A Comparison of Effectiveness Correlated with Different Doses of Doxapram in the Treatment of Post-Anesthetic Shivering / 대한마취과학회지

BACKGROUND: Although post-anesthetic shivering may be a temporary phenomenon, it leads to detrimental effects such as increased oxygen consumption, hypoxemia, and difficulty in monitoring. Doxapram is a relatively new treatment for post-anesthetic shivering, but there have been few reports about its minimum effective dose. The purpose of this study was to find the minimum dose of doxapram which would show an antishivering effect. METHODS: Sixty patients who had developed post-anesthetic shivering were divided into six groups of ten patients each. The groups were divided into a control group, which received normal saline, and the doxapram groups, which received five different doses of doxapram (0.15, 0.2, 0.5, 1.0, 1.5 mg/kg). The antishivering effect (2, 5, 10, 15 minutes after treatment), blood pressure, heart rate and temperature were compared among the groups. RESULTS: There was a significant difference in antishivering effect between the group which received normal saline and the groups which received doxapram; however, there was no significant difference within the groups which received doxapram. CONCLUSIONS: We conclude that the dose of doxapram required to achieve an antishivering effect is much less than that currently in use.

Tracheal Rupture Following Insertion of Double-Lumen Endobronchial Tube during Bronchoesophageal Fistular Repair: A case report / 대한마취과학회지

Tracheobronchial rupture following tracheal intubation with double-lumen endobronchial tube (DLT) is a rare complication, but may result in a massive air leakage with resultant pneumothorax, mediastinal emphysema and extensive subcutaneous emphysema in the postoperative period. We report a case of sustained laceration of the posterior membranous part of the trachea possibly due to overinflation of the double-lumen endobronchial tube. A 76-year-old, 45 kg, female was scheduled for a repair of her bronchopleural fistula. Following induction of anesthesia, intubation was performed with Robertshaw's DLT, and a tracheal cuff was inflated with 6 ml of air, but the sound of an air leak was heard coming from the patient's mouth during controlled ventilation. A further 5 ml of air was added 1 ml at a time into the tracheal cuff but the air leak sound continued. At that point, the sound was considered to originate from the bronchopleural fistula rather than from lack of sufficient air. After a thorough deflation of the tracheal cuff, 6 ml of air was reinjected and the operation was resumed. A 4 cm split was unexpectedly noticed in the posterior wall of the trachea during the operation and was repaired without complication.