Preoperative Assessment of Coagulation Profiles Using a Thromboelastography in Patients with Chronic Renal Failure / 대한마취과학회지

BACKGROUND: Patients with chronic renal failure traditionally have been recognized as being at risk for perioperative bleeding diathesis. However, there has been a few reports that chronic renal failure patients showed a hypercoagulability. The purpose of this study was to assess blood coagulation profiles in patients with chronic renal failure using a thromboelastography. METHODS: Thirty patients (ASA physical status, 2 and 3) with chronic renal failure (experimental group), were scheduled to get presenting for an arteriovenous fistula formation, and 30 patients with normal renal function (control group) were randomly selected. Blood sampling for a thromboelastography was performed prior to induction of anesthesia. A thromboelastography was analyzed by measuring R time, K time, maximum amplitude (MA), alpha degree, and TEG index. Laboratory tests including serum blood urea nitrogen, creatinine, hematologic data (hemoglobin, hematocrit, platelet count), and coagulation data (PT, PT-INR, aPTT, BT) were also measured in all patients preoperatively. RESULTS: In the thromboelastographic indices, K time was significantly decreased and MA, alpha angle, and TEG index were significantly increased in patients with chronic renal failure (experimental group) compared with the control group (P<0.05). However, there were no significant differences of PT, PT-INR, aPTT, BT between the groups. CONCLUSIONS: Thromboelastographic data demonstrates a hypercoagulable state in patients with chronic renal failure. This finding suggests that traditional concern for bleeding diathesis in patients with chronic renal failure may require reassessment.

Changes in Hemostatic Function Evaluated by Thromboelastography during the Normal Menstrual Cycle / 대한마취과학회지

BACKGROUND: As the menstruation has been thought to be associated with abnormal hemostasis and increased fibrinolytic activities, some surgeons and even anesthesiologists tend to postpone elective surgery. Many investigators have studied individual coagulation profiles and fibrinolytic activity during the menstruation, but conventional coagulation screens are frequently inadequate for the purpose of monitoring coagulation dynamically. This study was designed to evaluate the whole dynamic hemostatic process globally during the normal menstrual cycle by the thromboelastography (TEG). METHODS: Thirty six-healthy, normally menstruating female volunteers wrote a menstruation diary about their menstruation cycle. Blood samples were obtained for TEG analysis 3 days before menstruation, the 1st day of menstruation, the 2nd day of menstruation, the last day of menstruation and 5 days after menstruation. TEG coagulation indices (R value, K value, alpha angle, MA value and WBCLI60) were measured and statistically analysed with repeat-measured one way ANOVA. RESULTS: There were no significant difference in R value, K value, alpha angle, WBCLI60 during menstruation compared with pre- or post-menstruation period, but there was a significant decrease in the MA value on the 1st day of the menstruation. CONCLUSIONS: The result of our study showed the possibility of abnormal hemostatic function on the 1st day of menstruation. However, the more study is needed to confirm the possibility of bleeding tendency during surgery on the 1st day of menstruation.

Anatomicophysiologic Monitoring in the Surgery of Central Area

In the surgery of central area, identifying the motor cortex in front of central sulcus is imperative to prevent loss of motor function. Twenty five patients with tumors or intractable epilepsy near the central sulcus were operated on at the Department of Neurosurgery of Chonbuk National University Hospital, from September. 1991 to December 1993. An estimated localization of lesions was performed with Callosal Grid System, which is a methodolgy made available by the development of high quality of magnetic resonance imaging, digital subtraction angiography and high resolution computerized tomography. This system allowed us to be oriented to the motor cortex as well as permitted assessment of the extent of resection. This was further delineated by direct electrical stimulation, which confirmed the functional motor cortex and made it possible to maximized the tumor resection near and in the motor cortex. The combination of direct cortical stimulation(functional mapping) and the use of the Callosal Grid System(anatomical mapping) allowed us to identify the spatial relationship between them as well as to maximize the tumor resection in most cases without injury to the central area, so that the better outcome is guaranted.

A report of peripheral circulatory insufficiency following frequent percutaneous puncture of the radial artery and the bracheal artery cannulation / 대한구급학회지

No abstract available.

Clinical Study of the Patient with Traumatic Head Injury / 대한마취과학회지

Clinical analysis was done of 284 head injured patients admitted to the hospitals in the Chonbuk area from January to December 31, 1984. The results were the following. 1) Head injury occureed mostly in the 3rd and 4th decade and male patients were 3.7 times as friquent as the female patients. 2) The main cause of head injury was traffic accidents(79%) Other causes were blunt traums, falls, and gunshot in that orer. Many of the traffic accidents involved motorcycles. 3) The accidents were prevalent between 6 and 12 P.M. on Wednesday and Thursday, and in spring and autumn. 4) There was close relation between the level of the consciousness and the death rate of the victims. That is, everyone who was clear or in a stuporous mental state at the time of operation survived, while most of the patients who were semi-or fully comatose died. 5) The time lag between the accident and the surgical operation was 1 to 3 hours. 6) 71% of the injuries were epidural and subdural hematomas, and the rest of the injuries were compressed skull fracture, hemorrage inside the brain parenchyme, in that order. 7) The anesthesia was induced mostly with thiopental sodium and maintained with halothane-N2O-O2 sequence(91.5%). NLA was used in the rest ofr anesthesia(9.1%). 8) Total anesthesia time lapsed for the operation was 2~3 hour in 38%, 3~4 hour in 25% and less than 1 hour in 1.7%.

Anesthetic Management for Thymectomy in the Patients with Myasthenia Gravis - A report 2 of cases / 대한마취과학회지

Myasthenia gravis is a chronic neuromuscular disease with the chief complaints of muscle weakness and generalized fatigue. Many difficult problems may be encountered in the anesthetic management and the postoperative respiratory management. The authors anesthetized 2 cases of myasthenia gravis for thymectomy with success and these experiences are presented in this report with a brief review of the literature relevant to anesthetic management in patients with myasthenia gravis.

Respiratory Arrest following Intrathecal Administration of Morphine / 대한마취과학회지

Epidural and subarachnoid narcotics have raised new possibilities for selective blockade of pain transmission at the spinal cord level. However, it must still be regarded as an experimental technique until detailed pharmacological and physiological data are available, since many reports have treated the development of respiratory arrest which may be related to the dynamics fo CSF flow. We experienced 2 cases of respiratory arrest after intrathecal injection of 2mg morphine. One patient developed respiratory arrest at approximately 5 1/2 hours after intrathecal morphine and the other at approximately 12 1/2 hours. Those respiratory arrests were completely reversed with naloxone hydrochloride without interfering with the analgesic effect of the drug.