Effects of Low Dose Propofol on Core and Peripheral Temperatures during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Core hypothermia during the first hour after induction of anesthesia results primarily from a redistribution of body heat. Propofol in low doses provides reliable sedation and is associated with fast recovery. However, propofol-induced peripheral vasodilation is likely to facilitate core-to-peripheral heat redistribution. This study was designed to evaluate the effects of low dose propofol on core and peripheral temperatures during spinal anesthesia. METHODS: Fifty patients of ASA status I or II, aged 20 to 60, undergoing lower extremity surgery under spinal anesthesia were studied. Spinal anesthesia was administered to all patients, who were assigned sedation as follows: 1) control (n = 25), 2) propofol (n = 25); propofol infusion rates were, 8 mg/kg/h for the first 3 min, 4 mg/kg/h for the next 10 min, and 2 mg/kg/h for the next 15 min. Temperatures were recorded after beginning surgery at 5-min intervals for 30 min. RESULTS: Core temperature was significantly decreased after 15, 20, 30 min of surgery in the propofol group, and this result was statistically different between the two groups. Forearm skin temperature decreased in the control group and increased in the propofol group, without significance. Fingertip skin temperature did not changed significantly in the control group, but increased significantly after 15 min in the propofol group and continued to increasing to 30 min. Forearm minus finger skin temperature gradients were not changed significantly in control group, but decreased between 5 and 30 min in the propofol group, which was statistically significant. CONCLUSIONS: Low dose propofol may induce a degree of hypothermia during spinal anesthesia. Close monitoring is needed to prevent core hypothermia, if sedation is induced using propofol during spinal anesthesia.

Anesthetic Experience of Appendectomy of a Patient with Implantable Cardioverter Defibrillator: A case report / 대한마취과학회지

Implantable Cardioverter Defibrillator (ICD) devices have been developed for prompt recognization and termination of life-threatening ventricular arrhythmias. We experienced a case of 34-years old male patient with ICD diagnosed as Brugada Syndrome and undergone appendectomy under general anesthesia. Before anesthetic induction, the device was turned off to avoid electromagnetic interference (EMI) from electrocautery during operation and turned on again after surgery. There was no significant cardiac events during perioperative period and postoperative care for 7 days of admission.

Dellen Following Blepharoplasty: Report of 14 Cases

We report 14 cases of dellen in 2000 blepharoplasties. The purpose of this article is to report rare complication of corneal dellen that developed after blepharoplasties. We observed 6 cases (0.5%) of dellen among 1200 patients who underwent upper blepharoplasty, and 8 cases (1%) among 800 lower blepharoplasty cases. Most patients who developed dellen were in their forties and fifties. All dellen were observed at temporal limbus, and accompanied conjunctival bleb. Most of the dellen developed in dry season (from November to March) and were frequently found in the middle-aged neurotic women who lived in apartments where room temperature is relatively high. Patching to the eyes, artificial tear and steroid eye ointment were applied to the dellen patients, who usually healed without corneal opacity within 2 weeks. In conclusion, we think that the cause of the conjunctival bleb and dellen are obstruction of small lymphatic vessels due to too meticulous hemostasis and too tight key suture in case of lower blepharoplasty.

Double Fold Operation of Incisional Method: Skin-Tar-Sal Plate-Muscle-Skin Fixation

The purpose of this article is to introduce author's method of double fold operation by using skin-tarsal plate-muscle-skin fixation. Three thousand patients were operated during last ten years. The incision line is 7 to 10mm above the ciliary margin while the skin is pulled upward. Excess skin and orbicularis oculi muscle is removed. Orbital septum is opened on its lateral part and orbital fat is removed. 1) Skin of the lower flap, 2) tarsal plate and/or levator aponeurosis, 3) orbicularis oculi muscle of the upper flap, and 4) skin of the upper flap are sutured with removable suture material. The fixations are performed at three points of each eyelids(midpupillary line, medial and lateral margin of the tarsal plate). Additional nine stitches of skin-levator-skin fixation are put on each eyelid. Sutures were removed on third to 6th postoperative-day. Most of the patient were satisfied with the result. Only 30 patient complained loss of fold. However, 150 patients had conjunctival bleb and 15 patient suffered from dellen. This method is unique method which can avoid triple fold by fixating the orbicularis muscle of the upper flap.

The Pulmonary Hemodynamic Effects of Nitric Oxide Inhalation on Hypoxic Pulmonary Vasoconstriction / 대한마취과학회지

BACKGROUND: Nitric Oxide (NO) has been discovered to be an important endothelium-derived relaxing factor. The exogenous inhaled NO may diffuse from the alveoli to pulmonary vascular smooth muscle and produce pulmonary vasodilation, but any NO that diffuses into blood will be inactivated before it can produce systemic effects. To examine the effects of NO on pulmonary and systemic hemodynamics, NO was inhaled by experimental dogs in an attempt to reduce the increase in pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) induced by hypoxia in dogs. METHODS: Eight mongrel dogs were studied while inhaling 1)50% O2 (baseline), 2)12% O2 in N2 (hypoxia), 3)followed by the same hypoxic gas mixture of O2 and N2 containing 20, 40 and 80 ppm of NO, respectively. RESULTS: Breathing at FIO2 0.12 nearly doubled the pulmonary vascular resistance from 173 56dyn sec cm-5 to 407 139dyn sec cm-5 and significantly increased the mean pulmonary artery pressure from 16 3mmHg to 22 4mmHg. After adding 20~80 ppm NO to the inspired gas while maintaining the FIO2 at 0.12, the mean pulmonary artery pressure decreased (p<0.05) to the level when breathing oxygen at FIO2 0.5 while the PaO2 and PaCO2 were unchanged. The pulmonary vascular resistance decreased significantly and the right ventricular stroke work index returned to a level similar to breathing at FIO2 0.5 by addition of NO into the breathing circuit. Pulmonary hypertension resumed within 3~5 minutes of ceasing NO inhalation. In none of our studies did inhaling NO produce systemic hypotension and elevate methemoglobin levels. CONCLUSIONS: Inhalation of 20~80 ppm NO selectively induced pulmonary vasodilation and reversed hypoxic pulmonary vasoconstriction without causing systemic vasodilation and bronchodilation. Methemoglobin and NO2 were within normal limit during the study.

Hemodynamic Responses and Oxygen Availability in Unanesthetized Dogs during Apnea / 대한마취과학회지

BACKGROUND: This study examined hemodynamic variables, oxygen delivery, extraction, and consumption in response to acute progressive hypoxia and hypercarbia in the setting of apnea. METHODS: Apnea was induced in 9 healthy mongrel dogs by disconnecting animals from mechanical ventilation of 30 minutes with pure oxygen. Hemodynamic variables, oxygen transport, extraction, and consumption were rapidly and repeatedly measured using pulmonary arterial and arterial catheters until cardiac output was undetectable. RESULTS: The baseline PaO2, PaCO2, pH, base excess were 318 +/- 137 mm Hg, 36 +/- 3.5 mm Hg, 7.30 +/- 0.06, 6.81 +/- 2.65 mmol/l respectively. Hypercarbia and hypoxemia (76 +/- 33 mm Hg) was first noted at 1 and 4 minute respectively. Base excess was not changed. Indices of preload (PCWP and CVP) were increased early in the time course (p<0.05). In contrast, indices of afterload (SVR) increased later, just before cardiac decompensation began (p<0.05). No significant reduction of cardiac output, oxygen delivery, extraction, and consumption was detected just until abrupt cardiac decompensation started, 5 minute. CONCLUSIONS: These data suggest that the early increase in preload was primarily due to hypercarbia whereas the late increase in afterload was due to hypoxemia, but the main cause of acute cardiac decompensation was a critical decrease in arterial oxygen tension with some contribution of increased preload and afterload.

Therapeutic Effects of Stellate Ganglion Block in Management of Upper Extremity Reflex Sympathetic Dystrophy (RSD, CRPS Type I) / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the therapeutic effects of sympathetic block in management of reflex sympathetic dystrophy (RSD); renamed complex regional pain syndrome (CRPS) Type I, according to the duration of RSD, and to evaluate predictable factors responding to sympathetic block in patients suffering from RSD. METHODS: Prospectively designed this study was divided thirty patients with upper extremity RSD into three groups according to the duration of RSD; Group I (or = 7 months). All patients were received repeated stellate ganglion blocks (SGB) with 12 ml of 0.2% bupivacaine by paratracheal approach. We compared the therapeutic effects of SGB between the groups and the clinical signs on initial examination to receive the first SGB at pain clinic. RESULTS: Response rates to SGB were 84.6% in Group I, 62.5% in Group II and 44.4% in Group III. The early treatment less than 6 months was better prognosis (pcold>no difference, p<0.001), and allodynia (p<0.05) were favorable prognostic factors responding to sympathetic block. Especially, warm skin and edema in RSD were near-perfect predictors of sympathetic blocks. CONCLUSIONS: We conclude that SGB is effective in management of upper extremity RSD, and the duration and the clinical signs of RSD are important to the prognosis and responsibility to sympathetic block. If patients suffering from RSD visit pain clinic before 6 months, and they have edematous warm hands with allodynia, majority of them will be improved from their pain after sympathetic block.

Recovery Pattern after Anesthesia with Propofol or Thiopental/Isoflurane / 대한마취과학회지

One of the goals of anesthesia is complete, comfortable and rapid recovery without sequelae from anesthesia. We compared the recovery pattern between anesthesia with propofol and thiopental/isoflurane. The fifty patients undergoing emergency appendectomy were allocated randomly to receive one of the anesthesia with propofol or thiopental/isoflurane. All of the patients were also given fentanyl, atracurium in equivocal dosage per weight and 50% N2O. Group 1(patient No; 25) was received anesthesia with fentanyl, atracurium, N2O and continuous injection of 6~12 mg/kg/hour of propofol. Group 2(patient No; 25) was received anesthesia with thiopental, fentanyl, atracurium, N2O and 1~2 MAC(minimal alveolar concentration) of isoflurane. We studied the duration of return of self respiration from discontinuation of anesthetics and recovery pattern in time sequence. The results were as following; The group 1 compared with group 2 at early recovery phase. 1) The duration of return of self respiration from discontinuation of anesthetics retured more rapid. 2) Emergence time was more rapid. 3) Postoperative sequelae(nausea, vomiting, sedation, drowsiness, memory dysfunction, pain) rate was less severe. But at recovery phase after 24 hours, there were no significant difference in postoperative sequelae and recovery condition in both groups. Therefore, we concluded that propofol is better than thiopental/isoflurane for anesthesia of emergency appendectomy in view of early recovery pattern.

Effects of Patient Controlled Analgesia with Morphine after Obstetric or Gynecologic SurgerAnesthesia for Traumatic Diaphragmatic Hernia Detected after Operation of the Femur Fracture / 대한마취과학회지

Injury of diaphragm mainly occur in penetrating, crush and blunt injuries to the lower chest or upper abdomen, and it is most often secondary to automobile accidents. Diaphragmatic rupture is most frequent in blunt chest trauma and the rate is below 1% of them. Traumatic rupture of the diaphragm is responsible for the herniation of abdominal viscera. Physical finding and radiographic sign of diaphragmatic hernia is nonspecific and misreading. Therefore, the diagnosis of traumatic rupture of diaphragm may be difficult during the early period after the injury, especially when clinical features are dominated by associated injuries. Emergency surgical management is necessary when it is complicated with serious complication. We experienced the case of traumatic diaphragmatic hernia detected after the operation of femur fracture. The patient was injured by motor vehicle accident 6 days before the operation of the femur fracture. There was no specific symptom and sign and the manifestation of the diaphragmatic hernia. in radiographic studies until operation of the femur fracture was done. Diaphragmatic hernia was confirmed by chest X-ray and arterial blood gas analysis after operation of the femur fracture. The repair of the diaphragmatic hernia was directly performed after the diagnosis. The prognosis was favorable, and she was discharged to ward from intensive care unit after 1 day of operation. We must consider the possibility of traumatic diaphragmatic hernia in the patient who have the history of blunt chest or abdominal trauma.

Effect of the mutation in the carboxyl-terminal processing site of the hepatitis B virus core antigen on the HBeAg secretion

No abstract available.

Effects of mutation of hepatitis B virus poly(A) signal "TATAAA" to "AATAAA" on expression of hepatitis B viral genes

No abstract available.