During induction of anesthesia, apnea may persist in the case of difficult intubation or fiberoptic guide intubation. In that situation hypoxemia and hypercarbia may occur even though preoxygenation and hyperventilation has performed before apnea start. Sometimes anesthesiologist perform preoxygenation with mixed oxygen and nitrous oxide gas to facilitate and smooth induction. The aim of this study was to know the apnenic time that arterial oxygen saturation drop below 9%o in the patients who was preoxygenated with 100% oxygen or mixed gas (oxygen-nitrous oxide 1:1 ratio) before apnea begin and to know whether nasal oxygen insufflation during apnea affect arterial oxygen tension. Study was conducted in three groups. Each group has 13 patients, After induction of anesthesia with thiopental, pancuronium and isoflurane 1 vol%, Group 1 (Air group) and Group 2 (O2 group) were ventilated with facemask with 100% oxygen for 5 minutes and then remained apneic state in air (Group 1) or nasal insufflation of oxygen (1 L/10 kg/min) (Group 2) with patent airway. Group 3 (N group) was ventilated with O2 and N2O in 1: 1 ratio for 5 minutes and remained apneic state in air. Apnea continued until either SaO2 dropped to 93%, or 8 min had elapsed. At this time, duration of apnea and minimum SaO2 were recorded. During apnea period PaC2, PaCO2, SaO2, MAP, HR were measured 1 min interval. Duration of apnea and mean minimum saturation for Group 1, 2 and 3 were 7+/-1, 8, 3.0+/-0.9 min and 96.6+/-2.4%, 99.1+/-1.5%, 95.7+/-2.5% (mean+/-SD) respectively. In Group 2, SaO2 never fell below 95% during the entire 8 min apnea in any subject. PaCO2 were increased by 5.8 mmHg (Group 1), 7.4 mmHg (Group 2), 7.8 mmHg (Group 3) at first 1 min and then linealy increased by 2.9 mmHg/min for Group 1 and 2 and by 3.2 mmHg/min in Group 3 during apnea period. There was no difference in MAP among three groups during apneic period but HR of Group 3 showed significant increase after 2 min compared to Group 2. In conclusion, preoxygenation followed by insufflation of oxygen via nasal oxygen cannula provides at least 8 min of adequate oxygenation in healthy apneic patients whose airways are unobstructed in whom the trachea is not intubated. It is safe method not to use preoxygenation with mixed gas of N2O before apnea if there is any possibilty of difficult intubation or difficulty in establishing patent airway.
Anesthesia ; Anoxia ; Apnea* ; Carbon Dioxide* ; Carbon* ; Catheters ; Humans* ; Hyperventilation ; Insufflation* ; Intubation ; Isoflurane ; Nitrous Oxide ; Oxygen* ; Pancuronium ; Thiopental ; Trachea

Adverse respiratory events during endotracheal intubation for general anesthesia are variable. These events frequently occur to difficult airway patients. Traumatic endotracheal intubation with poor glottic exposure and blind thrust can perforate the hypopharynx or cervical esophagus. We experienced a case of esophageal perforation during endotracheal intubation for general anesthesia of total hip replacement in a 50 year old female patient. Neck extension was almost impossible due to longstanding ankylosing rheumatoid cervical arthritis. We tried several times of endotracheal intubation but failed. Post-operative esophago-graphy after we found subcutaneous emphysema confirmed esophageal perforation. Emergency tube drainage and general supportive care were done. Fortunately she recovered uneventfully and discharged on post-op. 30th days.
Anesthesia, General ; Arthritis ; Arthroplasty, Replacement, Hip ; Drainage ; Emergencies ; Esophageal Perforation* ; Esophagus ; Female ; Humans ; Hypopharynx ; Intubation, Intratracheal* ; Middle Aged ; Neck ; Subcutaneous Emphysema

To evaluate the change of platelet function during pediatric open heart surgery, authors measured CBC(hemoglobin, hematocrit, platelet count), bleeding time, activated clotting time (ACT), and the degree of platelet aggregation immediately after induction(Tl), after arrival at intensive eare unit (ICU)(T2) and 24 hours after operation(T3) separately. The patients were devided into two groups; one group (7 patients, DHCA(-) group) was not undergone deep hypothermic circulatory arrest(DHCA) and the other group (7 patients, DHCA(+) group) was undergone DHCA. Authors analized the differences between two groups(intergroup) and between pre-CPB and post-CPB values(intragroup). The correlations between the degree of platelet aggregation and platelet count, body temperatue, period of cardiopulmonary bypass (CPB), and hleeding time were also analized respectively. The results were as follows, 1) The age, weight, body surface, and the nadir of body temperature during CPB, except the period of CPB, were significantly different between two groups. The average period of DHCA was 53.7+/-7.5 minutes. The average nadir of rectal and esophageal temperature were 17.2+/-1.1 degrees C and 14.0+/-0.9 degrees C in DHCA(+) group. 2) Intergroup and intragroup differences were not significant in hemoglobin and hematocrit. 3) Intragroup differences in platelet count were significant but intergroup difference were not significant. 4) The percent changes of platelet aggregation at T2 and T3 compared to the value at Tl were 70-80%, and 80-90% respectively. 5) The correlations between the degree of p1atelet aggregation and temperature, period of CPB, platelet count and bleeding time were poor, but bleeding time correlated with platelet count(r=0.6, P< 0.05).
Bleeding Time ; Blood Platelets* ; Body Temperature ; Body Weight ; Cardiopulmonary Bypass ; Ear ; Heart* ; Hematocrit ; Humans ; Platelet Aggregation ; Platelet Count ; Thoracic Surgery*

The adverse cardiovascular effects of laryngoscopy and endotracheal intubation are well known. We compared the cardiovascular response of conventiomal tracheal intubation with that of newly developed Laryngeal Mask insertion in twenty-four ASA class I patients. Anesthesia was induced with injection of fentanyl 2 ug/kg, thiopental sodium 4 mg/kg and vecuronium 0.15 mg/kg intravenously. Ventilation was controlled for 5 minutes with inhalation of 50% nitrous oxide and 1 vo1% of isoflurane or 1.5 vol 8% of enflurane before tracheal intubation or laryngeal mask insertion in all patients. The patients are random1y assigned to either tracheal intubation group(ET group) or Laryngeal Mask group(LM group). After tracheal intubation or insertion of laryngeal mask, blood pressure(systolic, diastolic and mean) and heart rate were measured for 5 minutes at 1 minute interval. In all the parameter, cardiovascular response in ET group was significantly higher than that of LM group for 5 minutes after intubation. It is concluded that insertion of Larynaeal Mask is beneficial to a certain patients than use of laryngoscopy and tracheal intubation to avoid harmful cardiovascular respones in the management of airway during general anesthesia.
Anesthesia ; Anesthesia, General* ; Enflurane ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Inhalation ; Intubation ; Intubation, Intratracheal* ; Isoflurane ; Laryngeal Masks* ; Laryngoscopy ; Masks ; Nitrous Oxide ; Thiopental ; Vecuronium Bromide ; Ventilation

The authors studied the priming effects of the nondepolarizing neuromuscular blockers on the frequency of discomfort, intubation condition and the time interval between the administration of nondepolarizing neuromuscular blockers and endotracheal intubation. Thirty two patients were divided randomly into four groups: the patients administered vecuronium priming dose, 0.02mg/kg and intubating dose, 0.06mg/kg (Group I), vecuronium customary single dose, 0.1 mg/kg (Group II), pancuronium priming dose, 0.02 mg/kg and intubation dose, 0.06mg/kg (group III) and pancurnium customary single dose, 0.1 mg/kg (group IV). The results were as follows. 1) Seven patients complained discomfort after administration of priming dose in the priming groups. (Group I and III) 2) There was better intubating condition in the priming groups than the customary single dose groups. 3) The time intervals between the administration of intubating dose and the maximum depression of single twitch response were revealed 57.9+/-14.6 seconds, 115.5+/-27.2 seconds, 74.5+/-30.0 seconds and 101.4+/-13. 7 seconds in I, II, III and IV group respectively. The time interval in group I was significantly shorter than group II (p< 0.05). And the interval in group III was also significantly shorter than group IV (p<0.05). With the above results we conclude that the priming groups provide smooth and rapid intubation condition than the customary single dose group, in spite of small total intubating dose.
Depression ; Humans ; Intubation ; Intubation, Intratracheal ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents* ; Pancuronium ; Vecuronium Bromide

To determine the beta-sympatheitc activity of isoflurane and interaction between isoflurane and propranolol the study on cardiovascular effects in 8 dogs under various concentration of isoflurane anesthesia after intravenous injection of propranolol was undertaken. Heart rate, mean arterial pressure, central venous pressure, pumonary artery pressure, pulmonary capillary wedge pressure, and cardiac output were monitored and recorded under N2O-O2. N2O-O2-1 MAC of isoflurane, and N2O-O2-2 MCA of isofiurane, respectively and than at 20 minutes after wash;out with N2O-O2,and at 20 minutes after propranolol injection, and at 20 minute after the same conditioned anesthesia, above parameters were rechecked, respectively. Using above paramethers the cardiac index, stroke volume index, left ventricular stroke work index, systemic vascular resistance and pulmonry vascular resistance were calculated. Following results were obtained by comparing each data, and between isoflurane alone and isoflur- ane with propranolol injection.1) The heart rate, mean arterial pressure, cardiac output, cardiac index, left ventricular stroke index, systemic vascular resistance decreased significantly according to increment of isoflurane concentration. 2) The heart rate, mean arterial pressure, cardiac output, cardiac index and left ventricular stroke work index decreased significantly after injection of propranolol comparing with the data before injection and under same concentraion of isoflurane decreased significantly in the dogs pretreated with propranolol. 3) The stroke volume index did not change significantly with injection of propranolol but as adding isoflurane decreased significantly according to the concentration of isoflurane. 4) The pulmonary artery pressure did not change significantly with injection of propranolol but as adding isoflurane increased significantly comparing with that under the same concentration of isoflur-ane without propranolol. 5) The central venous pressure did not change significantly according to injection of propranolol or adding isoflurane. 6) The systemic vascular resistance and pulmonary vascular resistance increased significantly with injection of propranolol and adding isoflurane.
Anesthesia* ; Animals ; Arterial Pressure ; Arteries ; Cardiac Output ; Cardiovascular System* ; Central Venous Pressure ; Dogs ; Heart Rate ; Hemodynamics* ; Injections, Intravenous ; Isoflurane ; Propranolol* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Stroke ; Stroke Volume ; Vascular Resistance

Prostaglandin E1(PGE1) is a potent vasodillator of the systemic and coronary circulatory system, and when used in adult respiratory distress syndrome, PGE1 produces a decrease in pulmonary arterial pressure(PAP) and pulmonary vascular resistance(PVR), and increases cardiac output(CO) and arterial oxygen tension(PaO2). Another vasodilator hydralazine in patients with pulmonary hyertension and heart failure produces a decrease in PVR, and an increase in CO and inspite of an increase in CO, hydralazine maintains or increases the PaO2. The authors made a comparative studies on the effects of PGE1 and hydralarine on hemodynamics and gas exchange in experimentally induced acute lung injury. Oleic acid was infused in 8 dogs in order to induce acute lung injury and the effects on hemodynamics and gas exchange were measured every 30 minutes for 2hrs. After measuring Pre-PGE1 and Pre-hydralazine values, PGE1 and hydralazine were administered intravenously in order to evaluate and compare their effects. Doses for PGE1 and hydralazine were titrated until CO increased by 25%, heart rate(HR) increased by 15%, or mean arterial pressure(MAP) decreased by more than 20% from Pre-PGE1 and prehydralazine values. In PGE1 group, CO increased by 21%(p<0.01). MAP decreased by 14%(p<0.01). PVR decreased by 19%(p<0.01) and systemic vascular resistance(SVR) decreased by 29%(p<0.01). As CO increased with PGE1, intrapulmonary shunt(Qs/Qt) increased from 37% to 49%(p<0.01) and PaO2 fell from 109mmHg to 88mmHg(p<0.01). In hydralazine group, MAP, PVR, SVR and pulmonary capillary wedge pressure(PCWP) all decreased by 9%(p<0.01), 10%(p<0.05), 30%(p<0.0), 28%(p<0.01), respectively. CO increased by 41%(p<0.01) but the increase in Qs/Qt was only 5% inspite of a remarkable increase in CO, consequently PaO2 increased by 10% rising from 86mmHg to 94mmHg(p<0.01). Comparing the two groups, hydralazine resulted in a minor increase in Qs/Qt while there was a remarkable increase in CO. Moreover, it caused an increase in PaO2 and decrease in PCWP. The above results suggest that the effects of hydralazine are superior to those of PGE1 on the effects of hemodynamics and gas exchange in acute lung injury in dogs.
Acute Lung Injury* ; Alprostadil* ; Animals ; Capillaries ; Dogs ; Heart ; Heart Failure ; Hemodynamics* ; Humans ; Hydralazine* ; Lung Injury ; Oleic Acid* ; Oxygen ; Respiratory Distress Syndrome, Adult

The progress of anesthetic and surgical techniques has resulted in an increase in the number of operations requiring transfusions over the past 10 years. Thus, the incidence of complications from shortage transfusions increases daily and a blood supply shortage occurred recently. blood component therapy is now believed to be an answer to these problems. To assess the effect of blood component therapy, especially packed RBC transfusion compared with routine whole blood transfusion, the author compared the preoperative and postoperative hemoglobin, hematocrit and platelet count values. The conclusions are as follows: 1) There were no significant changes in hemoglobin and hematocrit values of the whole population studied, from preoprative values of 12.6+/-0.2g% and 37.6+/-0.6% to postoperative values of 12.7+/-0.1g% and 38.2+/-0.4%, respectively. The platelet count significantly decreased (p<0.05) from 305200+/-9500/mm(3) preoperatively to 249600+/-8800/mm(3) postoperatively in the whole population studied. 2) There were no significant changes in hemoglobin and hematocrit levels according to age distribution, type of transfusion, amount of transfusion, surgical department and operative site, except in the Department of General Surgery, in abdominal surgery, and tumor group surgery in which preoperative hemoglobin and hematocrit values were slightly increased postoperatively. 3) The platelet count significantly decreased postoperatively in the whole population studied except in transfusion amounts under 1 unit, in the age distributions of 20~29, 60~69 and above 70 years, in the Departments of Neurosurgery, Urology, Plastic Surgery, Dental Surgery, ENT, and in head and neck surgery. However, it did not decrease to the level of abnormal bleeding(50.000/mm(3). From the above results, blood component therapy, especially packed RBC transfusion, made no difference in maintaining postoperative hemoglobin and hematocrit levels compared with routine whole blood transfusion.
Age Distribution ; Blood Platelets* ; Blood Transfusion ; Head ; Hematocrit* ; Incidence ; Neck ; Neurosurgery ; Platelet Count* ; Surgery, Plastic ; Urology

On the 25 open heart patients with mechanical ventilatory support, we compared the stabilities of oxygen derived variable for predicting Pao2 after F1o2 modification. With arterial blood gas values in F1o2 1.0, F1o2 was reset succeesively by using AaDO2, a/A Po2 and Pao2/F1o2 to obtain the desired Pao2(100 torr). A total of 100 data were used to compare the Qs/Qt and varying F1o2 with AaDO2, a/A Po2 and PaO2/FlO2 respectively. 1) PaO2 obtained by a/A PO2 or PaO2/F1O2 was much closer to the expected PaO2(100 torr) than that by AaDO2. 2) The calculated values of F1o2 were decreased successively in order of equations used by AaDO2, a/A Po2 and PaO2/F1O2. 3) a/A Po2 anfl Pao2/Flo2 were constant mathematically with varying Flo2. 4) Qs/Qt was higher in F1o2 1.0 than in Flo2 below 1.0. In varying F1o2, it was difficult to find statistical correlations between a/A Po2, Pao2/F1o2 and Qs/Qr, but AaDO2 was relative Qs/Qt due to the used equation. 5) We found high Statistical Correlations (R>0.99) among AaDO2, a/A Po2 and Pao2/F1o2 in Flo2 1.0 which were decreased after F1o2 changes. AaDO2 ranged from 213 torr to 452 torr in Flo2 1.0 and it was decreased Progressivelr in Flo2 below 0.8. The Flo2 modified by AaDO2 in Flo2 1.0 must be changed to the lower level to keep the Pao2 100 torr. a/A Po2 could not be discarded due to its stability in spite of its complexity to calculate. But Pao2/F1o2 was also stable and had the advantage of a/A Po2 in point of simplicity to calculate.
Heart ; Humans ; Oxygen

Because of the increasing numbers of the operations requiring transfusions day by day, there is increase in transfusion reaction, and recently the shortage of blddd supply and the requirements for component transfusion are enhanced. In order to overcome the shortage of blood supply and to prepare the standard for com-ponent transfusion, the author compared the preoperative heraoglebin and hematocrit with postperative ones, and the conclusions are as followings. 1) There were no significant changes in hemoglobin and hematocrit of both male and female groups, as from preoperative values of 17.4+/-1.87g% and 42+/-5.0% to postoperative values of 14,2+/-1.79g% and 42+/-5.0% in male group, and from preoperative values of 12.8 +/-1.15 g% and 77+/-3.2% to postoperative values of 12.6+/-1.43g%, 37+/-4.0% in female group respectively. 2) There were no significant changes of hemoglobin and hematocrit according to the distributions of age and operating trite and the amount of b1ood transfusion. 3) There was significant decrease in hemoglobin of the transfusion group, but nut of the non-transfusion group, from 13.5+/-1. 59% to l3.3+/-1,73g%(P<0.05), but the practical sig- nificance of the change below 1.5% was considered negligible. 4) In the distribution of departments, there were significant changes in hemoglobin and hematocrit of obstetric gynecologic surgery from 12,8+/-1.24g%,37+/-3.3% to 12.3+/-1.44g%, 36+/-3.9% and hemoglobin of orthopedic surgery from 13.9+/-1.65g% to 13.2+/-1.88 g% respectively, but their practical significance of the changes in the range of 2 to 5% was also considered negligible. 5) There was significant change in hemoglobin of non cancer group, but not of cancer group from 13.6+/-1,65 g% to 13.4+/-1.75 g% (P<0.05) But the practical significance of the change under 1.5% was also considered negligible. From the about results, it is suggested that there are rooms for saving blood from curt-ailing transfusion of patients who were given one pint of blood only and even with multiple pints of blood, and also there are a great possibility for component transfusion after-wards but with slight limitation.
Blood Group Incompatibility ; Female ; Gynecologic Surgical Procedures ; Hematocrit* ; Humans ; Male ; Nuts ; Orthopedics