Control of Intraoeular Pressure by Intravenous Lidocaine Pretreatment / 대한마취과학회지

It is a known fact that the increase of intraocular pressure results from the action of succinylcholine, endotracheal stimulation to carina, bucking and coughing etc during the induction arid recovery periods. Efforts have been made by several inveatigators to prevent intraocular hypertension by giving trimetaphan, inderal or curare. However, their effects were not remarkable. In this study, lidocaine Img/tg was administered intravenously to selectee patients 2-3 minutes hefore induction ; followed by regular induction with pentothal, succinylcholine and incubation. Intraocular pressures were measured at the pre-induction and post-intutation time, and every 30 minutes until the early recovery period, thereafter. The result of this study showed that the post-intubational increase of intraocular pressure was prevented in 86.7% of the lidocaine pretreated cases. The increase of post-extuba-tional intraocular pressure was also reduced significantly in the lidocaine pretreated group-as well. We came to the conclusion that lidocaine pretreatment technic can be used effectively to prevent intraocular hyperteilsion caused by induction and extubation in clinical practice.

Awareness and Recall During Anesthesia for Cesarean Section / 대한마취과학회지

Balanced anesthesia is being equilibrated with the maintenance of light planes of anesthesia and the relatively free utilization of muscle relaxants to prevent untoward movement of the patient in response to surgical stimuli. However, muscle relaxants per se do not contributes to the state of hypnosis or analgesia. Therfore, awareness during modern anesthesia must be seriously taken. We have given anesthesia in 175 cases for cesarean section in order to investigate intraoperative awareness. Among the 175 anesthetic cases, 13 cases had awareness of pain and 19 cases had auditor awareness. Accordingly the total incidence of awareness in our investigation was 16% which was significantly high and should be considered in clinical anesthesia practice.

Jackson Rees Technique for Pediatric Anesthesia (1235 Cases) / 대한마취과학회지

The Jackson Rees technique has become increasingly popular in pediatric anesthesia. This article presents an original Jackson Rees technique that we have used on 1235 cases for the past 7 years, and which is known as Pentothal-Curare-Hyperventilation technique or the Liverpool technique because of its origin and agents used. Technique 1) Atropine and demerol generally are given as premedication but atropine is only given in the newborn baby. 2) Patients are given pentothal 4mg/kg to sleep. 3) A dose of curare 0.6mg/kg is administered to paralyse and the patient is intubated with an appropriate size tube. 4) The patient is hyperventilated with three times the minute volume of N2O/O2 in a 1:2 ratio using a Jackson Rees modification unit. 5) At the end of surgery N2O is discontinued and curare is reversed with prostigmine 0.1mg/kg and atropine 0.03mg/kg. As a result of our experience this technique has been considered to be a very satisfactory technique in all fields of pediatric andsthesia. The advantages and controverses are discussed.

Post-spinal Cauda Equina Syndrome / 대한마취과학회지

Cauda equina syndrome is characterized by urinary retention, loss of sexual function, loss of sensation in the perineal region and incontinence of feces. It had been reported by Courville, Kennedy, et al early in 1950. Since then Dripps, Vandam, Philips and others have reviewed many thousands of cases for evalustion of neurologic complications following spinal anesthesia, but there has not been a single case of permanent neurologic sequels reported. This 32 year old male with this postspinal neurologic complication was admitted to this institution on the twelveth post-operative day. His surgery had been carried out under spinal anesthesia for removal of an exostosis of the left knee at a local clinic. According to the history at the local clinic, a lumbar tap was performed at the level between L4-5, then 5% lidocaine in 5% D/W was injected into the subarachnoid space and the surgery was finished untevenfully. He developed pain in his buttocks and coccygeal region 6 hours after the surgery was done, so morphine sulfate was injected into the epidural space. After that, the pain was relieved for a while but he again started having the same pain associated with loss of sensation of the lower extremities, urinary retention, constipation and penile impotence on the 10th post-operative day. He came to this institution for 3 months with the above symptoms on the twelveth post-operative day. A cystoscopy and cystometry was done and showed a neurogenic bladder. He was treated with Urecholine for urinary retention and Dexamethasone for arachnoiditis for 2 months. He also had enemas intermittently for severe constipation and a Foley catheter was inserted. He was trained to void by himself by pressing his lower abdomen. He went home with the same symptoms after the Foley catheter was removed. The possible complications and preventions were listed in tabel l and ll. We will follow the patient.

Prolongation of the Neuromuscular Effect of Succinylcholine by Hexafluorenium / 대한마취과학회지

Hexafluorenium has not been popular in clinical anesthesia due to the occurrence of bronchospasm, cardiac arrest, arrhythmias and histamine release reported from its use since it was introduced in 1954. The authors were primarily interested in studying this drug because it has fascinating dual effects of a weak nondepolarizing action at the myoneural junction and a marked antipseudocholinesterase activity. Forty cases were studied in two different groups. In the 1st group of 20 patients, hexafluorenium, 0. 4mg/kg, was given for intubation. In the 2nd group of 20 patients, hexafluorenium followed by succinylcholine was given after an intubsting dose of succinylcholine had worn off. As a result of this study, we can summarize as follows: 1) This combination of hexafluorenium and succinylcholine provides good relaxation for abdominal surgery. 2) Duration of action of succinylcholine varied, ranging from 30 to 40 minutes. 3) In the 1st group, most of the 20 patients complained of discomfort:, with nausea and oral secretion, but muscular fasciculation elicited by succinylcholine injection was not observed. 4) In the 2nd group, untoward effects, such as nausea and oral secretion, were not observed but it was cumbersome to calculate adequate dose of the drugs in anesthesia practice. 5) No bronchospasm or cardiovascular effects were noted except for one suspected case. 6) It would be acceptable to use this combination of drugs when used with caution and also it is worthwhile to study to understand the physiology of muscle relaxation, because it has a peculiar dual action of muscle relaxation.