Effects of Halothane on Hepatic Function in the Dog / 대한마취과학회지

Since halothane, as a new potent, non-explosive, volatile agent, was introduced by Raventos(1956) and studied clinically by Johnstone(1958), Bryce-Smith (1958) and Stephen(1958), it has been used extensively all over the world. However recent case reports of liver necrosis following halothane anesthesia have raised the possibility that the agent may, under certain circumstance, damage the liver. Following the announcement of cooperative study of effects of halothane on the liver by the National Research Council Committee on anesthesia of U.S.A. in 1963, this investigation was undertaken. Experiments were carried out in 31 anesthetixed mongrel dogs, weighing approximately 10kg. After anesthesia with pentothel sodium (25mg/kg), an endotracheal tube with cuff was passed and connected to a closed circle absorption system using an Ohio Heidbrink machine. Oxygen flow was 300 to 500 ml/min. Fluotec Mark II vaporizer, using 1.5 to 2% for induction and 0.5 to 1% for maintenance, was set up outside of the circle system. Depth of anesthesia was judged mainly by clinical signs eg. respiration and blood pressure, and halothane anesthesia lasted for 3 hours. After laparotomy, a ligation of the cystic duct was done and bile was collected from the cannulated common bile duct continuously. Studies have been made on the cardiac output and hepatic blood flow with changes of blood pressure, bile formation, function of dye excretion, changes of serum protein, prothrombin time, coagulation time and histopathological changes of the liver. The results obtained may be summarixed as follows. 1. Measuring of cardiac output using RIHSA after halothane administration with lowered blood pressure, as compared with investigations before halothane (average blood pressure 155mmHg),showed 12.4% decrease in light anesthesia (average B.P. 140mmHg) and 27% in deep anesthesia (average B.P. 70mmHg). 2. Hepatic blood flow measured with radioactive colloidal gold(Au198) showed 218 ml/min in the control group (B.P. 170mmHg) and 309 ml/min in the deep halothane anesthesia group (B.P. 80mmHg). Thus there was a 42% increase in deep halothane anesthesia. As the blood pressure decreased the cardiac output also decreased but the hepatic blood flow showed a tendency to increase. 3. The amount of bile flow and cholate output in the pre-halothane state was 0.040 ml/min and 1. 069 mg/min, respectively. After halothane administration, the bile was significantly increased to 0. 061 ml/min at 90 min. Thereafter it returned to the initial level 3 hours later and cholateoutput continuously decreased for 3 hrs., showing that halothane may have a hydrocholeretic effect. Before and after the halothane administration, pO2 in arteral blood was 344 and 377 mmHg, pCO2 in arterial blood was 38.5 and 40.9mmHg, respectively. The pO2, pCO2, pH and electrolytes (sodium, potassium and chloride concentration) in the hepatic bile did not reveal a significant change. Electrolytes (sodium, potassium and chloride), and osmolarity in urine did not show significant changes.4. The function of biliary dye excretion was studied using bromsulfalein (BSP), phenol red (PSP) and indocyanine green. The one hour biliary excretion of indocyanine green did not show significant changes between the control group, the group with exposure only, and the group with two exposures with an interval of 1 week. However, the biliary excretion of indocyanine green for 2 hours was 45% of the given amount for the control group, 41% for one exposure, and 37% for the group with two exposures. PSP biliary clearance, before and after haIothane administration, showed 19.62 ml/min and 13. 35 ml/min respectively, but BSP biliary clearances were 21. 3 ml/min and 22. 0 ml/min respectively. It is concluded that the biliary excretion of indocyanine green and PSP showed a tendency for a decrease following halothane administration. 5. The coagulation time and prothrombin time, measured after halothane administration, were shortened during the first hour, and after this, they were gradually prolonged, returning to normal m two to three hours after the administration. The values of serum protein and thymol turbidity did not show significant differences among each group and between the time before and after halothane administration. 6. The histopathological examination showed that the anesthetic group had a much more intense degree of degenerative changes of liver parenchymal cells including vacuolar formation and hydropic degeneration, in addition to vasodilatetion, compared with the biopsy before halothane. 7. The above studies indicate that halothane administration exerts a slight influence on the hepatic function and induces histological changes in the liver. However, quantitative comparison between halothane and other anesthetic drugs will be clarified by further studies.

Clinical Survey of Patients in the Intensiva Care Unit / 대한마취과학회지

The intensive care unit(ICU) of Severance Hospital was opened on October 18, 1968 with 7 beds and expanded to 19 beds on February 2, 1981. Statistical analysis of the ICU patients has already been reported three time from 1970 to 1981. The following is clinical analysis of 3,498 cases and ventilator cases from March 1981 to February 1984. 1) During the 3 years the total number of patients was 3,498. In 1981 1,053 patients, in 1982 1,179 patients, in 1983 1,256 patients were admitted. 2) Total admission time in the ICU was 17,061 days. The average patient stay in ICU was 4.9days. The majority of the patients (2,675 cases, 76.6%) stayed in ICU less than 5 days. The number of patients stayin in ICU more than 9 days increased every year from 94 cases (8.8%) in 1981 to 130 cases (10.4%) in 1983. 2) The number of pre-teens was 1,090 cases, about 31.2% of the total patients and represented the highest number of patients admitted to the ICU. The mortality in the pre-teen group was the highest of numbered 148, a mortality rate of 13.6%. 4) The number of patients admitted to the cardiothoracic surgery department was 1,591 cases(45.5%) being highest among all department. Out of 100 patients who died, the pediatric service had the highest mortality rate, 29.2%. 5) All ICU patients have been divided into two categories, operative and non-operative cases. The operative cases numbered 1,889 and non-operative 1,609. Mortality rate was 4.9% for the operative cases and 15% for the non-operative. 6) Total mortality was 334 in number, an overall mortality rate of 9.5% in 3 years. It has decreased annually, 131 cases (mortality rate 12.3%) in 1981, 105 case (7.7%) in 1982, 97 cases(7.7%) in 1983. 7) Ventilator cases numbered 1,921 in 3years. Ventilator day increased year by year, 1, 220 days in 1981, 19,904 in 1982, 2,299 days in 1983. Total ventilatior days in 1983 increased 72.9% compared with the number in 1981. 8) The number of deaths under ventilator support was 90 in 1981, 71 in 1982 and 80 in 1983 respectively. Mortality rate has decreased every year: 16.1% in 1981, 11.2% in 1982 and 10.8% in 1983. From the above results, it can be concluded that the total number of ICU patients and ventilator cases are increasing and the attendant mortality rate is decreasing year by year.

Anesthesia for Aortoeoronary Bypass Surgery / 대한마취과학회지

Coronary artery disease is an ever-increasing problem to anesthesiologists as more patients with severe coronary artery are being accepted for surgery. Four cases of aortocoronary bypass graft procedure were done at Severance hospital. The procedure itself can result in perioperative myocardial infarction leading to death. Greater understanding of and constant attention to the myocardial oxygen supply and demand may reduce the incidence of perioperative myocardial infarction. Among the four patients, three tolerated the anesthesia and surgery well without gross pre and postoperative complications. However one patient developed hypotension in the recovery room and died 6 hours postoperatively, in spite of an intensive efforts at resuscitation. The problems, complications and precautions for anesthesia are discussed.

Clinical Effects of Hydroxyzine Hydrochloride as a Premedicant / 대한마취과학회지

Hydroxyzine hydrochloride, a minor tranquilizer and a ataratic, was tested clinically for effectiveness as a premedicant separate dosages of 1 and 2 mg/kg. Each 30 patients were in the physical status class 1 and 2 by A.S.A. classification, and the age distribution was from 20 to 60 years. The following results were obtained. 1) Emotionally calm response was seen in 70% in the hydroxyzine 1 mg/kg (group 1), and in 93.3%, in the 2 mg/kg (group 2). 2) Mental alertness was seen in 86. 6% in group 1, and in 66. 6% in group 2. 3) Complications after premedication were chilling and shivering, hypertension, nausea, and headache, and were not serious. Therefore this premedication was satisfactory in most cases, especially in group 2.

Clinical Use of Univent Tube with Movable Blocker for the Patient of Bronchopleural Fistula / 대한마취과학회지

The loss of Substantial portion of critically ill patient'a tidal volume through a broncho-pleural fistula may significantly alter the intrapulmonary distribution of ventilation, ventilation-perfusion matching and arterial blood gases. Prompt localization of surgical closure of bronchopleural fistu1a remains the treatment of Choice in most Patients. We had a chance to use a Univent tube with movable blocker to the patienta of breach-opleural fistula whith developed durinf esophageal bougienation. The endotracheal tube has two compartment, a large lumen for conventional air passage and a small lumen where a movable tube is placed. Intubation a accomplished by ordinary technique, advancement of the bronchial tube to the right lowers bronchus being guided by fiheroptic bronchoscopy.

Treatment of Trigeminal Neuralgia with Low-frequency Electrical Acupuncture / 대한마취과학회지

Trigeminal neuralgia has been treated in many ways, both medical and surgical. We wished to determine the efficancy of low frequency electrical acupuncture therapy for nine patients suffering from trigeminal neuralgia with Model 6,26 and G6805 Electrotherapeutic Apparatus. The results were as follows: (1)Initisl.beneficial during 1aw frequency electrical acupuncture therapy was recognized in a11 cases (2) Longterm.baneficial effect was seen in 77%, excluding 3 cases with no improvement. (3) Low frequency elactrical acupuncture therapy seemed to be valuable, preceding medical and .surgical treatment for acute trigemieal neuralgia.

Nerve Block and Low-frequency Electrical Acupuneture in a Pain Clinic / 대한마취과학회지

Pain is as old as mankind and is one of the physiological defense mechanisms, but when it lasts long, it may be harmful. We decided to conduct an exploratory trial with nerve block and acupuncture for 134 patients referred to this clinic with chronic or intractable pain syndromes. We used Model 6.25 and G6805 Electrotherapeutic Apparatus for acupuncture therapy. The results were as follows: (1) Sex and age distribution: 64 were male, 79 were female and 91 patients were over 40 years of age. (2) Localigation of pain: Scapular and upper extemities in 53 among 143 patients. (3) Method of treatment: Nerve block 84, low frequency electrical acupuncture 92 and combined therapy in 3 patients. (4) Effect of treatment: 92% of various nerve blocks and 88% of low frequency electrical acupuncture therapy gave good results.

Anesthesia for Cervical Trachesl Reconstruction / 대한마취과학회지

A 27 year-old male patient, who had cervical tracheal stenosis due to accidental inhalation of zinc dichloride gas, underwent tracheal reconstruction (tracheal resection and end to end anastomosis). Preoperatively, a special radiologic study (tracheography), pulmonary function tests and arterial blood gas analysis were performed for accurate diagnosis (to determine the location, degree and extent of the stricture) and to detect any associated abnormalities in the lung-function. Atropine and diazepam were given for premedication. After intramuscular injection of ketamine and succinylcholine, orotracheal intubation was done above the lesion, and N2O and halothane were added for maintenance of anesthesia. Respiration was assisted or controlled when necessary with gallamine. The lesion was approached through an anterior transverse cervical incision. The trachea. was dissected clear and transected distal to the lesion. The distal tracheal segment was then intubated through the operating field with a sterile cuffed endotracheal tube (the 2nd tube). This was connected to the anesthetic machine. After resection of the lesion and anastomosis. of the posterior tracheal wall, the 2nd tube was removed and orotracheal tube was pushed into the distal trachea. After complete anastomosis the orotracheal tube was placed above the suture line.Continuous arterial blood gas analysis during and after anesthesia was helpful for evaluation of the state of arterial blood oxygenation and ventilation.

Clinical Study of Ketamine Anesthesia for Cesarean Section / 대한마취과학회지

The pharmacological actions of ketamine in human volunteers were reported by Domino et al. in 1965, and use in 130 patients by Corssen and Domino (1966). Since then, its use in a wide variety of surgical procedures has been reported throughout the world. Several authors(Galloon, 1971; Gallon and Dick, 1971; Spoerel, 1971)reported that katamine has several advantages over conventional anesthetics. The advantages of using katamine anesthesia are: preservation of pharyngeal reflex and airway maintenance during induction of anesthesia, stimulation of the cardiovascular system, wide safety margin, short duration, fast recovery, little nausea and vomiting after anesthesia, little depression of the fetus and good uterine contraction with minimal bleeding. On the other hand, ketamine has also disadvantages: elevation of arterial pressure and pulse rate temporarily during induction of anesthesia, poor muscle relaxation and post-operative psychotic reactions are not uncommonly found. The authors tried to find out the feasibility of ketamine anesthesia for Cesarean section over the conventional method of thiopental muscle relaxant N2O with IPPV technique. Materials and Methods.52 Korean parturients were selected for Cesarean section including emergency and elective operation for this study. Thiopental Group. 25 cases were induced for anesthesia with 3.5+/-1.64mg/kg of thiopental and intubated with the help of 1 mg/kg of succinylcholine followed by N2O with controlled ventilation. After delivering the baby, anesthesia was maintained with N2O-O2-ether throughout the procedures. Ketamine A Group. 9 cases, just before skin incision, were injected intravenously with katamine 1.67+/-0.03mg/kg slowly for over one minute with or without N2O: O2(2: 1 L/min) through a mask. After delivering the fetus, a supplement of ketamine and diazepam 10mg I.V. was given intermittently. Ketamine B Group. Anesthesia was induced by 1.72+/-0.05mg/kg ketamine and 1mg/kg of succinylcholine with endotracheal intubation. After delivery, N2O with O2 and additional ketamine were given to 9 patients. Ketamine C Group. Anesthesia was performed with 1. 30+/-0.15mg/kg of ketamine, 0.08mg/kg of pancuronium, N2O, with endotracheal intubation for 9 patients, ether supplement was given following delivery .Conclusion .With these mentioned methods of anesthesia, the authors formed several conclusions about ketamine anesthesia in Cesarean section. 1. Ketamine can be used as the main anesthetic or for induction in elective and emergency Cesarean section because of its rapid onset and intense analgesic effect. 2. As in the method of anesthesia, it is useful to combine N2O-O2 mixture and muscle relaxants such as succinylcholine or pancuronium. This technique is more suitable for maintenance of anesthesia because of the poor muscle relaxation of ketamine alone. 3. For induction of anesthesia, under 1.6mg/kg of ketamine is advisable. Exceeding this dose, the infant respiration is more likely to be depressed because of hypertonicity of the skeletal musculature. 4. Ketamine has a maternal cardiovascular stimulation effect particularly diastolic blood pressure and pulse rate in the Ketamine-pancuronium-N2O-intubation group. 5. Less bleeding was found during and after the delivery, possibly due to an increased uterine contraction from ketamine. 6. Disadvantages of ketamine included a prolonged maternal recovery period, and newborn respiratory depression end these seemed to be dose related. Fro the above, ketamine anesthesia appears to be another safe and satisfactory method of anesthesia for Casarean section, provided that toxema of pregnancy patients with hypertension and patients who have had psychotic problems previously are avoided.

Cardiac Pacemaker and Anesthesia / 대한마취과학회지

Since the first successful use by Zoll (1952) of electrical stimulation through the chest wall to restart the arrested human heart, technical advances have made long-term electical stimulation of the heart effective in preventing recurrent Stokes-Adams syndromes and in treating the debilitating effects of low cardiac output in patients with heart block. This paper reviews experiences with anesthesia administered from Jan. 1968 through May 1975 to 17 patients who had cardiac pacemaker electrodes implanted, under general anesthesia in. 5 cases and local anesthesia in 12 cases. The 5 patients under light general anesthesia received respectively halothane in 2 cases, methoxyflurane in 1, ether in 1 and ketamine in one. No significant difference in morbidity and mortality was attributed to any of the anesthetics used. In 3 of the 5 cases under light general anesthesia, the implantation of permanent cardiac pacemakers was transvenously performed for complete heart block. The implantation of a temporary epicardial electrode in one of the 5 cases was performed because complete heart block had developed immediately after mitral valve replacement during cardiopulmonary bypass. Of the 5 cases under light general anesthesia, one. already had a transvenous pacemaker implanted permanently, and exploratory laparotamy was performed for repair of E-loop obstruction with recurrent stomach cancer. Of the 12 patients who had permanent cardiac pacemakers inserted transvenously under local anesthesia (1% procaine in 10 cases and 0.5% or 1% lidocaine in 2 cases), electrode malpositions appeared in 3 cases and infected electrodes in 3 cases respectively. There were no deaths during anesthesia and operation more important than the particular agent used were the precautions applied for control of cardiac action before and during anesthesia.

Clinical Use of Transcutaneous Monitoring of PO2 and PCO2 in the ICU Patients / 대한마취과학회지

Transcutaneous oxygen and carbon dioxide tension (PtcO2 and PtcCO2) measured with a heated electrode was compared with arterial owygen and carbon dioxide tension (PaO2 and PaCO2) in 5 groups of 37 patients admitted to the Intensive Care Unit, Severance hospital, from October 1985 to February, 1986. The results were as follows 1) In the group I (6 neonate patients), the PtcO2 and PtcCO2 index was 0.89. 1.02. The relationship of the two method is given br the regreasion equation(in mmHg) : PaO2= 1.15 (PtcO2) +0.77(r: 0.86 P<0.001) PaCO2=0.87 (PtcCO2) +5.12(r: 0.91 P<0.001) 2) In the group 2(13 mpmsirgocal patients) the PtcO2 and PtCO2 index was 0.71, 1.03. The relationship of the two methods is given by the regression equation(in mmH7) : PaO2 = 1.42(7t707) -0.27 (r: 7.53 p<0.001) rac07=1.73 (7tc007) -7.43 (r: 0.74 p<0.001) 3) In the group 3(8 immediate postopen heart patients) PtCO2 index was 0.20, PtcCO2 index was 1.25. There was no correlation between PtcO2 and PaO2. The relationship of the two method is given by the regression equation(in mmHg) : PaCO2= 0.40(ftcCO2) +2l. 68(r: 0.60 p<0,005) 4) In the Group 4(9 postpen heart patient after extubation) PtCO2 & PtCO2 index was 0.60, 1.05, and the relationship of the two method is given by the regression equation (in mmHg): PaO2 =1.92 (PtcO2)+67.26 (r=0.68 P<0.001) 7aCO2=0.64 (PtcCO2)+14.87 (r=0.66 p<0.001) 5) In the group 5(COPD Patient) the Ptco2 and rtcc09 index was 0.84, 1.04. and th? relationship of the two method is given br the regression equation(in mmHg) PaO2 = 1,10 (PtcO2) +7.35 (r=0.81 p<0.001) PaCO2=0.52 (PtcCO2) +21.59 (r: 0.63 P<0.001) Continuous montiroing can reveal large fluctuations in PaO2 and PaCO2 which would be missed by the use of intermittent arterial samples. The transcutaneous electrode can be employed usefully in the neonate and hemodynamic-allr stable adult patient in Intensive Care Unit. However this method is not recommended to the patients in shock, immediate postoper-ative patient with peripheral vasoconstriction and poor perfusion.

Clinieal Survery of Patients on Ventilator Support in the Intensive Care Unit / 대한마취과학회지

The Intensive Care Unit(ICU) of Severance Hospital was opened on October 18, 1968 with 7 beds and expanded to 19 beds on February 2, 1981. Statistical analysis of ICU patients has already been reported twice: 1. from 1970 to 1977 with 3, 072 cases and 2. from 197S to 1981 with 4,348 cases The following is a clinical analysis of l,458 ventilator cases which comprise6 33.5% of the ICU patients from March 1975 to February 1982. Until 1979 pressure and volume cycled ventilators were use6 at an equal ratio; however, since 1980, volume-cycled ventilators such as the Bennett MA I and MA g and the Bourns LS 104-150 were mainly used. The ventilator cases from the Department of Internal Medicine and Cardiac Surgery rem-ained almost constant at a 30: 30 ratio from 1975 to 1977 However since 1978, the cardiac surgery ventilator cases increased to over 50% of the total. The number of ventilator cases below the ten yearold age group was 396 cases, about 27% of the total. They have increased year by year. Among 587 ventilator cases in 1981, the Bennett MA I and II were used, in 225 and 203 cases respectively. In the under 1 year old age group, 36 cases(43, 9%) were Put on with the Bourns LS 104- 150 and 30 cases(36.6%) on the Drager Babylog I respectively. 487(90.7%) cases were supp-orted with controlled mechanical ventilation(CMV) mode and 135(25%) with the positive end expiratory pressure (PEEP). Of 537 cases, 441(85%) was disconnected from the ventilator within 3 days. Death according to duration of ventilator support was 47(18. 8%), 38(23. 8%) and 14(36.9%) in 1, 2 and 10 days respecitively. But, for the period of 10-19 days, the number of deaths was 4(36.4%) and for 2p or more days 1 case(25%). Reosons for ventilator support were postcardiac operation (301cases, 56%) followed by CNS(central nervous system), IRDS(idiopathic respiratory distress syndrome), and lap- arotomy cases in that order. All ventilator cases with neuromascular disease survived bat none with DEC(Disseminated microvascular cosgulopathy) did. From the above results it can be concluded that ventilator support cases are increasing and the attendant mortality rate is decreasing year by year.

Clinical Experience of Ketamine for Burned Patients / 대한마취과학회지

The severely burned patient, when first seen by the anesthesiologist, is usually in the "high-risk" category, envincing malnutrition and protein defficiency, combined with toxicity, dehydration and oliguria. Since homeostatic controls are markedly impaired, the cardiovascular system may be unable to respond to the changes in body position frequently necessary during surgical procedures. Especially when the burn involves the head, neck, and upper chest, the mucous membrane of the respiratory tract may be edematous and pulmonary atelectasis may be present. Inhalation agents such as ether, halothane, methoxyflurane, cyclopropane and nitrous oxide have serious disadvantages in anesthesia for burned patients, because: 1) the use of endotracheal tube to ensure an unobstructed airway is mandatory, but use of succinyl-choline for intubation may be dangerous, 2) there is a danger of introducing pathogenic organisms into upper respiratory tract with repeated intubation. 3) inhalation agents may impair the function of liver, kidney, and hemopoietic system. In the course of our clinical experience of ketamine in 45 burned patients, it became apparent that ketamine may be the anesthetic of choice for burn surgery, particularly for children, since the drug offers several distinct advantages over conventionally employed anesthetic agents. Protective reflexes are peserved, thereby rendering unnecessary an endotracheal tube. Also cardiovascular homeostasis, ease and simplicity of administration, rapid onset of anesthetic action, short duration, relatively quick recovery, virtual absence of postanesthetic nausea and vomiting and of toxicity for vital organs, and the absence of clinically detectable respiratory depression seemed to provide optimal conditions for surgery in burns.

Ketamine Anesthesia for the Shocked Patient / 대한마취과학회지

In order to determine the usefulness of Ketamine for the shocked patient, 31 cases were divided into 3 groups. Group 1: No hemorrhage or shock. Well maintained vital signs, 10 cases Group 2: Mild to moderate degree of hemorrhage. Fluid and blood replaced, 10 cases. Group 3: Hemorrhagic or septic shock state, 11 cases. The result of case analysis and change of vital sign after ketamine injection were as follows: 1. Physical status: Range of class of physical states in group 1, 2 and 3 were 1~3, 2~4 and 3~4 respectively, and 50% of group 1 and all cases of group 2 and 3 were emergency surgery. 2. Age distribution: The range of age distribution in groups 1, 2 and 3 was 23~62, 18~65 and 16~64 years old respectively. 3. Type of operation: In group 1, lobectomy, laparotomy and other operations were performed. Howrever in group 2 and 3, thoracotomy, laparotomy and other procedures were performed for hemostatic purposes. except one total hysterectomy for sepsis. 4. Premedicants: In one third of the total cases, mostly in group 1, secobarbital, meperidine or diazipam were: given. Atropire was given in 45% of the total cases, and 45%, mostly in group 2 snd 3, were not given any premedicants. 5. Anesthesia induction: Following preoxygenation, mastly in group 2 and 3, anesthesia was induced with ketamine (1~2 mg/kg) and intubation was done with succinylcholine, except for 3 cases in group 1. 6. Anesthesia maintenance: Ketamine as a sole anesthetic agent was given to 9 cases in operations of less than 1(1/2) hrs. duration. In other cases N2O or N2O with ether, halothane or methoxyflurane were administered according to the vital signs, and muscle relaxants (succinylcholine or gallamine) were given if necessary. 7. Duration of anesthesia: The range of duration of anesthesia in group 1, 2 and 3 was 40~360, 60~315 and 85~4845 min respectively. The average duration was 2.6, 2.5 and 4.3 hr in each group. 8. Blood and fluid replacement during anesthesia: The average blood replacement in each group was 259.6, 886.7 and 954.5 ml/hr for the entire surgical procedure, whole fluid replacement averaged 243.1, 228.0 and 432. 3 ml/hr respectively. 9. Hemoglobin: The range of Hb in preanesthetic state 8.2~14,9.5~12.8 and 7, 913.9 gm/dl in groups 1,2 and 3 and averaged 11 .8, 10.9 and 10.8. These Hb values increased after operation with blood and fluid to 12. 3, 11.0 and 12.3 gm/dl respectively. 10. Blood pressure: Before anesthesia the average systolic and diastolic Bp was 122.5/84.0, 94.5/68.0 and 108/79 mmHg in each group. Following the administration of ketamine, the systolic pressure increased 5.3, 14.3 and 26.7% respectively after 10 min. 11. Pulse rate: Change in pulse rate after ketamine injection was not significant in mast of cases. 12. Respiration: No remarkable change in respiration was observed however respiration was assiteded or controlled adequately through the anesthesia. With the above results, the rise of BP induced by ketamine during the induction period was found to be advantageous with such patients. We concluded that ketamine anesthesia for shocked patients of any etiology was safe, useful and satisfactory.

Midazolam Malate as an Intravenous Induction Agent for Open Heart Surgery / 대한마취과학회지

Midazolam, a water-soluble benzodiazepine that is shorter-acting, more potent, and less irritating to veins than diazepam, has been suggested for use for induction of anesthesia. The cardiovascular effects of an induction dose(0.2~0.3mg/kg) of midazolam in ASA class lll cardiac surgical patients (N=15) were compared in a couble-blind fashion with a similar group of patients (N=15) receiving thiopental (5.0mg/kg). The patients were premedicated by triflupromasine, pethidine, hydroxyzine, atropine and diazepam. The results were summarized as follows. 1) The thiopental group were more decreased in blood pressure and increase in heart rates than midazolam group. 2) Spontaneous eye closing time and loss of eyelash reflexes were observed. But those were a poor sign of adequate induction became of heavy preanesthetic sedation. 3) The changes of blood pressure and pulse rate after induction and intubation were almost similar in the two groups, but greater individual variation was seen in midazolam groups, depends on preload state before induction. From the above results, midazolam was sufficient as an induction agent for open heart cases. But a hypovolemic patients and completely beta blocked patients should be used cautiously because they may be developed severe hypotension and tachycardia.

A Clinical Study of Sore Throat after Endotracheal Intubation / 대한마취과학회지

Among the minor discomforts that occur as a result of intubation in the course of general anesthesia, sore throat was studied regarding its frequency and causal factors. Becausc of today's equipment and technique, endotracheal intubation has been greatly improved. Therefore, the incidence of postoperative sore throat has gradually been considerably reduced. Since surgical mortality was reduced strikingly in recent years, minor discomforts have been more important to the patients and anesthesiologists than before. We have studied sore throat in 239 cases of general anesthesia patients who have been operated in Severance Hospital between August 1, 1975 and September 30, 1975. and from April 1 to April 30, 1977. The results are as follows; 1. The incidence of sore throat after intubation in the course of general anesthesia was 20. 3% and female patients complained more of sore throat than male patients, 2. The incidence of sore throat increased according to the following conditions: a) When the muscle relaxation was poorer, b) When n ore attempts at intubation were needed, c) When larger tube sizes were used. 3. There was no significant difference in the in the incidence of sore throat between the rubber and the plastic tubes and no significant correlation between the incidence of sore throat and either the hours of intubation or the patients physical condition.

Respiratory Care in Guillian Barre' Syndrome / 대한마취과학회지

Guillian-Barre syndrome may result in severe pulmonary insufficiency and death. Four cases disgnosed as this syndrome were treated with respirators such as Bird Mk-7, Bennett PR-Z, Bennett MA-1 and Ohio-560. All of the patients were tracheostomized and had a cuffed tracheostomy tube inserted. Volume and pressure respirators were fixed according to vital signs and arterial blood gas tensions. Mechanical and ultrasonic nebulizer and a heated humidifier were used for humidification. Lung vibration, postural drainage and breathing exercises were performed as occasion required. To prevent cross-infection aseptic techniques were used far tracheal suction and the sterilizable parts of the respirator and tracheostomy tube were changed daily. During the weaning from the respirator the vital signs, lung volumes and blood gas tensions with pH were carefully observed. Duration of respirator uses were 19 to 79 days and thereafter all were improved without complications. The results were as follows; 1. In 3 of 4 cases pseudomonas aeruginosa were cultured in sputum. 2. Narcosis, due to hypercapnea, and atelectasis were observed in case 1 and 2. 3. Electrolytes remained within normal limits in all cases. 4. The period of complete weaning from respirators required 4 to 30 days. 5. Bennett MA-1 and Ohio-560 respirators were more convinient than pressure limited respirators for humidification and regular deep breathing.

Sympathetic Block for Reflex Sympathetic Dystrophy / 대한마취과학회지

Pain in an extremity that develops following trauma, infection, thrombophlebitis and many other leaions has been recognized for years and designated by a variety of names. These syndromes appear to have the same physiopathology and response to therapy. All of them are characterized by exeessive unduly prolonged pain, vasomotor and other autonomic disturbances, delayed recovery of function and trophic changes. We have treated two cases of reflex sympathetic dystrophy. One case was only treated by stellate gangUon block repeated 26 times and the other case required surgical thoracic sympathectomy for complete recovery after 60 repeated stellate ganglion blocks. We report these two cases of reflex sympathetic dystrophy and review the literature.

Continuous Epidural Block for Perioperative Pain Control and Treatment of Herpes Zoster - Two Cases Report / 대한마취과학회지

Continuous epidural block was used for pain control during and after operation and for herpes zoster in two cases. A 63 year old male patient with herpes zoster on the right T 12 level for 2 weeks was treated by continuous epidural block. After 10 days, elective right inguinal hernioplasty was performed under epidural blocks by the previously inserted catheter. Postoperative pain and herpes zoster have been controlled in the same manner. Two weeks later, he was discharged without post-herpetic sequelae. The second case, a 82 year old man, was admitted with dysuria and also herpes zoster on the right T 10 level for 10 days. Using only continuous epidural block, suprapubic prostatectomy was done and post-operative pain was controlled. Two days later, the catheter was removed by the urological department. However, two weeks after operation, post-herpetic neuralgia developed and continuous epidural block was restarted for 2 weeks. Then epidural methylprednisolone injection, 2 times, and transcutaneous electrical stimulations were required for 3 more months for complete recovery. This indicated that continuous epidural block was beneficial not only for the treatment of herpes zoster but also for the prevention of post-herpetic neuralgia.

Thiopental Anaphylaxis / 대한마취과학회지

Because of rarity of its incidence, a case of anaphy lactic hypotension developed following thiopental administration is reported with a brief review of the literature. This 55 year old female, at another hospital, twice cancelled proposed cholecystectomy due to hypotension to thiopental induction with 250 mg and 200 mg respectively. At the admission time, she had no abnormalities on C.B.C., urinalysis, E.K.G., chest X-ray, Thorn test and urine porphyrin test except increased alkaline phosphotase in liver function test and positive amobarbital test with 200 mg. This patient was premedicated with atropine 0. 3 mg. only without sedatives. Difficult induction with nitrous oxide and halothane in this non-cooperative patient was supplemented by 2.5% thiopental 4 ml. in divided doses. At this point blood pressure dropped from 140/90 mmHg. to 80/60 mmHg. 100% oxygen was, therefore, administered by the mask and 20mg. of ephedrine was given intravenously and intubated following succinylcholine. After intubation blood pressure rose to 140/80 mmHg. Two hours later the patient had apparently fully recovered. Postoperative course was uneventful. It was confirmed that this rare reaction during anesthesia was due to thiopental by intravenous testing with divided doses of the durg.