The correlation of cerebrospinal fluid pressure according to the degree of flexion and spinal block level in spinal anesthesia for Cesarean section

BACKGROUND: The use of neuraxial anesthesia for Cesarean section has dramatically increased. There was little information about the relationship of cerebrospinal fluid (CSF) pressure according to the position and spinal block level in pregnant women. The aims of this study are to investigate the cerebrospinal fluid pressure according to the degree of flexion in the lateral position and block height after spinal anesthesia in pregnant women undergoing Cesarean section. METHODS: We enrolled 40 patients, American Society of Anesthesiologists physical status I-II, aged 22-40 years, undergoing Caesarean section under spinal anesthesia. Patients were randomly divided into two groups. In group I, patients were placed in a full flexed position, and 10 mg of 0.5% hyperbaric bupivacaine was injected. In group II, the same dose of bupivacaine was injected when the hip and neck was straightened slowly. Following injection, the patients were immediately placed in supine position. The level of spinal anesthesia was checked by pinprick at 5, 10, 15, and 30 min after the subarachnoid injection. RESULTS: There was significant difference in the cerebrospinal fluid pressure between full-flexed position and non-full-flexed position. The spinal block height level was T3-T5 in both groups, and there was no significant difference in the spinal block height level in both groups. CONCLUSIONS: CSF pressures according to the degree of flexion in the lateral position during the subarachnoid injection have no significant correlation with the block level in spinal anesthesia for Cesarean section.

Audiovisual stimulation with synchronized pulsed tones and flickering lights set at a delta frequency can induce a sedative effect / 대한마취과학회지

No abstract available.

Anesthetic and Postoperative Intensive Care for Patient with Systemic Lupus Erythematosis and Antiphospholipid Syndrome: A Case Report / 대한구급학회지

The antiphospholipid syndrome (APS) is characterized by vascular thrombosis despite of prolongation of coagulation profile in laboratory findings and pregnancy morbidity in the presence of antiphospholipid antibody. It occurs primarily or secondarily to autoimmune disease. This case report concerns a pelviscopic left ovarian cystectomy in a 32-year-old female with APS and systemic lupus erythematosis. To manage the hypercoagulability, oral warfarin and low molecular weight haparin were given pre- and postoperatively. In perioperative period, we monitored activated clotting time to prevent intraoperative thrombosis and tried to avoid dehydration, hypothermia and infection.

The Effect of Perioperative Intravenous Lidocaine Infusion on the Recovery of the Bowel Function after a Laparoscopic Hysterectomy / 대한마취과학회지

BACKGROUND: The postoperative bowel function can affect the number of hospital days and morbidity. This study examined the effect of intravenous lidocaine on the postoperative bowel function. METHODS: Forty patients scheduled to undergo a laparoscopic hysterectomy were randomly allocated to receive intravenous lidocaine or an equal volume of saline. The lidocaine group received a continuous lidocaine infusion of 2 mg/kg/hr intraoperatively and for one hour after surgery. The saline group received an equal volume of saline. The time to the first flatus, defecation and hospital discharge were recorded. The incidence of postoperative nausea and vomiting (PONV) were assessed. The consumption of intravenous patient controlled analgesia (IV-PCA) over a twenty-four hour period and the dose of the rescue drug were measured. The visual analogue scale of pain was assessed at the recovery room and 24 hour after surgery. The side effects of intravenous lidocaine were recorded. RESULTS: The patients' demographics were similar in both groups. The median time to the first flatus was 30 hours in the lidocaine group and 42 hours in the saline group (P < 0.05). The median time to defecation was 65.5 hours in the lidocaine group and 96 hours in the saline group (P < 0.05). The number of hospital days was similar. Intravenous lidocaine significantly decreased the level of IV-PCA consumption (P < 0.05). In the lidocaine group, the incidence of PONV was significantly lower (P < 0.05), and no side effects were observed. CONCLUSIONS: Intravenous lidocaine facilitates the recovery of the bowel function after a laparoscopic hysterectomy by reducing the flatus time and defecation time. In addition, the level of IV-PCA consumption after surgery and the incidence of PONV were also reduced by intravenous lidocaine.

The Types of Medical Accidents and Strategies for Prevention: Focused in Medical Accidents occurred in Anesthetic and Surgical Fields / 대한마취과학회지

No abstract available.

Cardiac Arrest during Endoscopic Thoracic Sympathicotomy with One Lung Ventilation under General Anesthesia : Two cases report / 대한마취과학회지

Primary hyperhidrosis has been associated with an increased activity of the sympathetic nervous system. Conventional nonsurgical therapies are inconvenient and only temporarily effective. Endoscopic thoracic sympathicotomy (ETS) is a minimal invasive procedure of thoracic sympathetic block and has been used successfully and safely in the treatment of primary palmar and axillary hyperhidrosis. Sympathicotomy results in an initial sympathovagal imbalance with a parasympathetic predominance, which is restored in a long-term basis. ETS is commonly performed to treat hyperhidrosis but there are some rare complications including cardiac arrest. In our hospital, we experienced 2 cases of patients who suffered from sudden cardiac arrest during right ETS, which was performed soon after left ETS. We're going to report these cases and consider about possible causes.

Hemodynamic and Preemptive Analgesic Effect of Preoperative Epidural Analgesia during Laparoscopic Hysterectomy / 대한마취과학회지

BACKGROUND: A laparoscopic hysterectomy is gaining popularity on account of its many benefits. The trendelenburg position and pneumoperitoneum necessary for a laparoscopy causes intraoperative hemodynamic fluctuations. The aim of this study was to evaluate the intraoperative hemodynamic and postoperative analgesic effects of preemptive epidural analgesia in a laparoscopic hysterectomy. METHODS: Fifty ASA 1 and 2 patients were randomized to two groups. Nothing was applied to the control group before inducing general anesthesia. In the epidural group, an epidural catheter was inserted through the L2-3 space and 1% lidocaine 10 ml was injected. The blood pressures, heart rates, cardiac outputs, stroke volumes and cardiac indexes were measured using NICO(TM) (Non-Invasive Cardiac Output using partial carbon dioxide rebreathing technique, fast mode, Novametrix Medical Systems Inc, USA) at time before induction (T1), post-intubation (T2), post-insufflation and in the trendelenburg position (T3), post-intubation 10 (T4), 20 (T5), 30 (T6) and 60 minutes (T7), post-exsufflation (T8) and post-neutral position (T9). The pain scores were assessed by the patients using a 100 mm visual analogue scale at 1, 3, 6, 12 and 24 hours postoperatively. RESULTS: There were important differences in the blood pressures, cardiac outputs, stroke volumes and cardiac indexes between the two groups. No significant changes in the heart rate were observed during surgery in either groups. The postoperative pain scores were significantly lower in the epidural group compared with the control group. CONCLUSIONS: Preemptive epidural analgesia produces a more stable hemodynamic state during a laparoscopic hysterectomy and reduces the level of postoperative pain.

Severe Hypotension and Supraventricular Tachycardia during Insertion of Subclavian Catheter on a Patient with Wolff-Parkinson-White Syndrome: A case report / 대한마취과학회지

Wolff-Parkinson-White (WPW) syndrome is characterized by classical electrocardiographic findings resulting from preexcitation of a part of the ventricular myocardium due to anomalous atrioventricular conduction via a accessory pathway. Anesthetic management with this syndrome is aimed at avoiding tachycardia and cardiac arrhythmia by using the techniques to avoid hypoxia, hypercarbia, acidosis and sympathetic stimulation. We experienced a case of severe hypotension and paroxysmal supraventricular tachycardia (PSVT) during insertion of subclavian vein catheter on a patient with this syndrome prior to operation, in spite of adequate anesthetic management. The patient's condition was recovered after infusion of adenosine and removal of catheter. Operation was postponed for further evaluation of WPW syndrome. After 3 days, electrophysiologic study was done and accessory pathway was ablated by radiofrequency catheter. After 6 days, the patient was operated uneventfully and discharged 2 weeks later. We report that minor stimulation such as central venous catheterization on a patient with WPW syndrome can cause life-threatening severe hypotension and PSVT.

The Analysis of 137 Anesthesia-related Adverse Outcome Cases in Korea / 대한마취과학회지

BACKGROUND: 137 anesthesia-related adverse outcome cases were registered by civil courts, criminal courts, police departments, and district health care centers with the Korean Society of Anesthesiologists between November 1994 and October 2002. These cases were analyzed according to type of event causing the adverse outcomes (death, brain damage, disability). METHODS: 137 adverse outcome cases were classified into obstetric and gynecologic, orthopedic, surgical, and other cases. Also, based upon a review of medical records, anesthesia records, autopsy findings, investigation records and the decisions of civil courts and criminal courts, the cases were classified into four categories; e.g. problems due to anesthetic management, preexisting diseases or preoperative patient conditions, anesthetic agents or anesthetic techniques, and operating procedures. RESULTS: 1) 45 cases were associated with problems due to anesthetic management (ventilatory failure, drug overdose, etc). 2) 39 cases were associated with problem due to preexisting diseases (cardiovascular disease, cerebrovascular disease, diabetes mellitus, etc) or preoperative patient conditions. 3) 27 cases were associated with problems due to anesthetic agents or techniques (nerve injury, malignant hyperthermia, etc). 4) 26 cases were associated with problems due to operating procedures (massive bleeding, embolism, etc). CONCLUSIONS: The most common type of damaging event causing an anesthesia-related adverse outcome was connected with anesthetic management. Therefore, it is mandatory to prepare adequate anesthetic monitoring equipment and to monitor patients thoroughly, to ensure safer perioperative anesthetic management.

The Effect of Laryngeal Mask Airway ProSeal(TM) Cuff Inflation Prior to Insertion by the Inexperienced on the Success Rate of Inserting the PLMA(TM) and on Postoperative Sore Throat / 대한마취과학회지

Backgroud: The purpose of this study was to assess the effect of inflating a laryngeal mask airway ProSeal(TM) (PLMA(TM)) cuff, prior to insertion, on the degree of difficulty of inserting a PLMA(TM) by the inexperienced, and the incidence of postoperative sore throat. METHODS: Before induction, we measured the thyromental and sternomental distance. PLMA(TM) insertions were conducted by those with experience of less than 15 previous insertions. One hundred and five consecutive patients undergoing general anesthesia were randomized into 3 groups: In group 1, the PLMA(TM) was inserted with the cuff fully deflated, in group 2, the cuff was partially inflated (i.e., filled with half the recommended air), in group 3, the cuff was fully inflated. Successful insertion was judged primarily by the clinical function of the airway. The number of insertion attempts to achieve a satisfactory airway were recorded. Each patient was asked whether he had a sore throat, dysphonia, or dysphagia just before leaving the postanesthesia care unit (PACU) and again 24 hr after surgery. RESULTS: The number of insertion attempts required to achieve a satisfactory airway and the failure rate of insertion were not significantly different in the 3 groups. However, the 3 groups were significantly different in terms of the incidence of postoperative sore throat in the PACU. This was highest in group 3 (P<0.05). The incidences of other variables of laryngopharygeal morbidity in the PACU and 24 hrs after surgery were not significantly different in the 3 groups. CONCLUSIONS: Inflation of the cuff prior to insertion did not affect the success rate of inserting a PLMA(TM) by the inexperienced, and PLMA(TM) insertion after partial inflation was associated with higher incidence of postoperative sore throat in the PACU. Thus, in general anesthesia, it is desirable that the inexperienced insert the PLMA(TM) with the cuff fully deflated.

Cuff Volume of Laryngeal Mask Airway ProSealTM in Korean Adults / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine the cuff volume of the laryngeal mask airway ProSeal(TM)(PLMA (TM)) in Korean adults, which was measured at an intracuff pressure of 60 cmH2O. METHODS: A size 3 PLMATM was used for females (n = 57) and a size 4 PLMATM for males (n = 45). Anesthesia was induced with thiopental and rocuronium and maintained with sevoflurane, nitrous oxide and oxygen. After 5 minutes of conventional mask ventilation, the PLMATM was inserted using an the index finger in one motion. Increments of air up to a final intracuff pressure of 60 cmH2O were introduced and the patency of the airway was confirmed. Following successful placement during ventilation, the intracuff pressure was maintained at 60 cmH2O during anesthesia. The volume of air required to inflate the cuff to this pressure was measured, first after successful insertion of the mask (CV ins), and then 10 minutes before the end of anesthesia (CV end). Each patient was asked whether they had a sore throat, just before leaving the postanesthesia care unit (PACU) and again 24h after surgery. Data is presented as means standard error of mean (SEM). Statistical analysis was performed by bivariate correlation analysis, and by the paired t-test. Significance was accepted when P < 0.05. RESULTS: CV ins was 15-26 ml (22.8+/-0.3 ml)(female), 23-45 ml (33.6+/-0.6 ml)(male) and CV end was 17-27 ml (23.2+/-0.3 ml)(female), 22 45 ml (33.8+/-0.7 ml)(male). There were no significant correlation between BMI (body mass index), thyromental distance, sternomental distance and cuff volume (CV ins). In males, there was no significant difference between CV ins and CV end, but, in females, there was a significant difference between CV ins and CV end (CV ins < CV end)(P < 0.05). Incidences of postoperative sore throat just before leaving the PACU were 22.8% in females, 15.6% in males, and 24 hrs after surgery, these were 7% in females, 4.4% in males. CONCLUSIONS: We conclude that CV ins in both male and female was widely variable and that there is no correlation between anatomical variation and inflated cuff volume. Moreover, we could not prevent postopertative sore throat by changing cuff volume at an intracuff pressure of 60 cmH2O. Especially in Korean females, the cuff volume required to inflate the cuff to 60 cmH2O increased with anesthesia.

Fatal Venous Air Embolism during Lung Surgery / 대한마취과학회지

Venous air embolism (VAE) can be a lethal complication of surgical procedures during which (1) venous pressure at the site of surgery is subatmospheric or (2) air (or gas) is forced under pressure into a body cavity. We experienced a case of fatal massive venous air embolism during lung surgery in a 52 years old patient undergoing a right upper lobectomy and right lower lobe superior segment wedge resection for lung cancer. Anesthetic induction and the initial intraoperative course were completely uneventful until sudden severe hypotension and abrupt bradycardia occurred after artificial air insufflation into the intraabdominal cavity through the diaphragm to reduce the dead space of the thoracic cavity. We considered a venous air embolism as the etiology of these events and treated the patient with manual cardiac massage, various cardiotonic drugs and removal of air through the right atrium. The patient was extubated at 3 days after surgery and discharged from the hospital without the complication of the venous air embolism.

Effect of propofol on ion channels in acutely dissociated dorsal raphe neuron of Sprague-Dawley rats

To investigate propofol's effects on ionic currents induced by gamma-aminobutyric acid (GABA) and glycine as well as on those produced by the nicotinic acetylcholine- and glutamate-responsive channels, rat dorsal raphe neurons were acutely dissociated and the nystatin-perforated patch-clamp technique under voltage-clamp conditions was used to observe their responses to the administration of propofol. Propofol evoked ion currents in a dose-dependent manner, and propofol (10-4 M) was used to elicit ion currents through the activation of GABAA, glycine, nicotinic acetylcholine and glutamate receptors. Propofol at a clinically relevant concentration (10-5 M) potentiated GABAA-, glycine- and NMDA receptor-mediated currents. The potentiating action of propofol on GABAA-, glycine- and NMDA receptor-mediated responses involved neither opioid receptors nor G-proteins. Apparently, propofol modulates inhibitory and excitatory neurotransmitter-activated ion channels either by acting directly on the receptors or by potentiating the effects of the neurotransmitters, and this modulation appears to be responsible for the majority of the anaesthetic and/or adverse effects.

Comparison of the Effects of Propofol and Isoflurane Anesthesia on Respiratory Gas Exchange during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Introduction of a pneumoperitoneum using CO2 is accompanied by significant alterations in respiratory function and pulmonary gas exchange during laparoscopic cholecystectomy. Previous studies have shown differing results concerning pulmonary gas exchange: a significant decrease of PaO2 was induced with isoflurane. In contrast, no significant changes were observed with propofol. The purpose of the present study was to compare the effects of propofol vs isoflurane on pulmonary gas exchange during general anesthesia for laparoscopic cholecystectomy. METHODS: Forty patients were divided randomly between isoflurane and propofol groups. After induction of anesthesia, ventilation was controlled and intra-abdominal pressure was maintained automatically at 12 mmHg by a CO2 insufflator. After the measuring of baseline values of blood pressure, heart rate, PaO2, PaCO2 and PetCO2 before CO2 insufflation, measurements were also made immediately, 30min after CO2 insufflation and 5 min after CO2 exsufflation. RESULTS: In the isoflurane group, PaCO2, PetCO2, PaO2, and P(a-et)CO2 changed significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). In the propofol group, PaCO2 and PetCO2 increased significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05), but PaO2 and P(a-et)CO2 remained constant. When the two groups were compared, there were significant differences in PaO2, PaCO2, PetCO2 and P(a-et)CO2 at 30min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). CONCLUSIONS: These results indicate that during laparoscopic cholecystectomy the PaO2 was significantly lower and PaCO2 and P(a-et)CO2 were significantly higher in the isoflurane group compared with the propofol group.

Role of Fiberoptic Bronchoscopy in Conjunction with the Use of a Single Lumen Tube with Bronchial Blocker for Thoracic Anesthesia / 대한마취과학회지

BACKGROUND: Fiberoptic bronchoscopy has been recommended to verify the position of single lumen tubes with bronchial blockers (Univent(R) tube), but this remains controversial. The authors studied the role of a bronchoscopy for placing and monitoring bronchial blockers (BB) after blind intubation and after positioning the patient. METHODS: One hundred patients having thoracic surgery requiring a Univent tube insertion were prospectively studied. After "blind" tracheal intubations with Univent tubes, BB were advanced in the left-side mainstem bronchus for 60 patients and the right-side for 40 patients. A bronchoscopy was performed after conventional clinical verification of correct placement and after patient positioning for a thoracotomy. A BB was considered malpositioned when it had to be moved < 0.5 cm to correct its position. RESULTS: After "blind" BB intubation, clinical evidence of malpositioning was found in 5 patients. This was confirmed by fiberoptic assessment. In 95 patients in whom placement was judged correct by clinical assessment, malpositioning was detected by bronchoscopy in 39 cases. After patient positioning, BB were found to be displaced in 29 patients. Right-side BB were significantly more likely to be malpositioned than were left-side BB. CONCLUSIONS: After blind intubation and patient positioning, more than one third of BB required repositioning. A routine bronchoscopy is therefore recommended after intubation and after patient positioning.

Incidence of Pulmonary Aspiration in Patients with Tracheostomy / 대한구급학회지

BACKGOUND: Patients with tracheostomy tubes have altered glottic closure in deglutition that may result in aspiration and may cause dangerous pulmonary complication including bronchopneumonia and atelectasis. The incidence of pulmonary aspiration in patients with tracheosomy may be high but difficult to determine because investigators often apply different criteria. The present study was prepared to document the incidence of aspiration in patients with tracheostomy using a simple dye-marker test. METHODS: Thirty six surgical and medical patients (14 male and 22 female) in ICU with tracheostomy tube (high volume, low pressure cuffed tube) were included in this study. Mental status (presence of response to verbal command), the presence of nasogastric tube and the presence of ventilatory support were recorded in each patients to evaluate the effect of these factors on the incidence of aspiration. 1% solution of methylene blue dye was applied on the both side of posterior tongue and then any evidence of the blue dye-marker obtained microscopically on secretion through the tracheostomy tube at every 2 hours during 72 hours was considered the positive evidence of aspiration. RESULTS: Aspiration was detected by a positive methylene blue dye test in 11 of the 36 patients (30.5%) and average length of time before blue dye was obtained on tracheal secretion was 8.2 7.3 hours.The presence of response to verbal command, nasogastric tube and ventilatory support had no apparent effect on the incidence of aspiration. CONCLUSIONS: This observation suggests that a simple test using dye-maker is helpful to detect aspiration in patients with tracheostomy. Tracheostomy should be done under discreet decision because the high incidence of aspiration in trcheostomized patients.

Effects of Blood-Brain Barrier Disruption on Cerebral Oxygen Balance / 대한구급학회지

BACKGOUND: Disruption of the blood-brain barrier (BBB) can alter the internal milieu and may increase the release of excitatory amino acid neurotransmitters or catecholamines, which may affect metabolic rate or coupling. This study was performed to evaluate whether disruption of BBB by unilateral intracarotid injection of hyperosmolar mannitol would alter oxygen supply/consumption balance in the ipsilateral cortex. METHODS: Rats were anesthetized with 1.4% isoflurane using mechanical ventilation via tracheostomy. 25% mannitol was administered at a rate of 0.25 mlxkg-1s-1 for 30 s through unilateral internal carotid artery. The BBB transfer coefficient (Ki) of 14C-alpha-aminoisobutyric acid was measured in one group (N=7) after administering mannitol. Regional cerebral blood flow (rCBF), regional arterial and venous O2 saturation and O2 consumption were measured in another group using a 14C-iodoantipyrine and microspectrophotometry (N=7). RESULTS: Vital signs were similar before and after administering mannitol. Ki was significantly higher in the ipsilateral cortex (IC) than in the contralateral cortex (CC), (22.3+/-8.4 vs 4.4+/-1.1 microliterxg-1min-1). rCBF was similar between IC (105+/-21 mlxg-1min-1) and the CC (93+/-20). Venous O2 saturation was lower in the IC (43+/-7%) than in the CC (55+/-4). O2 consumption was higher in the IC (9.6+/-3.0 mlx100 g-1min-1) than in the CC (6.7+/-1.5). CONCLUSIONS: Our data suggested that increasing permeability of the BBB increased cerebral O2 consumption and deteriorated cerebral oxygen balance.

Comparison of Diclofenac or Fentanyl for Pain Following Tonsillectomy / 대한마취과학회지

BACKGROUND: This study was designed to compare intramuscular diclofenac with intravenous fentanyl in the prevention of pain after tonsillectomy and adenoidectomy for day-surgery. METHODS: We studied 60 patients, aged 3-13 years, undergoing tonsillectomy with or without adenoidectomy. Patients were randomly assigned to receive placebo injecton (Group 1), intramuscular diclofenac 1 mg/kg (Group 2) or intravenous fentanyl 1 microgram/kg (Group 3) after induction of anesthesia. Pain was evaluated by using an observer pain score for the first 30 min, 60 min and 4 hrs postoperatively. RESULTS: It is statistically significant that group 2 and group 3 had lesser pain than group 1 at 30 min and 60 min. But there is no difference among any groups at 4 hr postoperatively. CONCLUSIONS: We conclude that diclofenac may have advantages compared to fentanyl in safety and convenience for the treatment of pain after tonsillectomy in children.

The Influences of the Bispectral Index and Hemodynamics during Induction of Anesthesia with Propofol and/or Midazolam / 대한마취과학회지

BACKGROUND: The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. In this study, we measured BIS, blood pressure (BP) and heart rate (HR) during induction of anesthesia (IA) with propofol, with and without midazolam pretreatment. METHODS: A study design was used in 20 ASA physical status 1 and 2 patients aged from 18 to 60 years undergoing short (2 h) operation times. In the control group (group 1, n = 10), propofol 12 mg/kg/h was infused continuously after propofol 2 mg/kg as an intravenous bolus for IA preceded by normal saline. In group 2 (n = 10), propofol 12 mg/kg/h was infused continuously after half-strength propofol 1 mg/kg as an intravenous bolus for IA preceded by 0.1 mg/kg midazolam 2 min before. Patients received intravenous propofol for IA over 40 seconds. During the infusion, vecuronium (0.15 mg/kg) was given 3 5 min before intubation. The assistant and controlled ventilation were maintained with 100% oxygen over 5 min, and continued until BIS decreased to 40 and intubation was called for. The BIS, BP and HR were measured 2 min after midazolam or normal saline infusion, 3 5 min after propofol with vecuronium and 1, 3 and 5 min after endotracheal intubation. RESULTS: The midazolam pretreatment produced transient decreases in systolic BP and the BIS. During IA with propofol, BP decreased 20% in both groups. BIS decreased significantly 5 min after endotracheal intubation. CONCLUSIONS: Midazolam pretreatment attenuated the cardiovascular response to intubation, so BIS is considered a good monitor as a predictor of hypnotic state during intravenous anesthesia.

Comparison of a Double Lumen Endobronchial Tube with a Single Lumen Tube with Bronchial Blocker for One Lung Anesthesia / 대한마취과학회지

BACKGROUND: Double lumen endobronchial tube and single lumen tube with bronchial blocker are most frequently used tubes for one lung anesthesia. This study compared the double lumen endobronchial tube with the single lumen tube with bronchial blocker to determine whether there were objective advantages of one over the other during one lung anesthesia. METHODS: Sixty patients were randomly assigned to one of two groups. Thirty patients were intubated with a left-sided double lumen endobronchial tube, and thirty patients were intubated with a single lumen tube with bronchial blocker. Each group was subdivided into two groups with a person intubating (i,e, certified anesthesiologist or resident) to compare the easiness of intubation according to the type of tube. Fiberoptic flexible bronchoscope was used in all patients. The following were studied 1) time required to position each tube until satisfactory placement achieved, 2) frequency of malposition after initial placement with fiberoptic bronchoscopy, 3) surgical exposure ranked by surgeons blinded to type of tube used, 4) easiness of tracheobronchial toilet (TBT). RESULTS: 1) Statistically significant differences were observed in time required to place each tube by resident(double lumen tube 5.73+/- 0.48 min. versus single lumen tube with bronchial blocker 4.18+/-0.70 min (P<0.05) and in easiness of TBT (double lumen tube 18/30 versus single lumen tube with bronchial blocker 27/30) (P<0.05). 2) No differences were observed in time required to position each tube by anesthesiologist, the frequency of malposition and surgical exposure. CONCLUSIONS: Single lumen tube with bronchial blocker is better in easiness of intubation by resident and in easiness of TBT than double lumen endobronchial tube. But the selection of two tubes depends upon type of surgery and familiarity of each tube by the anesthesiologist.