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*

Anesthesiologists are often encountered arrhythmia during general anesthesia. Sometimes, ventricular arrhythmia may threaten patient condition to be fatal. On the other hand, anesthesiologists experience that an arrhythmia which existed pre-operatively may disappear during general anesthesia. And after anesthesia, in most of the cases, the former arrhythmia may reappear. The authors experienced one such patient who had arrhythmia pre-operatively and normal rhythm during and after general anesthesia until the 7th post-operative day. At the moment, the mechanism of disappearance of arrhythmia during general anesthesia is not clearly known, but we like to use the medical term Cardio-Anesthesia Restoration for a case who had pre-operative arrhythmia which was abolished during and after general anesthesia.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Hand ; Humans

This is an analysis of 75 cases of written interdepartmental consultations submitted to our department during January 1973 to December 1973. In all, 67 cases were surgical, 8 cases were non-surgical and, of which, 66 cases were for elective cases and 6 cases were for emergency cases, including 5 non-operative cases, and post-operative consultations were 3 cases. Among the 67 surgical cases, 4 cases of surgery were postponed according to our advice. The analysis was as follows; 1 Age; 58.6% were over 40 years old, which included 25.3% over 60 pears old. 2. Sex; male was 49.3% and female was 50.7%. 3. The consultation rate was 2.9% (consultation cases 75; total operation cases 2583). The number of monthly consultations was 7 cases on average. 4. The highest number of departmental consulations were requested from general surgery (42.7%), then from orthopedic department (30.7%), from internal medicine (8.0%), and from eye department (8.0%) respectively. 5. In pre-operative diagnosis of the consultations, around 45 diseases were encountered. 6. The problems of the consultations were varied in 153 subjects; 30.1% of the consulted problems were cardiovascular origins, including hypertension (8.5%), severe anemia (7.1%), and ECG abnormalities (5.9%). 23.5% of the consulted problems were respiratory dysfunction and 21.6% of the problems were endocrinological and metabolic disorders. 7. 3.9% of the problems were therapeutic pain control and/or block. Pain clinics were recently started in our country, in this regards, a joint clinic staff may help to operate the pain clinic efficiently. 8. There were 67 pre-operative surgical consultations (95.5%) and 3 post-operative consulations (4.5%). 9. Through this study, anesthesiologists are requested to have a much broad medical and surgical knowledge to keep their high standard of the speciality.
Anemia ; Diagnosis ; Electrocardiography ; Emergencies ; Female ; Humans ; Hypertension ; Internal Medicine ; Joints ; Male ; Orthopedics ; Pain Clinics ; Pyrus ; Referral and Consultation

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. A report has appeared on the effect of anesthesia per se on 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. Tcsticular blood level of testcsterone in man was increased by ether anesthesia but plasma testcsterone one in man was decreased by halothane anesthesia. Plasma testostercne levels were measured by others. by a competitive protein binding method. This study was performed to investigate the effect of methoxyflurane anesthesia and surgery on human sex hormone by a radioimmunoassay method. Serum testosterone levels measured in the pre-anesthetic period, (60 minutes after anesthesia and surgery, and at full recovery from. anesthesia were 3.80+/-1. 75 ng/ml, 0. 58+/-1. 22 ng/ml and 3. 55+/-1. 85 ng/ml, respectively. No statistical significance was observed. The obtained value of testostercne was the lowest when compared with the values reported by others.
Anesthesia* ; Ether ; Halothane ; Humans ; Methods ; Methoxyflurane* ; Pituitary Gland, Anterior ; Plasma ; Protein Binding ; Radioimmunoassay ; Testis ; Testosterone*

Acute pulmonary edema was experienced during the mass excision of a nasopharyngeal angiofibroma clue to massive transfusion (8,000ml of blood within 3 hours). High FIoz with manual PEEP, diuretics, steroid and digitalis were given immediately. Full recovery was observed after 18 hours of ICU care.
Angiofibroma* ; Digitalis ; Diuretics ; Edema* ; Pulmonary Edema

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

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

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