Respiratory Failure due to Myotonic Dystrophy after General Anesthesia -A case report- / 대한마취과학회지

Myotonic dystrophy is the most common and serious form of myotonic disease. It is a multisystem disease, although skeletal muscles are principally affected. Its most common complication is postoperative respiratory failure. We report such a case in a patient undergoing total abdominal hysterectomy after inhalational anesthesia. The patient had preoperative muscular weakness, which was, we concluded, induced by hypothyroidism and an old lacunar infarction in left thalamus with mild cerebral atrophy by preoperative thyroid function testing and brain CT. We studied electromyographic results and more intensively queried family history after postoperative respiratory failure. It was confirmed that the patient had myotonic dystrophy.

Changes in Middle Cerebral Artery Blood Flow Velocity after the Intravenous Injection of Lidocaine by Transcranial Doppler / 대한마취과학회지

BACKGROUND: Lidocaine is used for suppressing circulatory responses to endotracheal intubation. In this study the investigated changes of middle cerebral artery blood flow velocity (Vmca) before and after intravenous lidocaine injection by transcranial doppler. METHODS: Fifteen healthy volunteers received a bolus dose of intravenous lidocaine 1.5 mg/kg. Vmca's were measured on the temple using a bidirectional 2-MHz transcranial doppler probe before and after lidocaine injection. Vmca's were recorded continually every 10 sec for 10 minutes after lidocaine injection. RESULTS: Mean Vmca was 67.6 +/- 7.6 cm/sec before lidocaine injection. Maximal Vmca's (70.7 +/- 7.5 cm/sec, P<0.05) occurred 35 +/- 16 sec after lidocaine injection, and then the Vmca decreased gradually. Minimal Vmca's (56.6 +/- 7.4 cm/sec, P<0.05) were measured at 164 +/- 40 sec after lidocaine injection. CONCLUSIONS: We suggest that lidocaine generally causes the decreases in Vmca, excepting the temporarily increase in Vmca about 35 sec after a single bolus administration of intravenous lidocaine.

A Case on Diplopia after Epidural Catheterization for Postoperative Pain Control: A case report / 대한마취과학회지

A 53 year old man with gastric cancer was admitted for radical subtotal gastrectomy. The patient received general anesthesia with epidural analgesia. Epidural catheterization was performed using an 18-gauge Tuohy needle at the T10-11 interspace, and the epidural space was confirmed after a repeated attempt. An epidural catheter was then advanced smoothly 5 cm in cephalad direction without bleeding or CSF leakage. The patient received a test dose of lidocaine and epinephrine and continuous infusion with morphine and lidocaine 30 minutes before operation finished. Vital signs during the operation were stable. Two days after the operation, the patient complained of an orthostatic headache, and relieved ketolorac. On the seventh day, the patient complained of bilateral diplopia. Diffuse pachymeningeal gadolonium enhancement was seen on the brain MRI, and his CSF pressure was 0 mmHg by spinal tapping. We suspected abducent nerve palsy due to CSF hypovolemia and performed an epidural blood patch with 15 ml of autologus blood at the previous puncture site. The patient is receiving regular examinations at the Neurology and Opthalmology department. Abducent nerve palsy completely recovered by the Hess Screen test 6 months after operation, and diplopia disappeared 10 months after the operation.

The Effect of Pretreatment with Ketamine on Vascular Pain Due to an Intravenous Rocuronium Injection in Pediatric Patients / 대한마취과학회지

BACKGROUND: Rocuronium has a high incidence of vascular pain when injected intravenous by, and diverse methods have been examined to reduced this pain. The aim of this study was to evaluate the effect of ketamine pretreatment on vascular pain during the injection of rocuronium in pediatric patients. METHODS: Sixty ASA physical status 1 patients scheduled for elective surgery were randomly divided into three groups; a control group (placebo: normal saline, n = 20), group 1 (ketamine 0.5 mg/kg pretreatment, n = 20), and group 2 (ketamine 1 mg/kg pretreatment, n = 20). The ketamine pretreatment was injected in the preanesthetic room. After being moved into the operation room, general anesthesia was induced using thiopental sodium 5 mg/kg in control group. All groups were followed during and after injecting rocuronium 0.9 mg/kg IV. Vascular pain was graded using a 4-point scale. RESULTS: The incidence of vascular pain diminished significantly in the ketamine pretreated group, as follows: 17 (85%) in control group, 4 (20%) in group 1 and 7 (35%) in group 2. CONCLUSIONS: Intravenous ketamine pretreatment at 0.5-1 mg/kg may effectively reduce or prevent vascular pain on injecting rocuronium in pediatric patients.

The Incidence of Abnormal Electrocardiogram Findings in Preoperative Screening Tests / 대한마취과학회지

BACKGROUD: To study the prevalence of abnormalities found in routine preoperative eletrocardiograms (ECGs) and to analyze abnormal ECG findings in different age groups. METHODS: 9,709 patients undergoing elective surgery requiring anesthesia at Busan Paik Hospital from January to December 2002 were retrospectively studied. Preoperative ECGs were analyzed in terms of age, sex and specific abnormal ECG findings that might alter anesthetic management. RESULTS: 1,683 of 9,709 patients (17.3%) had abnormal electrocardiogram findings. The incidences of ventricular hypertrophy, bundle branch block, myocardial ischemia, arrhythmia, myocardial infarction and atrioventricular block were 5.3%, 4.1%, 3.9%, 2.5%, 1.0% and 0.5%. Those over 75 years, 43% had abnormal findings and the incidence of myocardial ischemia, arrhythmia and ventricular hypertrophy were 11.7%, 9.7% and 8.7%. CONCLUSIONS: The prevalence of unexpected preoperative ECG abnormalities among elective surgery patients is high, especially among older patients. Given the wealth of information provided by preoperative ECG at low cost, ECG is necessary to establish the components of routine preoperative assessment for cardiovascular disease, especially for older adults.

Correlation between Pre-ictal Bispectral Index and Seizure Duration during Electroconvulsive Therapy under Thiopental Anesthesia / 대한마취과학회지

BACKGROUND: Thiopental anesthesia increases the seizure threshold of patients receiving electroconvulsive therapy. However, excessive neuronal suppression could result in an unacceptably short seizure duration. We sought to identify the correlation between the pre-ictal Bispectral index (BIS) score and seizure duration during electroconvulsive therapy (ECT) under thiopental anesthesia. METHODS: Thirty patients with major depressive disorders underwent ECT. Anesthesia was induced by a bolus injection of 2 mg/kg of thiopental. BIS was monitored continuously, and recorded at specific end points, i.e., before anesthesia, just before ECT (pre-ictal BIS), on awaking (eye opening), before discharge to the recovery room and before discharge to the ward. The durations of motor and electroencephalographic seizures were recorded. RESULTS: The BIS score just before ECT was 52+/-9. Both motor and electro encephalographic seizure durations were positively correlated with the pre-ictal BIS score (R = 0.59 and 0.60, respectively; P < 0.01). On eye opening, BIS showed 48+/-13 and slowly recovered but remained low until discharge to the ward, reflecting post-ictal suppression. CONCLUSIONS: Pre-ictal BIS score is positively correlated with seizure duration, but the BIS score may not accurately reflect the depth of sedation after ECT.

The Effects of Normocapnia and Hypercapnia on Venous Oxygen Saturation and Lactate Levels at the Jugular Bulb during Rewarming from Hypothermic Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Neurologic and neuropsychologic dysfunction after cardiopulmonary bypass is frequent and can be caused by inadequate cerebral perfusion and oxygenation. A decrease of SjvO2 suggests a situation in which the oxygen supply to the brain is insufficient to meet metabolic demands. This study investigated the effects of normocapnia and hypercapnia on changes in SjvO2 and lactate levels during rewarming from hypothermic cardiopulmonary bypass. METHODS: Anesthesia was induced and maintained with bolus and continuous infusion of fentanyl, midazolam and vecuronium. Patients were assigned to a normocapnic (PaCO2: 35 - 40 mmHg, n = 10) or hypercapnic (PaCO2: 45 50 mmHg, n = 10) group during rewarming. SjvO2 and lactate levels at the jugular bulb were measured at 30, 34 and 37degrees C nasopharyngeal temperature. RESULTS: There was not a reduction in SjvO2 to < 50% in normocapnic and hypercapnic group during the rewarming period, and there was no significant difference in lactate levels at the jugular bulb. However, the hypercapnic group had a higher SjvO2 than the normocapnic group at 30, 34 and 37degrees C nasopharyngeal temperature during rewarming (P<0.05). CONCLUSIONS: Hypercapnia is more effective increasing SjvO2 than normocapnia and may contribute to the prevention of postoperative neurologic dysfunction, especially in patients having a low SjvO2.

Effect of Propofol Anesthesia on Blood Coagulation and Fibrinolysis: An Assessment Using Thromboelastograph at Clipping of Cerebral Aneurysms / 대한마취과학회지

BACKGROUND: Propofol may cause perioperative bleeding because it has an inhibitory effect on platelet aggregation and an accelerative effect on blood fibrinolysis in vitro. The aim of this study was to evaluate the perioperative effect of propofol anesthesia on blood coagulation and fibrinolysis with a thromboelastograph in patients undergoing clipping of cerebral aneurysms. METHODS: Fifteen patients who had cerebral aneurysms and no history of coagulation disorders were studied. Anesthesia was induced with a target controlled infusion of propofol to reach a calculated target blood concentration of 5ng/ml, and in addition, fentanyl 2ng/kg, lidocaine 1 mg/kg, esmolol 0.3 mg/kg and vecuronium 0.1 mg/kg were given intravenously. Anesthesia was maintained by propofol at target concentrations of 3 - 5ng/ml with nitrous oxide (67%) and oxygen (33%). The hemoglobin concentration, platelet count and a thromboelastogram were measured at before, during and after anesthesia. RESULTS: There was no significant difference in the perioperative hemoglobin concentration and platelet count. In terms of the thromboelastogram, r time (reaction time for clot formation) and k time (clot formation time) during and after anesthesia were shorter than those before anesthesia (P < 0.05), the alpha angle (rate of clot growth) during and after anesthesia was increased more than that before anesthesia (P < 0.05), and there was no significant difference in the perioperative fibrinolytic index. CONCLUSIONS: These results indicate that propofol anesthesia has no effect on anticoagulation and fibrinolysis in patients undergoing clipping of cerebral aneurysms in terms of the thromboelastogram, whereas, it showed a perioperative hypercoagulability. Therefore a clinical dosage of propofol may be used for neurosurgery without inhibition of coagulation.

Comparison of Cerebral Blood Flow Velocities by Transcranial Doppler during Anesthetic Induction: Rocuronium and Succinylcholine / 대한마취과학회지

BACKGROUND: In intravenous administration of a depolarizing neuromuscular blocker, succinylcholine is reported to produce activation of the electroencephalogram and increase cerebral blood flow and intracranial pressure. In this point, rocuronium was recently introduced as a non-depolarizing relaxant, and recommended as a safe alternative to succinylcholine. The purpose of this study was to evaluate the effects of rocuronium and succinylcholine on cerebral blood flow velocities during anesthetic induction. METHODS: Forty patients were randomly assigned into two groups. Group 1 was administrated rocuronium 0.6 mg/kg and group 2 was administrated succinylcholine 1 mg/kg for tracheal intubation after each group had intravenous administration of thiopental 5 mg/kg. The author observed changes of mean arterial pressure, arterial carbon dioxide tension, and middle cerebral arterial blood flow velocities at 5 times: before induction (control), 30 sec after thiopental administration, 30 sec, 60 sec and 90 sec after muscle relaxant administration. RESULTS: Mean arterial pressure decreased more at 30 sec after thiopental administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30 sec after thiopental administration and 60 sec after rocuronium administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30, 60, 90 sec after rocuronium administration compared with succinylcholine administration (P<0.05). CONCLUSIONS: We conclude that rocuronium has little effects on increasing cerebral blood flow. These result suggest that rocuronium have a less effect on increase in cerebral blood flow during neurosurgical anesthesia.

One Case of Anesthetic Management for a Cesarian Section in a Patient with Acute Fatty Liver of Pregnancy / 대한마취과학회지

Acute fatty liver of pregnancy is a uncommon complication of late pregnancy which may progress to hepatic failure, encephalopathy, disseminated intravascular coagulopathy, and death. A 65 kg 29-yr-old female at 35 weeks gestation complained of epigastric discomfort and jaundice 5 days before adimission. She had icteric sclera but other physical findings were non-specific. Anesthetic induction was achieved with thiopental, succinylcholine and vecuronium and the trachea was easily intubated. Maintenance of anesthesia was accomplished with oxygen : nitrous oxide (3 : 2) and 0.8% isoflurane. The Apgar scores were 8 and 10 at 1 min and 5 min, respectively. After the end of surgery, the patient was awakened and she was extubated after she followed verbal commands. She remained stable during her immediate postoperative course, but her vital signs were worse suddenly on postoperative day 3. On postoperative day 5, she was supported by artificial ventilation. The prothrombin time and the partial thromboplastin time were prolonged. Dopamine, dobutamine and norepinephrine were administered for maintaining her cardiovascular function. After that she was managed with artificial ventilation, cardiovascular drugs, fluid and blood products due to multi-organ failure. On postoperative day 25, she expired due to an acute cardiac arrest which was suspected to be due to multi-organ failure.

Comparison of Systolic Pressure Variation and Plethysmographic Pulse Wave Variation of a Pulse Oximeter / 대한마취과학회지

BACKGROUND: Maintenance of volume status and treatment of hypovolemia constitute an important component of anesthetic management. A Pulse oxymeter providing a continuous display of the pulse waveform offers a new method of estimating relative volume status during positive pressure ventilation. This study was undertaken to use the pulse wave variance of a plethysmographic signal measured from a pulse oximeter as a useful tool in the assessment of volume status. METHODS: Forty patients underwent general anesthesia with controlled positive pressure ventilation. After induction, the fluid infusion rate was 100 cc/hr until the dura was opened. During the operation, fluid losses were not replaced until hemodynamic variables were printed out. In addition to standard monitoring,the arterial pressure was monitored with a radial artery catheter. Systolic pressure variation (SPV) was defined as the maximum variation in peak systolic pressure during the respiratory cycle and measured in mmHg. Plethysmographic pulse wave variation (PWV) was defined as the maximum variation in the waveform peaks during the respiratory cycle and measured in millimeters from the printed output of the pulse oximeter. SPV and PWV were printed out right after induction and right before dura opening. In addition to SPV and PWV, other hemodynamic variables (HR, MAP, CVP) were obtained. RESULTS: Heart rate, SPV and PWV increased before the dura opening compared with those after induction. PWV correlated well with SPV after fluid losses CONCLUSIONS: A Pulse oximeter which is a standard monitor in anesthesia provides a useful, noninvasive and inexpensive adjunct to the more invasive estimators of volume status.

Perioperative Changes of Blood Coagulation by a Thromboelastograph in Patients Undergoing Clipping of Cerebral Aneurysms / 대한마취과학회지

BACKGROUND: Patients undergoing brain surgery have a high risk of developing a number of perioperative coagulation disorders. Anesthesia and surgical stress may affect blood coagulation and fibrinolysis. The aim of this study was to evaluate perioperative changes in hemostatic parameters of patients undergoing clipping of cerebral aneurysms with a thromboelastograph (TEG) in combination with simple laboratory tests. METHODS: Twenty adult patients who had cerebral aneurysms and no history of coagulation disorders were studied. Isoflurane and N2O were used for all anesthetic proceedings. Preanesthetic, intraoperative (after skin incision and after clipping of cerebral aneurysms) and postanesthetic measurements included a TEG and simple laboratory tests. The TEG variables included r time (reaction time for clot formation), k time (clot formation time), alpha angle (rate of clot growth), MA (maximal amplitude of clot strength) and LY30 (fibrinolytic index). RESULTS: In simple laboratory tests, prothrombin time (PT) and partial thromboplastin time (PTT) at intraoperation and postanesthesia were longer than those at preanesthesia (p < 0.05). In the TEG, r and k time at intraoperation and postanesthesia were shorter than those at preanesthesia (p < 0.05). However the alpha angle at intraoperation and postanesthesia was longer than that at preanesthesia (p < 0.05). There was no significant difference in MA and LY30 except an increase in MA after the skin incision (p < 0.05) compared to the MA at preanesthesia. CONCLUSIONS: These results indicate a general hypercoagulability during and after a cerebral aneurysms operation in terms of TEG, although, the level of the PT and PTT can be at the upper limits within normal. Therefore perioperative use of coagulants in cerebral aneurysms may increase the risk of a thromboembolism because of accelerating blood coagulability. By early intraoperative and postoperativeevaluation of the hemostatic abnormality with a TEG, appropriate measures might be initiated to prevent postoperative complications due to hypercoagulability.

Study of Lengths from the Upper Incisor to Left and Right Mainstem Bronchial Carina in Korean Adults Using a Fibroptic Bronchoscope / 대한마취과학회지

BACKGROUND: Accurate knowledge of mainstem bronchial lengths are required to prevent malpositioning of double lumen endobronchial tubes (DLT). Therefore we evaluated the length of the mainstem bronchus in Korean adults who had no abnormalities in both mainstem bronchus. METHODS: Two-hundred Thirty-seven patients were composed of One-hundred one males and One- hundred Thirty-six females who underwent elective surgery. After an endotracheal tube was placed, we measured the length from the upper incisor to the tracheal carina, the right mainstem bronchial carina, and the left mainstem bronchial carina using a fiberoptic bronchoscope. RESULTS: The lengths from the upper incisor to the carina of a male and female were 26.8 +/- 1.8 cm and 23.6 +/- 1.9 cm respectively, and the correlations between their length and height are significant for male and female (r = 0.32, P < 0.01 and r = 0.56, p < 0.0001). The lengths from the upper incisor to the right mainstem bronchial carina of male and female were 29.0 2.0 cm and 25.3 2.2 cm respectively, and the correlations between their length and height are significant for male and female (r = 0.39, P < 0.0001 and r = 0.59, P < 0.0001). The lengths from the upper incisor to the left mainstem bronchial carina of male and female were 32.0 2.1 cm and 28.5 2.1 cm respectively, and the correlations between their length and height are significant for male and female (r = 0.45, P < 0.0001 and r = 0.60, P < 0.0001). CONCLUSIONS: We found that as the height of patients increased, the length from the upper incisor to the carina, the right mainstem bronchial carina, and the left mainstem bronchial carina increased. Nevertheless,it should be understood that the length of DLT insertion at any given height is still normally distributed, and correct DLT positioning should always be confirmed fiberoptically after the initial placement.

Jugular Bulb Venous Oxygen Saturation Monitoring in Brain Surgery / 대한마취과학회지

BACKGROUND: During intracranial brain surgery, numerous factors may alter cerebral blood flow and the oxygen supply-demend balance. Continuous monitoring of the jugular bulb venous oxygen saturation (SjvO2) may help in the anesthetic management of such procedures. METHODS: Fiberoptic SjvO2 was continuously monitored and recorded 1, 3 and 5 min after the skin incision, skull bone craniotomy, dura open and dura closure in 20 patients. RESULTS: The SjvO2 was increased after the skin (scalp) incision at 1, 3 and 5 minutes and also after endotracheal suctioning for removal of secretions. CONCLUSIONS: Although the accuracy of Fibroptic SjvO2 determination is limited, it allows the detection of cerebral blood flow and oxygen supply-demend imbalance during brain surgery. The frequent occurance of SjvO2 elevations is suggestive of reactive hyperemia mechaniams.

Anesthetic Management for Xypho-Omphalopagus Conjoined Twins / 대한마취과학회지

This report describes the perioperative anesthetic management for surgical separation of xypho-omphalopagus conjoined twins. Male conjoined twins were delivered by cesarian section after 36 weeks plus 2 days gestation. A preoperative functional evaluation was performed in assessing the feasibility of surgical separation. A partial communication of the lower margin of the sternum and a union of the livers were found but with separate biliary and vascular systems. One twin (twin-B) had a small ASD. The twins were separated at 5 days of the birth. After induction with ketamine and succinylcholine, both infants were intubated and inhalated with isoflurane, N2O and O2 respectively. Continuous arterial pressure via the femoral artery and central venous pressure via the internal jugular vein were monitored. During the induction of anesthesia, an injected bolus of ketamine and succinylcholine to one twin was not effective for the other twin. Inhaled isoflurane in one twin did not appear in the expired gas of the other twin. During the operation, the intentional hemorrhage from one twin (twin-B) caused a reduction to some degree of blood pressure and SpO2 in the other twin. We must be careful in the anesthetic management of the surgical separation of conjoined twins to consider pharmacological and cross-circulation pathophysiology.

The Effect of Epidural Lidocaine Infused with Morphine on Pain and Bowel Motility after Hysterectomy / 대한마취과학회지

BACKGROUND: Postoperative ileus is considered to be caused by the activation of spinal reflexes originating from the abdominal cavity with the sympathetic nerves as the efferent nerves. Epidural anesthesia as a perioperative adjunct has been shown to provide superior pain control, and has been implicated in more rapid postoperative ileus resolution possibly through a sympathetic block mechanism. This study was undertaken to compare the effects of epidural morphine-lidocaine with those of epidural morphine alone on postoperative bowel motility and pain. METHODS: Forty-four ASA I or II women scheduled for transabdominal hysterectomy were considered for the study. They were randomly allocated to one of two groups. Group M (n = 22) received postoperative epidural morphine 16 mg by infusion pump, 2 ml/h, for 2 days, group ML (n = 22) received morphine 16 mg plus 0.42% lidocaine by infusion pump, 2 ml/h, for 2 days. Both group received morphine 4 mg in 0.5% lidocaine 8 ml epidurally as a single bolus when the peritoneum was closed. Postoperative pain, and the time interval from termination of operation to the first passage of flatus were checked RESULTS: In group ML, the times for first passing of flatus (33.4 +/- 10.5 h; mean +/- SD) and visual analogue scale score (0.3 +/- 0.6) were significantly shorter and lower than in group M (flatus 42.6 +/- 8.4 h and VAS score 1.3 +/- 1.7). CONCLUSIONS: The epidural lidocaine infused with morphine demonstrated earlier recovery of bowel motility and better postoperative pain relief than the epidural morphine alone.

The Cerebral Oxygen Extraction Ratio during Propofol and Isoflurane Anesthesia / 대한마취과학회지

BACKGROUND: The cerebral vascular response to CO2 has been reported to be preserved during isoflurane and propofol anesthesia. This study compared the cerebral oxygen extraction ratio during normoventilation versus hyperventilation in propofol anesthesia and isoflurane anesthesia. METHODS: 28 patients undergoing cerebral aneurysmal surgery were studied following informed consent. In the isoflurane group (n = 14), anesthesia was induced with thiopental 5 mg/kg, and maintained with isoflurane and nitrous oxide (N2O) in oxygen (FiO2 0.33). In the propofol group (n = 14), anesthesia was induced with propofol 2 mg/kg, and maintained by infusion of propofol and N2O-O2 (FiO2 0.33). Monitoring included measurement of mean arterial blood pressure, heart rate, body temperature, end-tidal CO2 (PetCO2), jugular bulb O2 saturation (SjO2) and arterial O2 saturation (SaO2). Mechanical ventilation was adjusted to achieve PetCO2 levels of 40 and 25 mmHg. Ten minutes of equilibration were allowed at each PetCO2 level. Blood was sampled from the jugular bulb and radial artery at each PetCO2 level (40 and 25 mmHg). The cerebral oxygen extraction ratio was calculated as (CaO2 CjO2) / CaO2 (CaO2; arterial oxygen content, CjO2; jugular bulb oxygen content). RESULTS: The cerebral oxygen extraction ratio was higher in hyperventilation (PetCO2 25 mmHg) compared to normoventilation (PetCO2 40 mmHg) in each group (P < 0.05) and higher in the propofol group compared to the isoflurane group (P < 0.05). CONCLUSIONS: The increased cerebral oxygen extraction ratio in hyperventilation during both isoflurane and propofol anesthesia showed that cerebral vascular CO2 reactivity was maintained during both isoflurane anesthesia and propofol anesthesia. The cerebral oxygen extraction ratio was higher during propofol anesthesia compared to isoflurane anesthesia in both normoventilation and hyperventilation, therefore this data showed that cerebral blood flow was lower during propofol anesthesia compared to isoflurane anesthesia.

The Neuroprotective Effect and Inflammatory Gene Expression of Hypothermia and Lamotrigine in Transient Spinal Ischemia in the Rat / 대한마취과학회지

BACKGROUND: Although rare, paralysis secondary to spinal cord ischemia after aortic aneurysm surgery is a devastating complication. Many papers have been published on this topic but without a clear consensus on the best way of minimizing the problem. Mild hypothermia and lamotrigine have been neuroprotective in several models of cerebral ischemia. In this study we compared the effects of mild hypothermia and the lamotrigine on neurologic and histopathologic outcomes, and inflammatory gene expression in transient spinal ischemia. METHODS: Rats were anesthetized with halothane, and divided into 4 groups; the Sham-operated (S) group; the Normothermic ischemic (N) group; the Hypothermic ischemic (H) group; and the Lamotrigine- treated (L) group. Spinal ischemia was produced by induced hypotension and thoracic aortic cross clamping. After spinal ischemia neurologic scores were assessed at 1, 2, 3, 24, and 48 hours after reperfusion. After 48 hours the rats were euthanized and their spinal cords were removed for histopathologic assessment. Also, spinal cords were removed at 1, 3, and 48 hours after reperfusion for the assay of TNF-alpha, IL-1 mRNA. RESULTS: The neurologic scores of the H group were significantly lower than from the N group. There was no significant difference between the L group and the N group. The histopathologic scores in the H and L groups were significantly lower than in the N group, and the histopathologic scores of the L group were higher than those of the H group. The TNF-alpha and IL-1 gene expression was increased in the N group. In the H group, the gene expression was significantly less than in the N group. The L group was not significantly different than N group in gene expression. CONCLUSIONS: The inflammatory gene expressions were increased in transient spinal ischemia. Hypothermia was neuroprotective in transient spinal ischemia. However, the lamotrigine showed only partial neuroprotective effects in transient spinal ischemia.

Complications Associated with Removal of the Laryngeal Mask Airway: Deep Anesthesia Versus Waking State / 대한마취과학회지

BACKGROUND: The optimal time to remove the laryngeal mask airway (LMA) at the end of surgery is still a matter of controversy. The purpose of this study was to compare the incidence of complications associated with the removal of the LMA from the deeply anesthetized and from the awake patient. METHODS: The LMA was used in 120 adults undergoing general elective lower abdominal or extremity surgery. The patients were randomly assigned to two groups. In 60 patients the LMA was removed by the anesthetist with the patient deeply anesthetized in the operating room. In the other 60 patients it was removed by the anesthetist when the patient responded to verbal commands in the operating room. Any airway complications occurring within 15 minutes of LMA removal were recorded. These complications included coughing, biting, retching, vomiting, excessive salivation, airway obstruction and laryngospasm. RESULTS: Groups were similar in age, weight, and duration of surgery. Airway complications associated with LMA removal were noted in fourteen patients. Airway complications occurred in six patients who had their LMA removed during deep anesthesia, and in eight patients who under went removal of their LMA on awakening. In the anesthetized group, there were four kinds of airway complications in six patients (retching, excessive salivation, airway obstruction and laryngospasm). In the awake group, eight patients experienced six kinds of airway complications (coughing, biting, vomiting, excessive salivation, airway obstruction and laryngospasm). There was no significant difference between the two groups in the incidence of complications after removal of the LMA. CONCLUSIONS: Removal of the LMA under deep anesthesia had no advantage compared to removal from awakening patients in terms of complications in adult.

Complications Associated with Removal of the Laryngeal Mask Airway: Deep Anesthesia Versus Waking State / 대한마취과학회지

BACKGROUND: The optimal time to remove the laryngeal mask airway (LMA) at the end of surgery is still a matter of controversy. The purpose of this study was to compare the incidence of complications associated with the removal of the LMA from the deeply anesthetized and from the awake patient. METHODS: The LMA was used in 120 adults undergoing general elective lower abdominal or extremity surgery. The patients were randomly assigned to two groups. In 60 patients the LMA was removed by the anesthetist with the patient deeply anesthetized in the operating room. In the other 60 patients it was removed by the anesthetist when the patient responded to verbal commands in the operating room. Any airway complications occurring within 15 minutes of LMA removal were recorded. These complications included coughing, biting, retching, vomiting, excessive salivation, airway obstruction and laryngospasm. RESULTS: Groups were similar in age, weight, and duration of surgery. Airway complications associated with LMA removal were noted in fourteen patients. Airway complications occurred in six patients who had their LMA removed during deep anesthesia, and in eight patients who under went removal of their LMA on awakening. In the anesthetized group, there were four kinds of airway complications in six patients (retching, excessive salivation, airway obstruction and laryngospasm). In the awake group, eight patients experienced six kinds of airway complications (coughing, biting, vomiting, excessive salivation, airway obstruction and laryngospasm). There was no significant difference between the two groups in the incidence of complications after removal of the LMA. CONCLUSIONS: Removal of the LMA under deep anesthesia had no advantage compared to removal from awakening patients in terms of complications in adult.