardiac output(CO) were measured and compared with values in postbypass period. PAP and PVR were significantly decreased(PAP from 39.64+/-1.88 to 29.18+/-1.65 mmHg, P 0.001, PVR from 6.16+/-1.14 to 3.53+/-0.62 units, P<0.05) in Group II(PAP> or = 30mmHg, n=23), whereas not changed in Group I(PAP30 mmHg, n=33)(P<0.05). Persistance of an elevated PVR may cause right ventricular failure and low-output syndrome, so that an attempt to reduce the PVR is needed postoperatiavely. This study demonstrated that the PAP and PVR fall significantly after MVR especially in patients with severe pulmonary hypertension.
Anesthesia ; Arterial Pressure* ; Humans ; Hypertension, Pulmonary ; Mitral Valve* ; Pulmonary Artery ; Vascular Resistance*

Removal of a left atrial myxoma using extracorporeal circulation was successfully performed first in 1954 by Craford. The problems of anesthesia for resection of atrial myxoma were the hemodynamic alterations, embolisation and valvular obstruction produced by tumor size and location, conduction defects due to myocardial invasion and anesthetic and operative procedures. Thus we have mad clinical analysis of 13 cases receiving anesthesia performend from 1976 to 1983 at Severance Hospital, Yonsei University College of Medicine. The results of clinical analysis are as follows: 1) Atrial myxomas were located(in the) in the lefte atrium except for 1 case. 2) Preoperatively most of these case showed congestive heart failure, cardiomegaly, arrhythmia and increased right atrial, pulmonary arterial and pulmonary capillary wedge pressures. 3) As premedicantes, one of the sedatives and a mild tranquilizer were given in all cases, atropine in about one third and triflupromaxine in about one half of the cases. 4) Anesthesia was induced with thiopental, morphine, midazolam, flunitrozepam and intubated after succinylchoilne or pancuronfum and maintained in the usual manner. 5) Myoxamas were resected during cardiopulmonary bypass and one case had to have a mitral value replacement. 6) The average duration of anesthesia and bypass was 372.14+/-42.0 and 104+/-12.9min. No mortality occurred. From the above results, it can be concluded that the understanding of the pathophysiology and the hemodynamic changes before anesthesia are important for safe anesthesia.
Anesthesia* ; Arrhythmias, Cardiac ; Atropine ; Capillaries ; Cardiomegaly ; Cardiopulmonary Bypass ; Extracorporeal Circulation ; Heart Failure ; Hemodynamics ; Hypnotics and Sedatives ; Midazolam ; Morphine ; Mortality ; Myxoma* ; Pulmonary Wedge Pressure ; Surgical Procedures, Operative ; Thiopental

The Bain circuit system was first used by bain and spoerel in 1972. It is a type of non-rebreathing system which is a variation of the Mapleson D or E system. Its total length, diameter of the inner tube and the outer tube are 1.8 m, 8 mm and 22 mm respectively. In this study the children and infants who weight 5~20 kg were selected, and during open heart surgery using bypass technique the respiration was controlled mechanically by using the bain circuit system with a fresh gas flow of 200 ml/kg/min. The minimum fresh fas flow was 2 L/min and the maximum fresh gas flow 3.5 L/min. The patients were divided into three groups according to body weight; group 1(5~10 kg of B.W.), group 2(10.1~15 kg of B.W.)and group 3(15.1~20 kg of B.W.). Each group was subdivided into the cyanotic heart disease group and the acyanotic. The results of our study showed that CO2 retention was not seen in either group. We observed that the Bain circuit system was very satisfactory and valuable in all groups during controlled ventilation, and this technique is also suitable for prolonged surgery(4~10 hrs) in infants and children.
Body Weight ; Child ; Heart Diseases ; Humans ; Infant ; Respiration ; Thoracic Surgery ; Ventilation

A 41 year-old male underwent resection of a pheochromocytoma under general anesthesia. The patient was treated with phenoxybenzamine for 14 days preoperatively and premedicated with triflupromazine, diazepam, pethidine and hydroxyzine in combination. Following induction of anesthesia with intravenous morphine, thiopental sodium and alcuronium, endotracheal intubation was performed. As soon as intubation, tachycardia(143/min) and hypertension(170/100 mmHg) developed, but were controlled by intravenous injection of propranolol. Anesthesia was maintained with nitrous oxide, oxygen and enflurane, and alcuronium. Blood pressure during manupulation of tumor mass was 160/100 mmHg without arrhythmia but gradually was controlled to the range of 120-130/80-85 mmHg after intravenous infuaion of nitroglycerine at the rate of 0.5-2 ug/kg/min. After removal of the tumor mass, the blood pressure dropped to 100/70 mmHg. Blood pressure was controlled by I.V. low molecular weight dextran, and Hartmanns solution, but a vasoconstrictive agent was not needed. There was no marked tachycardia or arrhythmia during anesthesia. The importance of preoperative preparation, premedication, selection of anesthetics and nitroglycerne for controling the episodic hemodynamic pressure response is discussed.
Adult ; Alcuronium ; Anesthesia ; Anesthesia, General ; Anesthetics ; Arrhythmias, Cardiac ; Blood Pressure ; Dextrans ; Diazepam ; Enflurane ; Hemodynamics ; Humans ; Hydroxyzine ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Male ; Meperidine ; Molecular Weight ; Morphine ; Nitroglycerin* ; Nitrous Oxide ; Oxygen ; Phenoxybenzamine ; Pheochromocytoma* ; Premedication ; Propranolol ; Tachycardia ; Thiopental ; Triflupromazine

We have mnanaged the anesthetic and postoperative care in 9 patients with myasthenia gravis who underwent thymectomy and obtained following resultsa : 1) Premedication was glycoprrrolate 0.004mg/kg or atropine 0.01mg/kg and hydroxyzine 1~2mg/kg, I.M. Anesthetic induction was by thiopental 4~5mg/kg with 7he inhalation of halothane 1~2 % or enflurane 4~5%, and followed by endotracheal intubation. Anesthetic maintanance was done by N2O and halothane or enflurane. 2) Mean duration from the end of operation to intubation was 11.83+/-3.37hrs. 5 patients required reintubation. The mean duration from the extubation to reintubation was 33.11+/- 21.06hrs for these 5 patients. Over all this entire group of patients were placed on the respirator for a mean of 5.33+/-1.46dara. 3) Complication occured were 2 cases of cholinergic crisis, 1 cases of lung abscess, 2 cases of dyspnea and 1 case of tension pneumothorax 4) Abstinence of muscle relaxants, adequate respiratory care and the protection from cholinergic crisis were the most important factora for successful management.
Anesthesia* ; Atropine ; Dyspnea ; Enflurane ; Halothane ; Humans ; Hydroxyzine ; Inhalation ; Intubation ; Intubation, Intratracheal ; Lung Abscess ; Myasthenia Gravis* ; Pneumothorax ; Postoperative Care ; Premedication ; Thiopental ; Thymectomy* ; Ventilators, Mechanical

To evaluate anesthetic experience during open heart surgery, 145 cases of patients under 15kg of body weight from January 1980 to June 1982 were analyzed according to age, sex, technique of anesthesia, anesthetica, premedicants, muscle relaxants, flow rates and mortality. The results were as follows: 1) Premedicants were mainly atropine, meperidine, hydroxyzine, triflupromazine and morphine. 2) Induction agents were thiopental in acyanotic group, but cyanotic group were mainly used ketamine. 3) The inhalation anesthetica that were halothane, methoxyflurane, N@O and enflurane were used in acyanotic group but cyanotic group did not used. 4) Early stage of open heart surgery, gallamine were mainly used but now, pancuronium were used. 5) During cardiopulmonary bypass, the lowest temperature were mean 27 degrees C and flow rate were 80~100ml/kg/m(2). 6) Overall mortality was 17.2%.
Anesthesia* ; Atropine ; Body Weight ; Cardiopulmonary Bypass ; Child* ; Enflurane ; Gallamine Triethiodide ; Halothane ; Heart Defects, Congenital* ; Heart* ; Humans ; Hydroxyzine ; Infant* ; Inhalation ; Ketamine ; Meperidine ; Methoxyflurane ; Morphine ; Mortality ; Pancuronium ; Thiopental ; Thoracic Surgery* ; Triflupromazine