Brachial plexus injury following median sternotomy / 대한마취과학회지

No abstract available.

Spectral entropy for assessing the depth of propofol sedation / 대한마취과학회지

BACKGROUND: For patients in the intensive care unit (ICU) or under monitored anesthetic care (MAC), the precise monitoring of sedation depth facilitates the optimization of dosage and prevents adverse complications from underor over-sedation. For this purpose, conventional subjective sedation scales, such as the Observer's Assessment of Alertness/Sedation (OAA/S) or the Ramsay scale, have been widely utilized. Current procedures frequently disturb the patient's comfort and compromise the already well-established sedation. Therefore, reliable objective sedation scales that do not cause disturbances would be beneficial. We aimed to determine whether spectral entropy can be used as a sedation monitor as well as determine its ability to discriminate all levels of propofol-induced sedation during gradual increments of propofol dosage. METHODS: In 25 healthy volunteers undergoing general anesthesia, the values of response entropy (RE) and state entropy (SE) corresponding to each OAA/S (5 to 1) were determined. The scores were then analyzed during each 0.5 mcg/ml- incremental increase of a propofol dose. RESULTS: We observed a reduction of both RE and SE values that correlated with the OAA/S (correlation coefficient of 0.819 in RE-OAA/S and 0.753 in SE-OAA/S). The RE and SE values corresponding to awake (OAA/S score 5), light sedation (OAA/S 3-4) and deep sedation (OAA/S 1-2) displayed differences (P < 0.05). CONCLUSIONS: The results indicate that spectral entropy can be utilized as a reliable objective monitor to determine the depth of propofol-induced sedation.

Generalized tonic-clonic seizure following spinal anesthesia for Cesarean section with bupivacaine: A case report

Regional anesthesia for Cesarean section is a popular anesthetic method and a subarachnoid injection of local anesthetics provides rapid onset and a reliable block. Furthermore, it maintains airway reflexes and consciousness of the parturient and is associated with less neonatal depression. Complications related with spinal anesthesia are most often postdural puncture headache, back pain, hematoma, abscess, paresthesia or motor weakness and very rarely, myoclonus. Generalized seizures as a complication following epidural anesthesia with bupivacaine has been reported, but rarely following spinal anesthesia. We present a case of a parturient who was well antenatally, but presented with generalized tonic-clonic seizures following delivery. Although the possible etiologic factors of these transient seizures after spinal anesthesia are difficult to clarify, we emphasize that careful airway monitoring after regional anesthesia is important.

Meningitis after a combined spinal epidural anesthesia: A case report / 대한마취과학회지

The incidence of post-dural puncture meningitis is very low. A 44-year-old patient developed a fever (38degrees C, headache, neck stiffness, nausea, and vomiting after combined spinal epidural (CSE) anesthesia and surgery for closed reduction and internal fixation (CRIF) with intramedullary (IM) nailing, tibia, Rt. With a preliminary diagnosis of bacterial meningitis, empiric broad spectrum antimicrobial treatment was immediately started after cerebrospinal fluid (CSF) sampling. The CSF was clear and revealed a white blood cell count, protein, glucose, and pressure of 146/micrometer, 225 mg/dl, 48 mg/dl (serum 151 mg/dl), and 26 cmH2O, respectively. The CSF stain and culture were negative. Considering the injection of preventive antibiotics before CSE anesthesia, partially treated bacterial meningitis was suspected. Four weeks later, clinical symptoms had improved before the patient was discharged.

Approximate entropy as the measurement of the electroencephalographic effect during sevoflurane induction / 대한마취과학회지

BACKGROUND: The processed electroencephalograms are useful surrogate measures of quantification of volatile anesthetics effect. We hypothesized that there is a certain relationship between the end-tidal concentration of sevoflurane and approximate entropy (ApEn). The aim of this study was to investigate the effect of sevoflurane on ApEn during induction. METHODS: Fourteen patients were enrolled. With recording of the electroencephalogram at the F3, F4, P3, and P4 montages, anesthesia was induced by increasing the vapor setting of sevoflurane by 1 vol% up to 8 vol% via a facemask. When the end-tidal concentration of sevoflurane did not show any further change, we increased vapor setting of sevoflurane by 1 vol%. When the end-tidal concentration of sevoflurane did not show any further change with 8 vol% of sevoflurane vapor setting, measurement of electroencephalogram was finished. The relation between end-tidal sevoflurane concentration and ApEn was tested by Spearman correlation. RESULTS: ApEn showed a significant correlation (R = -0.7551, P < 0.0001) with end-tidal sevoflurane concentration. The final pharmacodynamic parameters estimated by a sigmoid E(max) model were described as follows: E(0) = 0.91, E(max) = 0.28, C(e50) = 1.36 vol%, gamma = 1.27, kappa(e0) = 0.67 min(-1). CONCLUSIONS: Sevoflurane induction with gradual increase of end-tidal sevoflurane concentration increases the amount of regularity in approximate entropy.

Migration of human neural stem cells toward an intracranial glioma

Many in vivo and in vitro studies have demonstrated the targeted migration of neural stem cells (NSC) to infiltrating brain tumors, including malignant glioma, highlighting a potential therapeutic approach. However, there is not enough information to apply this approach to clinical therapy. The most important things in stem cell therapy for brain tumors involve selecting the appropriate neural progenitor type and optimizing the efficiency of the cell engraftment. By histological analysis using two different live-dyes, human NSCs were shown to migrate away from the transplanted site in the direction of the expanding C6 glioma and to intermix with the tumor bed, especially with the tumor core. This intermixing occurred within 7 days when NSCs were implanted into glioma model. The time course of migratory HB1.F5 with the greatest mobility of three NSC lines was as follows. As early as 3 days after transplantation, several NSCs were found leaving the implant site, primarily approaching microsatellites and frontier cells located near the site of NSC implantation. Through 7 days post-transplantation, massive numbers of NSCs continued to be attracted to and interspersed with C6 glioma, and were finally distributed extensively throughout the whole tumor bed, including the core and penumbra of the tumor mass. However, NSCs appeared to penetrate into the tumor mass very well, whereas normal fibroblast cells could not migrate. These findings strengthen the potential for human NSCs as attractive vehicles to improve therapeutic gene delivery to cancer or glioma if they are optimized to selectively kill neoplastic cells.

Vancomycin-induced Hypersensitivity Reaction with Slow Infusion : A case report

Vancomycin is a bacteriocidal antibiotic experiencing a resurgence of utility because of increasing clinical problems with methicillinresistant staphylcoccal infections. Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. There is a consensus that slow intravenous administration of vancomycin should minimize the risk of infusion related adverse effects. We report a case of vancomycin hypersensitivity reaction with slow infusion of vancomycin.

Open Lock of the Jaw on Induction of Anesthesia: A case report / 대한마취과학회지

The temporomandibular joint can be dislocated during anesthesia as a result of excessive oral opening and direct laryngoscope handling. Occasionally, yawning can be observed during the induction of anesthesia with propofol. The forceful and voluntary yawning after a propofol injection can lead to a dislocation of the temporomandibular joint. We report a case of an anterior dislocation of the temporomandibular joint upon induction with propofol, which caused difficulties in mask ventilation and endotracheal intubation. Although intubation had been carried out successfully in this case, an unanticipated difficult airway can be confronted at anytime. Therefore, anesthesiologists should be aware of the management of a difficult airway and practice various methods according to a difficult airway algorithm.

Anesthetic Management of a Patient with Pheochromocytoma in Pregnancy: A case report / 대한마취과학회지

Pheochromocytoma with pregnancy is very uncommon but it is associated with very high maternal and fetal morbidity and mortality. Antepartum diagnosis and proper management can prevent mother and fetus from potentially lethal outcome. Since pheochromocytoma produces and secretes catecholamines, hemodynamic instability can be brought. The aim of anesthetic management is the avoidance of drugs and episodes that will result in hypertensive crisis, and the selection of safe anesthetic measures and anesthetics to mother and fetus. We report a case of pheochromocytoma with pregnancy managed with combined anesthetic technique-epidural anesthesia for cesarean section and general anesthesia for resection of pheochromocytoma 3 weeks after cesarean section. ?

The Amount of Blood Use and Reorganization of Maximal Surgical Blood Order Schedule (MSBOS) in Elective surgery / 대한수혈학회지

BACKGROUND: Overpreparation of Red Blood Cells for elective surgery causes problems, such as returning of blood, inefficient task of the blood bank and waste of blood resources. At The National Medical Center, Maximal Surgical Blood Order Schedule(MSBOS) was organized for the first time in 1994. Recently, blood use is decreased as various transfusion side effects become known, and operation technique and anesthetic methods develop. As a result, we try to revise MSBOS investigating RBC utilization for elective surgery in 2002. METHODS: We investigated RBC utilization for elective surgery, the number of transfused patient, mean blood amount of all patient having been operated in. It was accomplished by referring to anesthesiologic records and blood delivery sheet at The National Medical Center during the 12 months from January through December in 2002. Average number of transfused units per patient of each operation was selected for MSBOS. RESULTS: For one year, the total number of surgery was 3,204, and transfusion was done in 1095 cases of surgery. Average transfusion rate is 34.4%. In 8 kinds of surgery(275 case, 9.3%), average amount of transfusion was under 0.5 unit and Type and Screen(T&S) is transduced for the elective surgery. Except for Cesarean section(C/S), blood use is decreased significantly, compared with the MSBOS organized at 1994. CONCLUSION: We could revise the guidelines for ordering blood on the basis of above results. And MSBOS should be revised at regular intervals, which can decrease blood disuse and medical cost.

Tissue-Engineered Human Neocartilage Formation Using Human Adult Auricular Cell Line

The purpose of these studies was an establishment of human auricular chondrocyte cell line using retrovirus mediated v-myc transfer, characterizing the human auricular chondrocyte cell line by type II collagen mRNA expression and transplantation of human auricular cell line into immunological incompetent nude mice to establish neocartilage formation. Also, I evaluated the growth rate of chondrocyte cell line to measure the cellular proliferative potency. I have established the human auricular chondrocyte cell line integrated v-myc and confirmed by v-myc transduced Myc protein expression by immunohistochemistry and immunoblotting study. And, growth rate of established human auricular chondrocyte cell line increased 4 folds times faster than primarily cultured human auricular chondrocyte. The established human auricular chondrocyte had type II collagen mRNA upto 8 months in monolayer culture. And we observed formation of neocartilage on the back of nude mice using chondrocyte cell line/fibrin glue polymer at 12 weeks transplantation.

Anesthetic Experience of a Patient with Chronic Hypoventilation Syndrome: A case report / 대한마취과학회지

Alveolar hypoventilation exists by definition when arterial PaCO2 increases above the normal range of 37 to 42 mmHg, but in clinically important hypoventilation syndromes PaCO2 is generally in the range of 50 to 80 mmHg. The management of chronic hypoventilation must be individualized to the patient's particular disorder, circumstances and need. This is a case report of anesthetic management of a 63-year-old woman with central alveolar hypoventilation (CAH) secondary to cerebral infarction. For hip surgery epidural anesthesia with 0.5% bupivacaine was performed and doxapram was applied to maintain respiratory drive. The anesthetic experience with a brief review of literature is reported.

Intracellular trafficking and metabolic turnover of yeast prepro-alpha-factor-SRIF precursors in GH3 cells

Chimeric genes coding for prepro region of yeast alpha-factor and anglerfish SRIF were expressed in rat GH3 cells to determine whether yeast signals could regulate hormone processing in mammalian cells. We report that nascent hybrid polypeptides were efficiently targeted to ER, where cleavage of signal peptides and core glycosylation occurred, and were localized mainly in Golgi. These data indicate that prepro region of yeast alpha-factor functions in sorting molecules to secretory pathway in mammalian cells. A hybrid construct with a mutated signal peptide underwent similar ER translocation, whereas such a mutation resulted in defective translocation in yeast (Cheong et al., 1997). This difference may be due to the differences in ER translocation between yeast and mammalian cells, i.e., posttranslational versus cotranslational translocation. Processing and secretion of metabolically labeled hybrid propeptides to mature SRIF peptides were assessed by HPLC. When pulse-labeled cells were chased for up to 2 h, intracellular propeptides disappeared with a half-life of approximately 25 min, showing that -68% of initially synthesized propeptides were secreted constitutively. About 22% of SRIF-related products were proteolytically processed to mature SRIF, of which 38.7% were stored intracellularly with a half-life of - 2 h. In addition, immunocytochemical localization showed that a small proportion of SRIF molecules accumulated in secretory vesicles. All these results suggest that yeast prepropeptide could direct hybrid precursors to translocate into ER lumen and transit through secretory pathway to the distal elements of Golgi compartment, but could process and target it less efficiently to downstream in rat endocrine cells.

Intracellular trafficking and metabolic turnover of yeast prepro-alpha-factor-SRIF precursors in GH3 cells

Chimeric genes coding for prepro region of yeast alpha-factor and anglerfish SRIF were expressed in rat GH3 cells to determine whether yeast signals could regulate hormone processing in mammalian cells. We report that nascent hybrid polypeptides were efficiently targeted to ER, where cleavage of signal peptides and core glycosylation occurred, and were localized mainly in Golgi. These data indicate that prepro region of yeast alpha-factor functions in sorting molecules to secretory pathway in mammalian cells. A hybrid construct with a mutated signal peptide underwent similar ER translocation, whereas such a mutation resulted in defective translocation in yeast (Cheong et al., 1997). This difference may be due to the differences in ER translocation between yeast and mammalian cells, i.e., posttranslational versus cotranslational translocation. Processing and secretion of metabolically labeled hybrid propeptides to mature SRIF peptides were assessed by HPLC. When pulse-labeled cells were chased for up to 2 h, intracellular propeptides disappeared with a half-life of approximately 25 min, showing that -68% of initially synthesized propeptides were secreted constitutively. About 22% of SRIF-related products were proteolytically processed to mature SRIF, of which 38.7% were stored intracellularly with a half-life of - 2 h. In addition, immunocytochemical localization showed that a small proportion of SRIF molecules accumulated in secretory vesicles. All these results suggest that yeast prepropeptide could direct hybrid precursors to translocate into ER lumen and transit through secretory pathway to the distal elements of Golgi compartment, but could process and target it less efficiently to downstream in rat endocrine cells.

Expression of Th1 and Th2 type cytokines responding to HBsAg and HBxAg in chronic hepatitis B patients

The cytokine pattern on viral antigen recognition is believed to exert a profound influence on the resolution of viral infections and viral clearance. This study was initiated to investigate whether a cytokine imbalance oriented toward Th2 type response plays a role in chronic hepatitis B. Cytokine profiles of peripheral blood mononuclear cells associated with chronic hepatitis B were analysed by RT-PCR. Upon HBsAg stimulation, expression of IFN-gamma, IL-2, IL-4, and IL-10 was detected in 41%, 8%, 41%, and 50% of the patients, respectively. Among these cytokines, the expression of IFN-gamma was associated with high levels of serum AST/ALT. However, we could not prove that Th2 type cytokines had a protective effect on hepatocytes. Upon HBxAg stimulation, there was no recognizable association of cytokine patterns with AST/ALT levels. In conclusion, production of a Th1 cytokine, IFN-gamma, by HBsAg-reactive cells was associated with hepatocyte damage in chronic hepatitis B, while no counteracting effect of Th2 cytokines produced by those cells was observed.

Acute Pulmonary Edema in the Parturient Pretreated with Ritodrine during Cesarean Section under Epidural Anesthesia: A case report / 대한마취과학회지

Ritodrine hydrochloride (Yutopar (R)) is widely used for the treatment of premature uterine contraction with betasympathomimetic effect on the uterus but adverse effects associated with cardiopulmonary system are frequently reported. We experienced a case of pulmonary edema that occurred suddenly during cesarean section under epidural anesthesia. She had been treated with ritodrine for 3 days to arrest preterm labor of twin pregnancy. Intensive care including mechanical ventilation with PEEP via endotracheal intubation and diuretic therapy was attempted. At the 3rd day after operation patient was transferred to general ward without any sequale.

Coagulation Management with Thromboelastography in Patient with Coagulopathy: A case report / 대한마취과학회지

A fifty five-year-old man who had been decrease in levels of coagulation factors V, VIII, X and XI was monitored by thromboelastography(TEG) to evaluate the effectiveness of blood component replacement therapy during operation of chest wall reconstruction. Cryoprecipitate(9 units) was infused in the preoperative day because the clot formation rate was slow( : 27.5 ). During the operation cryoprecipitate(9 units), fresh frozen plasma(9 units), whole blood(2 units) and packed red blood cells(6 units) were transfused for blood loss of 4000 ml and abnormal findings on TEG. The operation site was not abnormal bleeding tendency. So TEG patterns were normal toward the end of operation. As a result, TEG is effective to monitor hemostasis and guide for transfusion therapy of coagulation abnormalities associated with intraoperative blood loss.

Comparison of Onset Time of Mivacurium by Priming Principle with Succinylcholine during Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Mivacurium has a characteristics of rapid onset and the shortest duration of non- depolarizing neuromuscular relaxants and the onset of action could be accelerate more rapidly by using priming principle. The purpose of this study was to compare the onset time of mivacurium by priming principle with succinylcholine during rapid endotracheal intubation. METHODS: 36 patients were randomly divided into 3 groups: mivacurium group by priming principle (Group 1), mivacurium group by bolus injection (Group 2) and succinylcholine group (Group 3). In Group 1, subparalyzing dose of 0.02 mg/kg was administered 2 minutes before principle dose of 0.25 mg/kg was given. Onset time and intubating conditions were observed when twitch tension was reduced by 25% block in each group. RESULTS: The onset of Group 1 (75 sec) was significantly faster than that of Group 2 (90 sec) (p<0.05) but was significantly slower than that of Group 3 (37.5 sec) (p<0.05). Intubating conditions were excellent in all groups. CONCLUSIONS: The attempts of priming principle with mivacurium could accelerate the onset of action of mivacurium compared with that of bolus injection but their onsets were shorter than those produced by succinylcholine.

Effect of Esmolol on Serum Potassium Changes Induced by Succinylcholine / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine whether esmolol augmented the increase in serum K+ following administration of succinylcholine. METHODS: Forty patients were randomly divided esmolol group (n=20) and control group (n=20). The esmolol group received a 1 minute rapid infusion of 500 mcg/kg/min followed by a continuous infusion of 200 mcg/kg/min for 4 minutes before administration of succinylcholine. Serum potassium level, mean arterial blood pressure and pulse rate were measured prior to induction(baseline) and 1, 3, 5, 10, 15, 30, 45, 60, 75, 90 minutes after administration of succinylcholine. RESULTS: Serum potassium level was significantly higher in esmolol group after 3 and 15 minutes after succinylcholine than control group. Mean arterial blood pressure was not significantly different between two groups except 10 minute but the pulse rate significantly lower 1, 3, 5, 10 and 15 minutes in esmolol group than control group. CONCLUSIONS: Esmolol does not significantly elevate serum potassium level in clinical use(1 minute infusion of 500 mcg/kg/min followed by infusion of 200 mcg/kg/min for 4 minutes) after administration of succinylcholine. So succinylcholine can be used safely in the presence of beta-1-selective adrenergic blockade. And esmolol can attenuate more effectively increase of pulse rate than mean arterial pressure.

The Effect of Esmolol on Changes of Heart Rate during Induced Hypotension with Sodium Nitroprusside / 대한마취과학회지

BACKGROUND: The goal of this study was to demonstrate the effect of esmolol to prevent reflex tachycardia occurred during sodium nitroprusside(SNP) induced hypotension. METHODS: Thirty patients were randomly assigned to the SNP group(n=15) received continuous infusion of SNP at 2.72+/-0.56 mcg/kg/min or combined SNP and esmolol(SNP-ESM) group(n=l5) received combined continuous infusion of SNP at 1.54+/-0.34 mcg/kg/min and esmolol at 200 mcg/kg/min for 1 hour to maintain a 20~25% reduction of mean arterial pressure(MAP) from baseline. Heart rate(HR) and MAP were measured at baseline, during hypotensive period(5, 10, 20, 30, 60 min) and after hypotensive period(70, 80, 90,1 20 min). RESULTS: SNP-induced hypotension resulted in significant(P<0.001) increases in heart rate during hypotensive period and MAP after the end of SNP infusion. However, infusion of SNP-ESM resulted in significant(p<0.05) reduction in heart rate and SNP requirement during hypotensive period, and rebound hypertension was not observed after the end of induced hypotension. CONCLUSIONS: SNP-ESM infusion is a safe and effective pharmacologic means and provides several advantages over single SNP that include reduction in SNP requirement, no reflex tachycardia during induced hypotension and no rebound hypertension following hypotensive period.