Cervical pregnancy and therapeutic options / 대한산부인과학회잡지

Of all forms of ectopic gestation, the possibility of fertility catastrophe is highest with a cervical pregnancy. Though rare, it is a potentially life-threatening condition. In the past it was diagnosed late, after there was profuse hemorrhage from the cervix and it usually required hysterectomy. With ultrasound, diagnosis can be made earlier and conservative management attempted in order to preserve the reproductive potential. Methotrexate has been used both systemically and intra-amniotically to treat cervical ectopic gestation conservatively.

The efficacy of rapid biophysical profile for assessment of fetal well-being / 대한산부인과학회잡지

OBJECT: The nonstress test(NST) and complete biophysical profile(BPP) were compared with the rapid biophysical profile(BPP) in order to evaluate the efficacy of the rapid BPP, namely, the combination of amniotic fluid index(AFI) and sound-provoked fetal movement(SPFM) detected by ultrasound, in predicting intrapartum fetal distress in high-risk pregnancies. STUDY DESIGN: From JAN 9th 2000, through JAN 5th 2001, the prospective study of diagnostic tests was conducted on a total of 91 high-risk singleton pregnancies, undergoing antepartum assessment both the standard NST and the new rapid BPP(including other indices of complete BPP). The diagnostic indices of the NST, rapid BPP and complete BPP were calculated in term of predicting intrapartum fetal distress. RESULT: The sensitivity, specificity, negative predictive value, and positive predictive value of NST were 50.00, 94.81, 96.05, and 42.86% respectively, and those of rapid BPP were 75.00, 98.53, 98.53, and 75.00%, and those of complete BPP were 83.33, 98.72, 98.72, and 83.33%, as well. In addition, the efficiency of NST, rapid BPP, and complete BPP were 91.57%, 97.22% and 97.62% respectively. CONCLUSIONS: The rapid BPP is an effective and reliable predictor of intrapartum fetal distress with high-risk pregnancies. Moreover, it may be inexpensive and less time-consuming method.

Brachial Plexus Injury Following Axillary Brachial Plexus Block Using a Transarterial Approach: A case report / 대한마취과학회지

A 25-year-old male patient was received emergency operation, open reduction and tenorrhaphy owing to degloving injury on the dorsum of his left hand, under axillary brachial plexus block using a transarterial approach. Following operation, he revealed the signs and symptoms of brachial plexus injury such as weakness, sensory deficit and tingling sensation on his left forearm and hand. The finding on electromyography (EMG), performed on the 16th postoperative day (POD), was indicative of left incomplete brachial plexus injury, mainly in medial cord and ulnar nerve, and partially median and radial nerve at/above the axillary level. The signs and symptoms were improved slightly on POD 8 and a lot on POD 23. The complete recovery of symptoms and regeneration of injured nerve on EMG were confirmed 3 months following operation. In this case, the causative factors of brachial plexus injury were suggested in stretching of the brachial plexus due to improper positioning of injured arm during or after operation, combined with or without injury due to nerve block or tourniquet compression.

Effects of the Methods of General Anesthesia on the Changes of Blood Prssure and Arterial Carbon Dioxide Tension during Laparoscopic Chosecystectomy / 대한마취과학회지

Laparoscopic cholecystectomy is a relatively new non-invasive surgical procedures, enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incision and less postoperative ileus. During this procedure, the deliberate pneumoperitoneum with carbon dioxide(CO2) insufflation may cause some problems such as hypercarbia, hypertension, pneumomediastinum and other cardiovascular impairments. This study was performed to search a anesthetic method, which has least increase in blood pressure during CO2 insufflation, and to find out whether increased PaCO2 is a major causative factor in the changes of blood pressure during this period. Sixty patients of ASA class 1 or 2 were classified randomly into 3 groups. Group C(control group) was received enflurane-N2O-O2, and others were recieved enflurane-propofol(group P), or enflurane-propofol-fentanyl(group F), respectively. The blood pressure and heart rate were measured at 1 min before CO2 insufflation and 1 min, 5 min, 15 min after insufflation and 1 min before deflation, 5 min after deflation. Also PaCO2 were checked at 1 min before, and 15 min after insufflation. The results were follows ; 1) Changes of arterial pressure : The control group showed most prominent increasing in systolic and mean blood pressure during CO2 insufflation(P<0.05). Group F produced the least increase in blood pressure during CO2 insufflation, compared with group C and P(P<0.05). 2) Changes of heart rate : Although, in the preinsufflation period, heart rates in the group F were significantly lower than other groups, there were no significant changes in heart rates in each group. 3) Changes of PaCO2: There were no siginificant increases in PaCO2 in each group, and no differences between the groups. In conclusion, fentanyl and propofol added light enflurane anesthesia could be a method of the least increase in blood pressure during the laparoscopic cholecystectomy, and increased PaCO2 would not be a major causative factor in hypertension during CO2 insuftlation.

Hemodynamic Changes by Speed of Injection of d-Tubocurarine under General Anesthesia / 대한마취과학회지

d-Tubocurarine(d-TC) causes hypotension, probably as a result of the liberation of histamine; in larger doses, it produces ganglionic blockade. An increase of histamine levels in plasma to 200 to 300 percent of baseline causes a brief decrease in arterial blood pressure(1 to 5 minutes) and the increase in heart rate. The amount of histamine released by d- TC is dose related and is also related to speed of injection. Therefore histamine release can be minimized by the slow administration, light level of surgical anesthesia, and the use of smaller doses. Thus, the purpose of this study was to prevent the cardiovascular effect of d-TC by the slow administration undergoing general anesthesia. The study population was from 40 patients scheduled for elective surgery at Yeungnam University Hospital, who belonged to physical status I or II of ASA classification. Patients were divided into 4 groups by speed of injection of 10, 30, 60 and 120 seconds(group 1, 2, 3 and 4, respectively). All patients were premedicated with hydroxyzine 1mg/kg, glycopyrrolate 0.2mg, and fentanyl 1 ug/kg IM 30 minutes before anesthesia. Patients were induced with thiopental sodium 4-5 mg/kg until the disappearance of lid-reflex. Succinylcholine 1.0 mg/kg IV was used to facilitate endotracheal intubation. As soon as relaxafion was complete, laryngoscopy was initiated. After the completion of intubation, nitrous oxide and 50% oxygen with 0.6% halothane was administrated. The blood pressure and heart rate were measured using noninvasive automatic blood pressure manometer for 60 minutes per 1 minute. Data were analyzed with one-way ANOVA test within the groups. p<0.05 was considered significant. The results were as follows, The changes of blood pressure was decreased in rapid injection groups(Group 1 & 2) compared with slowly injection groups(Group 3 & 4) at 2 min, 5 min after d-TC administration. The changes of heart rate was significantly increased(p<0.05) at 1min, 2 min after d-TC administration in rapid injection groups compared with slow injection groups. These results show that the cardiovascular effect of d-TC might be prevented by slowly administration undergoing general anesthesia.