No abstract available.
Korea*

No abstract available.
Asian Continental Ancestry Group* ; Humans

>No abstract available.
Anesthesia* ; Joints* ; Respiratory Insufficiency*

No abstract available.
Anesthesia* ; Great Britain*

Tracheostomy is done to treat the acute upper airway obstruction. But when the condition. precipitating tracheotomy has resolved, the tracheal cannula cannot be removed sometimes because of the anatomical change at the tracheotomised tissue. This is described that decannulation is delayed. Delayed decannulation is uncommon but occurs more frequently in young children than in adults. The child who is difficult to decannulate is continuously at risk. His family experiences emotional, social and sometimes economic hardships. Many factors may delay decannulation; a frequent cause is posterior displacement of the: anterior tracheal well above the tracheotomy stoma induced by the position and pressure of the tracheotomy cannula itself. High tracheotomy, subglottic edema, emotional dependence increase of upper air-way resistance and delayed laryngeal development are solo the factors. One of the treatment of the difficult decannulation, T-tube stent was inserted through tracheoplasty. in this report, a 24 months old girl, nasotracheal intubation was used in the attempted decannulation. Radiological and endoscopic evaluation indicated that posterior displacement of the anterior tracheal well above the tracheal stoma was the cause of the delay. Dacalnnulation was achieved after 10 days of the intubation therapy. Etiology of the tracheal stenosis, pattern of respiratory difficulty, technic and patient care of nasotracheal intubation as the therapy of delayed decannulation and the role of anesthesiologists and pediatric intensive care was discussed.
Adult ; Airway Obstruction ; Catheters ; Child ; Child, Preschool ; Edema ; Female ; Humans ; Critical Care ; Intubation ; Patient Care ; Stents ; Tracheal Stenosis ; Tracheostomy ; Tracheotomy

To assess the effect of premedication for pediatric cases, flunitrazepam (Rohypnol) was given to small children under 6 years of age. 70 patients were divided into 4 groups to which the drug was given intramuscularly, 0. 06 mg, 0.1 mg, 0.15 mg and 0. 2 mg per kilogram of body weight, of the drug respectively. The dose was given 30 minutes before anesthesia and the maximum dose was limited to 2.0 mg for each patient if the calculated dose of the drug exceeded this amount. 1) The shortest time of onset of sleep was 5 minutes. The group which fell asleep between 5 and 10 minutes did not respond to needle stimulation. The group which fell asleep between 11 and 15 minutes moved upon needle stimuli but an intravennous needle was inserted without difficulty. 2) The group which fell between 16 and 20 minutes and became sedated after 20 minutes. without asleep was induced by anesthesia with an inhalational agent but aroused by needle stick. The last group was sedated in presence of their guardian only and became uncooperative when they were separated from the latter. 3) The patients were not affected at all with the dose of 0.06mg/kg of flunitrazepam. 4) With the dose of 0. 1 mg/kg, the group under 6 months of age did not sleep and in the; group between 4 and 6 years of age, half did sleep. ) With the dose of 0.15 mg/kg, in the group under the age of one year, 50% of the cases slept and in the group between 2 and 6 years of age, 30% of the cases slept. 6) With the dose of 0. 2 mg/kg, the sleep group was 25% under 1 year of age, 30. 8% between one and 3 years of age and 33% between 4 and 5 years of age, but the maximum. dose given was limited to 2 mg for each case. A tendency to increased effect according to the increase of age was noticed. 7) The optimum dose of the drug was suggested to be 0. 15 mg/kg and if a dose was used of more than 2. 0 mg, it was not needed to increase above this amount for the purpose of sedation. 8) Optimal time for premedication was suggested to be 30 minutes before the induction of anesthesia. 9) Respiratory and circulatory depression were not noticed with the above doses. 10) Endotracheal intuhation was faeilitated without the aid of muscle relaxant in about 30% of cases when 0.15mg)kg Of the drug was given. (Acknowledgement: We are grateful to Roche Far East Research Foundation for supplies of flu- nitrazepam for this study and to Dr. R. Lassere for advice.)
Anesthesia ; Body Weight ; Child* ; Depression ; Equipment and Supplies ; Far East ; Flunitrazepam* ; Humans ; Needles ; Nitrazepam ; Premedication

Glossopharyngeal neuralgia, first discribed by Labat in 1928, is a very rare disease of unknown cause. This neuralgia is associated with a characteristic sharp pain of the posterior pharynx, tonsils and larynx, and especially triggered by swallowing action. It is said that this pain is more severe than that of trigerminal neuralgia and the pain may last several up to 30 minutes and the attack repeats intermittently. Diagnosis of glosspharyngeal neuralgia is made by the symptoms and by the elongation of the right side of the styloid process in this case. The glossopharyngeal nerve block by the deposition of local anesthetic solution is useful in the accurate diagnosis of the douleureux or neuralgia in which this nerve is involved and in providing anesthesia for operative intervention upon the posterior third of the tongue. This is a report of a case of glossopharyngeal neuralgia, which did not respond to Tegretol and other analgesic drugs and treated by glossopharyngeal nerve block with 0.5% bupivacaine l.5-2.0 ml. The block was performed every day for 15 days and the neuralgia disappeared without complication.
Analgesics ; Anesthesia ; Bupivacaine ; Carbamazepine ; Deglutition ; Diagnosis ; Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases* ; Larynx ; Neuralgia ; Palatine Tonsil ; Pharynx ; Rare Diseases ; Tongue

The recovery process of brain damage caused by an acute severe cerebral hypoxia has been reported in various literatures. And the possibility of complete recovery of such case was said to be good in younger age group than in adult's group. We experienced a case of cardiac arrest of a 12 year old girl during halothane anesthesia induction and the cardiac and pulmonary resuscitation was succeeded promptly. But the hypotensive period persted for few minutes before the diagnosis was made. The condition of the patient after the resuscitation was good except that her unconsciousness state persisted unusually. The proposed appendectomy performed uneventfully and the anesthesia recovery of the patient was carefully observed in our I.C.U. The uncoscious state lasted for 2 days with agitated movements of legs, EEG showed abnormal, irregular patterns but showed no signs of damage of gobus pallidum and putamen. During the first month, the order of recovery of cerebral function was comatous state, swallowing, eating, and urination. The cerebellar dysunction was prominent. Then recovery of amnesia and defection followed. Speech and gate started to regain in the 26 and 36 post-operative day respectively. Writing function started recover quickly with the recovery of speech function, which occurred in 4 to 6 post-operative months. Recovery of intelligence was slowest and gradually reached to the intelligent level of 11 year old child in one year. It was found the primitive function recovered first and the highly cultivated function recovered last.
Amnesia ; Anesthesia* ; Appendectomy ; Brain* ; Child ; Deglutition ; Diagnosis ; Dihydroergotamine ; Eating ; Electroencephalography ; Female ; Halothane ; Heart Arrest* ; Humans ; Hypoxia, Brain ; Intelligence ; Leg ; Putamen ; Resuscitation ; Unconsciousness ; Urination ; Writing

Aspiration of gastric content is always a threat in emergency operations. The consequences of pulmonary aspiration are connected with both the volume and the character of the material inhaled, but perhaps the most serious consequences result from the relative acidity of gastric secretions. Inhalation of materiaI with a pH less than 2.5 causes an immediate iatense bronchoconstriction, epithelial degeneration of the bronchi, pulmonary edema and hemorrhage. Once the aspiration of material from the stomach is thought to have occurred, the airway should be cleared as soon as possible and any aspirated material remaining in the oropharynx should be cleared by means of suction. This experimental study was carried out to assess the therapeutic effect of suction on pulmonary aspiration of hydrochloric acid and the changes in chest X-ray findings caused by aspiration of the acid. The condition of oxygenation of the animals were studied by blood gas analysis. In this experiment,24 rabbits weighing 1.8-2.2 kg were used and divided into 4 groups each group consisting of 6 rabbits. Group I: No suction after aspiration Group II: Immediate suction after aspiration Group III: Suction 5 seconds after aspiration Group IV: Suction 10 secoads after aspiration Each of the four groups in the state prior to aspiration served as a control. All experimental animals were anesthetized by intravenous injection of ketamine 75 mg/kg and HC1 (pH: l.0, 2 ml/kg) was instilled into the trachea through a tracheostomy tube while the animals were fixed in a head-up position. Suction was made 5 times vigorously through a tracheostomy tube using an electric suction apparatus in the suction groups. Spontaneous respiration was maintained in room air throughout the experiment. To see cehange in the findings of the lung, chest X-ray was taken 24 hours after the aspiration of HCL. The sample of arterial blood was taken from the femoral artery and analyzed for blood gas 5 minutes, 10 minutes, 30 minutes, 1 hour and 2 hours after the aspiration of HCl. The results were as follows:1) In all rabbits except one in group II, the findings of radioopacity was visible in the lungs 24 hours after the aspiration of HCL. 2) In the chest X-ray findings, group I revealed radioopacity in the area of 74.76+/-8.93% of the whole lung field, group II in the area of 9.13+/-5.84%, group III in the area of 40.67+/-15.89% and group IV in the area of 58.96+/-6.65%. 3) In blood gas analysis, PaO2 decreased to 52.2% of control at 5 minutes in all aspiration groups (P<0.01) and 2 hours later, the recovery of PaO2 values observed were 73.2% of the control in group I, 88.7% in group II, 82.7% in group II and 77.1% in group IV, The value of the PaCO2, was significantly decreased at 10 minutes, 30 minutes, 1 hour and 2 hours in group II(P<0.01) after aspiration but in the other groups, the changes were insignificant. The value of pH shown insignificant decrease in group I and group IV, and insignificant increase in group II and group III. From the above findings, the pulmonary changes after the aspiration of hydrochloric acid seemed not to be lessened by suction treatment after 10 seconds following aspiration of the acid.
Animals ; Blood Gas Analysis ; Bronchi ; Bronchoconstriction ; Emergencies ; Femoral Artery ; Hemorrhage ; Hydrochloric Acid ; Hydrogen-Ion Concentration ; Inhalation ; Injections, Intravenous ; Ketamine ; Lung ; Oropharynx ; Oxygen ; Pulmonary Edema ; Rabbits* ; Respiration ; Stomach ; Suction* ; Thorax ; Trachea ; Tracheostomy

This is a case report of pulmonary embolism which occurred as a complication of mesenteric venous stasis with sepais. This 49 year old nun was operated upon for an obstructed intestine under general anesthesia with halothane and d-tubocurarine. She had a hystrectomy for myoma 2 years ago and has ailed for 6 days from this condition. The patient became dyspneic and cyanotic suddenly three hours after the surgery. The chest X-ray revealed three or four bilateral, rounded and moderately increased densities, and her ECG showed a large S wave in limb leads, P-pulmonare, and right ventricular strain pattern with right axis deviation. CPPV with 100% oxygen by the manual method improved the condition of the patient for about three hours, but tachycardia and a failing heart could not be corrected in site of digitalis, steroid, diuretics and heparinization. The patient died 11 hours after the operation.
Anesthesia, General ; Digitalis ; Diuretics ; Electrocardiography ; Extremities ; Halothane ; Heart ; Heparin ; Humans ; Intestinal Obstruction* ; Intestines ; Methods ; Myoma ; Nuns ; Oxygen ; Pulmonary Embolism* ; Tachycardia ; Thorax ; Tubocurarine