Application of Selective Nondependent Lung CPAP during Surgery for Bronchiectasis / 대한마취과학회지

One lung ventilation with a double lumen endobronchial tube during thoracic anesthesia is necessary for the protection of the healthy lung from contamination by the diseased lung and offers acceptable conditions for the surgeon. During one lung ventilation hypoxemia can frequently occur even with the administration of 100% oxyge. Recently we experienced markedly improved oxygenation during one lung anesthesia with a right sided double lumen endobronchial tube with application of CPAP 10cmH2O in the nondependent lung in a left lower lung brochiectatic patient. The healthy dependent right lung was ventilated by a conventional mechanical ventilator with FiO2 1.0, tidal volume 10ml/kg and respiration rate 12/min. Anesthesia was maintained with O2-halothane. Fifteen minutes after two lung ventilation in the right lateral decubitus position, the PaO2 and PACO2 were 400 and 33 torr respectively. 15 minutes after one lung ventilation PaO2 decreased to 99 torr. 15 minutes following application of CPAP 10cmH2O, the PaO2 increased to 229 torr, 30 minutes after CPAP 331 torr, and 2 hours after CPAP it rose to 373 torr. The nondependent lung was motionless and slightly expanded, and the surgical field was suitable for surgery.

Pulse Oximetry during Shunt Surgery in Pediatric Patients with Tetralogy of Fallot / 대한마취과학회지

Pulse oximetry is a relatively new and noninvasive technique for measuring O2 saturation continuously. We applied pulse oximetry to 9 pediatric patients with tetralogy of Fallot during shunt surgery. Arterial blood gas tensions were measured at the time of postinduction, just before insertion of the shunt, after the shunt and at the end of the operation. The SaO2 levels by blood gas analysis were compared with the SpO2 levels as measured by pulse oximetry. SaO2 and SpO2 levels increased after the shunt and at the end of the operation in comparison with before the shunt, but the PaO2 level remained the same in each period. The SaO2 and SpO2 levels were identical in all 4 periods. The pH increased at the end of the operation in comparison with the postinduction. In conclusion, continuous monitoring of SpO2 through pulse oximetry, instead of PaO2 is a very useful method to assess the adequacy of perfusion after the shunt. Pulse oximetry is also a valuable tool with which to choose the site of the pulmonary artery to be shunted.

Anesthetic Management of Coronary Artery Bypass Graft with Ventricular Fibrillation under Nitroglycerine Infusion / 대한마취과학회지

Cardioplegic myocardial protection has become the most popular method for coronary artery bypass surgery. In contrast, we reported 17 consecutive coronary artery bypass operations with ventricular fibrilation, nitroglycerine infusion, and moderate hypothermia. The average patients age was 55 years. 11 patients had stable angina, 4 patients unstable angina, 2 patients varient angina, and 6 patients had prior myocardial infarcation. On cardiac catheterization, the mean LVEDP was 17.32+/-2.13mmHg, EF was 0.67, and abnormal LV wall motion was noted in 5 patients. Premedication usually consisted of hydroxyzine 1~3mg/kg with or without morphine 0.05~0.1mg/kg IM. Induction agents was morphine sulfate, diazepam, lidocaine and pancuronium for muscle relaxant. Maintaninance agents were nitrous oxide, morphine with small dose of halothane or enflurane. Almost all case (15 patient) was infused nitroglycerine 0.5~1.5 microg/kg throughout entire procedure. After bypass, average patient's temperature maintained 25~28 degrees C, and ventricular fibrillation were induced with or without cold saline irrigation around the heart. Average mean arterial pressure were maintained 60~80 mmHg during bypass period. At the end of bypass, if spontaneous beating were not occurred under normal temperature, defibrillation were used. After bypass stop, methylprednisolone were injected in 15 patients. Average anesthetic time was 585 min., surgery time was 529 min, bypass time was 237 min. Arterial blood gas and electrolyte was acceptable range during all period. Complication implicated with anesthesia was myocardial infarction (3 patient), arrhythmia and transient vocal cord paralysis, 1 patient, respectively and no mortality. In all cases the anginal pain was improved.

Application of Selective Nondependent Lung High Frequency Jet Ventilation during Surgery for a Descending Thoracic Aorta Aneurysm / 대한마취과학회지

During surgical repair of a descending thoracic aorta aneurysm, one-lung ventilation improves visualization of the surgical field, facilitates surgical resection, and reduces lung trauma. Trauma to the left lung during surgical repair of the descending thoracic aorta is very common, and intrapulmonary hemorrhage can be occurred if both lungs are ventilated. A double lumen tube can isolate and protect the lungs. During one lung ventilation in the lateral decubitus position, hypoxemia can frequently occur and hypoxic damage can result. Selective nondependent lung high frequency jet ventilation was administered using a MERA JET VENTILATOR with FiO2 1.0, driving gas pressure 1kg/cm2, respiration rate 120/min., and an I:E ratio of 1:2. Oxygenation (PaO2 readings were all above 200 torr) was well maintained and PaCO2 values were all within normal limits throughout the operation. Under the left atrial femoral artery bypass with the cardiopulmonary bypass machine without oxygenator, an internal bypass graft with Woven dacron was performed. The patient tolerated the surgery well, and the postoperative course was uneventful except for left vocal cord paralysis.

Dosage Titration of Protamine using a Heparin Dose Response Curve and Evaluation of the Factors affecting ACT during Open Heart Surgery / 대한마취과학회지

Dosage titration of protamine using a heparin dose response curve for the reversal of heparinization after cardiopulmonary bypass and the factors which affect. ACT were investigate. This study included 170 patients undergoing surgery for congenital or acquired heart diseases. Patients were randomly allocated to 6 griyos according to a protamine dosage of either 0.8, 1.0, 1.3, or 1.5 times the residual heparin amounts, or protamine 3mg/kg. The factors affecting ACT which we investigated were the differences between arterial and venous blood, between men and women, between a hematocrit value less of greater than 40%, and between less or more than 2 hours duration of bypass time. The results are as follows: 1) There were no significant differences in postprotamine ACT among the 5 groups. 2) ACT of arterial blood was more prolonged than that of venous blood(139.85+/-4.77 vs 111.50+/-2.36 sec). 3) ACT in men was more prolonged than in women(638.81+/-32.10 vs 559.08+/-14.33 sec). 4) ACT in which the hematocrit value was less than 40% was more prolonged than that in which it was above 40%. 5) Although there was no difference between less and more than 2 hours duration of bypass time in ACT, additional protamine was needed in latter group.

Anesthetic management for Surgery of the Ascending Aortic Aneurysm / 대한마취과학회지

Fifteen cases of corrective operation for the ascending aortic aneurysm performed under general anesthesia from 1979 to 1985 in Severance Hospital were studied retrospectively. There were ten male patients and 5 female and their average age were 36.6 years(range 25~50 years). Most of the patients showed aortic regurgitation. Thus the anesthetic management involved consideration for patients with aortic dissection combined with aortic incompetence(annuloaortic ectasia). Patients were premedicated with atropine or glycopyrrolate in 14 cases and a combination of triflupromazine, hydroxyzine, diazepam and pethidine in 13 cases or a combination of hydroxyzine and morphine in 2 cases. Anesthesia was induced with thiopental sodium and/or diazepam and/or midazolam and/or morphine IV. Morphine and a mixture of 50% nitrous oxide and oxygen was administered for maintenance of anesthesia. Supplementary volatile anesthetics were inhaled as needed. Vasodilating therapy and avoidance of bradycardia during anesthesia are the most importance considerations for the reduction of left ventricular wall tension and to maximize the myocardial oxygen supply while maintaining cardiac output. Operative complications were reoperation due to bleeding in four cases, myocardial infarction in two cases, pericardial tamponade and urethral track infection in one case each. One patient died of sepsis. Fourteen patients improved in their heart size and function.