[Comparison of Cormack/Lehane classification grades decided by novice residents and those by board certified anesthesiologists].

BACKGROUND: Tracheal intubation training is one of the most important ones in anesthesia training. But it is difficult to evaluate from the outside whether the laryngeal view obtained with the laryngoscope is appropriate or not. METHODS: We chose a total of 389 cases of tracheal intubation performed by 12 novice residents in 2 months, and compared the grades of Cormack/Lehane classification of the same patients decided by novice residents and board certified anesthesiologists. RESULTS: During the 2-month period, the average number of tracheal intubation performed by a novice resident was 32 +/- 12 cases (mean +/- SD). A significant difference was found between Cormack/Lehane classification (P<0.05) decided by novice residents and those by board certified anesthesiologists. When the number of intubation performed by a novice resident was fewer than 30, the grade was grade II > III > I > IV. On the contrary, when it was more than 30, the ratio of grades I and II (appropriate laryngeal view) increased and the distribution changed to grade II > I >III > IV. CONCLUSIONS: We considered it useful in the tracheal intubation training that certified anesthesiologists evaluate patients' Cormack/Lehane classification grades before novice residents do, because we can obtain necessary information on laryngeal view and intubation difficulty in advance.

[Study of analgestic efficacy of ropivacaine-fentanyl patient-controlled epidural analgesia after upper abdominal gynecological surgery].

BACKGROUND: Most of the patients who undergo radical or subradical hysterectomy with paraaortic lymphadenectomy suffer from postoperative pain for upper abdominal incision. They also complain of postoperative nausea and vomiting (PONV) frequently, which are increased by opioids. METHODS: Reducing total fentanyl dose to 0.6 mg, frequency of moving pain complaints increased gradually. Therefore, we introduced patient-controlled epidural analgesia (PCEA) for suppressing pain on moving. We investigated analgestic efficacy of 0.2% ropivacaine-fentanyl PCEA in twelve patients undergoing upper abdominal gynecological surgery. Postoperative analgesic effects were evaluated by visual analogue scale (VAS) at rest and on moving, times of bolus infusion, side effects, and degrees of satisfication by patient's self-assessments. Continuous epidural infusion of 0.6 mg fentanyl in 288 ml 0.2% ropivacaine was started at a rate of 4 ml x hr(-1) with a bolus dose of 2 ml. RESULTS: VAS was maintained below 20 mm at rest but was elevated to the maximum of 45 mm on moving with few bolus requests. Ninty-two percents of the patients answered satisfied but fifty percents of them had PONV. CONCLUSIONS: We conclude that ropivacaine-fentanyl PCEA is effective after upper abdominal gynecological surgery, and we can decrease the dose of fentanyl by explaining PCEA system more effectively to the patients for suppressing the pain on moving and PONV.

[Anesthetic management of two patients with Brugada-type ECG and of different clinical severity].

Brugada syndrome is an arrhythmia syndrome characterized by typical electrocardiogram (Brugada-type ECG) and development of ventricular fibrillation (Vf) without any distinct structural heart diseases. The essential goal in the management of Brugada syndrome is to avoid the development of Vf. However, there has been no established consensus on pre-operative risk assessment of patients with Brugada-type ECG. We recently experienced two cases of anesthetic managements for patients with Brugada-type ECG. Based on these experiences and recent cardiological progress on the risk stratification of Brugada syndrome, we thoroughly discuss on the peri-operative managements for patients with Brugada-type ECG.

[Occupational exposure of operating room staff to anesthetic gases during inhaled induction--a comparison with intravenous anesthesia induction].

BACKGROUND: The risk of occupational exposure to waste anesthetic gases still remains during inhaled induction. In this study we investigated how much we were occupationally exposed to anesthetic gases during induction period. METHODS: Twenty-six adult patients were induced with sevoflurane 5% using a face mask for three minutes and maintained with sevoflurane 1% after end-tracheal intubations (IH-Group). Twenty-two adult patients were induced with intravenous anesthetics and maintained with sevoflurane 1% after end-tracheal intubations(IV-Group). The concentration of sevoflurane was measured by Multi-gas Monitor 1302 (Bruel & Kjaer: Denmark) every 70 seconds. Sample gas was suctioned from breathing zone of anesthesiologists. All of our operating rooms are equipped with waste gas scavenging system. RESULTS: The peak concentration of sevoflurane is significantly higher in IH-Group (15.91 +/- 22.64 ppm) compared with IV-group (0.36 +/- 0.25 ppm). The period when sevoflurane concentration exceeded 0.5 ppm is significantly longer IH-Group (18.55 +/- 10.51 min.) compared to IV-Group (1.92 +/- 4.56 min.). CONCLUSION: The induction with intravenous anesthetics is a better method in order to reduce occupational exposure of anesthesiologists to anesthetic gases.

[Intensive care management of acute pulmonary thromboembolism].

Three patients with acute pulmonary thromboembolism, who had fallen into cardiopulmonary arrest or severe respiratory failure, were treated and saved in our intensive care unit. Two patients were resuscitated with percutaneous cardiopulmonary support device. Two patients underwent surgical embolectomy and we carefully applied positive pressure ventilation to prevent postoperative reperfusion pulmonary edema. Early diagnosis and treatment are essential for saving critically ill patients with acute pulmonary embolism. However, cardiopulmonary resuscitation is often difficult and unsuccessful. Therefore prophylaxis is strongly recommended especially in patients with known risk factors of venous thrombosis. Since reperfusion pulmonary edema is a serious complication after surgical pulmonary embolectomy, careful postoperative respiratory care is needed.