Relationship between job competency, core self-evaluation, and job performance in dental hygienists / 대한구강보건학회지

OBJECTIVES: This study evaluates the relationship between job competency, job performance, and core self-evaluation in dental hygienists. METHODS: The subjects were registered and working dental hygienists in dental clinics. Two surveys were conducted. The first survey was conducted at an academic conference, and the second was via post. The conference participants were 200 dental hygienists, and 156 questionnaires were returned. Another 200 dental hygienists received the questionnaire via mail, and 123 returned the questionnaires. There were 279 questionnaires returned in total; however, only 269 questionnaires were included in the analysis. The collected data were analyzed using SPSS 12.0. RESULTS: Job performance was classified into oral health education, prevention treatment, and dental assisting. Competency was classified into achievement and behavior, personal leverage, and recognition specialty. All competency of dental hygienists was similarly taken, but the factors influencing each competency differed from the contents of job performance. Thus, appropriate education and training programs are needed by dental hygienists. Factors such as recognition specialty competency, age, and core self-evaluation influenced oral health education. Recognition specialty competency and core self-evaluation influenced prevention treatment. Moreover, academic ability and core self-evaluation influenced concertation of treatment. CONCLUSIONS: These results indicate that the dental hygienists who have a more positive attitude have better job performance. Thus, dental hygienists require continuous evaluation to enhance their professional qualities.

The recognition and attitude of student's parents of elementary school on the sealant and its operation by dental hygienists / 대한구강보건학회지

OBJECTIVES: The aim of this study was to look at elementary school student parents' recognition of pit and fissure sealant, national health insurance application and recognition of and attitude toward dental hygienist's treatment for pit and fissure sealant. METHODS: The subject of study was parents of children in the 3rd and 4th grades at an elementary school in Jeonju city. To consider those parents' socio-economic factors of elementary school grade level classified by Education Office, 'A: highest socio-economic' level and 'D: lowest socio-economic' level, elementary school student parents were surveyed. In this study, a set of questionnaire was distributed to student's parents, a total of 23 questions on recognition and attitude for pit and fissure sealant by national health insurance system, treatment of sealing by dental hygienist. The statistical analysis of the data collected was done by using SPSS 12.0. RESULTS: Of the student parents, the percentage of those who recognized that national health insurance covers the pit and fissure sealant was 36.9% only. The percentage of parents who did not know was larger than that of those who knew. Of the student parents, those who had once or more received treatment of the pit and fissure sealant by dental hygienist were highly satisfied and their attitude were also very positive about dental hygienist's ability to operate the pit and fissure sealant. CONCLUSIONS: The higher the recognition rate of pit and fissure sealant can be covered national insurance system, the lesser consumer's burden.

Cancer Incidence in Daegu in 1997~98: The First Results of the Daegu Cancer Registry / 대한암학회지

PURPOSE: A population-based cancer registry was set up in January 1, 1997 to estimate the incidence of cancer in Daegu, South Korea. MATERIALS AND METHODS: Data sources for case-finding and abstracting were hospital inpatients, other sources in hospitals other than inpatients, and private pathology laboratories. The registered cases were matched against two external databases, the death certificate and medical insurance claims. RESULTS: A total of 7,837 cases (4,203 males, 3,634 females) were registered in 1997~98 excluding 2,718 cases of DCN. The crude incidence rates of all cancers combined were 170.7/100,000 (ASR 255.0) in males and 149.8 (ASR 154.4) in females. In males, the most common cancer was stomach (47.3, ASR 69.0), followed by liver (28.0, ASR 37.6), lung (26.0, ASR 44.1), colorectum (14.9, ASR 23.3),urinary bladder (4.5, ASR 7.0) and prostate (3.5, ASR 7.0). The most common cancer in females was stomach (25.8, ASR 26.9), followed by breast (21.7, ASR 20.4), cervix uteri (21.1, ASR 20.4), colorectum (14.9, ASR 16.0), lung (9.9, ASR 11.0), liver (9.3, ASR 10.1), and thyroid (6.1, ASR 5.7). The overall percentage of microscopically verified and the DCN% were 80.3%, 27.7% in males and 88.7%, 20.7% in females, respectively. CONCLUSION: These results show that the incidence level of all cancers combined in both sexes in Daegu is approaching that of other industrialized regions in Asia as well as in the world.

Hemodynamic Effect of Thiopental and Propofol on Endotracheal Intubation: Measurement Using Thoracic Electrical Bioimpedance / 대한마취과학회지

BACKGROUND: The purpose of this study is to delineate hemodynamic changes resulting from endotracheal intubation under the effects of thiopental sodium and propofol using the thoracic electrical bioimpedance device. METHODS: Thirty healthy adult patients, scheduled for elective surgery under general anesthesia were randomly assigned to receive thiopental sodium 5 mg/kg (Group I, N=15), or propofol 2 mg/kg (Group II, N=15) for induction. Endotracheal intubation was performed following injection of succinylcholine 1 mg/kg. Anesthesia was maintained with enflurane 1.5-2.0% and 50% nitrous oxide in oxygen. Cardiovascular parameters were measured before induction of anesthesia, at the time of pre-intubation and immediate, 1, 2, 3 and 5 minutes after intubation. RESULTS: The mean arterial pressure was significantly decreased in the propofol group compared to that of the thiopental sodium group just after the post-intubation period (p<0.05). The heart rate were decreased in both groups but there were no significant changes in heart rate and cardiac output between group I and II. In group I, systemic vascular resistance was decreased but there was no significant changes between two groups. CONCLUSION: The data suggest that the usual doses of propofol could prevent the increase in mean arterial pressure following intubation due to systemic vascular maintenance. But the intubation of anesthesia using thiopental sodium could not prevent the increase in mean arterial pressure following intubation.

Comparision of Hemodynamic Changes in Patients Undertaking Hysterectomies under Genernal and Epidural Anesthesia / 대한마취과학회지

BACKGROUND: The purpose of the study was to evaluate the effect of postural change on hemodynamics using thoracic eletrical bioimpedance (TEB) device during general anesthesia with enflurane-N2O-O2 and lumbar epidural anesthesia. The TEB device is safe, reliable and non-invasive way to measure hemodynmic values continuously. METHODS: General anesthesia (twenty patients) was induced by administration of pentotal sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously, and was maintained with 1 vol% of enflurane, N2O-O2 (2 l/min-2 l/min) and vecuronium 0.1 mg/kg. Epidural anesthesia (twenty patients) was performed at the level of L3-4 epidural space using 20 ml of 2% xylocaine mixed with epinephrine (5 microgram/ml). Hemodynamic changes were measured before induction, 1 and 5 minutes after intubation or epidural injection, 1, 5, 10, 20, 30 minutes after head- down tilt and 1, 5, 10 minutes after returning to the supine position. RESULTS: HR and LVSWI were minimaly affected in group E with epidural anesthesia compared to group G with general anesthesia. BP (SBP, DBP, MAP) and SVRI were remarkably increased in group G compared to group E. BP and SVRI showed rapid increse 1 minutes after head-down tilt in group G (p<0.01) and decreased gradually thereafter. SI and CI were decreased significantly in group G compared to group E (p<0.001). SI was unchanged but CI was decreasd significantly after head-down tilt in group E (p<0.05). EDI and ACI showed lower values decreased in general significantly in group G compared to group E (p<0.05). CONCLUSIONS: All hemodynamic changes were more predictable, gradual, less variable, and stable in the group with epidural anesthesia compared to the group with general anesthesia for hysterectomy.

The Effect of General Anesthesia on Hemodynamics during Laparoscopic Hysterectomy / 대한마취과학회지

BACKGROUND: Laparoscopy with peritoneal carbon dioxide insufflation is a standard procedure in many gynecological departments. And more prolonged gynecological laparoscopic operations are being performed in recent years, and a steeper head-down position is required. Despite laparoscopic operations have many advantages, peritoneal insufflation of CO2 to create the pneumoperitoneum necessary for laparoscopy induces intraoperative hemodynamic changes that complicate anesthetic management of laparoscopy.The purpose of this study is to evaluate the effect of general anesthesia on hemodynamics during loparoscopic hysterectomy. METHODS: Twenty six women undergoing laparoscopic hysterectomy were randomly allocated to either a propofol (Group 1, n=13) intravenous anesthesia or a enflurane (Group 2, n=13) anesthesia with fentanyl-N2O/O2-vecuronium. Hemodynamic parameters were measured before induction (T1), 5 min after induction (T2), 5 min after head-down (T3), 5, 10, 15, 20 min after pneumoperitoneum (T4, T5, T6, T7), 5, 10 min after deflation (T8, T9). The MAP, HR, CI, SVRI, SI were measured by transthoracic electrical bioimpedence method and automated blood pressure device. RESULTS: The mean arterial pressure were increased during pneumoperitonem in both groups and heart rate were increased in Group 2. The cardic index were decreased in both groups after induction by 27.4 % in Group 1 and 25.7% in Group 2. The systemic vascular resistanace index were increased in both groups from head-down to after deflation by 68.3% in Group 1, 73.1% in Group 2 maximally. No significant changes of stroke index were observed during surgery in Group 1. CONCLUSIONS: Laproscopy with CO2 insufflation induces significant hemodynamic changes includig increases of MAP, SVR and a reduction of CI. And usual intraoperative hemodynamic monitoring; the blood pressure and heart rate give no information on the reduction in cardic output.

Comparison of Normal Gas Values in the CSF, Arterial and Venous Blood / 대한마취과학회지

The cerebrospinal fluid(CSF) contains only negligible concentrations of buffer anions other than HCO3- because there is no hemoglobin buffer syatem. CSF gas values have been reported and it has been shown that arterial CO2 diffuses easily into the blood brain barrier to form H2CO3 in the CSF. No study for normal valuea of CSF gaaes in Koreans has been reported. The study was attempted to obtain the normal. values of CSF gases and also to compare values of gases in the three different components, j,e. CSF, arterial and venous blood. Relatively healthy patients with no respiratory or systemic disturbances who were sch-eduled for simple operations have been studied. Prior to the induction of aneathesia, Ium-bar tapping was Performed at a level of L3-4 using a 22 gauge needle and CSF samples-were obtained. Then the racial samples were taken. The subclavian vein was cannulated with a 20 gauge catheter and venous b1ood samples were obtained. All the gas values were-compared as shown in the tab1es and figures. The results obtained were as fallows: PCSF O2 was 76.5+/-8.6 torr and PcsF CO2 was 44.9+/-3.6 torr. Both data in the CSF fall in the middle of the arterial and venous valses. The pH of the CSF was 7.329+/-0.017, HCO3- was 23.6+/-1.8 mEq/L and the base excess was -2.2+/-1.5. All the above data are the lowest among the three components, The pH of the CSF is more acid than arterial or venous blood and that pH regulation of the CSF is seemed to be limited because there is no compensatory hemoglobin buffer in the CSF. The finding of the CSF gas values obtained in this study is introduced as a normal data for further physiological study of the CSF.

Control of Intraoeular Pressure by Intravenous Lidocaine Pretreatment / 대한마취과학회지

It is a known fact that the increase of intraocular pressure results from the action of succinylcholine, endotracheal stimulation to carina, bucking and coughing etc during the induction arid recovery periods. Efforts have been made by several inveatigators to prevent intraocular hypertension by giving trimetaphan, inderal or curare. However, their effects were not remarkable. In this study, lidocaine Img/tg was administered intravenously to selectee patients 2-3 minutes hefore induction ; followed by regular induction with pentothal, succinylcholine and incubation. Intraocular pressures were measured at the pre-induction and post-intutation time, and every 30 minutes until the early recovery period, thereafter. The result of this study showed that the post-intubational increase of intraocular pressure was prevented in 86.7% of the lidocaine pretreated cases. The increase of post-extuba-tional intraocular pressure was also reduced significantly in the lidocaine pretreated group-as well. We came to the conclusion that lidocaine pretreatment technic can be used effectively to prevent intraocular hyperteilsion caused by induction and extubation in clinical practice.

Effect of Meperidine Spinal Anesthesia for Cesarean Section / 대한마취과학회지

Recently several reports have described the usefulness of meperidine as a sole agent for spinal anestaeaia. In this study, meperidine mixed with a 10% dextrose solution was used for a spinal anesthetic agent for Cesarean sections in twenty cases. The results from the meperidine spinal anesthesia were compared with lidocaine spinal anesthesia. The specific gravity was 1.043 with 5% lidocaine solusion and 1.029 with meperidine solution. Both were hyperbaric and very similar in baricity. Hypotension over 20% decre-ase in systolic blood pressure due to spinal aneshesia was found in nine out of 20 cases in the lidocaine group and eleven out of 20 cases in the meperidine group. A dose of ephed- rine used for hypotension was 14.+/-3.mg in the lidocaine group and 20.6+/-10.2mg in the meperidine group. The Apgar score was 10 in both groups at 5 minutes. The duration from the administration of the drug until the development of severe pain postoperatively was checked as 481.8+/-197.8 minutes in the meperidine group and 89.0+/-21.8 minutes in the lidocaine group (P<0.001) . As a result of thin study, it was concluded that meperidine can serve as an alternative agent for spinal anesthesia for a Cesarean section. The motor recovery from meperidine spinal anesthesia is shorter than lidocaine and the postoperative analgesic effect was very efficient and much longer than lidocaine, and no clinical signs of fetal depression with a good Apgar score were observed.

Intraspinal Morphine Anesthesia for Open Heart Surgery / 대한마취과학회지

Morphine anesthesia for cardiac surgery became very popular since Lowenstein at al. reported that 1.5~3.0mg/kg of morphine administered intravenously during ventilating with 100% oxygen did not alter cardiovascular dynamics in patients without heart disease and improved them in patients with aortic valve disease. However, morphine anesthesia soon appeared to cause significant disadvantages and many problems such as intraoperative awareness, histamine reactions marked increases in intraoperative blood pressure and prolonges postoperative respiratory depression. This study was primarily undertaken to evaluate the effects of intraspinal morphine anesthesia and compare them with the problems resulting from intravenous morphine anesthesia. We had 25 patients scheduled for open heart surgery. They were anesthetized mainly by intraspinal morphine and intravenous tranquilizers. Spinal tapping using Whitacre pencil point needle was performed in a sitting position at a level between L2-L4 and spinal fluid was drawn and mixed with morphine by a 10cc syringe and was administered rapidly with barbotage 3 times. Then the patient was given pentothal and anectin, and was intubated, followed by intravenous administration of Ativan or valium. The patient's respiration was controlled with 100% oxygen throughout the entire surgery. 1) The dosages of intraspinal morphine ranged between 6~10mg which was bridfly calculated by 0.1mg/kg with some variation according to heights and patients conditions. 2) Activan or valium was administered intravenously to eliminate intraoperative awareness. Ativan was preferred to valium for valve surgery. 3) Cardiovascular dynamics appeared stable throughout the intraoperative, recovery and ICUcare periods. 4) Respiratory depression seemed to be most serious between 12~16hour after intraspinal injection of morphine. Therfore this technique is recommended only in patients who need a controlled respiration for more than 12 hours because respiratory arrest occurs more commonly at that hour. 5) Respiratory care in the ICU was very effective satisfactory without any further medication for synchronisation between patient and respiratior becauses of the length of respiratory depression. 6) Somnolence lasts 24~36hours with no inadvertent reactions. 7) Well documented complications such as respiratory depression, pruritis and urinary retention were not problems in patients for open heart surgery. 8) The anesthesia induced by intraspinal morphine injection was satisfactory in anesthesia practice for open heart surgery. Therefore, we have called this procedure which has not been reported yet intraspinal morphine anesthesia.

CVP Changes in Hemodynamics with Vasoactive Drugs / 대한마취과학회지

No abstract available.

Awareness and Recall During Anesthesia for Cesarean Section / 대한마취과학회지

Balanced anesthesia is being equilibrated with the maintenance of light planes of anesthesia and the relatively free utilization of muscle relaxants to prevent untoward movement of the patient in response to surgical stimuli. However, muscle relaxants per se do not contributes to the state of hypnosis or analgesia. Therfore, awareness during modern anesthesia must be seriously taken. We have given anesthesia in 175 cases for cesarean section in order to investigate intraoperative awareness. Among the 175 anesthetic cases, 13 cases had awareness of pain and 19 cases had auditor awareness. Accordingly the total incidence of awareness in our investigation was 16% which was significantly high and should be considered in clinical anesthesia practice.

Intraspinal Demerol Anesthesia / 대한마취과학회지

Intraspinal morphine anesthesis for open heart surgery was first publicized by Jeon early in 1986. We came to the conclusion that the anesthesia induced by an intraspinal morphine injection was satisfactory in anesthesia practice for open heart surgery and we have called this procedure, "Intraspinal Morphine Anesthesia". However, respiratory depression seemed to be most serious between 12~16hrs, after an intraspinal injection of morphine so that this technique is recommended only in patients who need controlled respiration for more than 12 hours because respiratory arrest occurs more commonly at that time. In other words intraspinal morphine anesthesia is absolutely not recommended in patients for simple operations. This study was undertaken to evaluate the effects of demerol injected in the subarachnoid space and to compare them with the effects of intraspinal morphine anesthesia. This attempt was made to take advantage of the rapid onset and short duration of demerol action for simple and short procedures. We had 32 cases scheduled for open heart surgery but those were all simple cases such as ASD and VSD in which controlled respiration was not expected to be needed. They were anesthetized mainly by intraspinal demerol and intravenous tranquilizers with 100% oxygen throughout the surgery. 1) The dosage of intraspinal demerol which ranged between 1~2 mg/kg did not seem to be proportional to the duration and potency of the drug. 2) Valium was administered intravenously to eliminate intraoperative awareness. Valium was preferred to Activan for simple cases. 3) The main action of demerol seemed to last 3~4 hours and no respiratory problems were observed 4 hours after the injection of demerol. 4) The onset of an anlgesic effect appeared at 5~7 minutes and the respiratory depression or arrest occuresd around10 minutes after the injection. 5) Cardiovascular dynamics appeared stable throughout the surgery except for transient bradycardia with mild hypotension whcih was seem occasionally. 6) Respiratory depression seemed to be no problem in the recovery room and ICU periods. 7)Somnolence lasts around 2~4 hours with no inadvertent resctions. 8) documented complications such as pruritus and voiding difficulty were not problems with the use of demerol for open heart surgery. 9) The aneshtesia induced by intraspinal demerol injection was satisfactory in anesthesia practice for simple cases. Therefore, we have called this procedure "Intraspinal Demerol Anesthesia". However, this technique sometimes is inconvenient in clinical practice because of its short action.

Comparison of Blood Gases in Patients during the Reeovery Period / 대한마취과학회지

In the present study, an effort was made to evaluate the degree of hypoxemia in the early recovery period with general anesthesia. The patients were chosen in each of the following 3 groups, upper abdominal, lower abdominal and non-abdominal operations. The blood samples were taken preperatively, on arrival and 30 minutes after arrival in the recovery room. The blood gases on arrival showed significant decreases of PaO2 and increases of PaCO2 in all three groups in comparison with the preoperative gases. The blood gases at 30 minutes after arrival showed significant increases of PaO2 from the arrival data, in all three groups however there were no significant differences in Paco2. AS a result of this study, it is suggested that conservative and safe management of patients is better to provide supplement oxygen in the earlyer recovery period to all patients with general anesthesia.

Saddle Block Induced by Intraspinal Narcotic Injection / 대한마취과학회지

Since intsaspinal morphine and demerol anesthesia have been reported we have noted anesthetic effects from the intraspinal nareotic injection. However, intraspinal mophine anesthesia appeared to cause prolonged respiratory depression with a slow onset and a very long duration which is not suitable for short surgical procedures. On the other hand, demerol or pentazocine were found to have a very short onset and duration with excellent local anesthetic effects. This study was primarily an attempt to take advantage of the rapid onset and short duration of demerol and pentazocine for simple and short surgical procedures. We had 43 cases scheduled for surgeries in the saddle ares i.e. hemorrhoidectomy, T.U.R., radium appli cator insertion and vaginal hysterectomy. All operations were performed under intraspinal demerol or pentazocine anesthesia, witch was satisfactory and the following results were obtained: 1) intraspinal dosage of demerol was 50mg or pentazocine was 30mg ofr hemorrhoidectomy, radium applicator insertion and T.U.R. For vaginal hysterectomy, the dosage was increased to 75mg~100mg for with demerol or 45mg with pentazocine. 2) Both analgesic effects apeeared from 1~2minutes after intraspinal injection and lasted 2 hours. 3) Mild somnolences were observed occasionally but no respiratory depression was seen. 4) Hemodynamics were stable throughout the entire procedures as well as postoperatively. 5) We came to the conclusion that a saddle block induced by intraspinal demerol or pentazocine injection was quite satisfactory in anesthesia practice for perineal surgery.

Hemothorax Resulting from Subclavisn Vein Catheterization / 대한마취과학회지

Serious complications from subelavian vein cannulation have been reported, i.e., pneumothorax, hydrothorax, hemothorax and catheter embolism, etc. A 42 year old female with a diagnosis of septic cholangitis was catheterised in the right subclavian vein by the supraclavicular approach for the measurement of CP and on the 3rd day of admission and developed a hemothorax subsequently. She had a cholecystectomy on the 4th day. Aensthesia was induced with the injection of pentothal and succinylcholine through the CVP line and was maintained with Ethrane. Her vital signs were not stable during the surgery as well as post-operatively. She also was not able to breathe by herself so that her respiration was assisted with a MA-J respirator. On the 2nd post-operative day, blood gases suggested respiratory failure and a chest P-A showed right pleural effusion. A chest tube was then inserted and about 3,200ml of blood was drained. She recovered from the hemothorax and superimposed pneumonia with intensive respiratory care for 20 days.

Continuous Epidural Analgesia for Labor and Delivery / 대한마취과학회지

Continuous epidural analgesia for labor has become a very popular procedure in the Unites States. However it has not been introduced enough to the laypeople in Korea because of economic problems, lack of availabel anesthesiologists and traditional prejudice about anesthesia for delivery. This report is to present our clinical experience of 250 cases of continuous epidural analgesia for labor and delivery which was done at the Dong San Medical Center during the period of January to May 1985. An epidural puncture was made at the level between L3-4 with the same technique as used for an ordinary epidural anesthesia. The catheter was thereaded through an 18GTuohy epideral needle. The epidural catheter was fixed and tapped to the patient's right side. During the first stage of labor, 6~8ml of 1% lidocaine mixed with eqinephrine 1:300,000 was injected through the catheter when the cervix was 5~6cm dilated in primipara and 4~5cm dilated in multipara. After the initial injection, the same dose 1% lidocaine was repeated as needed when the pain recurred. The injections were usually repeated 3 to 4 times in primipara and once or twice in multipara. For the second stage of labor, 10~12 ml of 1.5% lidocaine was used. As a result of this experience, we have come to the conclusion that continuous epidural analgesia for labor is beneficail to most of the parturients and is highly useful for practice in Korea.

A Treatment for Intractable Pain / 대한마취과학회지

Recently, epidural tunnelling was introduced for the convenience of keeping a catheter inserted for a long period of time. We had 15 cases in which used epidural tunnelling for the tratment of intractable pain mainly in terminal cancer patients. Epidural puncture with cannulation was carried out in the same technique as used for epidural anesthesia. After the subcutaneous epidural tunnelling was done from the site of the epidural entry to the anterior chest, just under the skin using a tunnelling device, the catheter was threaded through the tunnelling needle at the sit of the outlet, was fixed and the tip of the catheter was connected to a filter. Five ml(2mg) of saline diluted morphine can be given at home as needed when intractable pain occurs. This long-term treatment of intractable pain by morphine injections through the epidural cannula place by subcutaneous tunnelling, is very convenient for the patient's daily routine and a better alternative in such a situation. Our technique, its advantages and problems were described in this paper.

A Clinical Report on Oxygen Therapy Used Over a 14 Year Period / 대한마취과학회지

Since 1971, (for 14 years) we have run the oxygen therapy unit in the Department of Anesthesiology. During this time, unauthorized personnel have carried out the duties in the unit under the supervision of anesthesiologist. We came to realize the necessity of having educated personnel to do the work in the oxygen therapy unit. 1) Our data on oxygen therapy increases yearly because the use of respiratory care is gradually increasing. 2) The postoperative use of a respirator increases due to the increase of critical surgical patients such as those who have had open heart and cerebral aneurysm surgery. 3) Hyperbaric oxygen treatment has decreased yearly. 4) Oxygen therapy was most frequently used in patients in the first 10 years of life. 5) The cases which had oxygen treatment were: pneumonia, atelectsis, pulmonary edema, CVA, head trauma, Gullian-Barre syndrome, sepsis, asthma and tetanus in that order. 6) Seasonally, the cases were more frequent in the spiring and fall.

A Cardiac Arrest during Surgery for Adrenal Tumor Causing Primary Aldosteronism / 대한마취과학회지

Primary aldosteronism is a rare syndrome which may reault from adenoma hyperplasia or carcinoma of the adrenal cortex and may thus be amenable to surgical correction. The findings of hypertension, hypoklemia and metabolic alkalosis suggest the diagnosis. This case report is to present the possibility of cardiac arrest due to hypokalemia during surgery for primary an adrenal tumor that was causing aldosteronism. This 25 year-old male who had a long history of aldosteronism, was admitted for surgery correction. Anesthesia was induced with thiopental sodium and was maintained with nitrous oxide and halothane. While the adrenal gland was being manipulated the patient appeared to have a sudden cardiac arrest with ventricular fibrillation as seen on the monitoring EKG. Cardiopulmonary resuscitation and D.C. shock to reverse the ventricular fibrillation was carried out immediately. The rest of the scheduled operation was continued and finished uneventfully. We concluded that the cause of the cardiac arrest in this case seemed to be a preoperative hypokalemia resulting from aldosteronism which was not corrected. In addition to that, the respiratory alkslosis from hyperventilation during the anesthesia even moreso lowered the preoperative level of hypokalemia.