ABSTRACT
BACKGROUND: Norepinephrine infusion has been reported to be associated with adverse events in ischemic heart disease due to elevation of afterload and cardiac oxygen consumption. During coronary artery bypass graft, we observed changes of hemodynamic and laboratory parameters in low dose norepinephrine infusion. Also, we investigated effects of norepinephrine on cardiac oxygen metabolism by calculating oxygen consumption and lactate extraction ratio. METHODS: Fifteen patients, ASA PS class IV-V, scheduled for elective coronary artery bypass graft were enrolled in this study. All of the operations were performed under general anesthesia. During harvesting of graft vessels, norepinephrine was infused at the rate of 0.02microgram/kg/min, and then at the rate of 0.05microgram/kg/min. We measured various hemodynamic and laboratory parameters in three periods (baseline, NE 0.02microgram/kg/min, NE 0.05microgram/kg/min). Also we calculated oxygen consumption and lactate extraction ratio of myocardium. RESULTS: In the baseline period(no norepinephrine infusion), oxygen consumption (VO2) is 159.2 +/- 78.6 ml/min, lactate extraction ratio (LER) is 33.1 +/- 13.0%. After norepinephrine infusion at the rate of 0.02microgram/kg/min, VO2 is 157.6 +/- 55.7 ml/min, LER is 29.9 +/- 10.7%. After norepinephrine infusion at the rate of 0.05microgram/kg/min, VO2 is 212.5 +/- 134.5 ml/min, LER is 27.9 +/- 13.4%. Although VO2 and LER are changed in relation to the rate of norepinephrine infusion, there was no statistical significance. CONCLUSIONS: In conclusion, infusion of low dose norepinephrine during coronary artery bypass graft did not produce significant differences in myocardial oxygen consumption and lactate extraction ratio associated with myocardial oxygen balance.
Subject(s)
Humans , Anesthesia, General , Coronary Artery Bypass , Hemodynamics , Lactic Acid , Metabolism , Myocardial Ischemia , Myocardium , Norepinephrine , Oxygen Consumption , Oxygen , TransplantsABSTRACT
To prevent ischemic brain damage, different techniques, such as, the deep hypothermic circulatory arrest (DHCA), selective antegrade cerebral perfusion (SACP) and retrograde cerebral perfusion (RCP), have been widely used in patients undergoing aortic arch replacement. However, these techniques have been reported to have potential hazards, and in these techniques. Coagulation defect, atheremboli and cerebral edema are known to lead to neuropsychological deficits after cardiopulmonary bypass (CPB). We believe that cerebral perfusion through the right axillary artery, modification of SACP, is the safer, more physiologic and feasible technique. Selective cerebral perfusion (flow: 8-10 mL/kg/min) by right axillary artery cannulation during deep hypothermic arrest was applied in two male patients; a 71-year-old male with ascending aortic aneurysm and a 76-year-old male with aortic dissection (Stanford type A). Both operations were successful and no neurologic complication occurred postoperatively.
Subject(s)
Aged , Humans , Male , Aorta, Thoracic , Aortic Aneurysm , Axillary Artery , Brain , Brain Edema , Cardiopulmonary Bypass , Catheterization , Circulatory Arrest, Deep Hypothermia Induced , PerfusionABSTRACT
Thrombelastography (TEG) performed by an anesthesiologist provides a rapid assessment of coagulation at the bedside. TEG analyzing coagulation status of native whole blood is a more accurate test with a relatively good sensitivity and specificity than PT and aPTT. We experienced an unexpected coagulopathy during the perioperative period. The case was a 47-year-old male patient with blood type O who underwent elective spine surgery. Perioperative coagulation tests (PT, aPTT, BT, CT, etc.) were within normal limits. Anesthesia was induced with propofol 90 mg, vecuronium 8 mg and alfentanil 0.5 mg and maintained with 1.0 1.5 vol% enflurane and 50% N2O in O2. Then we performed acute normovolemic hemodilution (ANH) with monitoring pre- and post-hemodilutional TEG. Hemostasis was revealed as abnormal by a pre-hemodilution TEG (CI = -11.06) and post-hemodilution TEG (CI = -13.06). We managed this coagulopathy with blood components and drugs on the basis of a follow-up TEG so that abnormal hemostasis and TEG findings improved (CI = -4.35). We report a case where undetected coagulopathy was revealed and treated successfuly with TEG.
Subject(s)
Humans , Male , Middle Aged , Alfentanil , Anesthesia , Anesthesia, General , Enflurane , Follow-Up Studies , Hemodilution , Hemostasis , Perioperative Period , Propofol , Sensitivity and Specificity , Spine , Thrombelastography , Vecuronium BromideABSTRACT
Enlargement of the thyroid gland is the most frequently encountered disorder of the endocrine system. A clinical evaluation is helpful in diagnosis but has its limitation. Until recently, surgical excision has been the only means by which a precise diagnosis of thyroid nodule is made, based upon the histopathologic evaluation. Authors studied 117 cases of thyroid nodule operated at Department of Surgery, College of Medicine, Hallym University, from January 1985 to July 1994. The results were analyzed with X2-test and summarized as follows. 1. The thyroid nodules were most frequently seen in third and fourth decades (57.3%), and more in female (5.9:1). 2. The most common symptoms and duration were palpable mass (97.4%) and within 3 months (41.1%). 3. Most cases of thyroid nodules were treated with lobectomy (41.0%). 4. On the radioisotope scanning, the incidence of malignant nodule with cold nodules was 17.9% and the incidence of benign nodule with hot nodule was 91.7%. 5. The overall postoperative and specific complications were only related to the histopathologic finding (P=0.0026, P=0.0207), and not related to the type of operation and size of the thyroid nodules.
Subject(s)
Female , Humans , Diagnosis , Endocrine System , Incidence , Radionuclide Imaging , Thyroid Gland , Thyroid NoduleABSTRACT
No abstract available.