ABSTRACT
We report a case of hemodynamic instability after aortic valve replacement, due to the anomalous origin of the right coronary artery. During the cardiopulmonary bypass weaning process, hemodynamic instability occurred. The cause was not identified at first, and compression of the anomalous right coronary artery was thought to be the culprit, thereafter.
Subject(s)
Aortic Valve , Cardiopulmonary Bypass , Coronary Vessels , Hemodynamics , WeaningABSTRACT
No abstract available.
Subject(s)
Humans , Infant , Hematoma, Subdural , Hemophilia A , Hemophilia BABSTRACT
BACKGROUND: The recovery time in propofol target controlled infusion (TCI) can be determined by the context sensitive decrement time (CSDT) using a Multichannel TCI system. Therefore, it is important to obtain the default CSDT in a Multichannel TCI system. The effect-site concentrations for eye opening and orientation in adults after propofol-remifentanil TCI were evaluated according to the CSDT using a Multichannel TCI system. METHODS: After obtaining informed consent and Institutional Review Board approval, 135 ASA Class I or II patients scheduled to undergo elective surgery were divided into 3 groups according to age. The three groups included the following: group 1 (n = 45), 18-19 years; group 2 (n = 45), 30-39 years; and group 3 (n = 45), 40-54 years. The propofol infusion was started at a propofol target effect-site concentration (CeT) of 6microg/ml. Anesthesia was maintained primarily with a propofol CeT of 2.5microg/ml, a remifentanil CeT of 6ng/ml and with 67% nitrous oxide in oxygen. The average effect-site concentrations of propofol at eye opening and orientation in each group were estimated. RESULTS: The average range of the effect-site concentrations of propofol at eye opening and orientation after surgery were 0.9-1.1microg/ml. The range of times to eye opening and orientation after stopping the nitrous oxide and infusion after surgery were 10.9-12.9 min. CONCLUSIONS: The average range of the effect-site concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans are 0.9-1.1microg/ml.
Subject(s)
Adult , Humans , Anesthesia , Anesthesia, Intravenous , Ethics Committees, Research , Eye , Informed Consent , Nitrous Oxide , Orientation , Oxygen , Piperidines , PropofolABSTRACT
BACKGROUND: The recovery time in propofol target controlled infusion (TCI) can be determined by the context sensitive decrement time (CSDT) using a Multichannel TCI system. Therefore, it is important to obtain the default CSDT in a Multichannel TCI system. The effect-site concentrations for eye opening and orientation in adults after propofol-remifentanil TCI were evaluated according to the CSDT using a Multichannel TCI system. METHODS: After obtaining informed consent and Institutional Review Board approval, 135 ASA Class I or II patients scheduled to undergo elective surgery were divided into 3 groups according to age. The three groups included the following: group 1 (n = 45), 18-19 years; group 2 (n = 45), 30-39 years; and group 3 (n = 45), 40-54 years. The propofol infusion was started at a propofol target effect-site concentration (CeT) of 6microg/ml. Anesthesia was maintained primarily with a propofol CeT of 2.5microg/ml, a remifentanil CeT of 6ng/ml and with 67% nitrous oxide in oxygen. The average effect-site concentrations of propofol at eye opening and orientation in each group were estimated. RESULTS: The average range of the effect-site concentrations of propofol at eye opening and orientation after surgery were 0.9-1.1microg/ml. The range of times to eye opening and orientation after stopping the nitrous oxide and infusion after surgery were 10.9-12.9 min. CONCLUSIONS: The average range of the effect-site concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans are 0.9-1.1microg/ml.
Subject(s)
Adult , Humans , Anesthesia , Anesthesia, Intravenous , Ethics Committees, Research , Eye , Informed Consent , Nitrous Oxide , Orientation , Oxygen , Piperidines , PropofolABSTRACT
Duchenne muscular dystrophy is a hereditary disorder characterized by progressive muscle weakness and contracture, and special care during anesthesia is needed in these patients. Because inhalational anesthetics and succinylcholine can cause fatal results, intravenous anesthetics are commonly used. However, monitorings for the pediatric population are not otherwise specified. We report our experience of a 6 year-old boy that underwent muscle biopsy suspicious of muscle dystrophy under general anesthesia. The patient received midazolam, fentanyl, propofol and a small dose of rocuronium. He was monitored with bispectral index (BIS), acceleromyography (TOF). At the end of surgery, recovery of TOF ratio to 90% was evaluated, followed by injection of pyridostigmine and glycopyrrolate. When reversal of neuromuscular block was confirmed quantitatively and clinically, the patient was extubated and he experienced no complication.
Subject(s)
Humans , Androstanols , Anesthesia , Anesthesia, General , Anesthetics , Anesthetics, Intravenous , Biopsy , Contracture , Fentanyl , Glycopyrrolate , Midazolam , Muscle Weakness , Muscles , Muscular Dystrophies , Muscular Dystrophy, Duchenne , Neuromuscular Blockade , Organothiophosphorus Compounds , Propofol , Pyridostigmine Bromide , SuccinylcholineABSTRACT
BACKGROUND: Emergence agitation (EA) in children after sevoflurane anesthesia is common. The purpose of this study was to compare the incidences of EA between ketamine and thiopental sodium induction in children underwent sevoflurane anesthesia. We also evaluated if a small dose of fentanyl could reduce the incidence of EA. METHODS: The patients who were scheduled for strabismus or entropion surgery were divided into 4 groups. The patients in Groups 1 and 2 were induced anesthesia with ketamine 1.5 mg/kg; those in Groups 3 and 4 were induced with thiopental sodium 5 mg/kg. The patients in Groups 1 and 3 received an injection of fentanyl 1.5 microgram/kg, whereas the patients in Groups 2 and 4 received IV saline of the same volume. Anesthesia was maintained with sevoflurane. The recovery characteristics and EA in recovery room were assessed. RESULTS: The incidence of EA was significantly higher in Groups 2 and 4 and there was no difference between Groups 2 and 4. Group 2 had almost an eleven-fold higher risk of developing EA than did Group 1, and the incidence of EA in Group 4 was sixty-nine-fold higher than that of Group 1. The risk factor for EA was only the kind of medication. Preoperative anxiety had no significant correlation with EA. CONCLUSIONS: The incidence of EA after sevoflurane anesthesia is similar between ketamine and thiopental sodium anesthetic induction in children undergoing pediatric ophthalmic surgery. Also, the addition of a small dose of fentanyl after anesthetic induction decreases the incidence of EA.
Subject(s)
Child , Humans , Anesthesia , Anxiety , Dihydroergotamine , Entropion , Fentanyl , Incidence , Ketamine , Methyl Ethers , Recovery Room , Risk Factors , Strabismus , ThiopentalABSTRACT
BACKGROUND: Emergence agitation (EA) in children after sevoflurane anesthesia is common. The purpose of this study was to compare the incidences of EA between ketamine and thiopental sodium induction in children underwent sevoflurane anesthesia. We also evaluated if a small dose of fentanyl could reduce the incidence of EA. METHODS: The patients who were scheduled for strabismus or entropion surgery were divided into 4 groups. The patients in Groups 1 and 2 were induced anesthesia with ketamine 1.5 mg/kg; those in Groups 3 and 4 were induced with thiopental sodium 5 mg/kg. The patients in Groups 1 and 3 received an injection of fentanyl 1.5 microgram/kg, whereas the patients in Groups 2 and 4 received IV saline of the same volume. Anesthesia was maintained with sevoflurane. The recovery characteristics and EA in recovery room were assessed. RESULTS: The incidence of EA was significantly higher in Groups 2 and 4 and there was no difference between Groups 2 and 4. Group 2 had almost an eleven-fold higher risk of developing EA than did Group 1, and the incidence of EA in Group 4 was sixty-nine-fold higher than that of Group 1. The risk factor for EA was only the kind of medication. Preoperative anxiety had no significant correlation with EA. CONCLUSIONS: The incidence of EA after sevoflurane anesthesia is similar between ketamine and thiopental sodium anesthetic induction in children undergoing pediatric ophthalmic surgery. Also, the addition of a small dose of fentanyl after anesthetic induction decreases the incidence of EA.
Subject(s)
Child , Humans , Anesthesia , Anxiety , Dihydroergotamine , Entropion , Fentanyl , Incidence , Ketamine , Methyl Ethers , Recovery Room , Risk Factors , Strabismus , ThiopentalABSTRACT
A 74-year-old male patient receiving ventilatory support due to aspiration pneumonia developed bilateral pneumothorax, pneumopericardium, pneumomediastinum, pneumo-retroperitoneum, and subcutaneous emphysema, after manual ventilation while being transferred from the intensive care unit (ICU) to the operating room (OR). These complications were assumed to be secondary to inappropriate manual ventilation of the intubated patient. In addition, it is likely that the possible migration of an already marginally acceptable endotracheal tube (ETT) position during transport was the cause of these complications. Finally, aggravation of a latent pneumothorax might have contributed to these complications.
Subject(s)
Aged , Humans , Male , Barotrauma , Intensive Care Units , Mediastinal Emphysema , Operating Rooms , Pneumonia, Aspiration , Pneumopericardium , Pneumothorax , Subcutaneous Emphysema , VentilationABSTRACT
An aneurysm of the innominate artery could compress the tracheal lumen, and this requires special care. Intubation without intensive monitoring and antihypertensive agents could aggravate the hypercapnia and completely rupture the aneurysm. There are few reports on the airway management of tracheal compression that's caused by an innominate artery aneurysm. We report here on a patient who had a severe hypercapnia after endotracheal intubation above the stenotic area of the tracheal compression, which was caused by an artery aneurysm. Permissive hypercapnia was inadvertently enforced without our knowledge, but the patient recovered without any neurologic problems.