Accuracy and Efficacy of Impedance Cardiography as a Non-Invasive Cardiac Function Monitor

PURPOSE: The most common method of monitoring cardiac output (CO) is thermodilution using pulmonary artery catheter (PAC), but this method is associated with complications. Impedance cardiography (ICG) is a non-invasive CO monitoring technique. This study compared the accuracy and efficacy of ICG as a non-invasive cardiac function monitoring technique to those of thermodilution and arterial pressure contour. MATERIALS AND METHODS: Sixteen patients undergoing liver transplantation were included. Cardiac index (CI) was measured by thermodilution using PAC, arterial waveform analysis, and ICG simultaneously in each patient. Statistical analysis was performed using intraclass correlation coefficient (ICC) and Bland-Altman analysis to assess the degree of agreement. RESULTS: The difference by thermodilution and ICG was 1.13 L/min/m², and the limits of agreement were −0.93 and 3.20 L/min/m². The difference by thermodilution and arterial pressure contour was 0.62 L/min/m², and the limits of agreement were −1.43 and 2.67 L/min/m². The difference by arterial pressure contour and ICG was 0.50 L/min/m², and the limits of agreement were −1.32 and 2.32 L/min/m². All three percentage errors exceeded the 30% limit of acceptance. Substantial agreement was observed between CI of thermodilution with PAC and ICG at preanhepatic and anhepatic phases, as well as between CI of thermodilution and arterial waveform analysis at preanhepatic phase. Others showed moderate agreement. CONCLUSION: Although neither method was clinically equivalent to thermodilution, ICG showed more substantial correlation with thermodilution method than with arterial waveform analysis. As a non-invasive cardiac function monitor, ICG would likely require further studies in other settings.

Chronic Back Pain Proven to Be Spinal Tuberculosis: A report of 2 cases / 대한통증학회지

The progression of spinal tuberculosis is usually slow and insidious, and its main symptom, backache, is nonspecific. Considerable delay in diagnosis may occur before an infectious process is considered. Even when a diagnosis of spinal tuberculosis is considered, it may be difficult to confirm. Radiological findings indicative of tuberculosis are involvement of the vertebral bodies on either side of the disc, subligamentous spread, abscess formation and collection and expansion of granulation tissue adjacent to the vertebral body, relative sparing of the disc space and calcification within a paravertebral abscess. We report two patients with spinal tuberculosis who had nonspecific backache and received a delayed diagnosis for several months or years.

Rocuronium Dosage Producing the Ceiling Effect on Onset Time in Young Male Patients / 대한마취과학회지

BACKGROUND: Rocuronium is considered a good candidate for rapid-sequence induction of anesthesia. Increased dose of rocuronium shortens the onset time but prolongs the duration of action. However, the ceiling effect of onset time appears when larger doses are used.Clinical trials have not shown the exact dose of ceiling effect. We performed this study to find dose producing the ceiling effect of onset time. METHODS: One hundred forty young male adults were randomized to oneof seven doses of rocuronium:0.6, 0.7, 0.8, 0.9, 1.0, 1.1 or 1.2 mg/kg.Anesthesia was induced with IV thiopental sodium and maintained with sevoflurane after tracheal intubation. Neuromuscular block was monitored with acceleromyography using single twitch.The onset time, the recovery of single twitch to 10% and also the changes in hemodynamics were checked. RESULTS: A dose of up to 1.0 mg/kg shortens the onset time but no further decrement was seen with doses larger than 1.0 mg/kg.The recovery time was prolonged as doses were increased but there were no differences in the hemodynamics. CONCLUSIONS: This study showed that in young male adults under IV induction with thiopental sodium, the ceiling effect of onset time appeared with rocuronium doses in excess of 1.0 mg/kg.