Effects of pneumoperitoneum and position changes on blood pressure variability and heart rate variability during laparoscopy-assisted vaginal hysterectomy / 대한마취과학회지

BACKGROUND: This study was designed to assess the effects of pneumoperitoneum and positional changes on the autonomic nervous system (ANS) in laparoscopy-assisted vaginal hysterectomy (LAVH) patients. METHODS: Systolic blood pressures and R-R interval were recorded for 5 minutes in 22 patients, and then power spectral analyses were conducted to evaluate the ANS. The following variables were measured at various positions: preinduction (BASE), prepneumoperitoneum (PREPP), pneumoperitoneum at head-down (PP), normoperitoneum at supine (POSTPP). RESULTS: High frequency of heart rate variability (HRVHF), Low frequency of heart rate variability (HRVLF), Low frequency of blood pressure variability (BPVLF), LF/HF ratios of HRV (LFHFr) were significantly lower than that of BASE at PREPP. HRVHF, HRVLF, BPVLF were significantly lower than that of BASE at PP. At PP, normalized HF of HRV (nuHF) is significantly lower than that of BASE and normalized LF of HRV (nuLF) is significantly higher than that of BASE and PREPP (P < 0.05). LFHFr was significantly lower than that of BASE and significantly higher than that of PREPP at PP. At POSTPP, HRVHF, HRVLF, BPVLF were significantly lower than that of BASE. But, BPVLF at POSTPP was higher than that of PP. CONCLUSIONS: We conclude that the pneumoperitoneum and trendelenburg positions caused sympathetic activation in LAVH patients.

Severe neck edema and pleural effusion caused by a large amount of irrigation fluid following shoulder arthroscopy : A case report

As a result of advanced surgical techniques, arthroscopy for shoulder surgery is becoming more common.Although serious complications from the absorption of fluid during shoulder arthroscopy are rare, significant absorption of irrigation fluid does occur during the procedure.This report describes a case of severe neck edema and pleural effusion following shoulder arthroscopy in a patient who received a large amount of arthroscopy fluid for irrigation.

Severe neck edema and pleural effusion caused by a large amount of irrigation fluid following shoulder arthroscopy : A case report

As a result of advanced surgical techniques, arthroscopy for shoulder surgery is becoming more common.Although serious complications from the absorption of fluid during shoulder arthroscopy are rare, significant absorption of irrigation fluid does occur during the procedure.This report describes a case of severe neck edema and pleural effusion following shoulder arthroscopy in a patient who received a large amount of arthroscopy fluid for irrigation.

Cardiorespiratory Effects of the Beach-chair Position in Shoulder Surgery: A Comparison between Sevoflurane and Propofol / 대한마취과학회지

BACKGROUND: Sevoflurane and propofol have different cardiorespiratory effects on postural changes. The purpose of this study was to compare the effects of sevoflurane and propofol on hemodynamics and gas exchange index when patients are raised from the supine position to the beach chair position. METHODS: Forty patients requiring beach chair position for shoulder surgery were randomly assigned to receive sevoflurane (end-tidal concentration 1 vol%, n = 20) or propofol (target concentration 3microgram/ml, n = 20). Hemodynamic variables and arterial blood gas analysis data were recorded and gas exchange indices were calculated before induction (baseline), 20 min after endotracheal intubation (supine position), and 20 min after beach chair position. RESULTS: There were significant decreases in mean arterial pressure, central venous pressure, and central venous oxygen saturation after beach chair position. There were no significant changes in gas exchange indices after the position changes. There were no significant differences between groups in hemodynamics and gas exchanges indices. CONCLUSIONS: Raising healthy patients from the supine to the beach-chair position produced a significant decrease in hemodynamic indices with little changes in gas exchange indices. However, the effects of sevoflurane and propofol on the both hemodynamic and gas change indices were not significantly different.

Anesthetic Management of a Patient with Tuberous Sclerosis Undergoing Bilateral Nephrectomy: A case report / 대한마취과학회지

Tuberous sclerosis is an autosomal dominantly transmitted genetic disorder that has characteristic symptoms triad of mental retardation, convulsion, and facial angiofibroma. Because it is a relatively uncommon disorder, there are few informations about anesthetic management for this disorder. We report a case of tuberous sclerosis that had involved bilateral kidneys. A 14-year old female patient was induced with thiopental sodium, rocuronium bromide and then intubated with an internal diameter 6.5 mm of reinforced tube. Anesthesia was maintained with O2-N2O-isoflurane. Surgery took 3 hours and there were no remarkable changes in vital signs and arterial blood gas analysis.

Left Atriotomy Entrapment of Pulmonary Artery Catheter during Mitral Valve Replacement: A case report / 대한마취과학회지

A 51-yr-old man underwent mitral valve replacement and tricuspid valve repair due to mitral and tricuspid regurgitation under cardiopulmonary bypass. The pulmonary artery (PA) catheter was inserted easily via right internal jugular vein and functioned well until the end of surgery. The surgery was uneventful and patient's hemodynamics were stable both in the operating room and intensive care unit. All PA catheter functions were normal, but the balloon rupture was suspected because it was unable to obtain pulmonary capillary wedge pressure. On attempted removal of the PA catheter at the next day, considerable resistance was encountered and pulmonary artery tracing was dampened. A followed-up chest X-ray revealed the catheter to be in the right pulmonary artery without evidence of knotting. Suture related entrapment was suspected, and on reoperation, PA catheter was found to be sutured at the left atriotomy site. The PA catheter was removed under cardiopulmonary bypass and revealed a hole between proximal port and thermal filament.

Changes in Arterial Blood Gas Variables with Changes of Discard and Deadspace Volumes / 대한마취과학회지

BACKGROUND: During arterial line sampling, 2 to 3 times of deadspace volume (from sampling port to catheter tip) are discarded to obtain accurate arterial blood gas variables. In this study, minimal discard volume was determined to decrease unnecessary blood loss. METHODS: Eighty patients scheduled for elective cardiac surgery were included. Two consecutive studies were conducted, in which the radial arterial line was placed with 20-gauge catheter. Once patients had stable hemodynamics, 5.5 times the deadspace of 1.5 ml was discarded before the sampling to obtain control value. In first study (n = 50), deadspace volume was fixed to 1.5 ml. After that, 1, 1.5, 2 and 2.5 times the deadspace were discarded in random before the sampling. In second study (n = 30), discard volume was fixed to 2 times the deadspace. The deadspace volumes were 1.5, 3.5 and 5.5 ml. Samples were analyzed for pH, PaCO2, PaO2, HCO3-, Na+, K+, Ca++ and hematocrit. RESULTS: In first study of fixed deadspace, there was no statistical difference in blood gas variables between discard volume of 2.5 ml and control value. In second study of fixed discard volume, the difference in blood gas variables was statistically significant only between deadspace volume of 1.5 ml and control value. CONCLUSIONS: The optimal discard volume was 2.5 times the deadspace to obtain accurate blood gas variables while decreasing unnecessary blood loss during arterial line sampling. On the other hand, when deadspace was larger than 3.5 ml, discard volume of 2 times the deadspace was sufficient.

General and Spinal Anesthetic Experiences in a Patient Suspected with a History of Anaphylactic Reaction to Muscle Relaxants: A case report / 대한마취과학회지

The use of anesthetic agents may induce a certain number of anaphylactic and anaphylactoid reactions. Anesthesiologists, therefore, are well advised to develop a rational approach to minimize risks and evaluate patients who present with histories of allergic drug reactions in the perioperative period. A 63-year-old female patient was withdrawn from operation due to anaphylactic reaction or life-threatening anaphylactoid reaction occurred during induction of anesthesia and successfully resuscitated. Thereafter, skin prick test to anesthetics including intravenous agents such as thiopental, propofol, ketamine, fentanyl and lidocaine, and muscle relaxants such as succinylcholine, vecuronium and atracurium revealed positive reactions to all the tested muscle relaxants. Next anesthetic experience was done for microvascular decompression surgery without use of muscle relaxants. Two years later, she underwent lumbar laminectomy successfully under isobaric spinal anesthesia using tetracaine.

General and Spinal Anesthetic Experiences in a Patient Suspected with a History of Anaphylactic Reaction to Muscle Relaxants: A case report / 대한마취과학회지

The use of anesthetic agents may induce a certain number of anaphylactic and anaphylactoid reactions. Anesthesiologists, therefore, are well advised to develop a rational approach to minimize risks and evaluate patients who present with histories of allergic drug reactions in the perioperative period. A 63-year-old female patient was withdrawn from operation due to anaphylactic reaction or life-threatening anaphylactoid reaction occurred during induction of anesthesia and successfully resuscitated. Thereafter, skin prick test to anesthetics including intravenous agents such as thiopental, propofol, ketamine, fentanyl and lidocaine, and muscle relaxants such as succinylcholine, vecuronium and atracurium revealed positive reactions to all the tested muscle relaxants. Next anesthetic experience was done for microvascular decompression surgery without use of muscle relaxants. Two years later, she underwent lumbar laminectomy successfully under isobaric spinal anesthesia using tetracaine.

Retrospective Analysis of 1436 Cases of Infant's Anesthesia / 대한마취과학회지

BACKGROUND: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. METHODS: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. RESULTS: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following : inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. CONCLUSIONS: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hernia. The most common postoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.

Retrospective Analysis of 1436 Cases of Infant's Anesthesia / 대한마취과학회지

BACKGROUND: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. METHODS: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. RESULTS: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following : inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. CONCLUSIONS: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hernia. The most common postoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.

Anesthetic Experience for Open Heart Surgery / 대한마취과학회지

This report is concerned with our clinical experience of 150 cases of anesthesia for open heart surgery at department of anesthesiology, In chon Gil hospital from Februry, 1990 to April, 1993. The results were as follows ; 1) Among 150 cases, 68 cases (45.3%) were congenital heart disease and 82 cases (54.7%) were acquired heart disease. 62 cases (41.3%) were males and 88 cases (58.7%) were females. 2) Glycopyrrolate, diazepam, morphine, were used as premedicants. 3) Fentanyl, ketamine, diazepam, thiopental sodium were used as induction agents and injected singly or in combination. 4) In congenital cyanotic heart diseases, ketamine was used as main anesthetic agent. In other heart diseases, fentanyl, isoflurane, diazepam were used. 5) Vecuronium was used for intubation and maintenance of muscle relaxation. 6) Overall mortality rate was 3.3% (5 cases) and the causes of death were low cardiac output, respiratory insufficiency, mediastinal infection.

A Physical Anthropological Study on the Corpus Callosum of Korean / 체질인류학회지

Authors analysed the corpus callosum of Korean(27 male & 14 female) anthrolopologically by the method of Kappers and Ban, and obtained the following results ; 1. The mean height of corpus callosum of the Korean male was about 25.9mm and that of the female was about 25.6mm. 2. The mean length of corpus callosum of the Korean male was about 69.1mm and that of the female was about 69.9mm. 3. According to the callosum horizontal index, the length of the cerebral hemisphere of the Korean male was about 2.22 times longer than that of the corpus callosum, and that of the female was about 2.27 times longer. 4. According to the callosum parietal index, the height of parietal lobe of the Korean male and female was about 2.8 times higher than that of corpus callosum. 5. The mean value of the callosum index of Korean was about 0.374, which was greater than that of the Japanese and Chinese, but lesser than that of Battak. 6. The most common type of corpus callosum of the Korean was the type III and VI, but the type I and X were not appeared. 7. According to the type distribution in relation to the callosum horizontal index, the type VI at callosum horizontal index 0.44 was the most common types.

A Case of the Malformation of Azygos and Hemiazygos System / 체질인류학회지

A malformation of azygos and hemiazygos system were observed from the cadaver for anatomy practice in College of Medicine, Chungnam National University. The observing results were as followings ; Hemiazygos vein was connected with left superior vena cava and drained into coronary sinus, which engorged enough to fill up with blood about 20cc to 30cc. Communicating pathway from hemiazygos vein to azygos veln wasn't found the diameter of left brachiocephalic vein was very small, about 2mm to 3mm. And, the diameter of left internal jugular vein was smaller than that of right infernal jugular vein. In this case, the azygos and hemiazygos system ceased its development at early embryologic stage(around 7 week embryo) and didn't progress into next stage.