The Efficacy of Epinephrine-Containing Test Dose during Propofol-Nitrous Oxide Anesthesia with High Dose Fentanyl / 대한마취과학회지

BACKGROUND: The aim of this study is to determine the effect of high dose fentanyl on the test dose containing 15microgram epinephrine during propofol anesthesia. METHODS: One hundred patients with ASA physical status 1 were randomized to receive 2 mg/kg propofol with or without 10microgram/kg fentanyl at the induction of anesthesia (n = 50 each). Anesthesia was maintained with propofol 8 mg/kg/h and 67% nitrous oxide in oxygen. Each group of patients were further divided into a test dose group receiving 1.5% lidocaine 3 ml plus epinephrine 15microgram or a saline group receiving 3 ml of isotonic saline (n = 25 each). Heart rate (HR) and systolic blood pressure (SBP) were monitored for 4 min after intravenous injection of the study drugs. RESULTS: In the propofol and the propofol-fentanyl group, the intravenous injection of the test dose produced a HR increase > or = 20 bpm (conventional HR criterion) in 25 and 23 out of the total 25 patients, respectively. Therefore, in the propofol-fentanyl group, sensitivity, specificity, positive predictive value, and negative predictive value were 82%, 100%, 100%, and 92.6%. According to the modified HR criterion (HR increase > or = 10 bpm), all the values were 100%. All patients receiving test dose developed SBP increase > or = 15 mmHg. CONCLUSIONS: Our results indicate that both HR increase > or = 10 bpm or SBP increase > or = 15 mmHg are clinically applicable during propofol-nitrous oxide anesthesia with 10microgram/kg fentanyl.

Novel Self-inflating Resuscitators Maintaining High FiO2 with High Minute Ventilation / 대한마취과학회지

BACKGROUND: Self inflating resuscitators are widely used for the patients who need positive pressure ventilation during transport. During self inflating resuscitator ventilation, the FiO2 may decreases even with the use of the oxygen reservoir. Such phenomenon may increase the difficulty and risk of transport of the critically ill patients. Twin self inflating resuscitator was assembled by being modified from two conventional ones to achieve more stable FiO2. METHODS: The twin self inflating resuscitator and one conventional adult self inflating resuscitator were tested on a test lung. In the twin resuscitator, two adult self inflating resuscitators were connected serially without distal unidirectional valve plate. The resuscitators were compressed at variable tidal volumes, respiratory rates and oxygen flow rates, guided by the monitor. RESULTS: With conventional self inflating resuscitator ventilation, the FiO2 was maintained over 95% until minute ventilation of 7,500, 1,4000, 17,500 ml at respectively 5, 10, 15 L/min oxygen flow rate. With serial type, the FiO2 started to decrease with the minute ventilation over 12,500, 24,000, 28,000 ml at 5, 10, 15 L/min oxygen flow rate. CONCLUSIONS: By simple connection of two self inflating resuscitators, the FiO2 during self inflating resuscitator ventilation could be maintained during almost two times of minute ventilation compared to conventional ones.

Chlorhexidine Versus Povidone Iodine in Bacterial Contamination Rate of Needles Used for Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Skin antisepsis prior to the induction of spinal anesthesia is important because infectious complications may occur. Povidone-iodine and chlorhexidine have been widely used as antiseptic solutions for skin preparation; however, no study has been carried out to evaluate the efficacies of these antiseptic solutions for skin disinfection for spinal anesthesia. The aim of this study was to compare the efficacy of povidone-iodine and chlorhexidine by monitoring needle contamination rates during spinal anesthesia. METHODS: One hundred patients were randomly assigned to receive either 0.5% chlorhexidine in 70% isopropyl alcohol solution or 10% povidone-iodine aqueous solution for skin preparation. Patients' skin was disinfected three times in the lumbar area using the designated antiseptic solution and then allowed to dry for 3 minutes. After the induction of spinal anesthesia, the spinal needle and trocar were kept in a sterile culture bottle containing 45 ml of tryptic soy broth. The needles and trocars were then incubated under aerobic conditions for 48 hours at 37oC, and contaminated microbes were identified by routine microbiological methods. RESULTS: Five of the 51-povidone-iodine treated patient group showed positive culture growth, while no contamination was observed in 46 chlorhexidine treated patients. The microbial organisms found in the povidone-iodine group were Staphylococcus aureus, Escherichia coli, Acinetobacter lwoffii, Acinetobacter baumannii, and G (+) Bacillus species. CONCLUSIONS: 5% chlorhexidine in 70% isopropyl alcohol solution showed more potent anti-microbial effect than 10% povidone-iodine aqueous solution in terms of reducing the bacterial contamination rate of spinal needles.

Could Modified Thromboelastogram Assess Platelet Inhibition by Aspirin in off Pump Coronary Artery Bypass Surgical Patients and Healthy Volunteers? / 대한마취과학회지

BACKGROUND: Thromboelastogram (TEG) is regarded as a method by which coagulation can be measured during surgery. Off pump coronary artery bypass (OPCAB) surgical patients are routinely placed on aspirin. But conventional TEG could not detect platelet dysfunction by antiplatelet agent. We used modified TEG (addition of heparin and platelet agonists) to determine whether this modified TEG could assess the platelet dysfunction by aspirin in OPCAB surgical patients and healthy volunteers. METHODS: After institutional review board approval and consent, platelet function of 10 OPCAB patients (group 1) and 10 healthy subjects (group 2: before aspirin, group 3: after aspirin) were measured using modified TEG. In each group, TEG parameters (R, K time and MA) were analyzed using paired t-test and one way ANOVA was used to determine the difference between groups. RESULTS: In group 1 (OPCAB patients) and group 2 (healthy subjects, before aspirin), the R and K time were increased significantly with the addition of heparin and then decreased subsequently with the platelet agonists (ADP or collagen) in the presence of anticoagulation (heparin). MA showed a decrease in both groups. This compares with no significant difference in all parameters in group 3 (healthy subjects, after aspirin) with the addition of heparin, ADP and collagen. There were no significant differences in each TEG parameter between groups. CONCLUSIONS: This study suggested that aspirin medication obliterated the effect of anticoagulation and platelet agonists in modified TEG. However modified TEG does not provide a comprehensive and sensitive reflection of platelet inhibition by aspirin. TEG should be supplemented by other methods of platelet function assessment.

The Current Status of Cardiopulmonary Resuscitation in Korean University Hospitals: Education, CPR Cart Items, Post-CPR Report / 대한마취과학회지

BACKGROUND: The low cardiopulmonary resuscitation (CPR) survival rate in Korea might be associated with inadequate education, an insufficient number of trained medical personnel, the inappropriate management of instruments and drugs in CPR carts. The purpose of this study was to determine the current status of these factors in major Korean university hospitals. METHODS: We surveyed the following items among anesthesiologists at 13 university hospitals via E-mail. The items in the questionnaire were; 1) the time allocated to CPR instruction for medical students and anesthesiology residents in a year, 2) the organization, call system, and the role of each member of the CPR team, 3) the establishment of standard in-hospital CPR protocol, 4) the CPR cart items list and their exchange intervals, and 5) post-CPR reporting. RESULTS: The durations of education for anesthesiology residents and medical students were <3 and 7 hours per year. The CPR team designated on documents differed from actual practice. Only one hospital had a standard CPR protocol. Most hospitals had a list of CPR cart, contents, items but the exchange intervals were irregular. Post-CPR reports were written only in intensive care units and emergency rooms. The involvement of nurses in CPR was minimal. CONCLUSIONS: In conclusion, recommend that the following be established; more profound CPR education program for anesthesiology residents and medical students, appropriate clarification of duties for each CPR team members, a standard in-hospital CPR protocol, and the systematic maintenance of drugs, instruments, and CPR records.

A Statistical Analysis of the Patients in Anesthesia Preoperative Evaluation Clinic / 대한마취과학회지

BACKGROUND: Inadequate preoperative evaluation leads to delay or cancellation of elective surgery. To minimize this problem, we launched an anesthesia preoperative evaluation clinic. We analyzed major causes of referral, requested departments and distribution of age to make guidelines of management and laboratory tests. METHODS: The data was collected based on 6,902 patients referred to the anesthesia preoperative evaluation clinic from August 1997 to February 2002. The number of patients each year, distribution of sex, age, requested departments and clinical causes of referral were analyzed retrospectively. RESULTS: The sex ratio (M/F) was 42:58. Twenty-three percent of the patients were in their 7th decade. Obstetrics and gynecology (24.3%), general surgery (20.7%), and orthopedic surgery (15.4%) were the main requested departments. Major causes of referral were cardiovascular problems (27.5%) and pulmonary problems (21.0%). Irrespective of age and department, the most common consultations were related to cardiovascular or pulmonary problems. Nineteen percent of patients had more than two problems that included diabetes mellitus and hypertension. CONCLUSIONS: We concluded that increases in the number of referral patients and making guidelines related to cardiovascular and pulmonary problems will contribute to reduce delay or cancellation of elective surgery.

Dopamine Concentration and Hemodynamic Effects according to the Methods of Dopamine Dilution / 대한구급학회지

BACKGROUND: Incorrect infusion of dopamine can be potentially life threatening. If the actual volume of a 100 ml intravenous bag or bottle used to mix dopamine solutions is greater than the labeled volume, overdilution of dopamine can occur, resulting in ineffective hemodynamic response. To determine the significance of dopamine overdilution induced by the excessive volume, dopamine concentration and hemodynamic effect were compared in the manually mixed dopamine and the manufactured premixed dopamine. METHODS: For 5% dextrose water (D5W) 100 ml intravenous bottle mixed with 160 mg (4 ml) of dopamine (group 1), D5W 96 ml mixed with 160 mg of dopamine (group 2), premixed dopamine with 1.6 mg/ml of concentration manufactured 2 months ago (group 3), premixed dopamine with 1.6 mg/ml of concentration manufactured 6 months ago (group 4), and D5W 100 ml intravenous bottle mixed with 160 mg (4 ml) of dopamine after removal of 4 ml dextrose water (group 5), dopamine concentration was measured by High performance liquid chromatography (HPLC). Hemodynamic data was obtained from 10 mongrel dogs for each group at baseline (T1), 15 minutes after dopamine infusion at a rate of 3 microgram/kg/min (T2), 8 microgram/kg/min (T3), and 15 microgram/kg/min (T4). RESULTS: Dopamine concentrations of group 1, 2, 3, 4, and 5 were 1.51+/- 0.09, 1.60 +/- 0.10, 1.63 +/- 0.06, 1.57+/- 0.08 and 1.57+/- 0.07 mg/ml, respectively. Group 1 showed a significantly low concentration (p< 0.05). There was no significant differences in all hemodynamic data between group 1, 2, 3, and 4. In group 1, however, there was no significant increase in both mean blood pressure at T4 and mixed venous oxygen saturation at T3 compared with T1. CONCLUSIONS: The actual volume of D5W in 100 ml intravenous bottle is greater than the labeled, and therefore can cause significant overdilution of dopamine. Premixed dopamine, however, has the same concentration and hemodynamic effects as the dopamine mixed manually but precisely.

Anesthetic Management during Aortic Arch Surgery Using Anterograde Selective Cerebral Perfusion / 대한마취과학회지

Cerebral protection during aortic arch surgery is an anesthetic challenge, since the surgical procedures for aortic arch aneurysm involve an interruption of cerebral blood flow. We report a successfully managed case of aortic arch aneurysm repair with antegrade selective cerebral perfusion (SCP) during TCA (total circulatory arrest) using a transcranial oximeter, cerebral oxygenation was monitored during surgery. Although at the beginning of TCA a decrease in the regional cerebral oxygen saturation was observed, this was soon recovered by SCP. Except for the short period of TCA without SCP, regional cerebral oxygen saturation (rSO2) value were well maintained during surgery.

Thromboendarterectomy in a Patient with Unilateral Chronic Thromboembolic Pulmonary Hypertension / 대한마취과학회지

Chronic thromboembolic pulmonary hypertension (CTEPH) is considered to be an aberrant outcome of acute pulmonary thromboembolism, due to inadequate thrombus dissolution. However, the mechanism of thrombi dissolution failure remains unclear. With respect to inherited thrombophilia, the co-occurrence of natural anticoagulant deficiencies with CTEPH was found to be rare. Pulmonary thromboendarterectomy (PTE) is a potentially curative surgical procedure for CTEPH, but it is associated with considerable mortality due to postoperative complications, such as reperfusion pulmonary edema and right heart failure. The postoperative course after PTE poses a unique series of ventilatory care and hemodynamic management challenges. We present the case of a 42-year-old woman with unilateral CTEPH combined with thrombophilia (Protein S deficiency). Successful PTE was followed by independent lung ventilation with unilateral nitric oxide (NO) inhalation, which resulted in functional improvement without postoperative complications.

Use of Preoperative Transthoracic Echocardiography to Predict the Prognosis after Off-Pump Coronary Artery Bypass Grafting / 대한마취과학회지

BACKGORUND: Echocardiography is usually performed for preoperative cardiac evaluation before coronary bypass graft surgery. if the variables detected by this noninvasive method could predict the outcome of the off-pump coronary bypass surgery (OPCAB), it would be very helpful. The purpose of this study is the evaluation of preoperative transthoracic echocardiographic findings as the predictor of OPCAB outcome. METHODS: We evaluated the relationships between preoperative variables identified by the transthoracic echocardiography and postoperative outcomes. RESULTS: Among the doppler findings trans-mitral flow shows no relationship with the postoperative outcome. But, left ventricular mass had the predictability of postoperative time of extubation, iCU stay, and hospital stay. CONCLUSiONS: Left ventricular mass can be used to predict the outcome after OPCAB and There are the need of further study to find out the reason the left ventricular mass show relationship with the postoperative outcome.

The Effect of Angiotensin II on Hypoxic Pulmonary Vasoconstriction in Isolated Rabbit Lung / 대한마취과학회지

BACKGROUND: The isolated lung model is a very useful model in investigation of hypoxic pulmonary vasoconstriction (HPV), and angiotensin II is extensively used in this model. But the exact role of angiotensin II in HPV is not clear in the isolated rabbit lung. Thus we were concerned about the role of angiotensin II in the blood-perfused rabbit lung. METHODS: New Zealand white rabbits (n = 28) lungs were isolated and perfused with a constant pulmonary perfusate flow; acid-base status and temperature were maintained at constant levels. Deoxyglucose (DOG group, n = 7), angiotension II and deoxyglucose (AG-DOG group, n = 7), calcium (CA group, n = 7), angiotensin II and calcium (AG-CA group, n = 7) were administered, and then hypoxic responses were measured. Three ratios were calculated and compared (P alpha: ratio of hypoxic response to pulmonary arterial pressure at normoxia, P beta: ratio of hypoxic response to baseline hypoxic response, P gamma: ratio of pulmonary arterial pressure at hypoxia to pulmonary arterial pressure at baseline). RESULTS: Angiotensin II increased the pulmonary arterial pressure by 14%, and increased HPV. Baseline pulmonary pressure was increased in the AG-DOG group and in the AG-CA group (P<0.05). P gamma significantly increased in the AG-DOG and AG-CA groups (P<0.05). The first HPV increased but the second HPV decreased in the AG-DOG group (P alpha: P<0.05) and in the AG-CA group. P beta showed no difference between groups. CONCLUSIONS: Angiotensin II resulted in an increase of pulmonary arterial pressure in the isolated rabbit lung. One may misinterpret this as an potentiation of HPV, but HPV was not changed by angiotensin II. Therefore we deny the necessity for angiotensin II in the isolated rabbit lung model.

Anesthetic Management for the Open Heart Surgery in a Patient with Cold Agglutinin Disease: Case report / 대한마취과학회지

Cold agglutinins are serum autoantibodies activated at reduced body temperatures to produce red blood cell agglutination and hemolysis. They are commonly found in the sera of healthy people but rarely become clinically important, because most of them exist at very low titers, and exert their greatest effect at low temperatures. By contrast, during open heart surgery, systemic hypothermia and cold cardioplegia are commonly used, and cold agglutinins can be a appreciable threat. This report describes a patient with documented cold agglutinins who successfully underwent atrial septal defect closure and patent ductus arteriosus ligation by normothermic cardiopulmonary bypass in an effort to avoid the adverse effects of hypothermia.

Amitriptyline, Desipramine, and Paroxetine Inhibit Nitric Oxide Production in Primary Schwann Cell Cultures of Rats / 대한마취과학회지

BACKGROUND: Antidepressants are being used as supplemental therapy in neuropathic and inflammatory pain. The mechanism of their inhibitory effect on experimental animal inflammation is not clear. Studies during the past few years clearly indicate an important role for nitric oxide (NO) in the inflammation and pain-processing system. We evaluated the effects of amitriptyline, desipramine and paroxetine on NO production in primary Schwann cell cultures. METHODS: Primary cultures of the Schwann cell were prepared from dorsal root ganglia of 1- to 3-day old Spraque-Dawley rats. Schwann cells were cultured in the presence or absence of interferon-gamma (500 ng/ml) plus tumor necrosis factor-alpha (500 ng/ml), amitriptyline, desipramine or paroxetine. Production of NO was determined in the supernatant of the culture media. RESULTS: Amitriptyline (10ng/ml), desipramine (10ng/ml) and paroxetine (10ng/ml) inhibited NO release by 29.8%, 51.4%, and 66.8%, respectively. No drug had a toxic effect on cultured cells, which was determined by an LDH assay. CONCLUSIONS: Inhibition of NO production by Schwann cells may be a mechanism by which some antidepressant medications affect inflammatory and neuropathic pain.

A Comparison of the Transoesophageal Doppler and Thermodilution Techniques for Cardiac Output Measurement in Off-Pump Coronary Artery Bypass Surgery Patients / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the accuracy of measured cardiac output using the newly developed esophageal doppler device with that of the thermodilution method using a pulmonary artery catheter. METHODS: In 15 patients undergoing off-pump coronary artery bypass surgery, cardiac outputs were measured at four episodes of surgery; (1) after induction of anesthesia, (2) during dissection of the internal mammary artery, (3) during anastomosis of the left anterior descending artery, and (4) after closure of the pericardium. RESULTS: The bias between the two methods was 0.52 +/- 1.09 L/min. Analysis of the changes in cardiac output from sample episode 1 to 2, from sample episode 2 to 3 and from sample episode 3 to 4, expressed as percent change values, shows no significant differences between the two methods (P > 0.05). CONCLUSIONS: The esophageal doppler accurately reflects changes in cardiac output with time when compared with that of the thermodilution.

Hemodynamic Changes during off Pump Coronary Artery Bypass Surgery / 대한마취과학회지

BACKGROUND: The number of coronary artery bypass graft surgery without cardiopulmonary bypass is increasing in Korea. This technique avoids a number of the adverse effects associated with cardiopulmonary bypass. But the cardiac exposure and stabilization during off pump coronary artery bypass graft surgery (OPCAB) are known to cause hemodynamic deterioration and it creates new challenges for the anesthesiologist. This study is designed to assess the hemodynamic changes during OPCAB. METHODS: Eighteen patients undergoing OPCAB were included in this study (male/female = 13/5, age = 63.5+/-5.2). An octopus(R), a local cardiac-wall restraining device was applied for stabilization of target coronary artery. Three different surgical settings of exposure and stabilization were used according to the site of anastomosis: left anterior descending artery (LAD), posterior descending artery (PDA) and circumflex branch of left coronary artery (LCx). Heart rate (HR), mean systemic arterial pressure (MAP), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were measured. CO was measured with thermodilution technique. Stroke volume index (SVI) and cardiac index (CI) were calculated. On each of the surgical settings, hemodynamic parameters were measured at 5 minutes before exposure of target coronary artery, and 5 minutes after placement of the stabilizer and 5 minutes after the completion of anastomosis. RESULTS: During LAD anastomosis, SVI decreased slightly (7.8%), but MAP and CI remained unchanged. During PDA and LCx anatomosis, MAP decreased moderately (15.7% and 16.1%, respectively) and SVI decreased remarkably (24.9% and 32.9%). Also CI did decrease, but it was less remarkable compared to the decrease in SVI due to the increase of HR. CVP and PCWP increased during PDA and Cx anastomosis. When the heart was released, all of the hemodynamic parameters were restored to baseline values. CONCLUSIONS: Hemodynamic changes during OPCAB were remarkable, especially with PDA and LCx reconstruction. However, these changes were transient and they were well tolerated in most patients.

Comparison of Cardiac Output Measured by Impedance Cardiography and Thermodilution in Open Heart Surgery / 대한마취과학회지

BACKGROUND: Impedance Cardiography is a noninvasive and simple method of cardiac output determination. The purpose of this study was to compare an impedance device with the thermodilution method during the intraoperative period in patients undergoing open heart surgery. METHODS: The study was undertaken in 12 patients undergoing elective open heart surgery without a shunt. When abnormal impedance signals were obtained, the patients were not included in the analysis. Stroke volume was calculated according to the formula of Bernstein. Cardiac output was measured simultaneously by the impedance cardiograph and thermodilution method. We obtained 41-paired measurements during the surgical procedure. The method described by Bland and Altman and linear regression analysis were used for comparison. RESULTS: The correlation coefficient between the two methods was r = 0.36 (P<0.05). Bias and precision analysis between the two techniques showed a mean difference between techniques of 0.80 L/min and a SD of the differences of 1.71 L/min (95% level of agreement 4.21 L/min to -2.62 L/min). Trending analysis showed the impedance cardiogram to inaccurately track the direction of thermodilution CO changes and to underestimate their magnitude (r = 0.57, intercept -3.29, slope 1.27). CONCLUSIONS: This study reveals clinically significant errors in impedance CO measurements. These inaccuracies may be related to the intraoperative environment and abnormal cardiovascular function. Further investigation of such techniques to improve the performance of the impedance cardiogram in the intraoperative setting is warranted.

Endoventricular Circular Patch Plasty and Intra-operative and Post-operative Care for Patients with Ischemic Cardiomyopathy / 대한구급학회지

BACKGROUND: Endoventricular circular patch plasty (EVCPP)was introduced as an effective reconstructive procedure for ventricular aneurysm and diffuse dilated cardiomyopathy after myocardial infarction.We report the 4-year results of EVCPP in Seoul National University Hospital, the experiences of anesthesia and intensive care for EVCPP in patients with ischemic cardiomyopathy. METHODS: EVCPP has been performed on 31 patients (22 men and 9 women wit h a mean age of 62 years)during 4 years from March 1998 to March 2002.Six patients (19%)were NYHA cl ass II,24 pat i ent s were cl ass III,and 1 pat i ent was cl ass I V.Preoperative and postoperative left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),ejection fraction (EF)were determined and compared.Transesoghageal echocardiograghy (TEE)was used to measure the distance between aortic annulus and ventricular aneurysm during EVCPP.Milrinone combined with beta -adrenergics was infused during separation from cardiopulmonary bypass (CPB) and in the intensive care unit. RESULTS: Three patients (10%)needed an intra-aortic balloon pump to wean from CPB and one patient (3%)died in the hospital.Out of 30 survivors,29 patients returned to NYHA class I or II and one patient to class III.Out of 30 patients who underwent echocardiographic study before and after EVCPP,EF increased from 34 +/-9%to 38 +/-10%,and LVEDV and LVESV decreased from 139 +/-43 ml to 94 +/-20 ml and from 90 +/-34 ml to 59 +/-17 ml,respectively. CONCLUSIONS: EVCPP is effective to exclude the akinetic left ventricular segment,thus improving left ventricular function and clinical status of patients with ischemic cardiomyopathy.However, studies concerning postoperative intensive care are warranted to reduce the postoperative complications and morbidity.

Role of Intra-aortic Balloon Pump in High Risk Patients undergoing Off-Pump Coronary artery bypass graft / 대한흉부외과학회지

BACKGROUND: This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease(>75 % stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction<35 %). MATERIAL AND METHOD: One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. RESULT: There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5+/-0.9 vs 3.4+/-0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. CONCLUSION: IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients.

Correlation between Epidural Depth and Physical Measurements / 대한마취과학회지

BACKGROUND: This study was performed to accurately discover the correlation between the epidural depth and physical measurements. METHODS: We measured the L2-3, L3-4 epidural depth pre-marked on the needle shaft only when the block was successful. Correction of the depth was made by the angulation of the needle from the perpendicular line (with regard to both the x- and y-axis) to the skin. Height and weight from the medical record was noted and neck, waist, and hip circumferences of each subject was measured. Physical parameters such as waist/neck (waist circumference-to-neck circumference ratio), waist/height (waist circumference-to-height ratio), waist/hip (waist circumference-to-hip circumference ratio), weight/neck (weight- to-neck circumference ratio), weight/height (weight-to-height ratio) and body mass index (BMI) were calculated. Peason's correlation and a regression test between the epidural depth and the physical mea surements were performed. RESULTS: Significant correlation with epidural depth was found in weight, waist, hip, neck, BMI, waist/height, waist/hip, weight/neck, and weight/height. With the regression test, we found weight to be the most important for predicting epidural depth (R square = 0.330, P < 0.05). CONCLUSIONS: Weight has the highest predictive value for lumbar epidural depth.

A Comparison of the Effects on Inducing Hypotension and Bradycardia between Esmolol Infusion Alone and Concomitant Use of Neostigmine for MIDCAB Anesthesia / 대한마취과학회지

BACKGROUND: Esmolol has been applied to lower myocardial oxygen consumption and creates a quieter operative field by reducing systemic blood pressure and heart rate but can cause a certain amount of hemodynamic instability during minimally invasive direct vision coronary artery bypass graft (MIDCAB). The aim of this study was to compare the hemodynamic differences between two methods; inducing hypotension and bradycardia between esmolol infusion alone, and concomitant use of neostigmine during MIDCAB anesthesia. METHODS: Twenty MIDCAB patients were randomly allocated into two groups, group E (n = 10) receiving esmolol 0.3 mg/kg/min, group EN (n = 10) receiving esmolol 0.2 mg/kg/min and neostigmine 1.0 mg for induced hypotension and bradycardia during coronary anastomosis. The hemodynamic parameters were evaluated 10 minutes after induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes before the end of anastomosis (T3) and 10 minutes after the end of anastomosis (T4). Data were analyzed by ANOVA test for intragroup comparisons, and by T-test for intergroup comparisons with significance set at a P value of < 0.05. RESULTS: Heart rate significantly decreased at T3 in both groups and more in group EN. Systolic blood pressure decreased at T3 in both groups and there were no group differences but more episodes of extreme hypotension in group E. The cardiac index significantly decreased at T3 in both groups and more in group E. There was a small but significant increase in pulmonary capillary wedge pressure at T3 and T4 in group E and no change of central venous pressure in both groups. CONCLUSION: Concomitant use of neostigmine during esmolol infusion produces more reliable induced hypotension and bradycardia than esmolol infusion alone for MIDCAB anesthesia in terms of prevention of myocardial ischemia and easiness of anastomosis technique.