Gadgets, ingenious small mechanical devices or tools, which are convenient for daily practice in anesthesia, pain clinic as well as intensive care, are summarized.
A questionaire was delivered to Registered Anesthetists and the answers were col-iectecd from those who devised a gadget by themselves. Most gadgets are used only in the deviser's institute and in affiliated hospitals.
Commercially available gadgets which has been or will be released lately are also gathered through a questionaire to companies of medical instruments.
107 out of 143 gadgets applied were selected to the presentation.

View full abstract

The effect of pretreatment with either 30mg/kg or 60mg/kg of magnesium sulfate on the degree of fasciculation and of potassium release produced by lmg/kg succinyl-choline in 24 adult patients was compared with 12 saline pretreated patients as controls. The hemodynamic changes were also observed following larygoscopy and tracheal intubation. In both magnesium sulfate groups, Succinylcholine induced fasciculation was significantly prevented (p<0.01). In the control group, serum potassium increased by an average of 0.16±0.29 (S.D.) mmol/l. No patient in either magnesium group had an increase in serum potassium (30mg/kg: -0.14±0.29mmol/l, 60mg/kg: -0.37±0.64 mmol/l). The differences between control and both magnesium groups were statisti-tally significant (p<0.05).
There were no significant changes in heart rate by intubation in both magnesium groups. However, mean arterial pressure after intubation increased 48±18% in thecontrol group, 21±50% in the magnesium 30mg/kg group and 18±40% in the magne-slum 60mg/kg group as compared with before intubation. There was a significant difference between the control group and the magnesium 60mg/kg group(p<0.05).

View full abstract

Changes in arterial and cerebral venous blood lactate (A-Lac, CV-Lac)and colloid oncotic pressure (A-COP, CV-COP) were studied in 36 patients who underwent craniotomy. A-Lac increased with time. Ten hours later the induction of anesthesia, A-Lac increased significantly to 47.0±2.1mg/dl. Postoperative shiverings occurred in 6 patients at the time of emergence. No significant differences were found between A-COP and CV-COP, nor between A-Lac and CV-Lac before shiverings. There were no significant differences between A-COP and CV-COP during shiverings, but A-Lac and CV-Lac increased significantly during shiverings, and A-Lac was significantly domi-nant than CV-Lac. This suggests that lactate moves from the blood into the brain tissue probably due to the significant increase in A-Lac during shiverings. Convulsions were observed in 5 patients during recovery from anesthesia. There were no significant differences between A-COP and CV-COP, nor between A-Lac and CV-Lac before convulsions. During convulsions no significant differences were found between A-COP and CV-COP, but CV-Lac and A-Lac increased significantly during convulsions, and CV-Lac was significantly dominant than A-Lac. This suggests that during convulsions, lactate moves from the brain tissure into the blood probably due to the increased production of lactic acid in the brain tissue.

View full abstract

A prospective study of hepatocellular damage following enflurane anesthesia was carried out for eight weeks in twenty-six children undergoing cleft lip and palate surgery. Fourteen children were exposed to enflurane anesthesia once and twelve children were exposed to the anesthesia twice within seven days. In both groups, serum Al-p, Al-p2, Ch-E, and type III procollagen aminopeptide concentrations were decreased significantly on first and second week after the anesthesia. Serum total bilirubin concentration was decreased significantly from first to third week after the anesthesia.
The present study suggests that hepatocellular damage by enflurane can cause inhibition of hepatic enzyme activities, collagen synthesis, and acceleration of biotransformation of bilirubin. This study also suggests that repeated anesthesia with enflurane within a short interval do not cause more injury to hepatocytes than one time anesthesia with enflurane.

View full abstract

We studied the SH/S-S redox states of human serum albumin in 110 uncomplicated patients who received common elective surgery (Group 1) and in 3 patients who received renal transplantation (Group 2) using high-performance liquid chromatography (HPLC). f_HMA values, which were calculated by dividing HMA area by HSA (HMA+HNA) area, significantly increased at 24 hours after the start of anesthesia (HNA → HMA coversion; p<0.001) and significantly decreased on the 4th postoperative day (HMA → HNA coversion; p<0.001) compared with those at the start of anesthesia in the group 1. In the group 2, f_HMA values gradually increased postoperatively, as a function of grafted kidney was improved. These results indicate that the changes of f_HMA values (HM_??_HNA conversion) may be one of the reliable indices of the function of grafted kidney when the patients' preoperative and postoperative courses are uneventful.

View full abstract

Ventilatory pattern (VP) and the hypercapnic ventilatory response (HVR) were investigated in thirteen healthy male volunteers before and after high thoracic epidural anesthesia (HTE) with 1% lidocaine in 6 subjects and 2% lidocaine in the others. Ventilatory variables were determined by pneumotachograph and respiratory inductive plethysmograph (RIP). RIP allowed us to partition the volume change of the lung into the rib cage component and the abdominal one. In resting condition, all parameters were unchanged after HTE with 1% lidocaine. By contrast, after HTE with 2% lidocaine significantly decreased duration of inspiration and volume displacement of the rib cage, and produced significant increase of mean inspiratory flow rate and minute ventilation. Partial pressure of end-tidal CO₂ and volume displacement of the abdomen were essentially unchanged. HVR was not altered with HTE with 1% lidocaine, whereas it decreased significantly with 2% lidocaine due entirely to the decrease of the slope of the rib cage component. In both cases, the slope of the abdominal component was un-changed. In summary HTE with 1% lidocaine affected neither VP nor HVR. However, HTE with 2% lidocaine caused significant ventilatory changes. HTE with 2% lidocaine may have a notable effect on the efferent and/or afferent pathway of the intercostal nerve roots.

View full abstract

Respiratory function, flow volume curves and arterial oxgen tension were measured before and after elective upper abdominal surgery in elderly nonsmokers (n=14) and smokers (n=13). Preoperative flow volume curves, FEV1, FEV1%, did not reveal significant differences between smokers and nonsmokers. Comparing to nonsmokers, smokers had a smaller % vital capacity (p<0.05). Arterial oxygen tension, while breathing room air in supine position, were identical in both groups preoperatively and on postoperative day 1 and 7. On third postoper-ative day, however, PaO₂ was significantly lower in smokers than in nonsmokers. In both groups PaO₂decreased significantly on postoperative day 1 and normal oxygenation was regained on day 3 in nonsmokers and on day 7 in smokers. These results indicate that postoperative arterial oxygen tension in elderly smokers remains depressed longer than in nonsmokers, suggesting that long term cigarette smoking increases age-related change in pulmonary function.

View full abstract

Under surgical stress, activity in the sympatho-adrenal system is increased in proportion to the degree of such stress. Urine catecholamines (CAs) were estimated as an index of the average activity in the sympatho-adrenal system. Urine CAs were estimated from the urine accumulated over a certain period of time. The urine CAs were measured in the recovery room, and the degree of surgical stress on each organ was compared.
The study was performed on 149 patients, who showed no renal dysfunction and patients were divided into two groups, NLA (fentanyl-N₂O-O₂) group and GOE (enflurane-N₂O-O₂) group. The values of norepinephrine (NE) and epinephrine (Epi) were corrected with creatinine (creat.) and were expressed in ng/mg Great.
From the values of NE and Epi of the NLA group, it was found that surgical stress was the highest on a hepatectomy and a colectomy. Gastrectomy, pulmonary resection, cholecystectomy, total hip replacement, hysterectomy and thyroidectomy were foll-owed. Further, urine CA values in the NLA group showed a significantly higher value than in GOE group, whereas the use of pentazocine during 60 minutes in the recovery room was 5% for the NLA group and 59% for the GOE group. These results suggest that the pain and the increase of sympathetic activity are not necessarily proportional to each other.

View full abstract

Patients with chronic respiratory failure who are suffering from advanced stages of irreversible pulmonary lesions, often have little respiratory reserve capacity. Therefore, in such cases, management is very difficult once the condition being exacerbated.
In this study, a retrospective investigation was made into the management of acute exacerbation of chronic respiratory failure in 185 patients admitted to our ICU for 9 yeares from Jan. 1, 1980 to Dec. 31, 1988. These patients were characteristic in the following respects: they had been repeatedly admitted to our units; and many of them were suffering from pulmonary tuberculosis as in the past. With respect to relations to seasons, a marked tendency toward exacerbation was observed in winter and summer, while a high mortality was obtained in spring and fall. The mortality rate in patients with impaired consciousness on admission was high. Overall mortality rate was 10.8%. Introduction of minitracheotomy resulted in a slight decrease in mortality and a marked decrease in duration of necessary treatment in our unit.

View full abstract

To evaluate the efficacy of prophylactic methylprednisolone in reducing nausea and vomiting in postoperative patients received intrathecal morphine, we studied 80 patients (ASA class 1-2) undergoing gynecological elective surgery. The patients were ran-domly divided to two groups: one group of patients (MP group, n=39) were treated with 500mg of methylprednisolone during operation, while the other (control group, n=41) were not treated.
After administration of 2ml of 0.3% dibucaine with 0.5ml of morphine hydrochlor-ide (0.125mg) intrathecally, all patients underwent the operation under endotracheal enflurane nitrousoxide anesthesia. Within 48 hours after the administration of morphine, the incidences of nausea and vomiting were 15% and 8% in the MP group, which were significantly lower than those in the control group (nausea: 61%, vomiting: 34%).
We concluded that prophylactic methylprednisolone was useful antiemetic agent in postoperative patients received intrathecal morphine.

View full abstract

A 64year old female received lower abdominal surgery under general anesthesia, she was administered morphine 3mg through the epidural catheter for the treatment of postoperative pain. Three hours after epidural morphine the patient had a tendency to sleep and the respiratory rate decreased. Six hours after epidural morphine application, because of respiratory arrest, she was reintubated and ventilation was controlled. The delayed respiratory depression of morphine was suspected judging from the postoper-ative passege and the onset of respiratory arrest.
As respiratory depression happened under the safe and moderate morphine dose, whatever case, we felt keenly, that it is necessary vigilant observation of rate and depth of respiration, as well as, general status and level of consciousness at frequent intervals.

View full abstract

A 61-year-old female was admitted to the hospital in November 1988. Six days prior to admission the patient complained severe pain in right face, 2 days later, by skin eruption in the right face was noted. Examination on the admission revealed vesicular skin eruption on the right maxillar nerve area including on the right external auditory meatus, and also noted abnormal signs in cerebrospinal fluid findings. She was diagnosed as maxillary zoster and meningitis. Stellate ganglion block (SGB), cervical epidural block and administration of acyclovir were performed.
Until thirteen the admission day, right facial pain, eruption and meningitic signs were subsided. However, right facial paralysis was noted on 21st admission day. SGB and cervical epidural block were continued as a treatment for facial paralysis. Then, she was cured of facial palsy. The pathogenesis of delayed facial paralysis followed after zoster maxillaris is unknown.

View full abstract

Among the patients with intracranial meningioma, the occurrence of hyperfibrinolysis was anticipated due to elevation of tissue-type plasminogen activator. We report one male patient with meningioma, who showed hyperfibrinolysis intraoperatively. His preoperative laboratory data revealed high activity of fibrinolysis. FDP, fibrinogen, PT and aPTT were repeatedly measured during surgery. FDP level was 2.5μg/ml before the surgery, and gradually increased and reached 14μg/ml three hours after the initiaton of manipulation, and bleeding tendency was observed in the operative field. FDP was lowered to the normal level (3.1μg/ml) and bleeding tendency was improved after the administration of 2.0g of antiplasmin agent (Tranexamic acid). The postoperative course was uneventful. It was indicated that the measurement of FDP and fibrinogen were useful for assessment of fibrinolytic activity during surgery and that administra-tion of antiplasmin agent was effective to control hyperfibrinolysis. When there appears bleeding tendency in the patient undergoing meningioma resection, hyperfibrinolytic activity due to plasminogen activator release should be considered.

View full abstract

We report a successful outcome in a 57-years-old female, who complicated cryog-lobulinemia, underwent thoracic aortic aneurysmectomy and bypass grafting under cardiopulmonary bypass. Cryoglobulin is a pathologic serum protein which is character-ized by formation of precipitation or gelatification at low temperature and by re-dissolution when heated. In our patients, steroid therapy and plasmapheresis were performed before the operation to prevent possible periferal circulatory disturbance caused by the precipitation of cryoglobulin at low temperature during cardiopulmonarybypass. Our case demonstrated that preoperative supression of cryoglobulin and intraoperative monitoring were important for prevention of possible disorders of organs due to associated vasculitis.

View full abstract

A RASCAL^® enabled us to continuously monitor inspired and expired concentration of oxygen, nitrogen carbon oxide, nitrous oxide, and volatile anesthetics during anesthe-sia. We measured inspired and expired concentrations of these gases with isoflurane in 6 adults patients utlizing the Rascal^®. Blood concentrations of isoflurane were also measured periodically by gas chromatography in order to compare with expired concen-trations of isoflurane. We confirmed the rapid induction of isoflurane by the blood concentrations and the inspired/expired ratio. Our clinical study demonstrated that the RASCAL^® served the same monitoring function during general anesthesia as does the mass spectrometer does. Furthermore, the RASCAL^® was proved to have some merits such as rapid response, real-time monitoring, and more compact.

View full abstract