Rebound Pulmonary Hypertension after Inhaled Nitric Oxide Withdrawal in Postoperative Congenital Heart Disease / 대한마취과학회지

BACKGROUND: Inhaled nitric oxide (NO) therapy causes selective pulmonary vasodilation in patients with pulmonary hypertension. However, attempts to discontinue inhaled NO may be complicated by abrupt life-threatening rebound pulmonary hypertension (RPH). The purpose of this study was to determine the risk factors to develop RPH and to present the adequate weaning methods. METHODS: We studied 19 consecutive children who were treated with inhaled NO because of pulmonary hypertension after surgery for congenital heart disease. We compared the dose of NO at the time of start and withdrawal, the duration of weaning and treatment, hemodynamic data, and blood gas analysis before inhaled nitric oxide withdrawal, between patients without (group I, n = 13) and with RPH (group II, n = 6). RESULTS: Compared with group I, group II patients were older in age (1204 1688 versus 546 1654 days, P < 0.05), had a lower NO concentration just before withdrawal (3 +/- 1.6 versus 5 +/- 2.6 ppm, P <0.05), a shorter duration of NO weaning period (4 +/- 3.3 versus 15 +/- 13.4 hours, P < 0.05) and received NO therapy for a shorter duration (26 +/- 11.6 versus 57 +/- 46.0 hours, P < 0.05). CONCLUSIONS: We recommend a progressive withdrawal of inhaled nitric oxide to avoid life-threatening RPH observed in the sudden discontinuation.

Inhaled Nitric Oxide as a Therapy for Pulmonary Hypertension after Operations for Congenital Heart Diseases / 대한마취과학회지

BACKGROUND: Congenital heart disease may be complicated by pulmonary hypertension. We assessed whether inhaled nitric oxide would produce selective pulmonary vasodilation in pediatric patients with congenital heart disease and pulmonary hypertension. METHODS: Inhaled low dose (10 20 ppm) nitric oxide was administrated in patients who were at risk of pulmonary hypertension after operations for congenital heart disease. To identify the nitric oxide effects, we evaluated hemodynamic and ABGA data before (T0) and after (T1) inhaled nitric oxide and just before (T2) decreasing concentration of inhaled nitric oxide. RESULTS: Inhaled nitric oxide decreased pulmonary arterial pressure and increased PaO2/FiO2 without decreasing systemic arterial pressure. CONCLUSIONS: Inhaled nitric oxide selectively decreased pulmonary arterial pressure in patients with congenital heart disease complicated by pulmonary artery hypertension.

Propofol Anesthesia in Stereotactic Operation for Movement Disorders / 대한마취과학회지

BACKGROUND: Stereotactic thalamotomy and pallidotomy for Parkinson's disease or essential tremor have been performed under local anesthesia. But some neurosurgeons have been reluctant to utilize this technique because of patient discomfort and neurological complications. So we used the propofol that provides excellent sedation and rapid and smooth recovery of mental abilities with minimal side effects. METHODS: After the patients were placed into the Leksell's stereotactic frame, anesthesia was induced by continuous infusion of propofol at the rate of 150 mcg/kg/min and then maintained at the rate of 50 mcg/kg/min. We investigated the hemodynamic changes, ABGA, total dose of propofol, time to loss of consciousness, recovery time from the end of infusion to eyes opening and side effects. RESULTS: The blood pressure decreased significantly at infusion start 15 min and 30 min (p<0.05) and heart rate decreased significantly at infusion start 30 min (p<0.05). The PaCO2 increased significantly at infusion start 15 min and 30 min (p<0.05). Total dose of propofol was 202.4+/-59.8 mg, time to loss of consciousness was 13.0+/-4.4 min, recovery time was 9.0+/-4.7 min and side effects were pain on infusion (2 cases) and postoperative nausea (1 case). CONCLUSIONS: Stereotactic thalamotomy and pallidotomy for Parkinson's disease or essential tremor were performed by infusion of propofol with minimal side effects and no neurological complications.

Radical Cystectomy in Elderly Patients: A Retrospective Analysis of Post Operative Mortality and Early Complications / 대한비뇨기과학회지

Radical cystectomy is the most common and effective treatment modality for invasive bladder cancer. However, in case of the elderly patient its application accompanies anxieties over the possible mortality and complications. We purposed to analyze the postoperative mortality and early complication of the elderly patients compared to those of non-elderly patients. We reviewed retrospectively the medical records of 27 elderly patients, over 70 years of age and 61 non-elderly patients, under 69 years of age who were not at high risk anesthesiologically and underwent radical cystectomies with ileal conduits for invasive bladder cancers during last 11 years. We compared mortality, early complications, and postoperative hospital days between two groups. There was no death related to operation in elderly group, but one of the non-elderly group died of sepsis and DIC(disseminated intravascular coagulation) postoperatively Overall early complications were significantly higher in elderly group(P=0.013). But the major complications that were life threatening or required reoperation revealed no significant difference between two groups. There was no significant difference in postoperative hospital days(16.8 days in elderly group, 16.1 days in non-elderly group) between two groups. In conclusion, radical cystectomy can be performed as an effective and safe modality for the treatment of invasive bladder cancer even in elderly patients if only they are not at high risk anesthesiologically.

Retrospective Analysis of 1436 Cases of Infant's Anesthesia / 대한마취과학회지

BACKGROUND: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. METHODS: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. RESULTS: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following : inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. CONCLUSIONS: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hernia. The most common postoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.

Retrospective Analysis of 1436 Cases of Infant's Anesthesia / 대한마취과학회지

BACKGROUND: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. METHODS: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. RESULTS: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following : inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. CONCLUSIONS: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hernia. The most common postoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.

Anesthetic Experience for Open Heart Surgery / 대한마취과학회지

This report is concerned with our clinical experience of 150 cases of anesthesia for open heart surgery at department of anesthesiology, In chon Gil hospital from Februry, 1990 to April, 1993. The results were as follows ; 1) Among 150 cases, 68 cases (45.3%) were congenital heart disease and 82 cases (54.7%) were acquired heart disease. 62 cases (41.3%) were males and 88 cases (58.7%) were females. 2) Glycopyrrolate, diazepam, morphine, were used as premedicants. 3) Fentanyl, ketamine, diazepam, thiopental sodium were used as induction agents and injected singly or in combination. 4) In congenital cyanotic heart diseases, ketamine was used as main anesthetic agent. In other heart diseases, fentanyl, isoflurane, diazepam were used. 5) Vecuronium was used for intubation and maintenance of muscle relaxation. 6) Overall mortality rate was 3.3% (5 cases) and the causes of death were low cardiac output, respiratory insufficiency, mediastinal infection.

A Comparison Study of the Ketamine and the Thiopental Sodium as an Induction Agent in the Cesarian Section / 대한마취과학회지

This study was undertaken to estimate the effects of the induction agents on the bioparameters such as changes in blood pressure, pulse rate, Apgar score, patients movement, fetal arterial and venous blood gas analysis, memory and emergence reactions. 116 parturients undergoing cesarian section were divided into two groups: ketamine group and thiopental group, and were given 1.2 mg/kg ketamine in ketamine group and 4 mg/kg thiopental sodium in thiopental group as an induction agent respectively. The results were as follows; I) Blood pressure increased in both groups, but ketamine group less increased than thiopental group statistically. Pulse rate did not increased in skin incision in ketamine group statistically. 2) The patient's movement were 5 case(9%) in ketamine group and 17 cases(29%) in thiopental group. 3) There was not significant difference in fetal arterial and venous blood gas analysis. 4) In Apgar score, ketamine group is better than thiopental group. 5) There was no psychologic side reactions in both groups. 6) Postoperative recalling of intraoperative awareness occured in seven patients(12%) only in the thiopental group.

Continuos Epidural Analgesia for Labor and Delivery / 대한마취과학회지

The most interesting change in anesthetic technic for pain relief during labor and delivery has been the widespread acceptance of continuous lumber epidural analgesia. Primary effect of epidural analgesia is to relieve pain and therapy to preserve the morale and to prevent exhaustion of the mother. For the past year in our hospital, continuous lumbar epidural analgesia was attempted on 38 pregnant women and its effect was assessed. In established labor, epidural analgesia was started for pain relief and was maintained with intermittent injections until delivery; in 45% the duration exceeded six hours. Labor was slightly retarded, probably due to inadvertent selection of patients with slow and painful progress. Vacuum extraction was used in 52.6%. Fetal condition was excellent(Apgar score of 7 or greater in 97.4%). Continuous epidural analgesia gives superior relief of pain but cells for experienced management and nursing care.

Ketamine Hydrochlorie as a Preanesthetic Agent in Children / 대한마취과학회지

Preoyerative sedation of children is a difficult problem of great importance, for the psychic trauma comsequent to anticipation of surgery may be as great a hazard to the patient as his original disease. Until now, a number of sedatives have been used commonly for adequate sedation of pediatric patients, but, no method has been universally accepted. At our hospital fifty pediatric patients receiving general anesthesia for minor elective surgery were studied to evaluate the effect of ketamine hydrochloride as a preanesthetic agent. The results were as follows: 1) The onset of drag action was about, about 5min. 2) The induction of anesthesia and maintenances of operation was smooth, because a sedative effect was obtained without cardiovascular and respiratory depression. 3) With a small dosage of ketamine(2mg/kg), patients were free from apprehension. So, perioperative psychic trauma was preventible. 4) The two excitable patients were anesthetized by intravenous anesthetics with ease. 5) Mild complications, accurred but they were not significant.

Hydrohemothorax following Subclavian Vein Catheterization / 대한마취과학회지

Central venous catheterization has become an important aid in the correct management of the critically ill patient and is being used more often than in the past. However, no technic of cannulation has been entirely free of complications. A needle which is inserted properly and positioned in the vein is not likely to produce complications arising from injury to adjacent structures; hence accurate knowledge of their anatomic relations is essential for central venous catheterization. We have experienced a case of hydrohemothorax as a complication of subclavian vein catheterization. We report this case with a review of the literature of central venous cathetherization and its possible complications.

Ketamine in Obstetric Anesthesia / 대한마취과학회지

The pharmacologic actions of ketamine in human volunteers were reported by Domino et al in 1965 and it was used in 130 patients by Corssen Domino in 1966. Chodoff and Stella were the first to investigate ketamines suitabilityas an in anesthetic in childbirth. Since then several authors reported that ketamine has several advantages over conventional anesthetics in obstetric anesthesia. Ketamine was used as the sole anesthetic agent for forceps delivery in 50 women who were selected randomly. Ketamine was administered intravenously just before delivery in doses of 30 to 60 mg and after delivery dosage was not limited, The following results were observed: 1) During delivery, a rapid and intense analgesic effect was sufficiently maintained with a small dose of ketamine. 2) With the use of ketarnine it is possible to shorten the second stage of labor with a short induction-delivery-interval because of the advantages of forceps delivery. 3) Ketamine could be used without intubation during with a short fasting time because protective laryngeal quate airway could be maintained. 4) Ketamine did not appear to induce an increase of Very. delivery even in patients and pharyngeal reflexes and an ade uterine bleeding during or after deli 5) The use of ketamine during delivery appeared to have almost no affect on the Apgar score. 6) The use of ketamine was accompanied by mild complications but they were not significant.

Catheter Embolism as a Complication of Intravenous Catheterization / 대한마취과학회지

The introduction of polyethylene catheters for intravenous use by Meyers in 1945 has been a major contribution to patient care. Within recent years however there has been a mounting number of reports warning of the hazards associated with their use. Especially, embolism of an intravenous polyethylene catheter is the most serious complication. The authors had experience with a case of catheter embolism from subclavian catheterization for monitoring of central venoas pressure and rapid transfusion or fluid infusion. The case, a woman with ectopie pregnancy, in extreme shock, was operated on with serious risk of catheter embolism. Vital signs were stable during the operation. When the patient recovered from the anesthesia she suffered a sudden onset of chest pain and slight dyspnea for 10- minutes in the recovery room. Due to the fact that the embolus could not be seen by X-Ray, operation for removal of the catheter embolus was not performed. The patient's condition was good during the hospital stay and at discharge, and no trouble has been noted during 9 months follow-up.