Since succinyl choline was introduced, into clinical anesthesia, it has been used as main muscle relaxant because of its rare side effects and short duration of action. Our interest in the effects of this drug on extraocular muscles and intraocular pressure began in 1957 following reports of vitreous expulsion in patients who received succinylcholine during ocular surgery. The effects of muscle relaxants on the intraocular pressure were studied in 60 healthy human subjects. When succinylcholine was given alone, 20 human subjects had a mean increase in intraocular pressure of 10. 5 mmHg. When gallamine 2. 5 mg/kg or pancuronium 80 ug/kg was used, 20 subjects showed a mean decrease of 3. 1 mm Hg from control. Giving gallamine (20 mg) or dtubo curarine(3 mg) 2-3 minutes prior to the administration of succinylcholine, 20 human subjects had no significant change in intraocular pressure. This simple method prevents the increase in intraocular pressure associated with the use of succinylcholine.
Anesthesia ; Choline ; Gallamine Triethiodide ; Humans ; Intraocular Pressure* ; Methods ; Muscles ; Pancuronium ; Succinylcholine

Cardiac arrhythmias were produced in the dog by the injection of epinephrine during the inhalation of 26 per cent cyclopropane in oxygen. Cardiac arrhythmias were usually associated with a rise in arterial pressure, but they were also seen with no change or decrease in blood pressure. The beta adrenergic blocking agent propranolol (0.3 mg/kg) caused transient but significant decrease in blood pressure and heart rate, increased the pressor response to epinephrine, abolished or diminished the tachycardia following epinephrine, and ccnsistentiy increased the arrhythmia threshold dose of epinephrine to 12 times that of control. Lidocaine (1.0 mg/kg) did not significantly alter the blood pressure or heart rate, moderate the tachycardia following epinephrine, or consistently increase the arrhythmia threshold dose of epinephrine. From the available evidence together with the authors' it seems reasonable to conclude that the mode of antiarrhythmic action of propranolol differs from that of lidocaine and that the anesthetic-catecholamine cardiac arrhythmias are due to stimulation of beta adrenergic receptors.
Animals ; Arrhythmias, Cardiac* ; Arterial Pressure ; Blood Pressure ; Dogs ; Epinephrine ; Heart Rate ; Inhalation ; Lidocaine* ; Oxygen ; Propranolol* ; Receptors, Adrenergic, beta ; Tachycardia

During massive transfusions especially under pressure, considerable hemolysis has been expected. It had been assumed that hernolysis would increase with increasing age of the bank blood, increasing pressure and with decreasing bore of the needle. Moss and Stauntan, however, found that hemolysis actually increased when blood was forced through larger bore needles. The authors have studied the magnitude of hemolysis according to various needle sizes under ordinary clinical transfusion conditions, and concluded as follows: 1) Hemolysis was maximum when a 18G needle was used and minimum with use of a 22G. needle regardless of the age and temperature of the bank blood, 2) Hemolysis increased with increasing age of the bank blood. 3) When the needle size was constant, hemolysis was not affected by warming of the bank blood.
Clinical Study* ; Hemolysis* ; Needles

Laryngeal granuloma is a localized inframmatory response to mucosal loss caused by endolaryngeal trauma. Endotracheal intubation is the most common cause of laryngeal granuloma. Mucosal loss is followed by ulceration and infection and then by an overproduction of reactive granuloma tissue. Granuloma formation is most frequent on the posterior one third of the vocal cord. The authors experienced two cases of laryngeal granuloma after endotracheal intubation for general anesthesia.

A 6-year-old boy was anesthetized with halothane-N2O-O2 for anal fistulectomy. During induction of anesthesia, trismus developed soon after intravenous injection of S.C,C. and persisted for several minutes, associated with increased serum creatinine phosphokinase (C.P.K.) levels and elevated body temperature only up to 37. 8C (without hyperkalemia & myoglobinuria). The operation was postponed and uneventfully performed 4 days later with a normal limit of serum C.P.K. levels, under premedication by intramuscular injection of Valium(diazepam) and induction of anesthesia with halothane-Oplus intravenous injection of Valium for intubation, without any muscular rigidity or increased serum C.P.K. levels. Therefore the authors think there is a difference between this case and malignant hyperpyrexia following anesthesia, and also that the boy had a hyposensitivity predisposition to S.C.C. rather than halothane. Without accurate investigation for predisposition of muscular rigidity, We recommended Valium injection for premedication and induction of anesthesia for prevention of the muscular rigidity.
Anesthesia ; Body Temperature ; Child ; Creatinine ; Diazepam ; Halothane ; Humans ; Hyperkalemia ; Injections, Intramuscular ; Injections, Intravenous ; Intubation ; Male ; Malignant Hyperthermia ; Muscle Rigidity ; Premedication ; Succinylcholine* ; Trismus*

Vasopressor effects of epinephrine, norepinephrine, ephedrine, phenylephrine, methoxamine and of mephentermine were compared in resrpinized dogs with or without nitrous oxide-oxygen-halothane anesthesia. The results are as follows: (1) Epinephrine and norepinephrine were shown to have the most potent pressor effect in reserpinized and nitrous oxide-oxygen-halothane-anesthetized dogs. Phenylephrine, methoxamine, mephen-termine and ephedrine were less potent in decreasing order. (2) Decrease in mean arterial pressure was less marked in dogs reserpinized and anesthetized with nitrous oxide-oxygen-halothane than in reserpinized but unanesthetized dogs. (3) It revealed that nitrous oxide-oxygen-halothane anesthesia potentiated the vasopressor effects of the sympathomimetic amines studied. Nitrous oxide-oxygen-halothane anesthesia is implicated to exert an sympathomimetic effect.
Anesthesia* ; Animals ; Arterial Pressure ; Dogs* ; Ephedrine ; Epinephrine ; Mephentermine ; Methoxamine ; Norepinephrine ; Phenylephrine ; Sympathomimetics*

To determine the effects of hydrcxyethyl starch upon liver, kidney, serm electrolytes and particularly upon blood coagulation, 500 ml of 6% HES in saline solution was administered intravenously to 15 patients during elective minor surgery. In all cases weighted blood loss was less than 600 ml without replacement. The following laboratory tests were performed immediately before infusion and again 1 hour, 24 hours, 48 hours, and 1 week after the infusion: RBC, WBC, hemoglobin, hematocrit, ESR, platelet, bleeding time, coagulation time, prothrombin time, total protein, albumin, total bilirubin, direct bilirubin, SGOT, SGPT, alkaline phosphatase, BUN, sodium, potassium, and chloride. The results are as follows: 1) No anaphylactic shock or bleeding tendency characteristic of colloids was encountered. 2) No functional disturbance of liver or kidney directly attributable to HES was identified. 3) All laboratory parameters except WBC and ESR decreased after infusion. The decrease was, however, within the normal range and believed secondary to dilational effect of infusion. WBC increased somewhat, but returned to the preinfusion level in a week. 4) Exceptionally erythrocyte sedimentation rate increased notably during the 24 hour period following infusion. As with dextran, this was interpreted not due to direct effect of HES, but due to increased adsorption of fibrinogen, alpha-beta-gamma-glcbulin to red cell surface with changes in electric charge between red cells. 5) Clinical applicability, metabolic aspect, degree of subtitution of hydroxyethyl group and safety with multiple infusion of HES must be carefully determined.
Adsorption ; Alanine Transaminase ; Alkaline Phosphatase ; Anaphylaxis ; Aspartate Aminotransferases ; Bilirubin ; Bleeding Time ; Blood Coagulation ; Blood Platelets ; Blood Sedimentation ; Colloids ; Dextrans ; Electrolytes ; Fibrinogen ; Hematocrit ; Hemorrhage ; Humans ; Kidney ; Liver ; Potassium ; Prothrombin Time ; Reference Values ; Selective Estrogen Receptor Modulators ; Sodium ; Sodium Chloride ; Starch* ; Surgical Procedures, Minor

An anesthetic experience with right adrenalectomy for pheochromocytoma in a 24 year-old woman has been reported. Thiopental was used for induction followed by nitrous oxide-oxygen-fluothane supplemented with fractional doses of morphine for analgesia and succinylcholine (0.1 per cent intravenous drip) for muscular relaxation. An endotracheal semi-closed circle absorption technique with controlled ventilation was employed. The patient tolerated the ansthesia and surgery well with appropriate cardiovascular control using Regitine to suppress excessive hypertension and Levophed, whole blood and cortisone to combat hypotension after removal of the tumor. Importance of preoperative preparation, sufficient sedation, smooth induction, complete analgesia, good muscular relaxation, adequate alveoiar ventilation and proper cardiovascular control has been stressed and discussed together with the choice of anesthetic agent and technique.
Absorption ; Adrenalectomy ; Analgesia ; Cortisone ; Female ; Humans ; Hypertension ; Hypotension ; Morphine ; Norepinephrine ; Phentolamine ; Pheochromocytoma ; Relaxation ; Succinylcholine ; Thiopental ; Ventilation ; Young Adult

While halothane, cyclopropane, chloroform and trichloroethylene have been clearly implicated to sensitize the myocardum and increase the risk of ventricular fibrillation, newer inhalation anesthetics have shown relatively less arrhythmogenecity. Isoflurane has been suggested to be compatible with epinephrine, while controversial data suggest enflurane, an isomer of isoflurane, may or may not sensitize the myocardium, which is to be clarified by the authors study. By constant intravenous infusion using VIP pump at the rate of 2.5ug/kg/min, the dosage of epinephrine causing premature ventricular contractions was measured in ten male mongrel dogs during halothane and enflurane anesthesia. While premature ventricular contractions were observed in all dogs anesthetized with halothane, the cardiac arrhythythmia was seen in only two dogs anesthetized with enflurane. Epinephrine dosage causing premature ventricular contractions and the resultant increase in mean arterial pressure at which arrhythmias occurred were significantly higher(p< 0. 05) during enflurane anesthesia than durinh halothane anesthesiae. These results suggest that enflurane, in comparison with halothane, is relatively less arrhythmogenic.
Anesthesia* ; Anesthetics, Inhalation ; Animals ; Arrhythmias, Cardiac* ; Arterial Pressure ; Chloroform ; Dogs ; Enflurane* ; Epinephrine* ; Halothane* ; Humans ; Infusions, Intravenous ; Isoflurane ; Male ; Myocardium ; Trichloroethylene ; Ventricular Fibrillation ; Ventricular Premature Complexes

Anesthetic experience with thymectomies for two patients with myasthenia gravis has been reported. Both of them talerated the surgical procedures under endotracheal nitrous oxide-oxygen-halothane anesthesia well, but one of tbem expired from cholinergic crisis on the 3rd postoperative day. Chemical diagnosis of myasthenia gravis and the salient clinical features including choice of preanesthetic medication, anesthetic agents, techniques and of neuromuscular blocking agents for myasthenic patients have been discussed. Paramount importance of rigid attention to ventilation, the maintenance of a patent airway and the removal of secretions by bronchoscopy or tracheostomy whenever necessary for the patient safety throughout operative and postoperative period has been stressed. Frequent determinations of pulmonary function and the use of edrophonium test in avoiding cholinergic crisis are advocated.
Anesthesia ; Anesthetics ; Bronchoscopy ; Diagnosis ; Edrophonium ; Humans ; Myasthenia Gravis ; Neuromuscular Blocking Agents ; Patient Safety ; Postoperative Period ; Preanesthetic Medication ; Thymectomy ; Tracheostomy ; Ventilation