Anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia and suspected impairment of T4 to T3 conversion: a case report / 대한마취과학회지

We report an anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia (elevated free thyroxine, fT4 and normal 3, 5, 3'-L-triiodothyronine, T3) and suspected impairment of conversion from T4 to T3. Despite marked hyperthyroxinemia, this patient's perioperative hemodynamic profile was suspected to be the result of hypothyroidism, in reference to the presence of T4 to T3 conversion disorder. We suspected that pretreatment with antithyroid medication before surgery, surgical stress and anesthesia may have contributed to the decreased T3 level after surgery. She was treated with liothyronine sodium (T3) after surgery which restored her hemodynamic profile to normal. Anesthesiologists may be aware of potential risk and caveats of inducing hypothyroidism in patients with euthyroid hyperthyroxinemia and T4 to T3 conversion impairment.

Hemidiaphragmatic paralysis and hemohydrothorax following right internal jugular vein catheterization / 대한마취과학회지

No abstract available.

The effect of heated breathing circuit on body temperature and humidity of anesthetic gas in major burns / 대한마취과학회지

BACKGROUND: Cold and dry gas mixtures during general anesthesia cause the impairment of cilliary function and hypothermia. Hypothermia and pulmonary complications are critical for the patients with major burn. We examined the effect of heated breathing circuit (HBC) about temperature and humidity with major burned patients. METHODS: Sixty patients with major burn over total body surface area 25% scheduled for escharectomy and skin graft were enrolled. We randomly assigned patients to receiving HBC (HBC group) or conventional breathing circuit (control group) during general anesthesia. The esophageal temperature of the patients and the temperature and the absolute humidity of the circuit were recorded every 15 min after endotracheal intubation up to 180 min. RESULTS: There was no significant difference of the core temperature between two groups during anesthesia. The relative humidity of HBC group was significantly greater compared to control group (98% vs. 48%, P < 0.01). In both groups, all measured temperatures were significantly lower than that after intubation. CONCLUSIONS: The use of HBC helped maintain airway humidity, however it did not have the effect to minimize a body temperature drop in major burns.

Pericardial tamponade caused by massive fluid resuscitation in a patient with pericardial effusion and end-stage renal disease: A case report / 대한마취과학회지

Pericardial tamponade can lead to significant hemodynamic derangement including cardiac arrest. We experienced a case of pericardial tamponade in a patient with end-stage renal disease. Hemodynamic changes occurred by unexpectedly aggravated pericardial effusion during surgery for iatrogenic hemothorax. We quickly administered a large amount of fluids and blood products for massive bleeding and fluid deficit due to hemothorax. Pericardial effusion was worsened by massive fluid resuscitation, and thereby resulted in pericardial tamponade. Hemodynamic parameters improved just after pericardiocentesis, and the patient was transferred to the intensive care unit.

Preoperative platelet response to collagen is associated with myocardial injury after off-pump coronary bypass graft in patients taking aspirin / 대한마취과학회지

BACKGROUND: We hypothesized that, even in patients taking aspirin, the variance of preoperative platelet response to collagen might be associated with myocardial injury during coronary artery bypass graft (CABG) surgery. Therefore, we evaluated the relationship between preoperative whole-blood aggregometry (WBA) by collagen and the postoperative myocardial injuries. METHODS: For 44 patients who were scheduled for elective off-pump CABG and taking aspirin, WBA was measured by the impedance method in the presence of collagen (2 mg/ml or 5 mg/ml) as stimulatory agents. After CABG, myocardial injury was evaluated by analysis of the creatine kinase (CK), creatine kinase-MB (CK-MB), and lactate dehydrogenase (LD), and by electrocardiography. RESULTS: High response group (n = 13) on preoperative WBA with collagen (2 and 5 mg/ml) showed significantly higher postoperative cardiac enzyme levels (CK, CK-MB and LD) than those of low response group (n = 31). CONCLUSIONS: In patients who take aspirin and undergoing off-pump CABG, the preoperative platelet response to collagen is correlated with postoperative myocardial injury.

One-lung ventilation with a bronchial blocker through a single-lumen endotracheal tube in a small woman: A case report

One-lung ventilation with a double-lumen endotracheal tube or a Univent(R) tube may be difficult or dangerous in small patients, children, and patients with anatomic abnormalities of the airway. The use of a bronchial blocker through a single-lumen endotracheal tube has been used successfully in such situations. A 69-year-old woman was scheduled for Ivor-Lewis operation and right upper lobectomy. She could not be intubated with a internal diameter 6.0 mm Univent(R) tube owing to narrow diameter of the vocal cord. We report a successful one-lung ventilation using a Uniblocker(R) through an adult-size single-lumen endotracheal tube in a small woman, who needed postoperative ventilator care.

Anaphylaxis by atracurium on a cardiac surgery patient: A case report / 대한마취과학회지

Effective treatment of hypotension during induction of general anesthesia depends onhow well the many causes of the hypotension are understood. However, differential diagnosis of hypotension is by no means easy, especially when the prevalenceof hypotension is low or when the patient is asymptomatic. A 75 year-old female, upon induction of general anesthesia for open thoracic surgery, became hypotensive and showed generalized erythematous papules, therefore having to postpone the surgery. Upon further evaluation through skin prick tests, the hypotensive event was concluded to be caused by anaphylactic side effects of atracurium. Hence, atracurium was avoided and the surgery was successfully performed.

Measurement of Hemodynamic Changes Caused by Administration of Atracurium Besylate after Pretreatment with Anti-histamine Agent / 대한마취과학회지

BACKGROUND: Hemodynamic changes through the histamine-induced release of atracurium are relatively common, but can be particularly dangerous in hemodynamically unstable patients. This study evaluated the effectiveness of a pretreatment with an anti-histamine agent before the administration of atracurium in the prevention of histamine-induced hemodynamic changes. METHODS: Forty-eight ASA class I and II patients were assigned to four groups. Groups 1 and 2 were assigned to receive atracurium through a bolus 0.5 mg/kg. Groups 3 and 4 were assigned to receive atracurium through a bolus 1.0 mg/kg. Group 1 and 3 were pretreated with pheniramine (H1-blocker) and ranitidine (H2-blocker) intravenously before the induction of general anesthesia. After induction, HemosonicTM 100 was installed and the following hemodynamic parameters were measured: systemic vascular resistance (SVR), cardiac index (CI), heart rate (HR) and blood pressure (BP) immediately before, 1, 2, 3, 5 and 10 min after the rapid administration of the atracurium bolus before the skin incision. RESULTS: Groups 1 and 3 showed more stable hemodynamics than groups 2 and 4. Group 2 showed more significant changes in the SVR, CI, BP, HR than group 1 (P< 0.05). Group 4 showed more significant changes in the SVR, CI, BP, HR than group 3, and some cases were significant hemodynamically (P< 0.05). Group 4 showed more significant changes in the SVR, CI, BP, HR than group 2 (P <0.05). CONCLUSIONS: Pretreatment with an anti-histamine drug prior to the administration of atracurium can be effective in attenuating the hemodynamic responses.

Comparison of Dexamethasone with Ondansetron for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy

BACKGROUND: Postoperative nausea and vomiting (PONV) are very common side effects of laparoscopic procedures. The aim of this study was to compare the effectiveness of dexamethasone with that of ondansetron in prevention of PONV after laparoscopic cholecystectomy. METHODS: Seventy-five ASA class 1, 2 patients planned for laparoscopic cholecystectomy were assigned to receive intravenously either dexamethasone 5 mg (dexamethasone group, n = 25), ondansetron 4 mg (ondansetron group, n = 25), or normal saline 2 ml (control group, n = 25) just after induction of general anesthesia. During the maintenance, end-tidal carbon dioxide tension was controlled to maintain 35-40 mmHg and intraabdominal pressure was controlled to maintain 12 mmHg. Patient's nausea and vomiting were observed in the recovery room just after operation and 6 h, 12 h and 24 h after operation. RESULTS: Incidences of PONV were significantly lower in dexamethasone group and ondansetron group than control group. However there was no significant difference between the two antiemetic groups. CONCLUSIONS: Both of dexamethasone and ondansetron were effective for the prevention of PONV after laparoscopic cholecystectomy.

Aortic Intramural Hematoma: Assessment of Clinical and Radiological Features in Comparison to Acute Aortic Dissection

PURPOSE: To compare the clinical and radiological features of aortic intramural hematoma(IMH) to those of acute aortic dissection(AD). MATERIALS AND METHODS: We analyzed the clinical and radiological features of 12patients with aortic IMH and 43 patients with acute AD. In aortic IMH, the diagnoses were made by means of both CTand transesophageal echocardiography (TEE) and included two surgically proven cases. In acute AD, the diagnoses were made by means of CT and TEE and included 21 surgically proven cases. We com- pared patients ages, etiologies, the extent of the disease, the presence or absence of aortic branch involvement, complications, and outcomes. RESULTS: Aortic IMH tended to develop in older patients (67.8+/-7.9 vs. 50.4+/- 13.4, P.05). In aortic IMH, there was no involvement of aortic branches, whereas in acute AD, 14 (33%) patients showed involvement of one or more aortic branches. Complications of aortic IMH included pericardial effusion (n=2) and pleural effusion (n=4) ; in acute AD, pericardial effusion (n=7), pleural effusion(n=4), aortic insufficiency (n=8), cerebral infarction (n=3), renal infarction (n=4) and spinal infarction (n=1)were seen. There was one (8%) death due to aortic IMH and ten (23%) deaths due to acute AD (p<.01). CONCLUSION: Aortic IMH is characterized by its occurrence in older patients with hypertension, a less frequent incidence of complications, and a more favorable outcome than acute AD.