Optimal positive end-expiratory pressure during robot-assisted laparoscopic radical prostatectomy / 대한마취과학회지

BACKGROUND: Increased intra-abdominal pressure during laparoscopic surgery causes cephalad displacement of the diaphragm, resulting in the formation of atelectasis, which can be overcome by positive end-expiratory pressure (PEEP). The aim of this prospective study was to investigate the level of optimal PEEP to maintain adequate arterial oxygenation and hemodynamics during robot-assisted laparoscopic radical prostatectomy (RLRP). METHODS: One hundred patients undergoing RLRP were randomly allocated to one of five groups (n = 20) (0, 3, 5, 7 and 10 cmH2O of PEEP). Hemodynamic variables and respiratory parameters were measured at baseline with the patient in the supine position; at 30 min, 1, 2, 3 and 4 h during CO2 insufflation with the patient in the post-Trendelenburg position; and after deflation in the supine position with increasing PEEP. RESULTS: The PaO2 levels and alveolar-arterial difference in oxygen tension (AaDO2) were improved in patients with PEEPs compared with patients in whom PEEP was not used. The application of PEEP (10 cmH2O) resulted in higher PaO2 levels compared to those with lower PEEP levels, but excessive peak airway pressure (PAP) was sometimes observed. The application of a PEEP of 7 cmH2O resulted in similar PaO2 levels without causing excessive PAP. There was a significant difference in central venous pressure between the groups, but there were no significant differences in heart rate, mean arterial pressure or minute ventilation between the groups. CONCLUSIONS: A PEEP of 7 cmH2O is associated with the greater improvement of PaO2 and AaDO2 without causing excessive PAP during RLRP.

The effect of hand dominance on neuromuscular monitoring at the adductor pollicis muscle / 대한마취과학회지

BACKGROUND: Neuromuscular blockade of the adductor pollicis muscle may be influenced by hand dominance resulting in conflicting results of several studies. The current study examined whether hand dominance could influence the measurements of neuromuscular blockade with acceleromyography at the adductor pollicis. METHODS: The acceleromyographic responses from 0.6 mg/kg of rocuronium were monitored supramaximally in both hands in 31 patients after induction of anesthesia. Onset, maximum effect, and offset of rocuronium were measured and compared in both hands. The train-of-four (TOF) ratios to 0.9 were recorded in all patients. RESULTS: In total, 27 patients were right-handed and 4 patients were left-handed. The mean supramaximal threshold or initial TOF ratio was not different between dominant and nondominant hands. No statistically significant differences were found between 716 paired TOF ratios in both hands. A correlation was seen between the dominant and nondominant hand (Nondominant = 0.931.Dominant + 1.714, R = 0.929). The analysis by the Bland-Altman plot showed an excellent agreement with a bias of 1.6% and limits of agreement of -21.2 to 24.5%. CONCLUSIONS: Dominant and nondominant hands can be used interchangeably for neuromuscular monitoring at the adductor pollicis.

Hemodynamic parameters during robotic radical prostatectomy in elderly patients with increased cardiac risk

BACKGROUND: We studied the hemodynamic changes associated with steep Trendelenburg position and prolonged pneumoperitoneum during robot-assisted laparoscopic prostatectomy in elderly patients with cardiac diseases. METHODS: Hemodynamic variables were measured at baseline supine position, at 30 min, 1, 2, 3 and 4 h during CO2 insufflation in post-Trendelenburg position, and after deflation in the supine position. RESULTS: In comparison with normal subjects, the cardiac index and systemic vascular resistance index of patients with cardiac diseases were significantly affected by the Trendelenburg position and pneumoperitoneum (P < 0.001). However, other variables of heart rate, mean arterial pressure and central venous pressure were not differed between the groups. CONCLUSIONS: We conclude that attention should be paid to maintain adequate hemodynamic status during prolonged pneumoperitoneum in the Trendelenburg position, and which is unfeasible in patients with severe heart failure and unstable angina.

A comparison of the accuracy of ulnar versus median nerve stimulation for neuromuscular monitoring / 대한마취과학회지

BACKGROUND: Inexperienced anesthesiologists are frequently unclear as to whether to stimulate the ulnar or median nerve to monitor the adductor pollicis. The primary purpose of this study was to determine whether monitoring the adductor pollicis by positioning the stimulating electrodes over the median nerve is an acceptable alternative to applying electrodes over the ulnar nerve. METHODS: In 20 patients anesthetized with propofol and remifentanil, one pair of stimulating electrodes was positioned over the ulnar nerve. A second pair was placed over the median nerve on the other hand. The acceleromyographic response was monitored on both hands. Rocuronium 0.6 mg/kg was administered. Single twitch (ST) and train-of-four (TOF) stimulations were applied alternatively to both sites. RESULTS: None of the patients showed a twitch response at either site after injection of rocuronium. There were no differences in the mean supramaximal threshold, mean initial TOF ratio, or mean initial ST ratio between the two sites. Bland-Altman analysis revealed a bias (limit of agreement) in the TOF and ST ratios over the median nerve of 7% (+/- 31%) and 26% (+/- 73%), respectively, as compared with the ulnar nerve. The median nerve TOF ratio was overestimated by 16.2%, as compared with that of the ulnar nerve value, and the median nerve ST ratio was overestimated by 72.9%, as compared to that of the ulnar nerve. CONCLUSIONS: The ulnar and median nerves cannot be used interchangeably for accurate neuromuscular monitoring.

Irregular antibody found during emergency subarachnoid hemorrhage operation : A case report

Irregular or unexpected antibodies are alloantibodies against serum or red blood cells after previous exposure to transfusion. When encountered in critical condition, however, risk of ongoing complication is not entirely predictable. Rapid transfusion of safe blood is thus, crucial not to compromise further procedure. A 78-year-old ASA IV man presented with Hunt-Hess grade IV subarachnoid hemorrhage with huge temporal bleeds. While in operating room, his blood pressure dropped when the dura was opened. Meanwhile, routine screening of blood typing repeatedly denoted Rh+O with irregular antibodies. Soon, compatible cross-matched blood was infused with 37 degrees C normal saline 200 ml at a rate of 4-5 ml/kg/hr. There was no laboratory evidence of hemolytic transfusion reaction. Postoperatively, BUN and creatinine increased slightly, but urination and respiration were unremarkable.

Extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever with respiratory failure : A case report

Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.

Tumor Induced Disseminated Intravascular Coagulation : A case report

Neuroblastoma, relatively common pediatric nervous system malignancy, presents as in various clinical aspects, including mass, pain, fever, weight loss, and infrequently anemia and hepatopathy. Hematologic abnormalities are also brought about according to the disease stage or pancytopenia due to radiation, mainly in the form of coagulopathy. We herein briefly report a rare case of stage IV neuroblastoma accompanied by chronic or subacute disseminated intravascular coagulation in a 5-year-old boy. Despite apparently normal coagulation profiles, we could not conduct routine invasive vascular procedures after induction of general anesthesia because of unexplained bleeding diathesis. Anesthesiologists should be alert to this kind of unexpected but potentially lethal complication and prepare to avoid mishaps.

Effects of Steroid Administration on the Blood Glucose Level during Spine Surgery in Patients with Metabolic Syndrome

BACKGROUND: The risk of steroid-induced hyperglycemia is debated, and methylprednisolone is still used during spinal surgery. We have compared the blood glucose level in patients with metabolic syndrome treated with or without methylprednisolone. METHODS: This study was conducted in 68 adult patients who underwent elective spine surgery. Patients were classified into the following groups: methylprednisolone group (n = 39, group M), placebo group (n = 29, group P), group M patients with metabolic syndrome (n = 17, group MM), and group P patients without metabolic syndrome (n = 21, group NMP). Before and after injection of either 125 mg methylprednisolone or a placebo, we consecutively checked the blood glucose level every 30 minutes up to 4 hours. RESULTS: The blood glucose level was significantly increased in group M patients as compared to group P patients. The blood glucose level was more significantly increased in group MM as compared to group NMP patients. The increased blood glucose levels over 4 hours were 50 mg/dl in group MM and 35 mg/dl in group NMP patients. CONCLUSIONS: We recommend that close monitoring of the blood glucose level up to several hours after injection of a steroid should be seriously considered during spine surgery, particularly in patients with metabolic syndrome.

Vital Sign Change after Placement in the Prone Position in an Obese Patient: A case report / 대한마취과학회지

When performing spine surgery, placement of the patient in the prone position with longitudinal padding is most frequently utilized.However, hemodynamics could be compromised by compression of the internal organs, particularly if surgery is being conducted on an morbidly obese patient or on a patient with a soft frame.An increase in the intraabdominal and intrathoracic pressure might cause a perfusion defect of major venous return, a decrease in cardiac output and a defect in pulmonary ventilation and venous congestion within the spinal canal.Accordingly, serious alteration of vital signs or significant expected consequences can occur.We briefly report a case of life-threatening hemodynamic change after placement in the prone position of a morbidly obese patient during general anesthesia.Placing a risky patient on a semi-rigid, stable Wilson frame can be a promising alternative to avoid such intraoperative mishaps.

Effects of Steroid Administration on Blood Glucose Concentration during Brain Surgery / 대한마취과학회지

BACKGROUND: Steroids are normally used in neurosurgery, especially when treating brain edema and reducing the intracranial pressure. Methylprednisolone is known to increase the blood glucose concentration. However, the effect of a single methylprednisolone injection on the blood glucose concentration is unknown. Therefore, this study measured and compared the blood glucose concentration in a methylprednisolone group with that in a placebo group at the same interval. METHODS: Thirty-three adult patients were enrolled in this study. The patients were scheduled to undergoing an elective craniotomy with the procedure lasting 4 hours or longer. The candidates were divided in two groups. One group was the methylprednisolone group (patients receiving methylprednisolone 125 mg, n = 18), and the other group was the placebo group (n = 15). The exclusion criteria were a clinical diagnosis of diabetes mellitus, an impaired glucose tolerance and had received steroid previously. Before injecting 125 mg of either methylprednisolone or the placebo, the blood glucose concentration was checked by glucose analyzer. After the injection, blood glucose concentration was checked every 30 minutes for more than 4 hours. RESULTS: The blood glucose concentration increased significantly over time compared with the baseline concentration in both groups. The glucose concentration increased significantly in the methylprednisolone group than in the placebo group (P < 0.05). The magnitude of this difference was greater in those who received methylprednisolone (54 mg/dl increase over 4 hours) than in the placebo group (11 mg/dl increase over 4 hours). CONCLUSIONS: In this study, compared with placebo controls, an injection of methylprednisolone (125 mg) produced a significant increase in the blood glucose concentration over a 4 hours period. Therefore, we recommend that the blood glucose level be monitored carefully in cases of brain surgery and/or when steroids are used.

Clinical Significance of Prolonged QTc Dispersion in Spontaneous Intracerebral Hemorrhage

PURPOSE: QTc dispersion is a quantitative measure of myocardial repolarization and is a new important prognostic factor for many diseases. We have analyzed the admission ECGs of 53 patients with spontaneous intracerebral hemorrhage (ICH) for QTc dispersion. This study was performed to investigate the value of QTc dispersion as a prognostic factor in ICH patients. METHODS: ECGs done within 24 hours from attack onset were analyzed for abnormalities and QTc. The QTc dispersion is the QT duration of the longest minus the shortest rate-corrected QT interval. We studied the differences in QTc dispersions on the initial ECGs in the ED between a favorable group and an unfavorable group. RESULTS: We found that patients had less chance for a good recovery if they had a lower Glasgow Coma Scale (GCS) score on admission, a larger volume hematoma, a prolonged QTc dispersion, or a longer maximal QTc interval of the 53 patients with ICH, 16 (30.2%) patients demonstrated ECG abnormalities. The QTc dispersion was extremely prolonged in both groups. The favorable group included patients with a mean QTc dispersion=70.6 ms, whereas the unfavorable group included patients with a QTc dispersion= 117.6 ms. CONCLUSION: A prolonged QTc dispersion and a lower GCS score were significant predictors of a poor prognosis for spontaneous ICH patients. An increased QTc dispersion on the initial ECG is an important prognostic factor for ICH patients. More attention should be given to the disposition and intensive care of such patients.

Genotoxicity of Enflurane in Human Peripheral Blood Lymphocytes Studied in vivo by Single Cell Gel Electrophoresis / 대한마취과학회지

BACKGROUND: The alkaline single cell gel electrophoresis comet assay was applied to study the genotoxic properties of enflurane on the human peripheral blood lymphocytes (PBL) of cancer patients before and during anesthesia as compared to an non-cancer control group. Method: The cancer group consisted of 24 patients (aged 15-77 years), while the control group consisted of 14 trauma individuals (aged 20-81 years). After anesthesia induction (thiopental 4 mg/kg and vecuronium 0.1 mg/kg), it was maintained by enflurane inhalation; 1-2 minimal alveolar concentration in oxygen - nitrous oxide mixture. Venous blood samples were obtained before the induction of anesthesia, and after 60 and 120 min of anesthesia. The comet assay detects DNA damage, such as strand breaks and alkaline labile sites induced directly by genotoxic agents, and DNA degradation due to cell death. Fifty cells from each sample were examined and Olive tail moments (OTM) were calculated using Komet 4TM software. RESULTS: OTM values were no different between controls and patients before anesthesia. However, the OTMs of blood sampled from cancer patients at 60 (7.97 +/- 1.83) and 120 min (7.86 +/- 2.05), and from trauma patients at 120 min (8.04 +/- 1.32) of anesthesia were significantly increased. CONCLUSIONS: In immunocompromised cancer patients, we suggest the existence of a higher risk of an association DNA damage and enflurane exposure.

The Effects of a Tourniquet on Serum Catecholamine Levels for General and Spinal Anesthesia in Total Knee Replacement / 대한마취과학회지

BACKGROUND: Pneumatic tourniquets are most frequently used during operations on the lower extremities, especially during knee operations, and provide a bloodless surgical field and prevent excessive blood loss. But tourniquets increase blood pressure, though the cause has not been identified. We thought that plasma catecholamine is increased by pneumatic tourniquet inflation. Troponin I is specific cardiac marker in myocardiac injury. So we measured plasma catecholamine and Troponin I under general and spinal anesthesia in patients undergoing total knee replacement. METHODS: We divided the patients into two groups, the first group (Group I, n = 25) was the general anesthesia group and second group (Group II, n = 26) the spinal anesthesia group. All patients underwent an operation for total knee replacement. Serum enzyme levels are instable so we tried to keep changes at a minimal level. Thus all operations were carried out by the same group of surgeons, in the same operating room, at the same time (AM 8:00 start operation). The same tourniquet was applied for all subjects (tourniquet pressure 350 mmHg, 9 cm width). Group I patients had general anesthesia with N2O - O2 - Enflurane. Group II patients had spinal anesthesia with 0.5% tetracaine: the dermatomal level of sensory blockade to pin-prick was T6 - T4. We measured blood pressure, heart rate, SpO2, ECG, serum catecolamine and trophonine I. Blood sampling were performed preoperation, 50 minutes after tourniquet application, and 30 minutes after operation to obtained serum catecholamine and trophonine I levesl. Result: Mean arterial pressure increased in group I during tourniquet inflation. The serum catecholamine level was higher in group I than in group II. The serum troponin I level was statistically significance in the general anesthesia groups (Group I). CONCLUSIONS: It might be suggested that an increased level of serum catecholamine causes tourniquet induced hypertension. Myocardial injury due to tourniquet induced hypertension was not affected by anesthesia type

Predictive Factors of Prognosis in Paraquat Poisoning

PURPOSE: Paraquat is widely used non-selective contact herbicide. In spite of efforts to improve the outcome in paraquat poisoning, the mortality rate still remains high. The purpose of this study is to assess the predictive factors of prognosis by investigating initial laboratory data on paraquat poisoning. METHODS: The author retrospectively analyzed the clinical features, laboratory data, and outcomes for 130 paraquatpoisoning patients treated from June 1997 to September 2003 at the emergency medical center of Chonnam National University Hospital. RESULTS: The results were as follows: 1) The mortalities were significantly older than the survivors (49.3 years vs 37.6 years, p<0.05). Among the total 130 cases, the survivors numbered 50, and the deceased numbered 80. The mean age of all 130 cases was 44.8+/-16.9 years. 2) The white blood cell count and the levels of serum AST and ALT in the deceased were significantly higher than they were in the survivors. The levels of arterial pH, PaCO 2, base excess, HCO3 -, and serum potassium in the survivors were significantly higher than they were in the deceased. 3) A multivariate Cox-Regression analysis revealed that sex, serum potassium, and arterial HCO3 - were associated with the mortality rate. CONCILUSION: The above data reveal that the ingested amount, the result of the urine sodium dithionite test, and the initial state of laboratory parameters, including the white blood cell count, ABGA (pH, PaCO2, HCO3 -, base excess), serum potassium, AST, and ALT, can be used to predict the outcome of paraquat poisoning.

The Effects of Peripheral mu and kappa Opioid Receptor Agonists on the Thermal Injury Induced Hyperalgesia in the Rat / 대한마취과학회지

BACKGROUND: Previous reports have described that the local administration of opioid receptor agonist can attenuate the nociceptive responses induced by a variety of inflammatory states. This study evaluated the effects of mu or kappa opioid receptor agonists peripherally administered at a site of injury on the state of thermal hyperalgesia induced by mild burn injury. METHODS: Thermal injury was induced after briefly anesthetizing with halothane, by applying the left hindpaw to a hot plate (52.5 degree C) for 45 seconds. Paw withdrawal latency of the hindpaw was determined using an underglass thermal stimulus, which allowed the response latency of the injured paw to be obtained. In this work, the mu receptor agonist, morphine (10, 30, 100 microgram), or the kappa receptor agonist, U50,488H (10, 30, 100 microgram), was administered respectively at the injured site on the right hindpaw in rats. To compare the systemic effects of the drug, the same drug was administered at the normal left hindpaw site with mild burn injury. Naloxone (40 microgram/kg) was administered at the injured site or at the normal site to determine the reversibility of the opioid used. RESULTS: Mild burn injury produced thermal hyperalgesia manifested as reduced paw withdrawal latency. Administration of either morphine (10, 30, 100 microgram) or U50,488H (10, 30, 100 microgram) at the injured site attenuated hyperalgesia in a dose-dependent manner. But the administration of drugs at the normal site had no effect on hyperalgesia at the injured site. In addition, naloxone had the effect of morphine and U50,488H reversed significantly. CONCLUSIONS: These results suggest that peripheral mu or kappa opioid receptor administration at an injured site may play an important role in the hyperalgesia induced by mild burn injury.

Malaria in Korea / 감염

Since the national malaria eradication service (NMES) was implemented in 1959, extensive malariometric survey were conducted throughout the country. A total of 73,859 malaria cases of Plasmodium vivax were confirmed out of 268,259 blood smears through passive and active case detection (PCD and ACD) in 1960~1969 including chloroquine/ pyrimethamine combined tablets for the presumptive treatment of all of fever cases. The majority of the positive cases occurred in Gyeongsang buk-do, revealing 62,859 cases as of 85.2%, followed by Gyeonggi-do 5,844 cases (7.9%), Chungcheong buk-do 3,458 cases (4.7%), Gangwon-do 812 cases (1.1%), and 29 cases developed in Jeju-do. ACD was more sensitive and advantageous for detecting the malaria cases over PCD in the pilot study area. The high endemic area was located in the north Gyeongsang buk-do and north east Gyeonggi-do. The malaria incidence was high in the age group under 14 years in malaria foci, and that was low in non-malarious area. High parous rate (77.7%) and survival rate (91.4%) of the vector mosquitoes were shown in malaria foci, which were hilly or mountainous area. On the other hand, low parous rate (50.6%) and survival rate (42.7%) were found in non-malarious area, the rice field of south western part of the country even in abundance of vector mosquitoes. NMES had contributed the control of the malaria by carring out the residual DDT focal spray, mass drug administration, radical treatment of the positive cases, and mass blood survey in the heavy malarious area. Since then malaria disappeared rapidly, and no indigenous case was reported after 1984. In order to ascertain whether this country was malaria-free or not, mass blood survey was carried out for the juveniles, adolescents and adults in Yeongju-gun Gyeongsangbuk-do in 1986 where the highest incidence of malaria was recorded during the 1960s. The result showed no positive case at all. However vivax malaria reemerged, and made a dramatic resurgence since 1993 in the demilitarized zone (DMZ) bordering North Korea, and expanded toward eastern and southern part of the country year after year, totaling 14,089 cases including U.S. army by the end of 2000 in spite of the strong activities of antimalaria in the Republic of Korea. So vector control including the encouragement of the livestock farming in the malaria endemic area must be more sensitive and effective measure to reduce the risk of malaria transmission by the eliminating the dangerous age of mosquitoes in the points of characteristics of the Korean strain of parasites such as the mild symptoms, long-term incubation period and asymptomatic parasitaemia. Focal application of thermal fogging and mist spray of insecticides would be certainly effective in preventing the vector mosquitoes from infecting the gametocytes of malaria for the first peak of multi malaria cases in the early season of the year. All of the civilians who are in the high risk area for malaria should be forced to sleep under the permethrin impregnated mosquito nets. All of the soldiers near the DMZ are strongly recommended to take the combined tablets of chloroquine/ pyrimethamine instead of the single base of chloroquine at present to prevent the action of source of infection of the reservoirs and the completion of the sporogonic stages of the vector mosquitoes because the vector control activities are not allowed in the DMZ. The experts of entomologists and malariologist of the South and North Korea should discuss the antimalaria programme to eradicate the malaria from the Korean peninsular near future.

Comparison of an Effective Dose of Intravenous Postoperative Patient-controlled Analgesia with Nalbuphine / 대한마취과학회지

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.

Study of Acid-Base in Arterial and Central Venous Blood during / 대한마취과학회지

BACKGROUND: Although pulmonary artery catheters are useful to monitor hydration, these devices may be associated with severe morbidity and are not routinely used in kidney transplantation. A central venous pressure (CVP) catheter is preferred rather than a pulmonary artery catheter. Noninvasive continuous blood pressure monitors may substitute for intraarterial catheters, thereby preserving the radial artery in kidney transplantation patients should it be needed later to create an arteriovenous fistula. If there is a relationship between central venous and radial arterial blood for acid-base (pH, BE, HCO3(-)), we can use the blood sample from a CVP catheter instead of arterial blood from aradial artery catheter for testing acid-base and it can help patients. METHODS: A central venous catheter and radial artery catheter was inserted in 67 patients while undergoing kidney transplantation. To assess arteriovenous differences in acid-base status at operation start, before reperfusion of the transplanted kidney, after reperfusion, we measured the pH, BE and HCO3(-) simultaneously from the arterial and central venous circulation. RESULTS: Aacid-base using arterial and central venous samples at operation start, before reperfusion and after reperfusionb was evaluated. We found the relationship as follows: pH between arterial (pHa) and central venous blood (pHcv) in each: linear regression equation; pHcv = 0.668 + (0.906 X pHa), pHcv = 0.225 + (0.965 X pHa), pHcv = 0.646 + (0.908 X pHa), determination coefficient; 0.908, 0.926, 0.888, P values < 0.001 in each period. Base excess (BE) between BEa and BEcv in each period: linear regression equation; BEcv = 0.483 + (0.952 X BEa), BEcv = 0.032 + (0.939 X BEa), BEcv = 0.008 + (0.954 X BEa), determination coefficient; 0.844, 0.954, 0.962 P values < 0.001 in each period. HCO3(-) concentration between HCO3(-)a and HCO3(-)cv in each period: linear regression equation; HCO3(-)cv = 2.434 + (0.937 X HCO3(-)a), HCO3(-)cv = 2.093 + (0.942 X HCO3(-)a), HCO3(-)cv = 1.755 + (0.954 X HCO3 a), determination coefficient; 0.950, 0.925, 0.932 P values < 0.001 in each period. CONCLUSIONS: The acid base status of arterial blood is similar to that of central venous blood. Central venous blood gas values (pH, BE, HCO3(-)) may be an acceptable alternative to arterial blood gas values in kidney transplantation patients.

The Effects of Etomidate on the Isolated Porcine Coronary Artery / 대한마취과학회지

BACKGROUND: Etomidate produces minimal cardiovascular effects in clinical uses but their effects on the porcine coronary arteries are not well known yet. We studied the direct effects of etomidate on porcine coronary arterial tone and the underlying mechanism of its vascular relaxation. METHODS: Porcine coronary arterial ring segments (3-4 mm) with or without endothelium were suspended in modified Krebs solution (37oC) and preconstricted with K+ 40 mM. Changes in tension were measured following cumulative administrations of etomidate (10(-5), 5 x 10(-5) and 10(-4) M). Relaxation caused by etomidate (10(-4)M) were measured in the presence of either NG-nitro-L-arginine methyl ether (L-NAME 10(-5)M, n = 13), indomethacin (2.8 x 10(-5)M, n = 12), methylene blue (2 x 10(-5)M, n = 12), tetraethylammonium (TEA, KCa2+ blocker, 20 mM, n = 11), glibenclamide (n = 13) 2.5 x 10(-5)M or 4-aminopyridine (4-AP, K+ DR blocker, 10 4 M, n = 12). Effects of etomidate on Ca2+ influx through the voltage operated channel (VOC) of the vascular cells were also evaluated. RESULTS: Arterial reings were relaxed by etomidate in a concentration-dependent manner and these effects were not affected by endothelium. In the etomidate pretreated group, arterial ring in a calcium-free solution showed no contraction with KCl 40 mM, but the contraction after the administration of calcium 2.5 mM less than without etomidate group (47.2 +/- 8.7% vs 97.7 +/- 10.6%). The other group, not pretreated with etomidate, showed the same vascular tone of the control group in a slow upstroke manner with calcium administration. Pretreatment with either L-NAME, indomethacin and methylene blue did not affect etomidate-induced vasorelaxation. The TEA, glibenclamide and 4-AP pretreated groups also did not affect the vascular relaxation. CONCLUSIONS: Etomidate relaxes the porcine coronary artery in a concentration-dependent manner withor without endothelium, via inhibition of Ca2+ influx through the voltage-operated Ca2+ channel.

Resurgence of the Malaria Vivax Cases in Korea / 감염

Vivax malaria, which was once thought to be eradicable since more than 20 years ago, has made a dramatic resurgence since 1993 in the northern parts of Kyeonggi-do in the background of 0.13 of the annual parasite incidence in the population of 956,773 and 2 positives (0.07%) of asymptomatic parasitaemia among the 2,937 residents of mass blood survey in the area in 1969. The majority of the cases were soldiers infected in several counties located within 5 km from the Demilitarized Zone (DMZ) in 1994. Since then, malaria cases have increased and have tended to expand toward eastern and southern areas. Korean malaria is characterized by asymptomatic parasitaemia with long prepatent period, so malaria cases, including those manifesting as general fever should be treated with a combination of chloroquine and pyrimethamine to prevent the completion of sporogonic cycle in the mosquitoes. For the most effective control of vector mosquitoes, residual insecticides should be applied in the military houses and animal shelters with thermal fogging, including the control of the pre-stages of physiological age of the mosquitoes within 25 km from the DMZ. It is strongly suggested that military uniforms be treated with 0.5% permethrin complex (permethrin 39%+cyfluthrin 1%) or permethrin formulation. Further genetic studies are desired to determine the subspecies of Plasmodium vivax because Korean strain of malaria is likely to be a complex form of Plasmodium vivax vivax and Plasmodium vivax hibernans.