Earlier Application of Percutaneous Cardiopulmonary Support Rescues Patients from Severe Cardiopulmonary Failure Using the APACHE III Scoring System

Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score > or =50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores > or =50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival.

Laparoscopy vs. laparotomy for embryo transfer to produce transgenic goats (Capra hircus)

This study was performed to produce transgenic Korean native goat (Capra hircus) by laparoscopic embryo transfer (ET) to overcome the limitations of ET performed by laparotomy. Transgenic embryos were produced by DNA pronuclear microinjection of in vivo zygotes. The recipient goats were synchronized for estrus by using an introvaginal progesterone devices as a controlled internal drugreleasing insert (CIDR) for 13 days and injection of 400 IU PMSG 48 h before removal of the insert. Embryos were transferred on day 3 and 4 after removal of the insert. Recipient goats were deprived of feed for 48 h, then suspended in a laparotomy cradle at an angle of 45degrees. After obtaining a sufficient pneumoperitoneum, the laparoscope and forceps were inserted abdominally through 5 mm trocar sleeves. Examination of the ovaries and uterus was performed and then 213 embryos were transferred into the oviducts via the infundibula of 76 recipient goats. To compare pregnancy rates, ET was also performed by laparotomy in 82 recipient goats. The pregnancies in the recipient goats were diagnosed by ultrasound on day 30 after embryo transfer. The pregnancy rate with laparoscopic ET was significantly higher than with ET performed by laparotomy (46.1% vs. 28.6%, p < 0.05). In addition, the pregnancy rates were compared between ovulated and non-ovulated ovaries of the recipient goats in the laparoscopic ET group. No significant difference was observed between the pregnancy rates of ovulated and non-ovulated ovaries (41.3% vs. 33.3%, p < 0.05) suggesting that ET may also be possible in non-ovulated recipients through artificial rupture of Graafian follicles. These results suggest that laparoscopic ET is a highly efficient method for the transfer of goat embryos.

First Experience of Cardiac Surgery using da Vinci(TM) Surgical System in Korea / 대한흉부외과학회지

da Vinci(TM) Surgical System is an advanced mode of minimal invasive surgery, using 3-dimensional imaging system and robotic arms which can mimic the dexterity of the human hand. Thus, various operations can be performed with minimal incision and limited surgical field and the merits of minimal invasive surgery can be maximized by using it. We report our first experience of robotic open heart surgery using the da Vinci(TM) Surgical System for repairing atrial septal defect.

Clinical Results and Optimal Timing of OPCAB in Patients with Acute Myocardial Infarction / 대한흉부외과학회지

BACKGROUND: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardiopulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. MATERIAL AND METHOD: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005. Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups ( 8 days). OPCAB was performed a mean of 5.3+/-7.1 days after AMI in total, which was 4.2+/-5.9 days in group 1, and 6.6+/-8.3 days in group 2. RESULT: Mean distal anastomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months (4~42 months). The 42 months actuarial survival rate was 94.9+/-2.4%, which was 91.4+/-4.7% in group 1 and 98.0+/-2.0% in group 2 (p=0.26). The 42 months freedom rate from cardiac death was 97.6+/-1.4% which was 97.0+/-2.0% in group 1 and 98.0+/-2.0% in group 2 (p=0.74). The 42 months freedom rate from cardiac event was 95.4+/-2.0% which was 94.8+/-2.9% in group 1 and 95.9+/-2.9% in group 2 (p=0.89). CONCLUSION: OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.

Effects of Pseudocholinesterase, Anticholinesterase, and 4-Aminopyridine to the Mivacurium-induced Neuromuscular Block on Rat Diaphragm / 대한마취과학회지

BACKGROUND: Prolongation of the neuromuscular block of mivacurium can occur when there is a genetic deficiency of the enzyme or in the presence of anticholinesterase (AntiChE) which inhibit the activity of the enzyme. The aim of this study was to determine the efficacies of cholinesterase, AntiChE (neostigmine, pyridostigmine), and 4-aminopyridine in reversing mivacurium block, using the phrenic nerve-diaphragm preparation of a rat. METHODS: Forty-eight Sprague-Dawley rats (200~300 g) were anesthetized with peritoneal injection of 2.5% thiopental 5~10 ml. After a stable twitch and train-of-four responses were established for at least 30 minutes in each preparation, incremental dose of mivacurium was added to obtain 90~95% inhibition of control twitch height. The effects of 0.1 and 1.0 u/ml of horse pseudocholinesterase (pChE, Sigma), 0.1 and 1.0 g/ml of neostigmine, 0.2 and 2.0 g/ml of pyridostigmine, and 1.6, 16 g/ml of 4-aminopyridine (P.B.I) on reversal of mivacurium block were tested. The effects of 0.1 g/ml of neostigmine, or 0.2 g/ml of pyridostigmine with and without 0.1 or 1.0 u/ml of pChE following mivacurium were also tested. RESULTS: In reversing mivacurium block, single twitch and TOF ratios were recovered completely with pChE but not with antiChEs or 4-aminopyridine (p<0.05). Second set of experiments showed that antiChE mixed with pChE had a tendency to recover faster (p<0.05). The comparable recovery patterns of pChE 0.1u/ml alone and neostigmine 0.1 g/ml with pChE 0.1u/ml in our study, indicated that neostigmine would prolong the mivacurium block especially in the presence of hereditary or acquired defects of pChE activity. CONCLUSION: The authors conclude that pChE 1.0 u/ml with and without antiChE were equally effective in reversing neuromuscular block of mivacurium. If these results can be extrapolated to human, it is unlikely that mivacurium block is potentiated by antiChE that may slow its metabolism.

The changes of arterial and end-tidal carbon dioxide tension by respiratory rate and tidal volume / 대한구급학회지

No abstract available.

Anesthesia for ambulatory pediatric patients / 대한구급학회지

No abstract available.