The liver function during operation is influenced by several factors. These factors include preoperative condition of the patient, site and durstion of the operation, operation per se. and anesthetic agents. Recently, there have been many controversies about hepatic dysfunction of the halogenated inhalation: anesthetics. This study was done to evaluate the hepatic dysfuncson by comparison of pre-and: postoperative liver dysfunction in randomized selection of 127 cases arnong 495 elective operations. As results, 1) There was increased tendency of post-operative 48 hour s-GOT in balanced anesthesia group. 2) After prolonged operation, there was more tendency of marked elevation of LFT values. 3) The elevation of s-GOT was also noted in adult low-weighted person. 4) In the cases of intraabdominal operation, changes of LFT were more prominent than the operation of the other site. 5) Choice of anesthetic agent alone is not enough to prevent hepatic dysfunction during operation.
Adult ; Anesthesia, General* ; Anesthetics ; Balanced Anesthesia ; Humans ; Inhalation ; Liver Diseases ; Liver*

BACKGROUND: Pulse transit time (PTT), the time it takes a pulse wave to travel from one arterial site to another, is a noninvasive indicator of arterial stiffness. The main objective of our study was to compare two common anesthetic techniques using PTT in order to explore which technique would bring more vascular distention. METHODS: Sixty female patients, ages 18-65, classified by ASA 1 or 2 undergoing general anesthesia, were randomly allocated into two groups, S and P. Group S (n = 30) was inducted with 2 mg/kg of propofol and remifentanil 5.0 ng/ml. Group P (n = 30) was inducted with propofol 4.0 ug/ml and remifentanil 4.0 ng/ml using a target controlled infusion (TCI) pump. Group S was anesthetically maintained with sevoflurane at 1.0 MAC and 1.0 ng/ml remifentanil while group P was anesthetically maintained with propofol 3.0 ug/ml and remifentanil 1.0 ng/ml for 10 minutes. PTT values were obtained by measuring the distance between the electrocardiographic R wave, which approximates the opening of the aortic valve, to the radial artery. Three consecutive values of prePTT, postPTT, and corresponding vital signs were measured and recorded before and 10 minutes after anesthetic induction. RESULTS: PrePTT in group S and group P was 240.18 +/- 3.66 and 239.32 +/- 3.69 ms, respectively. Ten minutes after anesthetic induction, postPTT in group S increased to 284.16 +/- 4.37 ms while postPTT in group P increased to 278.7 +/- 4.53 ms (P > 0.05). However, despite the slope of group S (43.98 +/- 22.18) being greater than group P (39.38 +/- 18.39), the difference between the two groups was statistically insignificant (P = 0.2239). CONCLUSIONS: Changes in PTT values were statistically insignificant regarding arterial distension in patients anesthetized with target controlled infusion of propofol compared to those with balanced anesthesia with sevoflurane.
Anesthesia, General ; Aortic Valve ; Balanced Anesthesia ; Electrocardiography ; Female ; Humans ; Inhalation* ; Propofol* ; Pulse Wave Analysis* ; Radial Artery ; Ultrasonography ; Vascular Stiffness ; Vital Signs

A clinical observation was made randomely selected 30 of 78 cases of balanced anesthesia consist of Demerol, Valium and N2O-O2, inhalation, performed from January to March 1980 at Eul-Ji General Hospital, Seoul, Korea. After pre-oxygenation, all cases received 5 mg of d-Tubocurarine, 5 mg/Kg of thiopental sodium, orotracheal intubation was facilitated with l.5 mg/kg of succinylcboline chloride intravenously and N2O-O2, (2:1 L/min) inhalation was carried out with semiclosed circle absorber system and 1 mg/kg of Demerol and 0. 2 mg/kg of Valium were intermittently injected intravenously. 0.04 mg/kg of pancuronium bromide, 0.4 mg/kg of succinylcholine chloride intravenously or 0.1% succinylcholine chloride by way of dripping was given and maintained controlled respiration. The following results were observed; 1) Systolic blood pressure was decreased 6. 5% at 5 minutes following anesthesia initiated, and maintained initial pressure at 30 minutes, at the end of anesthesia, and in recovery room. 2) Diastolic blood pressure was increased 4. 5% at 5 minutes, 7. 9% at 30 minutes following anesthesia initiated, however maintained the pressure at the end of anesthesia and in recovery room. 3) Pulse rates were maintained 5 minutes. 3.7% increased 30 minutes following anesthesia was initiated, maintained same rates at the end of anesthesia and in the recovery room. 4) 26% of anesthetized patients required narcotics for pain up to 4 hours of staying recovery room. 5) Jerking movement and psychosis were not observed following anesthesia. 6) Respiratory assistance and antidotes were not needed for all patients.
Anesthesia ; Antidotes ; Balanced Anesthesia* ; Blood Pressure ; Diazepam* ; Heart Rate ; Hospitals, General ; Humans ; Inhalation ; Intubation ; Korea ; Meperidine* ; Narcotics ; Pancuronium ; Psychotic Disorders ; Recovery Room ; Respiration ; Seoul ; Succinylcholine ; Thiopental ; Tubocurarine

Maintenance of optimum blood sugar level is a basic factor in energy metabolism and maintenance of cell function. Insulin and glucagon are the important factors in blood sugar control. The surgical stress increases the secretion of catecholamine, glucocorticoid and induces hyperglycemia. These hormones inhibit glucose-induced insulin secretion. Inhalation anesthesia affect the carbohydrate metabolism by reducing glucose-induced insulinogenic response and inhibiting the insulin secretion from the pancreas. Diazepam and muscle relaxant used in balanced anesthesia do not significantly affect blood glucose level. Methylprednisolone has an important role in maintenance of homesostasis of body function and is often used in surgical anesthesia. When large dose of methylprednisolone is administered to a normal person, fasting blood increases and glucose tolerance decreases. These factors may aggravate the symptoms of diabetic patients. We measured blood sugar level, systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate after administration of methylprednisolone. The results were as follows: 1) Blood sugar leve increased significantly in all groups after induction of anesthesia, and the increase was greater in methylpredinsolone group and halothane anesthesia group. 2) Systolic blood pressure increased significantly and more in methylprednisolone group in balanced anesthesia. In halothane anesthesia group, systolic blood pressure decreased, but recovered in methylprednisolone group, 2 hours after anesthesia. 3) The changes in mean and diastolic blood pressure were similar to the changes in systolic blood pressure in all groups. 4) The changes in heart rate in methylprednisolone group was less than other groups.
Anesthesia ; Anesthesia, General* ; Anesthesia, Inhalation ; Arterial Pressure ; Balanced Anesthesia ; Blood Glucose* ; Blood Pressure* ; Carbohydrate Metabolism ; Diazepam ; Energy Metabolism ; Fasting ; Glucagon ; Glucose ; Halothane ; Heart Rate* ; Heart* ; Humans ; Hyperglycemia ; Insulin ; Methylprednisolone ; Pancreas

A number of reports have documented that air-filled cavities in the body will expand if the gas within the space is less soluble in blood than the gas respired. Since an air inflated endotracheal tube cuff within the trachea represents an air-filled body cavity the intracuff gas volume and pressure may be altered during general Inhalation anesthesia. This study was conducted to determine the degree of intracuff pressure and volume changes during general anesthesia. The results were as follows; 1) Twenty three patients, ranging in age from 17 to 73 years, in ASA physical status class 1.ll were reviewed. There were 9 male and 14 females with 19 cases from the general surgical department and 4 from the gynecological department. 2) The duration. of annesthesia ranged was from 120 to 205.7m minutes. 3) Significant intracuff pressure changes develeped in Groups IA and IB (p <7.75), and a significant difference was noted between group 1 and 2. 4) Intracuff gas volume was increased in Groups IA (50% 02, 50% N27) and 1B (33.3% 02, 66.7%N20) with a p value<7.05, but a singificiant time sequential intracuff pressure difference was not observed between the two groups.
Anesthesia, General ; Anesthesia, Inhalation* ; Female ; Humans ; Inhalation* ; Male ; Trachea

Anesthesia for Cesarean Section entails many considerations not pertinent to surgical patients. The anesthesiologist is required to provide anesthesia for mother and fetus simultaneously and to perform emergency anesthesia in high risk paturients with no preoperative evaluation. Variable phrsiologic changes in pregnancy in the cardiovascular, respiratory, gastro-intestinal and renal systems entrance the uptake of anesthetic gases and in the apneic status, PaO2 decreases significantly. During general anesthesia, maternal hypoxia, hyperventilation, aortocaval compression of the enlarged uterus and prolonged induction-delivery time may contribute to circulatory changes which may result in fetal hypoxia and acidosis Kalapa et at (1971) and Gibbs (1981) reported that balanced anesthesia is safe for Cesarean section as long as the time from induction to delivery (IDT) is not prolonged. Maternal arterial blood gases after induction and delivery and fetal umbilical arterial and venous blood gases were measured in 30 paturients under going Cesarean section with thiopental-SCC-N2O-O2 anesthesia (general balanced anesthesia). The relationship between IDT and the apgar score was also studied. The results were as follows : 1) Analysis of tole Paturients arterial blood gases after induction arid after delivery, had no statistical significance. 2) Blood gas analysis from the umbilical of the fetus was pH 7.36 +/- 7.04, PCO2 39.8 +/-3.7 torr, PO2 36.8+/-3.4 torr, BE -2.8+/-0.7 mEq/l and oxygen saturation was 72.2+/-5.8%. Umbilical arterial blood from the fetus was 7.31+/-0.03, PCO2 49.1+/-4.8 torr, PO2 25.9+/-4.7 torr, BE -2.6+/-0.6 mEq/I and oxygen saturation was 36.2+/-3.4%. 3) The results of blood gas tension and acid-base status of the paturient according to IDT were not Statistically Significant in any group- 4) The results of' the apgar score according to IDT indicated that the 1 minute apgar score was statistically singinificant but not clinically the 5 minute appear score was not statistically significant.
Acidosis ; Anesthesia ; Anesthesia, General* ; Anesthetics, Inhalation ; Anoxia ; Apgar Score ; Balanced Anesthesia ; Blood Gas Analysis ; Cesarean Section* ; Emergencies ; Female ; Fetal Hypoxia ; Fetus* ; Gases ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Mothers ; Oxygen ; Pregnancy ; Uterus

BACKGROUND: Sevoflurane anesthesia may show emergence agitation and delirium in children, compared to other inhalation agents. Therefore, we studied the effect of low dose sevoflurane on recovery time and emergence agitation in children. METHODS: We studied 50 patients who were planned for surgery under general anesthesia, aged between 2 and 8 years. They were randomly divided into two groups. Patients of group S were anesthetized with sevoflurane 2.5-3 vol%, whereas those of group R were given sevoflurane 1.2-1.5 vol% and continuous intravenous infusion of remifentanil 0.1-0.2microgram/kg/min. All patients received N2O:O2 50:50 during maintenance of anesthesia. After the surgery, the anesthesiologist recorded recovery time and determined agitation score using 5-point scoring scale in both groups. Agitation score, incidence of emergence agitation and recovery time were compared with each other between the two groups. RESULTS: The agitation scores were 2.72 +/- 0.98 and 2.64 +/- 0.95 in S and R groups, respectively, showing statistical insignificance. The incidence of emergence agitation score 4 or 5 was not significantly different, either. The recovery time was statistically shorter in R group (P<0.05). CONCLUSIONS: Compared with sevoflurane inhalation anesthesia alone, the use of sevoflurane and remifentanil in combination provided shorter recovery time, but no effect on emergence agitation.
Anesthesia* ; Anesthesia, General ; Anesthesia, Inhalation ; Child* ; Delirium ; Dihydroergotamine* ; Humans ; Incidence ; Infusions, Intravenous ; Inhalation

Pulmonary atelectasis is a common complication following surgery under general anesthesia. However, collapse during anesthesia and surgery is rare, and usually is not diagnosed until the surgical procedure is well under way. Total or segmental lung collapses are usually resulted from the obstruction of bronchial pathway by secretions such as mucus, blood and pus etc. We experienced acute lung collapse of right upper lobe during left thoracotomy. We assumed that the cause of the atelectasis was an obstruction of right superior lobar bronchus by mucus. The possible cause of lung collapse is described.
Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation* ; Bronchi ; Inhalation* ; Lung ; Mucus ; Pulmonary Atelectasis* ; Suppuration ; Thoracotomy*

BACKGROUND: Using rotational thromboelastometry (ROTEM) analysis, we investigated the difference in blood hemostasis, based on the primary anesthetic agents used during general anesthesia. METHODS: Sixty-six adult patients scheduled for elective ophthalmic surgery under general anesthesia were evaluated with regard to changes in each parameter in INTEM, EXTEM, and FIBTEM analyses. The patients received intravenous anesthesia with propofol and remifentanil (TIVA group) or inhalation anesthesia with sevoflurane (SEVO group). The ROTEM tests were performed 10 min before starting anesthesia and 1 h after finishing anesthesia. The INTEM and EXTEM analyses included the clotting time (CT), clot firmness time (CFT), alpha angle (alpha), and maximum clot firmness (MCF). The FIBTEM analyzed only MCF. Maximum clot elasticity (MCE) was calculated by (MCF x 100) / (100 - MCF). The platelet component of clot strength was calculated as follows: MCE(platelet) = MCE(EXTEM) - MCE(FIBTEM). RESULTS: The preoperative and postoperative parameters (CT, CFT, alpha, and MCF) in the INTEM, EXTEM, and FIBTEM analyses were not significantly different between the two groups. The MCE(platelet) also did not show a significant difference. CONCLUSIONS: Presuming that the ophthalmic surgery had a minimal traumatic effect, we conclude that both anesthetic agents cause negligible changes in ROTEM analyses postoperatively.
Adult ; Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Anesthetics ; Blood Platelets ; Elasticity ; Hemostasis* ; Humans ; Propofol* ; Thrombelastography

A case of a congenital diaphragmatic hernia was operated upon at our hospital employing a combination of light general anesthesia and epidural block, with effective results and post-operative analgesia. Cases with congenital anomalies, prematurity and neonatal respiratory distress syndrome(RDS) are at great risk during general anesthesia. To insure a good ariway and to prevent aspiration of stomach contents, tracheal intubation was done and light general anesthesia(N2-O2) administered. Unver this state candal block was done. By this method, good abdominal relaxation was obtained and the amount of inhalation anesthetics could be reduced. The author believe that in this group of patients, epidural block in combination with light general anesthesia is a good and safe method of administering anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Anesthetics, Inhalation ; Gastrointestinal Contents ; Hernia* ; Hernia, Diaphragmatic ; Humans ; Intubation ; Relaxation