Effects of Normal Saline for Maintenance of Arterial Lines of Surgical Patients

PURPOSE: The purpose of this study was to analyze the effectiveness of saline solution vs. heparinized-saline for maintenance of arterial lines and to detect changes in platelet and aPTT as physiological indexes. METHODS: In this nonequivalent control group, non-synchronized, double-blind study the effects of heparinized and saline solution on the maintenance of arterial lines were compared. Fifty five patients received the heparinized solution and fifty nine patients received the saline solution. All patients who had surgery in K-university hospital between September and December 2011 were eligible for participation in the study. RESULTS: There was no statistically significant difference between the saline and the heparin group in the maintenance time of the arterial lines or the number of irrigations. There was no statistically significant difference between the groups in changes in the number of platelets and aPTT for interaction between the groups and time intervals. CONCLUSION: The results indicate that saline solution can be used as an irrigation solution for the maintenance of arterial lines of adult surgical patients, rather than heparinized-saline, in view of potential risk factors in the use of heparin.

Prediction of Difficulty in Endotracheal Intubation in Patients with Obstructive Sleep Apnea: Comparison of Modified Mallampati Test and Upper Lip Bite Test / 대한마취과학회지

BACKGROUND: Patients with obstructive sleep apnea (OSA) may exhibit difficult endotracheal intubation and mask ventilation because of anatomical abnormalities of their upper airway. Many anesthesiologists try to predict difficult endotracheal intubation using simple bedside screening tests. Among these tests, modified Mallampati test (MMT) is the most popular one, but a newer method, called upper lip bite test (ULBT) has been investigated. We compared the clinical accuracy of modified Mallampati test and upper lip bite test for patients with OSA. METHODS: 65 patients with OSA were included in the study. Preoperatively, anestheiologist not involved in endotracheal intubation evaluated patient's airway with MMT and ULBT. Another anesthesiologist assessed the direct laryngoscopic grade. Using Fisher's exact test, we analyzed the correlation of MMT and ULBT with direct laryngoscopic grade and calculated the sensitivity, specificity, positive predictive value and negative predictive value. Furthermore, AUC of ROC (area under a receiver operating characteristic) curve were used to estimate the predictive accuracy of each tests. RESULTS: MMT grade III, IV and ULBT class III was significantly correlated with Cormack-Lehane grade III, IV (P < 0.05). The ULBT showed higher specificity and positive predictive value, but sensitivity and negative predictive value were higher in MMT. AUC of ROC curve was poor for MMT (0.656) and ULBT (0.617). CONCLUSIONS: These results suggest that MMT and ULBT has a poor diagnostic accuracy for predicting difficult intubation in OSA patients as a single bedside screening test.

The Effect of Enflurane, Isoflurane and Propofol on Hepatic Function in Tympanomastoidectomy / 대한마취과학회지

BACKGROUND: Isoflurane and propofol are known to have a low potential for hepatotoxicity. However, no study has compared the effects on hepatic function after of enflurane, isoflurane or propofol in tympanomatoidectomy. Anesthetic techniques should permit the maintenance of low blood pressure during operation for a bloodless surgical field. Because of a long operation time and low blood pressure, the liver may be damaged. The purpose of this study was to evaluate the effects of isoflurane and propofol on liver function by comparing them with enflurane in patients who had been received tympanomatoidectomy. METHODS: Eighty-seven patients with normal liver function were studied following tympanomastiodectomy. The patients were randomly assigned to Group E (n = 28), who received enflurane, Group I (n = 30), who received isoflurane or Group P (n = 29), who received propofol. The plasma concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were measured on the day before the operation, and 1, 2 and 3 days after the operation. RESULTS: one and two days after the operation, all groups showed a significant increase in AST (P < 0.05), but this recovered to the baseline level at 3 days postoperatively, and there was no difference among the three groups. ALT and ALP were not changed until 3 days postoperatively in all groups, and there were no difference between the three groups. CONCLUSIONS: We conclude that there are no significant difference in terms of postoperative hepatic function after tympanomatoidectomy between the three groups.

The Effects of Lidocaine and Clonidine Premedication on Cardiovascular Response during Induction of Anesthesia with Ketamine / 대한마취과학회지

Ketamine may increase blood pressure and heart rate and should be avoided in hypertensive patients. However, in hypovolemic and asthmatic patients, ketamine is used as an induction agent because of its cardiovascular stimulating effect and bronchodilating effect. This study aims to assess the effects of clonidine and lidocaine on the cardiovascular response of intravenous ketamine administration during induction of anesthesia. sixty patients were divided into 3 groups as followed: group I: control ( received no lidocaine or no clonidine) group II: received lidocaine (1.5 mg/kg IV) 3 minutes before intubation group IIl: received clonidine (0.3 mg PO) 90 minutes before induction of anesthesia The changes of blood pressure, heart rate and rate pressure product following intubation were measured at different time interval (before induction,before intubation just after intubation, postintubation 1, 3, 5, 10 min) and compared with the value of control (2 hours before induction of anesthesia). The results are as follows 1) Group I and Group II: The systolic and diastolic blood pressure increased significantly compared to the control value from preinduction to 5 minutes after intubation(p<0.05). It recovered to the control value in 10 minutes, but heart rate and rate-pressure product increased significantly for 10 minutes after intubation(p<0.05) 2) Group III: The systolic and diastolic blood pressure, heart rate and rate-pressure product of preinduction and preintubation values decreased significantly compared to control values but 1 minute after intubation,all values increased significantly(p<0.05). The systolic and diastolic blood pressure and rate-pressure product values recovered to control value in 3 minutes after intubation and heart rate recovered in 5 minutes. Comparing group III with group I and II, it showed significant changes(p<0.05). From the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia. the above results, it can be concluded that clonidine inhibits cardiovascular stimulating response by ketamine during induction of anesthesia.

Subcutaneous Emphysema and Inadvertent One Lung Ventilation during General Anesthesia for Laparascopic Hysterectomy / 대한마취과학회지

In obsterics and gynecology laparoscopic surgery is increasing in numbers and gaining wide popularity replacing classical laparotomy and is becoming new trend in surgical fields. Laparoscopic surgery is favoured over the classical laparotomy because of numerous advantages but it can cause complications by insuffulatory CO2 to induce artificial pneumoperitoneum. Therefore, wide knowledges and thorough understandings of anesthesiologist on the prevention of complications and their treatments are essential. Authors present one case that the patient developed subcutaneous emphysema and ateleciasis on right upper lobe, pulmonary edema in left side lung resulting from inadvertent one lung ventilation during laparoscopic hysterectomy under general anesthesia and on trendelenberg position.

A Clinical Study of the Effects of Time - interval and Temperature Change on the Arterial Blood Gases and PH / 대한마취과학회지

Blood gas samples are highly susceptible to preanalytic error due to improper methods of obtaining or handling the sample prior to delivery to the laboratory. The errors in the measurement of blood gas analysis are currently derived from the exposure of sample to atmosphere, effects of anticoagulant itself, temperature difference between the measuring electrode and drawn blood and the delay in running the sample. To study the effects of the delay in measuring the sample and the temperature difference between the measuring electrode and drawn blood on values of blood gases and pH, we analyzed the arterial sampling from the 24 patients who were taking elective surgery or on his/her recovery period with indwelling arterial catheter. The plastic sampling syringes were kept at 4 degrees C (refrigerator) or 22-24 degrees C (room temperature) and analyzed at regular intervals (1, 10, 30, 60,120 min) for 120 minutes. The following results were obtained: 1) When the arterial blood drawn from the anesthetized patients were stored at 4 degrees C, partial pressure of oxygen (PaO2) decreased significantly after 20 min, whereas those stored at room temperature decreased significantly after 10 min. 2) When the arterial blood drawn from the recovery patients were stored at 4 degrees C, PaO2 did not decrease significantly through the experimental period of 120 min. Although those stored at room temperature did not decrease significantly through the period of 120 min. 3) Partial pressure of carbon dioxide in the arterial blood (PaCO2,) drawn from the anesthetized patients increased significantly by 120 min. at 4 degrees C, whereas those at room temperature increased significantly after 20 min. 4) PaCO2, of the recovery patients increased signigicantly by 120 min. at 4 degrees C, whereas those at room temperature increased significantly after 30 min. 5) pH of the arterial blood drawn from either anesthetized or recovery patients decreased significantly by 120 min. at 4 degrees C, whereas those at room temperature decreased significantly after 60 min. 6) No significant changes of arterial oxygen saturation (SaO2) and content (CaO2) were noted in either anesthetized or recovery. patients in accordance with time elapsed at 4 degrees C or room temperature. In summary, as the changes of PO2 in particular higher than physiologic PO2 and PCO2 in the arterial blood stored at room temperature are significant in accordance with the delay in measuring, it would be advisable to analyze the sample in a short period of time or to store it in a cool place when the measuring will be delayed.

The metabolic Effects of Torniquet in the Adult Lower Extremity / 대한마취과학회지

The use of a pneumatic torniquet to obtain a blood less field in the extremities is essential in the precise operations of present-day plastic and orthopedic surgery. There have been studies conducted regarding systemic and metabolic change in response to torniquet ischemia and complication, associated with torniquets have been reported such as injuries to nerves, muscles and blood vessel. The purpose of this investigation was to examine changes in the systemic circulation, blood gases serum potassium and base status on release of torniquet ischemia in adult. The results were as follows: 1) The mean blood pressure and heart rate did not change significantly after torniquet release. 2) The pH decreased significantly after the torniquet release. 3) The PaO2, and PaCO2, did not charge significantly after torniquet release. 4) The HCO3, and BE decreased significantly after torniquet release (P<0.05). 5) The serum potassium levels tended to increase after torniquet release but the changes was not significant. There-fore to minimize the predictable complications, the ventilatory control and rapid volume replacement are needed during the time immediately preceeding and following torniquet release.