The Impact of Cardiac Surgery with Deep Hypothermic Circulatory Arrest on Systemic Inflammatory Response and Postoperative Morbidity in Adults

BACKGROUND: The inflammatory response to cardiopulmonary bypass (CPB) surgery is believed to play an important role in the end organ dysfunction after open heart surgery. The effect of temperature on the post-bypass inflammatory response has been studied in normothermic and hypothermic patients. This study compared the influence on the systemic inflammatory response and postoperative morbidity in hypothermic cardiopulmonary bypass patients with those in patients in deep hypothermic circulatory arrest. METHODS: Fifty patients undergoing elective redo-valvular replacement or double valve replacement using a hypothermic cardiopulmonary bypass (26-28oC, H Group) and 9 patients undergoing an elective ascending aortic aneurysm replacement using deep hypothermic circulatory arrest (16oC, D Group) were prospectively investigated. The serum samples were collected to estimate the interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha levels immediately after induction, 30 min after the initiation of the CPB, 30 min after weaning from the CPB, 2 hours after the CPB, 24 hours after the CPB. RESULTS: Patients preoperative and intraoperative characteristics (age, gender, aortic cross clamping time, cardiopulmonary bypass time) were not similar in the two groups. The serum level of IL-6 and TNF-alpha were also similar in the two groups. There were no statistical differences in the intubation time, ICU stay and oxygenation index (arterial PO2/inspired fraction of oxygen). There were also no statistical differences in the incidence of systemic inflammatory response syndrome and the APACHE II scores. CONCLUSIONS: Deep hypothermic circulatory arrest was not shown to produce a more profound inflammatory response or influence the postoperative morbidity than a hypothermic cardiopulmonary bypass.

Radiation Exposure from a Patient Treated with I-131 during Emergency Operation: A case report / 대한마취과학회지

Among the hazards in anesthesiologic field, the radiation exposure is not uncommon and is mainly from the exposure to imaging equipment. The presented case is a very extraordinary one of radiation exposure from the patient taking radioactive iodine (I-131). Recently we experienced a radiation exposure during the emergency surgery of a thyroid cancer patient who was administered I-131 before surgery. The oral administration of I-131 is recognized as a standard medical treatment for thyroid carcinoma. But the patient treated with I-131 can be a potential radiation source of external exposure to surroundings and the radiation was actually near the recommended limit of yearly exposure in spite of short surgery time. Hereby we report the case and contemplate the peri-operative risk of radiation exposure.

Retrograde Study on Thoracic Percutaneous Vertebroplasty and Kyphoplasty Done by Transpedicular Approach / 대한통증학회지

BACKGROUND: Transpedicular percutaneous vertebroplasty, along with kyphoplasty of the thoracic vertebrae, is technically more difficult than those of the lumbar vertebrae due to the anatomical differences. During the last four years, all the percutaneous vertebroplasty and kyphoplasty of the thoracic vertebrae carried out at our institution were performed using a transpedicular approach; therefore, we tried to find if there were any problems or complications associated with the process. METHODS: The medical records of all the patients who had undergone thoracic percutaneous vertebroplasty or kyphoplasty were retrospectively reviewed. The following were looked up: the procedure name, unipedicular or bipedicular, the level of the thoracic vertebrae treated, and the pre- and postoperative changes in the Visual Analog Scales (VAS), the volume of cement injected and complications. RESULTS: In the last four years, 58 vertebral bodies in 58 patients were treated. Twelve and 46 vertebral bodies were treated by kyphoplasty and vertebroplasty, respectively. A total of 58 mid and lower thoracic levels were treated: T5 (n=1), T6 (n=1), T7 (n=3), T8 (n=4), T9 (n=1), T10 (n=4), T11 (n=14) and T12 (n=30). The mean preoperative and postoperative VAS scores were 8.1+/-1.4 and 5.2+/-1.7, respectively. The mean volume of cement injected was 4.01+/-1.85 ml; 3.18+/-0.60 ml at T5-8 and 4.22+/-2.27 ml at T9-12. There were no clinical complications, such as pedicular fracture or cement leakage. CONCLUSIONS: Although transpedicular vertebroplasty and kyphoplasty at the mid to lower thoracic vertebral bodies is technically difficult compared to that at the lumbar region, the procedures can be performed safely.