Acute Attack of Asthma and Pulmonary Collapse Induced by Tracheal Intubation / 대한마취과학회지

Identification of the presence of chronic obstructive pulmonary disease in the elderly patient who was scheduled for surgery is vitally important. If appropriate therapeutic and preventive measures should not be instituted, tracheal intubation of the patient should be associated with a number of complications. We experienced a case of acute attack of asthma and pulmonary collapse during endotracheal intubation. A 54-year-old male who was scheduled for an emergency of primary corneo-scleral suture have had history of bronchial asthma. On the preoperative physical examination, there was no specific finding except expiratory wheezing. After endotracheal intubation with the aid of ketamine 2 mg/kg, pancuronium bromide 0.1 mg/kg and lidocaine 2 mg/kg, iv, acute asthmatic attack was appeared. Breathing sounds on the both lung fields can not be audible during manual ventilation and SpO(2) was dropped to 70% at F(1)O(2) 1.0. To relieve asthmatic attack, epinephrine(1: 1.000) 0.5 ml, sc, aminophylline 4 mg/kg, iv and methyprednisolone 1 mg/kg, iv were injected. Erosion of tracheal mucosa, blood clots and mucous plugs were found by the fibroptic bronchoscopy. After removal of blood clots and mucus, lung compliance and SpO2 were improved. The patient was discharged 7 days later without any complications or sequelae.

A Comparison of The Induction Characteristics of Propofol and Thiopental on The Hypertensive Patients / 대한마취과학회지

We have compared the cardiovascular effects during intravenous induction and endotracheal intubation with propofol or thiopental sodium on the forty hypertensive patients. Propofol was given 2 mg/kg or thiopental sodium was given 5 mg/kg intravenously for induction of general anesthesia, and endotracheal intubation. The patients were allocated in two groups according to the intravenous anesthetic sgents that were administered (Group I; 20 patients Propofol group and Group II; 20 patients Thiopental group), Arterial blood pressure and heart rate was recorded by automatic noninvasive blood pressure cuff (ESCORT 100/200 Medical Data Electronics. Arleta Ca. U.S.A.). Systolic, diastolic arterial blood pressure, and heart rates were recorded 1 minute before administration of intravenous anesthetic agents, 1 minute and 5 minutes after endotracheal intubation. Reduction of systolic and diastolic arterial blood pressure were significantly greater after propofol(30%) than thiopental sodium administration and intubation. The change of the heart rate after propofol induction and intubation was not significant. However, the heart rate was increased about 23% after thiopental sodium induction and intubation. The results of this study indicate that propofol 2 mg/kg intravenous induction and intubation for hypertensive surgical patient should be contribute to patients prognosis.

Differential diagnosis of pelvic masses by gray-scale sonography

Ultrasongraphy is a safe, noninvasive examination which should be the first procedure in the workup of apatient with a definite or suspected pelvic masses. The diagnostic schemes were derived from correlating the sonographic features with histomorphology in 230 surgically proven pelvic masses. Besides separating pelvic masses into the conventional categories of cystic, complex and solid, grayscale sonographic features of a pelvic mass canbe used to subcategorized these masses into a more useful differential diagnosis. The results are as follows; 1.The most characteristic finding of uterine myoma was midly to mederately echogenic uterine enlargement (90.7%)with a lobulated uterine margin (62.8%), and often less echogenic than the normal uterine echoes. 2. The typical ultrasonographic finding of H-mole was uterine enlargement with multiple small vesicular patterns of intrauterincontents(93%). 3. The most frequent finding of cystic teratoma was cystic mass with echogenic foci(48%), but the echogenic appearance of the lesions was extremely variable. 4. The ultrasonographic findings of ectopic pregnancywere adnexal mass(comlex or cystic), decidual proliferation of the uterus, enlargement of uterine size, fluid incul-de-sac, deveiation of uterus by adnexal mass, and psuedointrauterine appearance. 5. Ultrasound provided information leading to the correct diagnosis in 57% of cases, contributory data in 21.3%, and non-specific information in 10.4%. Errors occured in 3.9% and false-negative in 7.4%.