Pneumothorax can occur during general anesthesia by various mechanism.

Because tension pneumothorax may be manifested by unexplained hypotension or wheezing during anesthesia, prompt diagnosis of the complication is often difficult.

The incidence of iatrogenic pneumothorax seems to ve increasing, for the procedure associated with pneumothorax such as internal jugular or subclavian venipuncture, intercostal or interscalene nerve blocks, laparoscopy, operator should be prepated to treat this potential complication without delay.

We presented one case of tension pneumothorax developed during general anesthesia perhaps resulting from inadvertent lung injury during internal jugular vein puncture.

The infant or child with a difficult airway is easily recognized, either by symptomatology or anatomic features. However, in a small but significant number of cases, a difficult airway is unrecognized during the preanesthetic assessment, and becomes recognized only upon the induction of anesthesia.

We report a case of difficult airway with congenital tracheal stenosis in neonate. We performed tracheal intubation with small sized tube by using technique to bring head forward slightly while trying to advance tube.

Conftroversy has existed concerning the choice of anesthetic technique for Cesarean section.

The aim of this study was to compare the effects of epidural anesthesia using bupivacaine-fen-tanyl-epinephrine-sodium bicarbonate mixture on mother and neonate with general anesthesia.

The induction-to-delivery time(IDT), uterine incision-to-delivery time(UDT), Apgar scoresat 1 and 5 minute. maternal arterial, umbilical arterial and venous blood gas analysis, degreeof uterine contraction. and preoperative, postoperative hemoglobin and hematocrit level weremeasured in 28 pregnant women underwent Cesarean section(15 under epidural anesthesia,13 under general anesthesia).

The results were as follows :

1) The mean IDT was much longer(p<0.001) with epidural anesthesia group comparedwith general anesthesia group, but the average UDT were similar. The Apgar scores at 1 and5 minute were generally satisfactory with no significant differences between groups.

2) Mean maternal arterial PH, PCO₂ and BE were simitar between two groups. but meanmaternal PO₂ and O₂ saturation were less in the epidural anesthesia group. reflecting thesmaller FI₀₂ inhaled by the mother in the epidural anesthesia group.

3) The PH. BE and O₂ saturation in both umbilical vein and artery was significantly lowerin the epidural anesthesia group than in the general anesthesia group respectively, but remainedwithin normal ranges.

4) No significant differences in the degree of uterine contraction was noted between twogroups.

5) A decrease in the homoglobin level 72 hour after Cesarean section is significantly less in epidural anesthesia group than in general anesthesia group.

These data suggest that epidural anesthesia using bupivacaine-fentanyl-ephinephrine-sodiumbicarbonate mixture in patients undergoing Cesarean section may be safe without significantmaternal or neonatal side effect.

Preoperative consultation interwines anesthesiology, surgery and internal medicine. Its goalis the efficient transfer of information in each consultant's speciality to other members ofthe team caring for the patient thus increasing the liklihood of satisfactory outcome and decresaing the morbidity and the mortality.

Form January 1988 to December 1992 at the anesthetic department of Ewha Womans University Hospital, 775 patients who were consulted to department of anesthesiology preoperativelywere analized annually, according to age, ASA classification, depaartments, causative diseases.recommendations and anesthetic methods.

The results were as follows :

1) The ratio of anesthetic consultation to operation was 3.8% Annually consultation ratiowas increased about twice from 2.0% in 1988 to 4.1% in 1992.

2) The number of 61~70 years of age was the greatest number of cases as 156 cases(20.1%).each 132 cases(17.0%) were in 51~60 and 71~80 years of age, 45 cases(5.9%) over 81 yearsof age and 26 cases(3.4%) under 1 year of age. Over 61 years of age were 333 cases(43.0%).

3) According to ASA clssification. 406 cases(52.4%) in class 2 was the greatest and theorder was 332 cases(42.9%) in class 3, 22 cases(2.8%) in class 4. The almost cases were inclass 2 and 3.

4) Comparing between departments, the order of the greatest number of cases was 239 cases(30.9%) of orthopedic forgery. 151 cases(19.5%) of general surgery. 131 cases(16.9%) of urologyand 114 cases(14.7%) of chest surgery.

5) Comparing between causative diseases. the order of the greatest number of cases was389 cases of repiratory diseases. 326 cases of cardivoascular diseases. 124 cases of endocrinedisease and 89 cases of hepatic diseases.

6) About preoperative recommendations. the number of the checklists for the respiratorydiseases was 249 cases 173 cases for the cardiovasclar disease and 153 cases for the hematologicdiseases. 177 cases was anesthetic permission that was taken by anesthesiologist with sufficient explanations to patients and relatives about the risk of anesthesia and surgery. The numberof consultation to other department was 96 cases and 272 cases was no more necessaries ofmanagements.

7) According to anesthetic managements, the number of general anesthesia was 484 cases(62.5%) and that of regional anesthesia was 159 cases(20.5%). Among the regional anesthesiathe incidence of epidural anesthesia was increased annually and up to 96 cases(12.4%) andthat of spinal anesthesia was decreased to 57 cases(7.3%).

Although pulse oximetry is a potentially useful diagnostic tool under anesthesia. there are concerns regarding its reliability for measuring oxygen saturation (SpO₂ ; arterial oxygen saturation by pulse oxymeter) in hypothermic or low perfusion states. To test pulse oximeter reliability under hypothermic condition 30 data from 14 patients were collected.

Subjects were divided into group I which was as body temperature>36℃ and group 2 which was body temperature <36℃.

The results were as follows:

1) There were no differences between group I and group 2 in the SaO₂(arterial oxygen saturation by blood gas analyzer) and SpO₂.

2) The SpO₂ in group I was underestimated by 1.20±0.85% than SaO₂ in group 1(P<0.001).

3) The SpO₂ in group 2 was underestimated by 0.60±1.03% than SaO₂ in group 2(p<0.05).

Although the SpO₂ was underestimated under hypothermic condition, the pulse oximeter with expired CO₂ tension monitor decreased the frequent invasive arterial blood gas analysis. And it was useful tool for the detection of the hypoxia which is most commom cause of preventable anesthesia related death.

The aim of this study was to evaluate the effects of a transdermal scopolamine patch on the incidence and severity of postoperative nausea and vomiting in patients undergoing outpatient laparoscopy.

Transdermal scopolamine patch was placed behind ear the night before surgery in study group. Anesthesia was induced with thiopental(4~5mg/ku iv) and succinylcholine(1.5mg/kg) and maintained with meperidine. valium and N₂O(50%) in O₂.

The results were as follows :

1) Scopolamine-treated patients had significantly less nausea and vomiting compared with control group. Nausea and/or vomiting was present in 46.4% of the control group but only 18.5% of those getting the scopolamine-treated group.

2) Side effects were more frequent among scopollamine-treated patients than control patients (77.8% vs 32.1%) but were not troublesome The common reported side effects were a dry mouth and dizziness.

In conclusion transdermal scopolamine appears to be an effective antiemetic agent in patients undergoing outpatient laparoscopy.

Citations

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• Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis
  Stephanie Weibel, Gerta Rücker, Leopold HJ Eberhart, Nathan L Pace, Hannah M Hartl, Olivia L Jordan, Debora Mayer, Manuel Riemer, Maximilian S Schaefer, Diana Raj, Insa Backhaus, Antonia Helf, Tobias Schlesinger, Peter Kienbaum, Peter Kranke
  Cochrane Database of Systematic Reviews.2020;[Epub]     CrossRef

Brain ischemia due to a critical reduction in cerebral blood flow is a common cause of irreversible brain damage. Ischemia is invariably accompanied by an increase in tissue lactate concentration due to anaerobic metabolism of glucose and energy failure.

Despite new insights into the pathophysiologic mechanism of cerebral ischemia, the clinical therapeutics of cerebral ischemia is usually limited to agressive anticoagulation and supportive measures.

But. recently, new pharmacological agents including calcium channel blocking agent, perfluorocarbon, free radical scavenger and opiate antagonist are considered as possible therapeutic application for restoration of blood flow to areas of focal ischemia in both laboratory and clinical trials.

Naloxone, an opiate antagonist, has been reported to improve neurological function, spinal blood flow and somatosensory evoked potentials after spinal injury. Thus, Endogenous opioids might play a role in pathophysiology of central nervous system ischemia and that opiate antagonist might be of benefit in the treatment of experimental stroke.

But, on the other hand. there are many evidences that naloxone is not benefical. So use of naloxone for the treatnebt of ischemia insult is controverial.

Therefore, The present investigation was undertaken to elucidate the effects naloxone on cerebral ischemia by measurement of the cerebral energy metabolites concentration.

Cerebral ischemia was produced in spontaneously hypertensive rat(SHR) by bilateral common carotid artery ligation. Naloxone(1mg/kg) was administered intraperitoneally 30 min after the carotid artery ligation.

The results obtained were as follows :

1) There were no differences in the concentration of APT and lactete between normotensive Sprague-Dawley rats and SHR.

2) In bilateral common carotid artery ligated SHR, the concentration of APT was considerable decreased and that lactate was slightly increased.

3) Naloxon didn'y change the cerebral energy metabolism in ischemic model. These data indicated that naloxone had no benefical effect on cerebral ischemia but for definite conclusion, more controlled experiments must be performed.

Bananced anesthesia was termed because each intravenous compound employed was selected and administrated for a specific action, e.g.m analgesia, sedation, amnesia and muscle relaxation. This technique is a safe, simple technique that has no demonstrable toxic effects on liver or kidneys. The cardiovascular system remains stable during anesthesia. The method has proved useful in aged and poor risk patients. In using this technique, fentanyl and droperidols are used commonly. Unfortunately, we could not get the commercially available fentanyl and droperidol in Korea. So the present author have used meperidine or morphine as substitute for fentanyl, diazepam as substitute for droperidol since 1977. The author analyzed the anesthetic records of 10,456 cases in relation with the years, sex, age, operation site, dosages per body weight and operation time during the period of 1977 to 1983. The result are as follows: 1) Of the total 14,078 cases, 74.3%(10,456 cases) was the balanced anesthesia and showed increasing tendency annually. 2) The ratio of males to female was 1:1.9. 3) The most common age group was 3rd decades. 4) The most common operation was Cesarean section. 5) The mean dosages for meperidine was 0.89mg/kg/hr and diazepam was 0.17mg/kg/h.

Diazepam(Valium), a benzodiazepine derivative, has been widely used for the treatment of anxiety and seizures. Recently, diazepam has been used as preanesthetic medication, preparation for endoscopy, bronchoscopy, cardiac catheterization, arteriography, and to supplement local anesthetic during surgery. One patient who suffered cardiopulmonary arrest after receiving small doses of diazepam intravenously is reported in view of the frequent intravenous use of diazepam. Small doses of intravenous diazepam can cause respiratory arrest. We suggest that equipment and personnel trained in cardiopulmonary resuscitation and physostigmine be available a whenever diazepam is administered intravenously.

Respiratory insufficiency frequently occurs in patients after thoracoabdominal surgery, because of sudden inability of the pulmonary system and adult respiratory distress syndrome(ARDS).

We experienced a case of ARDS which developed during general anesthesia in panperitonitis due to perforated stomach, and reviewed etiology, clinical features, diagnosis and treatment in ARDS.

Thirteen patients with a variety heart diseases were underwent operation for total correction of their defect successfully at Ewha Womans University Hospital from March, 1982 to February, 1983. Among 13 patients, three had patent ductus arteriosus, two tetralogy of Fallot, one ventricular septal defect, two constrictive pericarditis and five rheumatic valvular heart diseases. There was no surgical mortality. Their functional improvement was excellent until 6 to 12 months' postoperative period. Although they were a few patients, we report these cases because we thought they might be a good experience for us in performing coming cardiovascular work.

Among 8142 patients who underwent anesthesia at Ewha Womans University Hospital from January 1976 to December 1980 statistical analysis for the hypertensive cases was carried out with the following results. 1) Generally speaking, number of hypertensive patients who underwent surgery was increasing. 2) Percentages of hypertensive patients between man and woman didn't differ significantly. Hypertensive cases were most abundant in 4th decade. 3) Hypertensive cases were most abundant in general surgery. 4) Before the operation, most of the patients were in ASA Class I-II physical status, and majority of cases were elective operation. 5) The majority of pre premedications were meperidine and atropine sulfate. 6) As the anesthetic method, general anesthesia was the most abundant. 7) Thiopental sodium was the most frequent inductive agent. 8) Balanced anesthesia using diazepam and meperidine as main anesthetic agent was the most frequent. 9) Abnormal findings of EKG monitoring shows the most frequent left ventricular hypertrophy. 10) In 8.5% in hypertensive pts, cardiovascular disease was suspected by chest X-ray finding. 11) Borderline and mild hypertsions were abundant. 12) In general anesthesia, blood pressure increased after induction of anesthesia, and returned to normal after operation. 13) In spinal anesthesia, Blood pressure didn't change appreciably after induction of anesthesia, and decreased slightly after operation, 14) In the complication after anesthesia, hypotension was frequently observed.

Clinical survey on 508 blood recipients were undertaken to find out the incidence of urticaria and the effects of pretreatment with antihistamine on urticaria. The following were obtained: 1) Among 508 recipients, the incidence of urticaria was 30 (5.9%). 2) The urticaria was 15 (50%) severe in degree. 3) The incidence of the urticaria was more frequent in general anesthesia than spinal anesthesia. 4) There was no significant relationship between transfusions and the apperance of urticaria. 5) The rate of appearance of urticaria was higher in female than male. 6) In various age groups the majority of urticara were in the third decade. 7) The average number of eosinophiles was within normal limits in all recipients. 8) The average duration of uricaria was 2 hours and 45 minutes. The result of present study indicates the possibility that pretreatment with anihistamine can prevent the urticaria after transfusion during anesthesia and involving more number of recipients further study is necessary to verify the above results.