Margin of Safety in Positioning Double-lumen Endotracheal Tubes Using a Fiberoptic Bronchoscope in Korean Adult / 대한마취과학회지

BACKGROUND: The margin of safety is the length of the mainstem bronchi, over which double-lumen endotracheal tubes (DLTs) can be moved and still be correctly positioned. A negative value of margin of safety means that DLTs may not be safe. We measured the length of the left and right mainstem bronchi and margin of safety in Korean adults. METHODS: One hundred and fifty-six ASA I or II adult patients undergoing an elective surgery were examined. After nduction of general anesthesia, we measured the lengths from the upper incisor to the tracheal carina, to the proximal margin of the left and right upper lobe bronchial opening using a fiberoptic bronchoscope. We calculated the lengths of the left and right mainstem bronchi and margin of safety using the measured lengths. RESULTS: In Korean adults, the average margin of safety of left-sided DLTs of males and females was 2.4 +/- 1.0 cm and 1.9 0.7 cm and right-sided DLTs of males and females was 1.0 +/- 0.9 cm and 0.8 +/- 0.3 cm, respectively. The percentage of a negative value of the margin of safety in positioning right-sided DLTs was 10.4% in males and 8.6% in females. However, all values of the margin of safety in left-sided DLTs were positive. CONCLUSIONS: Using left-sided DLTs, regardless of the operative side, is better than right-sided DLTs because left-sided DLTs have a greater margin of safety in positioning. If we use right-sided DLTs, we should confirm the proper position of tubes using a fiberoptic bronchoscope.

The Effect of Preoperative Clonidine in a Laparoscopically-Assisted Vaginal Hysterectomy / 대한마취과학회지

BACKGROUND: Laparoscopic surgery is a technique with cosmetic advantage, reduction of hospital days, postoperative pain and morbidity. However, in terms of anesthetic care, increase of airway pressure and blood pressure, decrease of ventilatory capacities, and hypercarbia have been problematic issues. The purpose of this study was to evaluate the effect of preoperative administration of clonidine for controlling blood pressure during laparoscopic surgery. METHODS: Forty patients who underwent a laparoscopically-assisted vaginal hysterectomy were randomly allocated into clonidine administered group (group C) or a control group (group N) before the operation. Clonidine 0.15 mg was given intravenously for group C patients, then induction was started. Blood pressure and pulse rates were measured at times of entering the operating room, intubation, post-intubation 1, 3, and 5 minutes, post-insulfflation 10 minutes, and postoperatively 1 hour. Blood sugar was checked at post-insulfflation 10 minutes and postoperatively 1 hour. RESULTS: In both groups blood pressure and pulse rate increased significantly compared to the control value after intubation and this feature continued to post-intubation 1 minute in group N. There was significant increase of blood pressure in the postoperative 1 hour period only in group N. Blood sugar also increased significantly at post-insufflation 10 minutes in group N and 1 hour in both groups. Comparing the two groups, blood pressure values of group N at postintubation 1, 3, and 5 minutes were significantly higher than group C, and pulse rate at postinsuflation 1 hour was significantly higher than group C. In addition, the blood sugar in group N was significantly higher than group C at postinsufflation 10 minutes. CONCLUSIONS: Preoperative clonidine administration is an effective and convenient method to control hypertension and the blood sugar level during laparoscopic surgery.

Comparison of the Changes of Liver Function in Patients after Open Versus Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Laparoscopic cholecystectomy is a standard treatment for cholelithiasis and indication is continuously widened to acute and complicated cholecystitis. It has been proved to give advantages such as less postoperative pain, postoperative complications and early recovery. However, postoperative hepatic dysfunction after laparoscopic cholecystectomy has been repeatedly reported and when we evaluate postoperative hepatic dysfunction, laparoscopic surgery has been thought as one of the contributors. So authors planned this study to satisfy the growing need of reevaluation of postoperative hepatic dysfunction because we have had many achivements and improvements in knowledge and operative techniques since a while. METHODS: From January to December in 2000, 182 patients were randomly selected among who had undergone cholecystectomy in one university hospital. The numbers of each group (group OC; open, group LC; laparoscopy) were equal. Demographic data, duration of operation and level of liver enzymes (alanine transferase, alkaline phosphatase, total bilirubin and direct bilirubin) on operation day and one postoperative day were estimated by medical records. RESULTS: Mean operation time was longer in group OC than in group LC. Levels of alanine transferase, total bilirubin and direct bilirubin of postoperative one day were increased significantly in both groups. The degrees of increase of alanine transferase and bilirubin were higher in group OC than group LC in statistically significant manner. CONCLUSIONS: Laparoscopic cholecystectomy has more advantages than open cholecystectomy in many aspects.

The Comparison of Characteristics in Emergence between Inhalational Anesthesia Using Isoflurane and Total Intravenous Anesthesia Using Propofol and Ketamine / 대한마취과학회지

BACKGROUND: Total intravenous anesthesia (TIVA) is one of the anesthetic techniques that needs no inhalational agent but only an intravenous agent for induction and maintenance of anesthesia. Among drugs used in TIVA, propofol is the most popular agent. Rapid emergence and antiemetic characteristics of propofol are well known advantages but a dose dependent cardiovascular depressant effect is one of the disadvantages of this drug. Otherwise, ketamine, a dissociative agent, has been restricted in its use because of bad dreams, delirium and delayed emergence even though it has profound analgesic characteristics. However, ketamine has a stimulatory effect on the cardiovascular system, so it can raise blood pressure and pulse rate and in the case of TIVA, these properties can be advantageous when used with propofol. This study was aimed to decide whether TIVA using propofol and ketamine would have more stable vital signs during anesthesia and more rapid and smoother emergence in comparison with inhalational anesthesia using isoflurane. METHODS: Thirty two patients scheduled for elective general anesthesia were randomly allocated into two groups; I (inhalational anesthesia using isoflurane) group and PK (TIVA using propofol and ketamine) group. I group was controlled with isoflurane 1 - 1.5 vol% and the PK group was controlled with propofol 3 - 12 mg/kg/hr and ketamine 0.5 - 1.0 mg/kg/hr. Arriving at the recovery room, a single observer recorded the time to spontaneous movement, responses to painful pinch and verbal command, and orientation to age, name, place, date and time. At 5, 10, and 30 minutes after anesthesia, a PARS (postanesthesia recovery score), count-down test, and VAS (visual analogue scale) were checked. Postoperative events were checked in the recovery room and 24 hours lator. RESULTS: There was no significant difference in demographic data or characteristics of operation. Compared with the I group, the PK group had significantly rapid orientation responses on place, date and time. Restoration in the count-down test was more rapid in the PK group after 10 minutes in the recovery room. The VAS was lower in the PK group after 30 minutes in the recovery room. CONCLUSIONS: TIVA using propofol and ketamine has a more rapid emergence than inhalational anesthesia using isoflurane and better postoperative analgesic effect without respiratory depression.

The Comparison of the Characteristics of "Nonspecific ST-T Change" Patients in Perioperative Periods / 대한마취과학회지

BACKGROUND: ST changes that do not fulfill the criteria of specific one-ST changes greater or equal to 1 mm and lasting over 1 minute-, are termed as "nonspecific". The term, "nonspecific ST-T change", has not had an important role as a guildeline of treatment. However, the incidence of "nonspecific ST-T changes" is estimated as not so negligible, and the relation to postoperative complications or the role as a coronary prognostic risk value has not been studied so far, so the authors thought to examine the general characteristics and course during the perioperative period of "nonspecific ST-T change" patients to conduct better anesthesia services. METHODS: From January 1st to June 30th in the year 2000, medical charts of patients who underwent an operation in one university hospital under general or regional anesthesia and whose preoperative electrocardiographic finding was "nonspecific ST-T changes" were reviewed. In the preoperative viewing of charts, demographic data, co-existing disease, findings in electrocardiography or echcardiography, and replies of a consultation to a cardiologist were reviewed. In the anesthesia records, nature of conducted anesthesia, agents, operation time and drugs acting on the cardiovascular system were reviewed. RESULTS: Incidence of "nonspecific ST-T changes" patients is 8.24%. Mean age is 54 +/- 16 yrs and the ratio of M : F is about 1 : 2. The number of patients who had other medical diseases was 42, about 27%. The number of patients who underwent a preoperative echocardiography was 64, about 42%. Mean ejection fraction was 65 +/- 7%. The number of patients who consulted a cardiologist preoperatively was 44, about 22% and the majority of them were OK'd as "no problem". Administration of drugs acting on the cardiovascular system was done in 49 cases, about 33%. General anesthesia was conducted in 131 cases, regional anesthesia in 23 cases. CONCLUSIONS: In all cases, operations were performed without specific events or major complications. However more attention and risk evaluation is desirable in "nonspecific ST-T change" patients to conduct safer and more ideal anesthesia.

Partial Obstruction of an Armored Endotracheal Tube / 대한마취과학회지

An 47-year-old woman presented for a microscopic vascular decompression with facial nerve palsy. Past medical history was noncontributory. There were not abnormal physical or laboratory findings. Oral tracheal intubation with an armored tube was performed without any problems. Anesthesia was maintained uneventfully in spite of a high peak inspiratory airway pressure (28 30 cmH2O). After surgery, she had symptoms of airway obstruction and the endotracheal tube was removed. The removed tube was found to have a protrusion through almost all the length of tube which reduced its internal diameter a half. Finally, in any case of "airway obstruction" in an intubated patient, we should consider mechanical problems. We should keep in mind the presence of an armored endotracheal tube cannot be regarded as a guarantee of a patent airway. We must test not only leakage of the cuff but also passage of the tube prior to usage.

The Effect of Pretreated Ketorolac on Postoperative Pain and the Satisfaction of Patients / 대한마취과학회지

BACKGROUND: Postoperative pain is the principal acute pain and many trials have been done for it. The preemptive analgesic method is one of the trials and nonsteroidal antiinflammatory drugs (NSAIDs) have been under study to reduce the side effects of opioids and to gain some other advantages, and many positive results have been reported. The author therefore planned this study to evaluate whether or not NSAIDs could have a preemptive effect, to observe any difference in effect with increasing dose, and to identify any advantage to patients under preemptive analgesia. METHODS: Seventy-five patients undergoing open cholecystectomy or choledochocystostomy were randomly allocated into three groups, group K0, K30 and K60. In group K0 (n = 25), patients were given no medication before operation. In groups K30 and K60, patients were given ketorolac 30 mg and 60 mg by intravenous route at 15 minutes before operation respectively. After operation, one observer who didn't know which group the patients were allocated to recorded patients' pain score (visual analogus scale; VAS and Prince-Henry score; PHS), side effects and satisfactory score at postpoperative 0, 1, 6, 12, 24 and 48 hours. For VAS > 50 or PHS > 3, morphine 2.5 mg was given by intravenous route and pain score was reestimated after 10 minutes and this was repeated until VAS < 50 and PHS < 3. RESULTS: In group K60, VAS, PHS and dose of morphine were lower than in other groups (p < 0.05). Satisfaction score was higher in group K60 and the nurse's satisfaction score was higher than the patient's in group K0 and K30 (p < 0.05). There was no significant difference in hospital days between groups. Side effects were negligible. CONCLUSIONS: Preoperative intravenous administration of ketorolac 60 mg in open cholecystectomy or choledochocystostomy could have a preemptive analgesic effect and give more satisfaction to patients. In the immediate postoperative period, pain status may be highest, so more attention and evaluation will be needed by pain management staffs for the proper management of acute pain.

The Application of Total Intravenous Anesthesia & Propofol-N2O Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: According to the increasing rate of cesarean section, the efforts of seeking safer and more satisfactory obstetric anesthesia techniques have been continued. Propofol, 2,6 di-isopropyl phenol, is a relatively new intravenous anesthetic agent and has been used for induction and maintenance for total intravenous anesthesia (TIVA). Authors examined the anesthetic technique using following anesthetics combinations; N2O-propofol, fentanyl-propofol, ketamine-propofol and made comparison of these ones for intraoperative hemodynamic stability, maternal and fetal safety. METHODS: Sixty patients (ASA physical status 1 or 2) scheduled for cesarean section were randomly allocated into three groups, group N (propofol-N2O, n=20), group F (propofol-fentanyl, n=20), group K (propofol-ketamine, n=20). We checked the changes of blood pressure and heart rates during operation, anesthetic induction time, neonatal status (Apgar score, umbilical vein blood gas analysis), presence of intraoperative awareness and recovery time. RESULTS: No significant differences in intraoperative hemodynamic changes, induction time and baby status. Total propofol dosages were greater in group N than group K (p<0.05) and maternal recovery time was prolonged in group K than group N or F (p<0.05). CONCLUSIONS: Anesthetic management using propofol-N2O or propofol-fentanyl or propofol-ketamine for cesarean section would provide satisfactory anesthesia without significant adverse effects to both mother and fetus.

Comparison of Propofol with Enflurane Anesthesia in Laparoscopic Cholecystectomy for the Change of Liver Function / 대한마취과학회지

BACKGROUND: Recently, using propofol as intravenous anesthetic agent is increasing. And it is known that propofol has little effects on liver function even after long operation such as plastic surgery. But its effect on liver functon after hepatobilliary operation which may damage liver was not studied. Thus, authors carried out this study to evaluate the effect of propofol on liver function by comparing with enflurane in the patients who had laparoscopic cholecystectomy. METHODS: Patients's anesthesia records and hospital charts from January 1994 to June 1996 were anlaysed retrospectively. Three hundred and thirty three patients who had normal liver function preoperatively and had no complications during and after operation were selected. They were divided into two groups ; propofol group (n=191) and enflurane group (n=142). The preoperative values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were compared with those of 1 and 3 days after operation. RESULTS: One day after operation, both propofol and enflurane group showed significant increase in AST and ALT (p<0.05) and decrease in ALP (p<0.05). But there was no difference between two groups. CONCLUSION: Concerned to liver function, propofol is as useful as enflurane to the patients who scheduled for laparoscopic cholecystectomy.

Does Pretreated NSAIDs Decrease the Postoperative Consumption of Morphine? / 대한마취과학회지

BACKGROUND: NSAIDs (Nonsteroidal antiinflammatory drugs) had been known as having analgesic property and its mechanism is prostaglandin synthesis blocking action -peripheral mechanism-. Nowadays, central mechanism of NSAIDs were postulated by some animal or clinical studies, but the preemptive analgesic effects have been still in controversy. Thus, authors planned this study to evaluate whether NSAIDs have the preemptive analgesic effect by using propacetamol and ketorolac. METHODS: Seventy five patients undergoing laparoscopic vaginal hysterectomy were subjected and randomly allocated into three groups according to drugs given. Group P (n=25) and group K (n=25) were given propacetamol 2 gm or ketorolac 30 mg intravenous respectively at 15 minutes before induction. Group C (n=25) had no medication. Pain control using morphine were started in all three groups before skin incision. One anesthesiologist who didn't know which group the patients were allocated visited the patients when the patient arrived at recovery room after operation, postoperative 1 hour, 6 hours, 12 hours, 24 hours and 48 hours and estimated pain score and side effects. Parameters using pain score were visual analogue score (VAS; 100 mm) -subjective parameter- and Prince-Henry score (PHS) -objective parameter-. If VAS>50 or PHS>3, morphine 2.5 mg were given by i.v. and pain score were reestimated after 5 minutes and same dose of morphine were given until VAS<50 and PHS<3. RESULTS: Demographic data of three groups were insignificant. In group P, lower VAS, PHS and morphine consumption were observed than the other groups. Significant changes according to time were observed until postoperative 6 hours in each groups. Side effects occurred as nausea, vomiting and somnolence but statistical significance between groups were absent. CONCLUSIONS: Preoperative i.v. administration of propacetamol 2 gm in laparoscopic vaginal hysterectomy could have preemptive analgesic effects. But we think that determining the proper dosage and timing of administration that could have preemptive analgesic effect of NSAIDs are subjects demands further study.

Comparison of Effects of Propofol and Enflurane on Blood Glucose Level / 대한마취과학회지

BACKGROUND: Even though surgery and anesthesia give stress to patients, adequate anesthesia could attenuate stress reactions and minimize side effects from these reactions. Abnormal glucose homeostasis is well documented side effect during anesthesia, especially when inhalational anesthetics are used. We planned this study to investigate and compare the effects of two popular anesthetics-between propofol, intravenous anesthetics, and enflurane, inhalational agents on blood glucose level. METHODS: Adult patients free of diabetes mellitus and any other endocrine disease were randomly allocated into two groups. In both groups, anesthesia was induced with 2.5% pentothal sodium 5 mg/kg and succinylcholine 1 mg/kg. After intubation, propofol 6~10 mg/kg with 50 % N2O-O2 mixture 4 liter were used for maintenance in one group (Group P). In other group, enflurane 1.5~2% with 50% N2O-O2 mixture 4 liter were used (Group E). Hartmann's solutions were used for maintenance fluid in both groups. Blood glucose levels were measured at preintubation period, postintubation 5, 10, 15 minutes and just-preincision period. Blood glucose level at admission was regarded as control value and statistical analysis was done by Student's t-test. RESULTS: In group E, there was significant increase of the blood glucose level about 23 minutes after induction but in group P, there was no significant increase of glucose level during entire experimental time. Blood glucose levels were higher from postintubation 5 minutes to just-preincision period with statistical significance in group E than group P. CONCLUSIONS: Propofol maintained stable blood glucose level compared to enflurane during general anesthesia.

The Adequate Timing of Arterial Blood Sampling during the Changes of Inspired Oxygen Fraction by Nitrous Oxide / 대한구급학회지

BACKGOUND: Arterial blood gas analysis is essential on diagnosis and treatment of hypoxia and acid-base imbalance. It is important to decide the timing of arterial blood sampling as well as sampling method, sample transport, and analysis of the results. So we investigated to the adequate timing of sampling when inspired oxygen fraction is changed from 0.5 to 1.0. METHODS: 20 patients were anesthetized with enflurane-N2O-O2 (FiO2=0.5), and paralyzed with pancuronium 0.07~0.08 mg/kg. Ventilation was controlled with Ohmeda 7000 ventilator (BOC Health Care Inc., Madison, USA), using a constant tidal volume of 10 ml/kg and respiration rate of 12/min. After 1 hour of anesthesia, the nitrous oxide inhalation was stopped and 100% oxygen was inhaled, and then arterial blood gas values were measured at 2 min intervals for 20 min, 5 min intervals for next 30 min, and 10 min later. Blood samlpes were drawn from the radial artery and measured immediately on a blood gas analyzer (Civa-Corning 288 Blood Gas System, Civa-Corning Diagnostic Corp., Medifield, USA). Determining the optimal time of sampling was performed with the rate of variation of PaO2 according to time progression, then the point at which the slope decreased abruptly was regarded as statistically significant timing. RESULTS: After 12 minute, arterial oxygen partial pressure was not any more changed significantly. There were no change of pH, arterial carbon dioxide partial pressure, oxygen saturation, base excess, and bicarbonate. CONCLUSION: The timing of arterial blood gas sampling in change with inspired oxygen fraction from 0.5 to 1.0 is about 12 minute later.

The Effect of Endotracheal Tube Cuff Filled with Lidocaine and Sodium Bicarbonate Mixture on Postoperative Sore Throat and Hoarseness Following General Endotracheal Anesthesia / 대한마취과학회지

BACKGROUND: Postintubational sore throat and hoarseness are usually mild symptoms but they are very common complaints among the patients after endotracheal general anesthesia. In addition, some might have severe discomfort and need invasive procedure to relieve these problems. We tried new method of endotracheal tube cuff filling with local anesthetics to reduce postoperative sore throat and hoarseness and evaluated the results. METHODS: Endotracheal cuff filling was done with air 5 ml in healthy 20 patients (ASA I-II, control group). And in another healthy (ASA I-II) 35 patients, the cuffs were filled with 4% lidocaine 3.5 ml and 8.4% sodium bicarbonate 1.5 ml mixture. After 24 hours following general anesthesia, patients were visited and asked whether there were sore throat or hoarseness, if any, how the degree was. RESULTS: In lidocaine-treated group, the incidence of postintubational sore throat was less compared to control group significantly. There was no difference in incidence of hoarseness between two groups. CONCLUSION: Endotracheal cuff filled with lidocaine and sodium bicarbonate mixture is suggested as an effective protective method that reduces the frequency of postintubational sore throat.

A Study of Cancellation Cases of the Elective Operations / 대한마취과학회지

BACKGROUND: Unexpected cancellation of the elective operation on scheduled day is stressful event to both of patients and doctors, especially when there is little explanation and understanding. Above all, it is against cost-saving policies in hospital management. Thus the author investigated the rate, distribution and causes of cancelled cases to get help to make plans to reduce the cancellation rates. METHODS: From March 1st in 1996 to February 28th in 1997, all operation schedules were reviewed and cancelled cases on scheduled day were analyzed. All the elective operations except emergency operations under general, regional or local anesthesia were included in this analysis. Total cancellation rate was analyzed according to surgical departments, month, week day, age and causes. In statistical analysis, SAS program was used. RESULTS: Total number of cancellation was 424 cases and mean cancellation rate was 8.47%. In analysis of cancellation rate by months, it was highest in October and lowest in November. In August, October and December the cancellation rates were higher than the other months. It was higher on Tuesday and Thursday. Most common causes of cancellation was the problems related patient's condition, especially related to coexisting diseases. Among these, cardiac disease was predominant. Non-medical causes were predominant than medical causes in most cancelled cases. CONCLUSION: Trying to reduce the cancellation rates is suggested as one of methods that will make the quality and quantity of medical services better. Careful preoperative evaluation of patient and consultation of abnormal findings or laboratory data before hospitalization, appropriate scheduling of operation, complete preparation of operation apparatus, through all these, firm establishment of doctor-patient rapport are core element of reducing of cancellation rate. So, attention and support by not only anesthesiologist but surgeons and hospital managers are needed to achieve these goals of reducing of cancellation rate.

Pain on Injection of Propofol: Comparison of the Methods of Alleviation / 대한마취과학회지

BACKGROUND: Various kinds of methods had been tried to reduce pain on injection of propofol. In this study, the effect of lidocaine pretreatment and that of temperature controlled injections were compared and evaluated its clinical utility. METHODS: One hundred and twenty patients were randomly allocated into 4 groups after permission. Room temperature propofol was used as induction agent in group P,. In group C, cooling (4 degrees C) propofol was used and warming propofol (37 degrees C) in group H. And room temperature propofol following lidocaine (1 mg/kg) was used in group L. Injection dosage of propofol was 2 mg/kg and injection speed was 2 ml/sec in all groups. In each patients, pain score and visual analog scale were measured and tested by ANOVA or Kruskal-Wallis test. RESULTS: There were no statistical significant difference in pain score among the 4 groups. But in visual analog scale analysis, group L markedly reduced values than the other groups by statistically significant manner (in Duncan grouping). CONCLUSION: The alleviating effect of lidocaine pretreatment on painful injection was better than that of changing temperature of propofol itself. More over effectiveness, in view of simplicity, we recommend lidocaine pretreatment.

Comparision of Laparoscopic and Open Cholecystectomy / 대한마취과학회지

Recently, laparoscopic cholecystectomy becomes a favorite surgical treatment of cholelithiasis instead of traditional open cholecytectomy. The reasons include small wound, small pain and short hospital-stay. But it also has disabvantages by pneumoperitoneum made of carbon dioxide insuffulation. We attempted to investigate the effect on hemodynamics, arterial blood gas parameters and pulmonary function of each surgical technique-laparoscopic(Group I) vs open cholecystectomy(Group II). We randomly selected realative healthy 30 patients for each group and baseline arterial blood gas and pulmonary function test were measured. During the operative proeedure, hemodynamic parameters(blood pressure and heart rate) were measured by 5-minute interval. Postoperatively, arterial blood gas and pulmonary function test were measured. The results are following; 1) In group I, blood pressure was increased to l14.2+/-18.0mmHg significantly(p<0.01) compared to preoperative value 101.4+/-21.5 mmHg. Heart rate was not shown significant change in both technique groups. 2) PaO2 was significantly decreased to postoperative 24hr value 82.2+/-15.8mmHg in group II and 82.3+/-19.4 mmHg in group I compared to preoperative 24hr value 98.7+/-14.8 mmHg and 94.4+/-ll.3mmHg, respectively. There was no significant difference of PaCO2 of between two groups. pH was significantly increased to postoperative 24hr value 7.42+/-0.02 in group II compared to preoperotive 24hr value 7.39+/-0.03 but no significant change in group I compared to preoperative 24hr value 7.39+/-0.03. 3) In group I, FVC and FEV1 were decreased preoperative 24hr value 77.9% and 81.1% to postoperative 24hr value 61.1% and 62.3%, respectively. But in group II, FVC and FEV1 were decreased more significantly, compared preoperative 24hr value 90.8% and 95.6% with postoperative 24hr value 59.4% and 58.6%. FEV1,/FVC value was not changed in two groups. 4) Postoperative analgesics requirement was 53% in group I, 80% in group II at the day of surgery. Also frequency was 1.8 in group I, 2,4 in group II at the day of surgery. 5) Mean Operation time was 43 min in group I, 52 min in group II and mean hospital days were 6 days in group I, 12 days in group II. Conclusively, in case of group I, blood pressure change was more labile than group II. But postoperative pulmonary function derangement, requirement of analgesics and hospital day were reduced in case of group I.

Anesthetic Management for Surgery of Patients with Budd-Chiari Syndrome / 대한마취과학회지

Budd-Chiari Syndrome is a rare disorder due to obstruction of hepatic venous outflow and generally follows a rapid fatal course. Hepatic vein thrombosis is a common complication with a high mortality rate and surgery for this condition is associated with a high perioperative mortality. Those who survive the acute phase almost invariably go on to develop cirrhosis of the liver and die within a few years from hepaic failure, bleeding esophageal varices or other complications of chronic liver disease. We have experienced the anesthetic management of three parients with Budd-Chiari syndrome who were treated with finger fracture and mesoatrial shunt. It is important that the anesthesiologist realizes that certain pathophysiological changes occur during the several surgical approaches to relieve the effect of hepatic vein obstruction, and perioper-ative hepatic dysfunction.