A 52 year old female patient was operated under the diagnosis of stomach cancer. She was very obese; her body weight and height were 95.5 kg and 161.5 cm, respectively. Radical subtotal gastrectomy was performed and the operation time was 4 hour and 40 minutes. The day following surgery, signs of right radial nerve palsy including wrist drop were noted. Neurologic examination revealed O-l/5 power of the wrist and finger extensor muscles of the right arm with reduced sensation in the radial aspects of the dorsum of the hand. The electromyography & nerve conduction test revealed incomplete right radial nerve injury above elbow level. During surgery, the patient was in the supine position, the right arm fully adducted to the lateral side of the trunk, and the left arm was 90 degree abducted from the trunk. The blood pressure cuff had been applied to the right upper arm and automated sequential blood pressure measurements performed every 5 minutes during the operation. Thirty minutes into the procedure, a Kent retractor had been applied, the side frame of which contacted the patients right upper arm. We hypothesize that firm pressure from the retractor frame against radial nerve where it passes superficially in the upper arm was responsible for the injury. No abnormalities in function of the automatic cuff were discovered. The patient was discharged 19 days after operation with partial recovery of the radial nerve palsy. Two months later the radial nerve palsy had completly resolved.
Arm ; Blood Pressure ; Body Weight ; Diagnosis ; Elbow ; Electromyography ; Female ; Fingers ; Gastrectomy ; Hand ; Humans ; Hypesthesia ; Middle Aged ; Muscles ; Neural Conduction ; Neurologic Examination ; Paralysis* ; Radial Nerve* ; Stomach Neoplasms ; Supine Position ; Wrist

Hydroxyzine hydrochloride, a minor tranquilizer and a ataratic, was tested clinically for effectiveness as a premedicant separate dosages of 1 and 2 mg/kg. Each 30 patients were in the physical status class 1 and 2 by A.S.A. classification, and the age distribution was from 20 to 60 years. The following results were obtained. 1) Emotionally calm response was seen in 70% in the hydroxyzine 1 mg/kg (group 1), and in 93.3%, in the 2 mg/kg (group 2). 2) Mental alertness was seen in 86. 6% in group 1, and in 66. 6% in group 2. 3) Complications after premedication were chilling and shivering, hypertension, nausea, and headache, and were not serious. Therefore this premedication was satisfactory in most cases, especially in group 2.
Age Distribution ; Classification ; Headache ; Humans ; Hydroxyzine* ; Hypertension ; Nausea ; Premedication ; Shivering

Dose-related depression of left ventricular function or cardiac output has been reported in humans and in vivo animal studies with sevoflurane (SEVO) anesthesia and myocardial depressant effect of SEVO appeared to be comparable to that produced by isoflurane (ISO). This study was designed to determine the mechanical and electrophysiologic mechanism of the direct negative inotropic effects of SEVO. The effects of SEVO were comprared to those produced by equipotent concentration of ISO in the same isolated myocardial preparations. Isometric force of isolated guinea pig ventricular papillary muscle was studied in normal and 26 mM K+ Tyrode's solution. Rat papillary muscle was also used to evaluate the effect on Ca2+ release from the sarcoplasmic reticulum (SR) at low stimulation rates. Muscles were bathed at 36-37 degrees C in normal K Tyrode's solution bubbled with 95% O2/ 5% CO2 (pH 7.4) and were electrically stimulated following rest and at rates up to 3 Hz. Normal and slow action potentials were evaluated by using conventional microelectrodes. Muscles were also subjected to rapid cooling (from 37 degrees C to 2 degrees C) in order to elicit a transient rapid cooling contracture (RCC) known to be activatel by Ca2+ content released from the SR. RCCs were elicited after 2 Hz stimulation, which produced an RCC tension similar to that of the preceding contraction in control. SEVO and ISO were administered by dial setting in each vaporizer at 1.7 (1 MAC) and 3.4% (2 MAC), and 1.15 (1 MAC) and 2.3% (2 MAC), respectively. 20% and 40% depression of contractility was shown at 1.7 and 3.4% concentration of SEVO and the extent of depression was similar to equipotent concentration of ISO from rested state up to 3Hz stimulation rates. 1 and 2 MAC concentrations of SEVO (1.7 and 3.4%) or ISO (1.15% and 2.3%) in normal K+ Tyrode's solution caused dose-related depression of peak force at low stimulation rates (RS, 0.1, and 0.5 Hz). Although the normal action potential (AP) amplitude or Vmax were not changed, APD50 and APD90 were prolonged characteristically at 2 MAC of both anesthetics. Whereas no contractile depression was shown at RS and 0.1 Hz stimulation rates in rat papillary muscles, significant depression was noted from 0.5 to 3 Hz in 3.4% SEVO or 2.3% ISO. In the partially depolarized (26 mM K+ Tyrode's solution) beta-adrenergically stimulated myocardium, 2 MAC concentration of both anesthetics caused selective depression of late peak in the biphasic contraction without changing early peak. In slow AP, 3.4% SEVO or 2.3% ISO did not cause any change in AP amplitude and Vmax whereas APD50 and APD90 were prolonged as in Normal APs. Rapid cooling preceded by 15 min rest showed little contractile force and marked prolongation of the time to peak contracture with almost complete absence of contracture after 2Hz stimulation rates following 3.4% SEVO or 2.3% ISO. Although complete recovery of peak force could be observed, little restoration of RCC was shown after washout for 15 minutes at 2 MAC concentration of both anesthetics characteristically. The effect of SEVO on isolated myocardial contraction was similar to that of ISO. While neither anesthetic depressed the rapid initial Ca+ release from the SR, the depression of RCC and late tension suggest an alteration in some SR pathway. The direct myocardial depressant effects of SEVO and ISO are likely to be related to depressed Ca2+ influx through the cardiac memebrane, while AP prolongation may be due to actions on K+ currents.
Action Potentials ; Anesthesia ; Anesthetics ; Animals ; Baths ; Cardiac Output ; Contracture ; Depression ; Guinea Pigs ; Humans ; Isoflurane* ; Microelectrodes ; Muscles ; Myocardial Contraction ; Myocardium ; Nebulizers and Vaporizers ; Papillary Muscles ; Rats ; Sarcoplasmic Reticulum ; Ventricular Function, Left

This study was undertaken to determine the effect on blood gas determinations of an incomplete purging of the heparinized flush solution from an indwelling arterial catheter and pressure tubing. Arterial blood gases were measured serially after withdrawing 2,4,6,8,10, and 12 ml of flush-blood solution from a 20-gauge radial artery catheter which was connected to one of two kinds of pressure tubing (4-ft and 6-ft Cobe pressure lines). In those samples from the 4-ft Cobe pressure tubing the pH was nearly unchanged in samples 2 thru 6, while the PaCO2, PaO2, actual bicarbonate, and base excess remained approximately constant in samples 3 thru 6. The results of samples taken from the 6-ft tubing were that the pH remained unchanged from samples 3 to 6, and PaCO2, actual bicarbonate, and base excess remained the same from samples 4 onward. PaO2 was unchanged in all sample. In conclusion we suggest that at least 4 ml of blood from a 4-ft Cobe pressure tubing and 6 ml from a 6-ft tubing should be withdrawn prior to arterial blood gas measurements.
Arm/blood supply ; Arteries ; Blood Gas Analysis/instrumentation* ; Catheters, Indwelling* ; Female ; Human ; Male ; Middle Age

Although heparin solution is widely used as an anticoagulant in blood gas analysis, alterations in blood gas measurements may occur when small sample volumes are diluted by heparin. Cook pressure tubing for infants and children and Gould pressure line for adults were applied to each of 10 adult patients whose cardiovascular fuction was normal. Arterial blood gases were measured serially after withdrawing 2,4,6,8,10 and 12 ml of flus-blood solutions from the Gould pressure connecting tubing, and 1,2,3,4,5 and 6 ml from the Cook pressure line, which were connected to a transducer through a 3way stopcock. In the Gould pressure tubing, the pH was unchanged from sample 2 and PaCO2, HCO3- and base excess were unchanged from sample 3. PaO2 did not change between the samples. In the Cook pressure line, the pH and base excess were unchanged from sample 2 and PaCO2, HCO3- and PaO2 from sample 3. We conclude that arterial blood should be withdrawn in volumes of at least 4ml by the Gould pressure connecting tubing and 3ml by the Cook pressure line to obtaine accurate results in blood gas analysis.
Adult ; Blood Gas Analysis ; Child ; Gases ; Heparin ; Humans ; Hydrogen-Ion Concentration ; Infant ; Transducers

Epidural anesthesia was given to a 72-year-old female patient suffering from cholecystitis due to multiple gallstones, and chronic bronchial asthma. In the course of the procedure we inserted an epidural catheter (Deseret catheter with a plastic stylet) via a 17G Tuohy needle at the L1-2 intervertebral space. Since it was very difficult to insert the catheter through the Tuohy needle, we pushed it forward applying a considerable amount of force. Following the insertion of the catheter and prior to injection of a test dose of local anesthetic, it was found-that cerebrospinal fluid was flowing out through the catheter from a puncture of the dura. In a second attempt, we approached another intervertebral space, this time with a Portex catheter without a stylet, and succeeded in administering the anesthetic by means of a continuous epidural procedure.
Aged ; Anesthesia, Epidural/adverse effects* ; Catheterization/adverse effects* ; Dura Mater/injuries* ; Female ; Human ; Plastics

Changes in serum potassium concentration following administration of succinylcholine (1.5mg/kg) were evaluated in 15 cases of donors and 20 cases of reciepients in kidney transplantation.There were no changes prior to and follwing administration of succinrlcho-line in serum potassium levels in the donors and recipients. Changes in serum potassium concentration were also eyaluated in livining-related recipients, in which the donor kidney was flushed with cold Ringer's lactate solution with the amount of about 750 ml. The mean vascular clamping time was 39.5+/-71.8 minutes. There were no difference between before clamping and following release of the vascular clamp in spite of the interruption of blood flow to the clamped leg. We suggest that succinylcholine in this dose is not contraindicated in patients with chronic renal failure and in the living related recepients who received dornor kidnie which was flushed with Ringer's lactate solution and there is no risk of potassium elevation after relesaing vascular clamp.
Constriction ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Lactic Acid ; Leg ; Potassium* ; Succinylcholine* ; Tissue Donors

During the laparoscopic cholecystectomy, the ventilatory and hemodynamic changes could occur due to the peritoneal insufflation of CO2 as well as the position change. Various sults of the relationship between arterial and end-tidal PCO2 in different conditions have been reported. The authars studied to determine how closely end-tidal PCO2 reflects arterial PCO2 before, during, and after laparoscopic cholecystectomy. Peak inspiratory airway pressures, arterial blood pressures and heart rates were also measured simultaneously. Peritoneal insufflation of CO2 resulted in significant increase in peak inspiratory airway pressure and arterial blood pressure, but there were no significant changes in heart rates. Arterial and end-tidal PCO2 increased during laproscopy and, although there was no statistical significance in P(a-ET)CO2, P(a-ET)CO2 increased during laparoscopy and retumed to perinsufflation level after deflation of CO2. There was positive correlation between arterial and end-tidal PCO2 before CO2 insufflation, 10 minutes after CO2 insufflation and 10 minutes after deflation of CO2. However there was no correlation at 30 and 50 minutes after CO2 insufflation. These results suggested that the arterial PCO2 could not reflect end-tidal PCO2 exactly, and intermittent arterial blood gas studies should be warranted during laparoscopic cholecystectomy.
Arterial Pressure ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Hemodynamics ; Insufflation ; Laparoscopy

Pulmonary barotrauma is defined as an extra-alveolar gas from lung damage secondary to changes in intrathoracic pressure. Pneumothorax, pneumoperitoneum, pneumomediastinum and subcutaneous emphysema developed due to complete occlusion of the expiratory tube of the scavenging system. During controlled endotracheal ventilation of the lungs of a 22 year old woman undergoing thyroidectomy increased airway pressure about 50 mbar on the airway pressure gauge approximately 8 minutes after starting ventilator was detected. Vital signs were stable. Subcutaneous emphysema around the neck, face and both shoulders were observed. The expiratory tubing was found to be trapped and competely obstructed between the upper and lower parts of the ventilator. The operation was cancelled and chest x-ray was taken in the operating room, which showed about 15% pneumothorax on the right chest, subcutaneous emphysema and pneumomediastinum. The follow up chest x-ray was taken in postanesthesia care unit and pneumoperitoneum was also detected on the right upper side of the abdomen. The signs of rupture of the abdominal viscus were not noted. She recovered uneventfully with insufflation of 100% oxygen and discharged 3 days later with complete spontaneous resorption of the pneumothorax.
Abdomen ; Anesthesia* ; Barotrauma ; Female ; Follow-Up Studies ; Humans ; Insufflation ; Lung ; Mediastinal Emphysema ; Neck ; Operating Rooms ; Oxygen ; Pneumoperitoneum* ; Pneumothorax* ; Rupture ; Shoulder ; Subcutaneous Emphysema ; Thorax ; Thyroidectomy ; Ventilation ; Ventilators, Mechanical ; Vital Signs ; Young Adult

BACKGROUND: Methylmethacrylate monomer (MMA) bone cement has been associated with sudden systemic hypotension. The present study was aimed to explore the mechanism of direct myocardial depressant actions of MMA. METHODS: The isometric contraction of isolated guinea pig's right ventricular papillary muscle was measured. Normal and slow action potentials were evaluated by a conventional micro-electrode technique. The effects of MMA on sarcoplasmic reticulum (SR) function were evaluated by its effect on: rapid cooling contractures, rested state contraction of rat papillary muscle in normal Tyrode's solution and of guinea pig's papillary muscle in low Na+ Tyrode's solution. To measure the inward calcium currents (ICa), whole cell patch clamp techniques were applied. RESULTS: MMA caused a dose-dependent depression of the peak force (PF) and maximal rate of peak force (dF/dt-max). About a 30% depression of PF was shown at rested state (RS) contraction in rat myocardium and under low Na+ Tyrode's solution in guinea pig myocardium, respectively. In the 26 mM K+ Tyrode's solution, MMA caused dose-dependent depression of late force development without alteration in early force development. MMA depressed rapid cooling contracture accompanied by prolongation of time to peak contracture. MMA did not alter the amplitude or maximum depolarization rate of normal and slow action potentials. Action potential durations were significantly reduced. In patch clamp studies, MMA reduced ICa in a dose-dependent manner. CONCLUSIONS: MMA depressed cardiac contractility in a dose-dependent manner and may be partly related to the depression of Ca2+ influx through the cardiac membrane. SR Ca2+ release seems to be mildly inhibited by MMA. Based on common clinical concentrations, the direct myocardial depressant effect of MMA may not be a main cause of hypotension during an operation.
Action Potentials ; Animals ; Calcium ; Contracture ; Depression ; Guinea ; Guinea Pigs ; Hypotension ; Isometric Contraction ; Membranes ; Methylmethacrylate* ; Myocardium ; Papillary Muscles ; Patch-Clamp Techniques ; Rats ; Sarcoplasmic Reticulum