One-lung ventilation (anesthesia) has been indicated for certain intrathoracic surgery. However the recommended oxygen concentrations and ventilatory patterns have been variously reported. To clarify this, the author has investigate the effect of left lung collapse and right lung ventilation with relatively large, constant tidal volume of 100% oxygen on pulmonary homodyamic and shunt ratio in 10 mongrel dogs with their left main bronchi ligated and cut following thoracotomy under Pentothal anesthesia. The results are as follows: 1) Heart rate, mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure did not change significantly. 2) Mean pulmonary artery pressure and pulmonary vascular resistance increased significantly during one-lung ventilation. 3) Cardiac output decreased slightly, and alveolar-arterial oxygen tension difference and pulmonary shunt ratio increased significantly. However arterial oxygen and carbon dioxide tensions remained in the normal range. It is concluded that to maintain noramil arterial oxygen and carbon dioxide tensions during one-lung ventilation, it is mandatory to ventilate with relatively large, constant tidal volume of 100% oxygen and all measures and precautions should be exercised to maintain normal cardiac output.
Anesthesia ; Animals ; Arterial Pressure ; Bronchi ; Carbon Dioxide ; Cardiac Output ; Central Venous Pressure ; Dogs* ; Heart Rate ; Hemodynamics* ; Lung* ; One-Lung Ventilation* ; Oxygen ; Pulmonary Artery ; Pulmonary Atelectasis* ; Pulmonary Wedge Pressure ; Reference Values ; Thiopental ; Thoracotomy ; Tidal Volume ; Vascular Resistance ; Ventilation

In anesthetized normocapnic and normotensive dogs, the effect of arterial hypoxemia on cerebral blood flow and oxidative carbohydrate metabolism was studied. The results are as follows: 1) The hypoxic vasodilatory effect on cerevral vessels is intact even at profound systemic hypoxemia(Pao2 30 torr) if Paco2 is controlled within normal limits. 2) CMRO2 did not significantly increase above the normal even during profound arterial hopoxemis, indicating that CMRO2 levels are poor indices of hypoxia. 3) A disporportinately high glycolysis at Pao2 of 50 torr suggested early cerebral metabolic changes which became more marked with further decrease in Pao2. 4) One hour after restitution of normoxia, however, carebral blood flow and metabolism manifested complete recovery. 6) It is concluded that a transient(20 minutes) profoun systemic arterial hypoxemia does not produce prolonged disorder of cerebral blood flow and oxidative carbohydrate metabolism provided that the cerebral perfusion pressure is kept normal.
Animals ; Anoxia* ; Carbohydrate Metabolism ; Cerebrovascular Circulation* ; Dogs ; Glycolysis ; Metabolism*

The management of patient undergoing thoracic aortic surgical procedures represents a major challenge for the anesthesiologists. Aortic cross-clamping and unclamping are particularly hszardous during the- course of the thoracic aortic operation. Proximal hypertension, myocardial ischemia and arrhythmia have been reported to occur after application of the aortic cross-clampmg. Removal of the cross-clamp often results in severe hypotension with subsequent myocardial, cerebral and renal ischemia. In this case, the patient was managed successfully using Regitine drip during the cross-clamp and slow release of clamp during unclamp, combined with slight overhydration just before unclamp.
Aortic Aneurysm, Thoracic* ; Arrhythmias, Cardiac ; Humans ; Hypertension ; Hypotension ; Ischemia ; Myocardial Ischemia ; Phentolamine

The anesthetic experience in 20 years was evaluated by statistically analyzing the total of 17,595 cases which were performed at S.N.U.H. from 1960 through 1979 according to age, sex, anesthetic agents and methods. To simplify the analysis, the authors selected the anesthetic cases of 1960, 1965, 1970, 1975, and 1978. The results were as follows: 1) General anesthesia has been used with increasing frequencies and local anesthesia with decreasing frequencies during the period. 2) More than half of the totaI cases were performed for the patients in their second or third decades. 3) General surgery cases were the majority of the total. 4) The usage of halothane has been increased ever since its introduction into clinical anesthesia in this hospital. 5) For intravenous induction, thiopental has been used as the main agent, and succinylcholine and pancuronium as the major muscle relaxants since 1975. 6) For anesthetic technique, semiclosed circle absorption system has been employed in almost all cases, and non-rebreathing system has been used recently with increasing frequencies in pediatric anesthesia.
Absorption ; Anesthesia ; Anesthesia, General ; Anesthesia, Local ; Anesthetics ; Halothane ; Humans ; Pancuronium ; Succinylcholine ; Thiopental

Inhalation anesthetics, particularly the hydrocarbons and cyclopropane. lower the threshold to the arrhythmogenic activity of catecholamines. This interaction is of concern during the resection of a pheochromocytoma when the surgically-induced release of large amounts of norepinephrine and epinephrine from tumors sets the stage for ventricular arrhythmia by a direct effect on the myocardium together with an increase in blood pressure. In this communication, anesthesia was performed with N2,O-O2,-halothane. In addition patient was managed successfully, using d-tubocurarine, phentolamine (Regitine) and propranolol (Inderal). For the next same case, enflurane is recommended because of absence of flammability, arrhythmogenic activity and nephrotoxity. etc.
Anesthesia ; Anesthetics, Inhalation ; Arrhythmias, Cardiac ; Blood Pressure ; Catecholamines ; Enflurane ; Epinephrine ; Humans ; Hydrocarbons ; Myocardium ; Norepinephrine ; Phentolamine ; Pheochromocytoma* ; Propranolol ; Tubocurarine

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

One hundred patients, scheduled to receive operations under spinal anesthesia with tetracaine, were premedicated with haloperidol (Serenace, 0. 08mg/kg I.M.) or diasepam (0.3mg/hg LM.) and evaluated for effects of these premedicants in Seoul National University Hoapital. The results were as follows: 1) Haloperidol was superior to diaxepam in poetoperative antianxiety and analgesic effects. 2) Haloperidol and diasepam were equal in their antiemetic effects. 3) Both haloperidol (0. 04 mg/kg) and diaaepam (0. 1mg/kg) as an intravenous bolus were effective for sedation during operation. Patients given haIoperidol, however, were more cooperative to anesthesiologists and surgeons than were those given diazepam.
Anesthesia, Spinal ; Antiemetics ; Clinical Study* ; Diazepam* ; Haloperidol* ; Humans ; Seoul ; Surgeons ; Tetracaine

It is well known that undue pressure and prolonged use of tourniquets on an extremity can cause peripheral nerve palsy and vascular damage either from direct pressure or from acid metabolites accumulating in the tissues distal to the tourniquet applied. After release of a tourniquet that has been on for 2 hours, the acidotic changes in the limb take approximately half an hour to recover, and it has been suggested that two hours' ischemia should never be exceeded. The authors have conducted a study to clarify the effect of these acid metabolites on the systemic circulation upon release of tourniquet after 105 minutes (mean) use. In 12 orthopedic patients, 20~32 years of age, who underwent operations below the knee, anesthesia was induced by the intravenous thiopental-succinylcholine-endotracheal intubation sequence and maintained with nitrous oxide-oxygen-halothane in a semiclosed circle absorption system. Respiration was controlled throughout the procedure. Measurements of PO2, PCO2 and pH in the femoral vein and radial artery before inflation of a tourniquet and 15 minutes, 10 minutes, 20 minutes, and again 30 minutes were performed following the release of tourniquet. The results are as follows: 1) Femoral vein pH significantly decreased with concommitant increase in PCO2 reflecting severe metabolic acidcsis during the tourniquet time. 2) Femoral vein PO2 was significantly increased, suggesting the presence of A-V shunt in the extremity. 3) These changes continued to exist for approximately half an hour after release of tourniquet. 4) Analyses of radial arterial blood for PO2, PCO2 and pH revealed no significant changes throughout the study. 5) It is concluded that acid metabolites produced by tourniquet application do not seriously affect when tourniquet is released as long as the buffering capacity and blood volume are kept normal and the patient is kept alkalemic by controlled ventilation.
Absorption ; Anesthesia ; Blood Volume ; Extremities ; Femoral Vein ; Humans ; Hydrogen-Ion Concentration* ; Inflation, Economic ; Intubation ; Ischemia ; Knee ; Orthopedics ; Paralysis ; Peripheral Nerves ; Radial Artery ; Respiration ; Tourniquets* ; Ventilation

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

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