An Analysis of Use by EMS Helicopter at Organ Transplantation / 대한이식학회지

From Feb. 1. 1997 to Mar. 1. 1999, Samsung Medical Center EMS Helicopter was used for air evacuation of the organ donors and the transportation of havested organs. These data were analyzed prospectively. A total of 29 times flight was confirmed. 12 flights were for the transportation of the harvested organs and the transported organs were the liver (4), the heart valve (2), the heart (1), the kidney (1), the cornea (1). The mean flight time was 59.5 minutes. There were 17 cases organ donors. The mean flight time was 66.9 minutes and the mean age was 18.2 years. The most common cause of the brain death was the trauma resulting in MVA (58.8%). For the transportation of the donors, portable ventilator, EKG mornitor, non-invasive BP monitor, non-invasive oxygen saturation monitor were utilized. There was only one cardiac arrest during the transportation.

The Effects of Prostacyclin Aerosol and Infusion on Pulmonary Hypertension / 대한마취과학회지

BACKGROUND: Prostacyclin administered intravenously has demonstrated intermediate pulmonary specificity and its aerosol form has an even greater pulmonary selectivity. There have been few systematic analyses of the difference in response according to the route of administration and the dose of administration of prostacyclin. So we have compared prostacyclin infusion versus inhalation in various concentrations in an animal model. METHODS: Pulmonary hypertension was induced by continuous intravenous infusion of the vasoconstrictor U46619 and prostacyclin solutions of 10, 50, 100, 200 mcg/ml were inhaled using a jet nebulizer. Prostacyclin infusion was done at a rate of 100, 200, 400 ng/kg/min. RESULTS: With inhalation of 10, 50, 100, 200 mcg/ml prostacyclin, PVR fell to values of 85%, 76%, 64%, 55% of the preinhalation value and SVR fell to values of 94%, 80%, 76%, 64% of the preinhalation value, respectively (p<0.05). PVR/SVR ratios decreased significantly in all inhalation doses (p<0.05). With infusion of prostacyclin at a rate of 100, 200, 400 ng/kg/min, PVR fell to values of 73%, 60%, 50% of the preinfusion value and SVR fell to values of 68%, 54%, 38% of the preinfusion value, respectively (p<0.05). PVR/SVR ratios increased at an infusion rate of 400 ng/kg/min. CONCLUSION: Prostacyclin inhalation did not result in selective pulmonary vasodilation without causing any efects on the systemic vascular bed (absolute pulmonary selectivity). But it did cause more predominant vasodilation on the pulmonary vascular bed (relative pulmonary selectivity). By contrast, prostacyclin infusion caused more predominant vasodilation on the systemic vascular bed, creating the risk of severe systemic hypotension.

The Effects of Oral Clonidine on the Cytokines and Stress Hormone Responses in Patients Undergoing Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: Surgery cause alterations in immune and neuroendocrine responses. Cytokines and stress hormones are importanat mediators which modulate the various immune reactions. The aim of present study is to investigate whether clonidine premedication can affect on the concentrations of cytokines and stress hormones in abdominal hysterectomy patients. METHODS: Twenty two healthy women undergoing abdominal hysterectomy were randomly allocated to two groups: eleven control patients and eleven clonidine(0.15 mg) pretreated patients. Variations in blood cytokines, Interleukin-1beta(IL-1beta), IL-2, IL-6 and tumor necrosis factor-alpha(TNF-alpha), and stress hormones, cortisol and ACTH were studied. Blood sampling were conducted 4 times in each patient: after induction, after incision, after surgery 1 h and 3 h. Cytokines assays were carried out with commercially available ELISA kits, and cortisol with radioimmunoassay and ACTH with immunoradiometric assay. RESULTS: IL-1beta increased early and the concentrations of IL-1beta in clonidine treated group were significantly lower than control. The mean concentrations of IL-2 at 1 and 3 h after surgery were slightly higher than after induction in clonidine treated group. IL-6 increased significantly at 3 h after surgery in both groups. Clonidine lowered IL-6 during the whole period. TNF-alpha, and cortisol and ACTH concentraitons were not affected by clonidin. CONCLUSIONS: Clonidine pretreatment decreased IL-1beta and IL-6 concentrations, but not stress hormones in response to abdominal hysterectomy.

Effects of Hypothermia on Astrocytes Death Due to Depolarization or Inhibitors of Glycolysis and Oxidative Phosphorylation / 대한마취과학회지

BACKGROUND: There are evidences that cytotoxic cell death occurs first by intracellular sodium entry and then followed by calcium accumulation during ischemic damage. To investigate the protective effect of hypothermia on the sodium induced or energy depletion induced cell death, we studied the relationship of incubation temperature with viability of the cultured astrocytoma cells. METHODS: The survival rate of astrocytoma cells under veratridine and/or iodoacetate(IAA)/carbonylcyanide m-chlorophenylhydrazone (CCCP) treatments was assessed. To measure the cell viability by veratridine or IAA/CCCP, 3-[4,5-dimethylthiazol-2yl]-2,5, diphenyl tetrazolium bromide (MTT) test using ELISA was utilized. Incubation temperature was varied to 27, 30, 37oC. RESULTS: Veratridine (30, 15, 3 M) known to increase intracellular sodium caused cell death. The survival rate was 88.8 1.3, 100.04 3.8, 105 4.5% of control, respectively at 1hr and 80.0 1.72, 90.9 1.68, 97.5 0.9%, of control respectively at 3 hrs after treatment. The survival rate with IAA/CCCP 1.5 mM/20 M or 150 M/2 M was 12.75 0.99, 32.85 2.93, respectively at 1 hr, and 3.1 0.36%, 15.48 1.11, respectively at 3 hrs. Veratridine addition to IAA/CCCP exacerbated cell death as compared with IAA/CCCP alone (6.6 0.43 vs 15.48 1.11). Lowering incubation temperature decreased cell death by veratridine or IAA/CCCP significantly: veratridine treated group revealed 80.0 1.72 % survival rate at 37oC and 94.1 4.0% at 27oC after 3 hrs incubation. IAA/CCCP (150 M/2 M) treated group showed 15.48 1.11% survival rate at 37oC and 39.96 5.20% survival rate at 27oC after 3 hrs incubation. CONCLUSIONS: Cell death caused by veratridine or IAA/CCCP was ameliorated by hypothermic incubation.

An Experience in Anesthesia for Ambulatory Surgery / 대한마취과학회지

BACKGROUND: Ambulatory surgery has the advantages of reduced demand for postoperative medications, faster recuperation, less disruption to personal life and reduced hospital costs. At present, 60-70% of surgery in North America is performed on an ambulatory basis. DSC (day-surgery center) was opened on March 1995 in our hospital. We want to introduce an experience in anesthesia for ambulatory surgery. METHODS: Ambulatory surgeries were reviewed from March 1995 to July 1996. Total ambulatory surgeries were 5,593 cases. The medical records of 1,816 patients who were anethetized by anesthesiologists for ambulatory surgery were an alyzed retrospectively (3,777 patients who were operated under local anesthesia were excluded). RESULTS: The rate of utility was 14.1% on March 1995 and 27.7% on January 1996. The mean rate of utility was 22.2% per month in DSC. The overall mean rate of delayed discharge for the period was 2.9% and the overall mean rate of admission for the period was 1.9%. The principal reasons for the both were requestion by surgeons without surgery and anesthesia-related complications. CONCLUSIONS: The increase of demands of patients for ambulatory surgeries, new technological developements for surgery and anesthesia and increased experiences of surgeons will stimulate the utility of day surgery center.

Anesthetic Management of Congenital Tracheal Stenosis with Hypercarbia / 대한마취과학회지

Congenital tracheal stenosis is a rare life-threatening obstruction in infancy and childhood. Symptoms are ranged from recurrent stridor and wheezing to severe respiratory compromise and hypercarbia. If the patient with tracheal stenosis, who has hypercarbia, is hyperventilated to maintain normocarbia, air is trapped in the lung and the risk of pulmonary barotrauma is increased. Cardiopulmonary-bypass is recommended for this patient to have corrective surgery. Permissive hypercapnia is proposed for the mechanical ventilation of patients with severe tracheal stenosis before cardiopulmonary-bypass.

Effects of Clonidine on Blood pressure and Heart rate, and Anesthetic Requirement During Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Laparoscopic cholecystectomy has become popular in the recent year. However, CO2 insufflation and patient's position changes during laparoscopic surgery can create severe hemodynamic changes, and increase anesthetic requirement. The major aim of this study is to assess the effect of oral clonidine on the cardiovascular lability during the operative and post-operative periods and enflurane requirement during operative period. METHODS: 43 patients(ASA I or II) undergoing elective laparoscopic cholecystectomy were selected for this study. The patients were randomly allocated into 3 groups: group 1(n=14) received no clonidine, group 2(n=15) 0.2 mg of clonidine and group 3(n=14) 0.3 mg of clonidine. Blood pressure and heart rate were continuously monitored during both the operative and post-operative periods. The enflurane concentration was also continuously adjusted to maintain blood pressure and heart rate within the range of 20% changes of baseline values. RESULTS: Since enflurane concentration was controlled to maintain systolic blood pressure within 20% of baseline values, there was no statistically significant difference in vital signs in the three groups during anesthesia. However, vital signs including systolic and diastolic blood pressure during their time in PACU (post anesthesia care unit) between the control and the clonidine treated groups were significantly different. The results of the blood pressure for the groups were found as follows. group 1) 134.9 +/-22.3 mmHg and 77.1 +/-12.4 mmHg, group 2) 116.8 +/-11.1 mmHg and 68.9 +/-12.2 mmHg and group 3) 113+/- 9.2 mmHg and 65.9+/- 9.2 mmHg for systolic and diastolic blood pressure respectively. Also, both the clonidine 0.2 mg and 0.3 mg treated groups, showed significantly decreased anesthetic requirement compared with the control group (P<0.05). There were dose dependent changes between 0.2 mg and 0.3 mg clonidine pretreated groups. CONCLUSIONS: Preoperative clonidine administration was effective in decreasing anesthetic supplement during laparoscopic cholecystectomy, and lessening the severity of hemodynamic changes during PACU.

Intracellular Calcium Alterations Induced during Reperfusion Injury are Altered by Local Anesthetics and Hypothermia / 대한마취과학회지

No abstract available.

Paresthesia and Motor Weakness of Left Shoulder after Interscalene Nerve Block: A case report / 대한마취과학회지

Nerve injury can arise as a complication of peripheral nerve block. Three factors are of special etiologic interest: nerve lesion due to the needle injury or intraneural injection; toxic effects of drugs injected overall when epinephrine is used; ischemic trauma. The symptoms of such nerve lesions are dysesthesia, motor weakness or paralysis. We report a case of severe neurologic symptoms of left shoulder after interscalene nerve block in a 23-year-old ASA I male patient. Interscalene block utilizing nerve stimulator and elicitation of paresthesia was performed smoothly for incision and drainage of 2nd finger mass. Total 30 cc of 2% lidocaine with epinephrine was used. After the procedure, the patient developed a severe dysesthesia and motor weakness of left shoulder which gradually improved over the next 6 months through the extensive rehabilitation program. The block should be handled with care: rough paresthesia seeking techniques and intraneural injections should be avoided; short bevel needles and plain solutions should be used to avoid complications.

Paresthesia and Motor Weakness of Left Shoulder after Interscalene Nerve Block: A case report / 대한마취과학회지

Nerve injury can arise as a complication of peripheral nerve block. Three factors are of special etiologic interest: nerve lesion due to the needle injury or intraneural injection; toxic effects of drugs injected overall when epinephrine is used; ischemic trauma. The symptoms of such nerve lesions are dysesthesia, motor weakness or paralysis. We report a case of severe neurologic symptoms of left shoulder after interscalene nerve block in a 23-year-old ASA I male patient. Interscalene block utilizing nerve stimulator and elicitation of paresthesia was performed smoothly for incision and drainage of 2nd finger mass. Total 30 cc of 2% lidocaine with epinephrine was used. After the procedure, the patient developed a severe dysesthesia and motor weakness of left shoulder which gradually improved over the next 6 months through the extensive rehabilitation program. The block should be handled with care: rough paresthesia seeking techniques and intraneural injections should be avoided; short bevel needles and plain solutions should be used to avoid complications.