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*

Ketamine, a phencyclidine derivative, has been used as an anesthetic agent since 1965 and it has received much attention as an anesthetic for minor surgical procedures, in some diagnostic procedures in children or as an induction agent for poor risk patients. A troublesome problem has been psychic disturbance on emergence. There are many reports on ketamine anesthesia but some cases describing the failure of recommended doses of ketamine to produce adequate analgesia have been reported with cerebral cortical disease or massive craniocerebral trauma. In this case, we experienced a failure to produce adequate analgesia with intramuscular ketamine (11 mg/kg). It was not confirmed in this case whether the patient had suffered any cerebral cortcial disease or not.
Analgesia* ; Anesthesia ; Child ; Craniocerebral Trauma ; Humans ; Ketamine* ; Minor Surgical Procedures ; Phencyclidine

Central to the question of anesthetic risk is the definition of an anesthetic death. This has yet to be defined within any reasonable limits. A number of factual and philosophical considerations have complicated attempts to derive a precise definition. Anesthetic risk is largely confused with surgical risk, involving a second set of persons and procedures. Only events between induction of anesthesia and onset of operation clearly relate the risk of anesthesia to patient diseases and the causes of deaths during and after operation are usually speculative. Among those factors which relate to anesthetic risk; age, physical status, surgical area, anesthetic method, selection of anesthetic agent, inadequate preoperative preparation, improper decision and skill of anesthesiologist himself, and elective vs emergency operations are most important in minimizing the anesthetic risk. Furthermore, elective vs emergency operations relate more to anesthetic mortality than to other factors. Many emergency operations were practiced in our hospital, more than in other institutions. Thus, our anesthesiologists are faced with a higher incidence of anesthetic risks. Evaluated results were as follows; 1) The percentage of emergency operations was 57.4% of the total performed operations. 2) The mortality rate is significantly higher in emergency surgical procedures than in elective surgical procedures, 3) Frequent changing of the operation schedule may cause confusion in the anesthesiologist's decision on preparation and selection of the anesthetic agent and technique, and may also cause an increased workload.
Anesthesia ; Appointments and Schedules* ; Cause of Death ; Elective Surgical Procedures ; Emergencies ; Humans ; Incidence ; Methods ; Mortality

Anesthesia consent was requested by our anesthesiology department when the patient condition was found to be critical during the preanesthetic visit. To evaluate the trend, one hundred and five anesthesia consent cases among the 6,430 anesthetics from January 1977 to December 1978 at the department of anesthesiology, St. Mary's hospital, Catholie Medical College, were analyzed according to the anesthetic method, age, sex, surgical department, anesthetic agent, physical status, site of operation, diagnosis, preanesthetic problem and cause of death. The results were as follows; 1) Fifteen cases(14%) died among the 105 cases of anesthesia consent during and/or after .surgery, within the first 7 days. 2) Physical status was class ll E in 43% and the ratio of elective to emergency surgery was 1 to 1.4. 3) Upper abdominal surgery was performed in 52 cases(50%), urogenital surgery in 21 cases (20%), head and neck surgery in 18 cases(17%), surgery on extremities in 12 cases(11%) and thoracic surgery in 2 cases(2%), accordingly. 4) Cardiovascular problems were found in 27 cases(26%), hematologic disorders in 13 cases (12%), respiratory problems in 13 cases(12%), sepsis in 9 cases (9%), problems of central nervous system in 9 cases(9%), hepato-renal disorders in 8 cases(8%) and endocrine disorders in 5 cases(5%), respectively, 5) Postanesthetic cause of death was cardiopulmonary disturbance(33%), sepsis(27%) cerebral edema(20%) and hemorrhage(13%).
Anesthesia* ; Anesthesiology ; Anesthetics ; Cause of Death ; Central Nervous System ; Diagnosis ; Emergencies ; Extremities ; Head ; Humans ; Methods ; Neck ; Sepsis ; Thoracic Surgery

Recently, with the help of medical development which is able artificially to control respiration, circulation, nutrition and excretion, human beings may still survive in spite of brain death. We have had experience with the first case of cadaveric kidney transplantation in Korea. Because the prognosis of kidney transplantation is relatively good in comparison to the five-year survival rate of cancer patients and because postoperative rehabilitation is fair, nowadays kidney transplantation is popular. With the limitations of confluent acceptance and supplimental functioning together of the living kidney, cadaveric kidney transplantation has been preferred, although several problems still exist. We have used the conventional method to maintain the cadaver donor's life after clarification of death. As soon as brain death was confirmed on EEG monitoring, then an artificial respirator was applied to the tracheotomy site, adequate urinary excretion was maintained and infection prevented. At the same time, the HL-A(human lymphocyte-antigen) compatibility test and ABO blood matching had to be performed before anesthesia. The patient's intraoperative and postoperative course was satisfactory and he now has no problems of physical or social activity. However cadaveric kidney transplantation is in the early phase in Korea, and therefore further improvement is needed, and several problems should be solved. We hope many cadaveric kidney transplantations will be performed.
Anesthesia ; Brain Death ; Cadaver* ; Electroencephalography ; Hope ; Humans ; Kidney Transplantation* ; Kidney* ; Korea ; Methods ; Prognosis ; Rehabilitation ; Respiration ; Survival Rate ; Tracheotomy ; Ventilators, Mechanical

The history of muscle relaxants is fascinating, and their use for clinical applications has been accepted. Depolarizing drugs can produce a non-depolarizing type of neuromuscular block. Decamethonium produces a nondepolarizing block in the isolated rabbit lumbrical muscle. Electromyographic studies of the hand muscles in man have demonstrated that a dual block will be produced with doses of succinylcholine varying from 500 to 1,500 mg (initially a delpolarizing block and subsequently a non-depolarizing block exists). The common peroneal nerve in the rabbit knee was stimulated by a "train of four" method (Ali et al) repeated intermittently. The muscle response with the "train of four" method to intravenous succinylcholine chloride (1 mg/kg) in the rabbit was recorded and analysed after a single injection and repeated intravenous injections of succinylcholine chloride 1 mg/kg. Result were as follows: 1) Time after the "train of four" to depression of muscle twiteh of 25, 50, 75 & 100% was 128. 2, 135. 3, 142. 8 and 159 seconds respectively. 2) Recovery index of a single intravenous injection of succinylcholine chloride 1 mg/kg was observed as 3 minutes and 14 seconds. 3) A depolarizing form of "train of four" response to the first succinylcholine chloride injection 1 mg/kg was observed and, a non-depolarizing form of "train of four" response to the second dose of succinylcholine chloride 1 mg/kg was observed definitely.
Depression ; Hand ; Injections, Intravenous ; Knee ; Methods ; Muscles ; Neuromuscular Blockade ; Peroneal Nerve ; Rabbits* ; Succinylcholine

Autoclaving the local anesthetic ampuls has been suggested as a safer method of sterilization. However the method and time necessary to sterilize the ampul has not been standardizzed, and the amount of deterioration of anesthetic agents by this method is unknown, and the effect of injection of the caramelized dextrose has not been determined. If ampuls are autoclaved with the spinal tray or set up, the ampuls are subjected to sterilization for a prolonged time which in turn causes caramelization of dextrose and possible deterioration. We have studied the effect of multiple autoclavings on pH of the drugs whichart used in spinal anesthesia, 1% tetracaine, 10% dextrose, 2% xylocaine and epinephrine at 134C, 36 psi for 5 minutes. Statistieal significance of the pH changes were observed by multiple autoclavings.
Anesthesia, Spinal ; Anesthetics ; Anesthetics, Local* ; Epinephrine ; Glucose ; Hydrogen-Ion Concentration* ; Lidocaine ; Methods ; Sterilization ; Tetracaine

The relationship between the Ledig cell of testis and the tropic hormones of the anterior pituitary gland has been ineddquately expiored in man because of methodological difficulties levels in human serum. As testosterone in one of the most important anabolie hormones, it would therefore serve as an index to hormanal response to stress in man. This study was performed to inveatigate the effect of thalamonal-N2O-O2 anesthesia and surgery on human sex hormone by radioimmunoassay method. Measured serum testosterone lexels in the preanesthetic period, 60 minutes after anesthesia and surgery, and at full rectxary from anesthesia were 5.64ng/ml 4.40ng/ml and 5.02ng/ml, respectively.
Anesthesia* ; Humans ; Methods ; Pituitary Gland, Anterior ; Radioimmunoassay ; Testis ; Testosterone*

The effect of nitrous oxide on endotracheal tube cuff pressure was measured during N2O-O2-halothane anesthesia. Intracuff pressure was increased in a time-related fashion up to 150 minutes. Thereafter no significant increase was observed, The other hand, there is no endotracheal tube cuff pressure change during O2-halothane anesthesia. These findings demonstrate that nitrous oxide has the capacity to diffuse into Portex endotracheal tube cuffs in significant volumes and may result in increased intracuff pressure, and in O2-halothane anesthesia, the nitrogea in the cuff was diffused out from the cuffs.
Anesthesia ; Anesthesia, Inhalation* ; Hand ; Inhalation* ; Nitrous Oxide

The tetralogy of Fallot is the commonest cyanotic congenital heart disease and is not a single entity but is classified according to variations in clinical and hemodynamic findings based primarily on the degree of pulmonary stenosis and the size of the ventricular septal defect. Total surgical correction was performed with Sarns 500 pump oxygenator, hypothermia 28 to 30 C and perfusion flow rates of 2. 4 L/min/m2. A successfully performed tetralogy of Fallot discussed mainly fromthe pathophysiological view.
Anesthesia* ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Hemodynamics ; Hypothermia ; Oxygen ; Oxygenators ; Perfusion ; Pulmonary Valve Stenosis ; Tetralogy of Fallot*