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*

Hypotension immediately after spinal anesthesia has been considered as the result of pre-ganglionic sympathetic paralysis and secondarily due to changes in cardiac output. And also the increase of vascular bed space about 20~25% was pointed ont during spinal anesthesia which was another cause of spinal hypotension. Same degree of increased vascular bed space was produced by vasodilators such as Dibenzyline and Arfonad. Therefore, vasopressors have been used as the drug of choice to prevent and treat this spinal hypotension. This study was attempted to combat the hypotension during spinal anesthesia by filling this increased vascular bed space with Lactated-Ringer's or Dextrose solution instead of giving vasopressors. Lactated-Ringer's or Dextrose solution was administered to 141 cases, before and immediately after. spinal anesthesia was performed. The given amount of fluid was about 12.5~15% of estimated total blood volume (Group A). And no intravenous fluid was given to 101 cases as control (Group B). Changes of the systolic, diastolic blood pressure and pulse rate were observed. In the Group A, significant changes of the systolic (t=2.52, p<0.02) and diastolic blood pressure (t=1.98, p<0. 05) was observed. The changes of pulse rate were found not significant in the both group series.
Anesthesia, Spinal* ; Blood Pressure ; Blood Volume ; Cardiac Output ; Glucose ; Heart Rate ; Hypotension ; Paralysis ; Phenoxybenzamine ; Vasodilator Agents

Laryngospasm is a serious complication which may be seen following extubation in children. During laryngospasm either the true vocal cords or the true and false cords become opposed in the midline and close the gllotis. Intravenous lidocaine has been used in adult patients to prevent cough following extubation. The present study was made to see if intravenous 1% lidocaine, 2mg/kg of body weight, can be safely used to prevent or control extubation laryngospasm in children. Anesthesia was maintained with halothane-N2O-O2, in a semiclosed circuit. In 20 children, a bolus of 1% lidocaine 2mg/kg was injected intravenously two to three minutes prior to extubation; in the other 20 children, extubation was carried out without prior injection of lidocaine. The incidence of laryngospasm, coughing, respiratory depression, and changes of blood pressure, pulse rate were measured. The results were as follows: 1) Two cases of laryngospasm (10%), 11 cases of coughing (55%) and 2 cases of stridor (10%) were observed following extubation in the control group. Blood pressure and pulse rate showed a tendency to increase about 20%, in the control group. 2) One case of laryngospasm (5%) and 4 cases of coughing (20%) were observed following extubation in the lidocaine pretreated group. Incidence of trouble following extubation was markedly reduced (75 to 25%) in the lidocaine pretreated group. Blood pressure and pulse rate showed a tendency to decrease about 15% in the lidocaine pretreated group.
Adult ; Anesthesia ; Blood Pressure ; Body Weight ; Child* ; Cough ; Heart Rate ; Humans ; Incidence ; Laryngismus* ; Lidocaine* ; Respiratory Insufficiency ; Respiratory Sounds ; Vocal Cords

No abstract available.
Cholecystectomy, Laparoscopic*

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

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*

The relationship between the Leydig cell of testis and the tropic hormones of the anterior pituitary gland has been inadequately explored in man because of methodological difficulties. Ether anesthesia has been shown to increase testicular blood level of testosterone in man. Some report has appeared on the effect of anesthesia person sex hormone levels in human serum. As testosterone is one of the most important anabolic hormones, it would therefore serve as an index to hormonal response to stress in man. Testosterone levels were measured by Oyama et al by competitive protein binding method. This study was done to investigate the effect of halothane anesthesia and surgery on human sex hormone by radioimmunoassay method. Serum testosterone levels measured at preanesthetic period, 60 minutes after anesthesia and surgery, and full recovery from anesthesia were 4. 18+/-l. 64 ng/ml, 4. 19+/-1.40 ng/ml and 3. 74+/-1. 65 ng/ml, respectively. No statistical significance was noticed each other. The obtained value of testosterone was the lowest compared with the values reported by other authors.
Anesthesia* ; Ether ; Halothane* ; Humans ; Methods ; Pituitary Gland, Anterior ; Protein Binding ; Radioimmunoassay ; Testis ; Testosterone*

Inhalation anesthesia oy endotracheal intubation is commonly used in current anesthetic tech nique. But the increased use of endotracheal tubes in inhalation anesthesia expose the patients to the consequence of increased pressure in the tracheobronchial tree sometimes to a great extent than is true of a patient in whom intubation is not done. In addition, disposable plastic units has been introduced to obviate hazards of cross infection in anesthesia and inhalation therapy and which do not stretch after full inflation. Pressure exceeding 250 cm water may develop within seconds when the plastic units are inadvertently overfilled with gases. Such high pressures transmitted to the airways are harmful. Immediate, prompt and adequate management of the bilateral tension pneumothorax are essential, otherwise the patient becomes rapidly fatal. A case of bilateral tension pneumothorax, which occurred due to a excessive pressure to the airway by use of disposable plastic units was reported.
Anesthesia* ; Anesthesia, Inhalation ; Cross Infection ; Gases ; Humans ; Inflation, Economic ; Intubation ; Intubation, Intratracheal ; Plastics ; Pneumothorax* ; Respiratory Therapy ; Trees ; Water