Primary Irritant Dermatitis to Povidone-Iodine after Caudal Anesthesia: A Case Report / 대한마취과학회지

Povidone-iodine (PVP-1) is a widely used antiseptic because of its low toxicity and germicidal effect. A 16 year old patient who had undergone incision and debridement of an anal abscess developed contact dermatitis on his buttocks postoperatively. The lesion had been exposed to a gauze immersed in a 10% povidone-iodine solution for 8 hours, but the skin around the surgical field directly painted with 10% povidone-iodine solution didn't show any effect. A patch test with povidone-iodine produced a negative response in this patient. These observations indicate that prolonged exposure to wet povidone-iodine is harmful. It is important that povidone-iodine be used carefully to prevent contact dermatitis.

Hyperamylasemia Due to Ruptured Cerebral Aneurysm: A case report / 대한마취과학회지

Unexpected findings of hyperamylasemia have been observed in patients with primary neurosurgical abnormalities without abdominal trauma or evidence of pancreatitis. However, the causes of hyperamylasemia in abovementioned cases have not been clearly elucidated. We have experienced hyperamylasemia in a 66 year-old female patient with subarachnoid hemorrhage caused by ruptured cerebral aneurysms who had had 2 aneurysms in right pericallosal and left middle cerebral trifurcational artery. Among the 2 aneurysms, the one in right pericallosal artery was ruptured and subarachnoid, intraventricular and intracranial hemorrhage was observed on the initial brain CT scan. There was no specific problem during operation and patient's staying in recovery room. Seven hours after the operation finished, severe hypotension and metabolic acidosis were occurred. Vital signs and acidosis were corrected with fluid and bicarbonate therapy. We incidentally found marked hyperamylasemia in the first postoperative day and serum amylase level was decreased and thereafter normalized through the seventh postoperative day. There was no evidence of acute pancreatitis on either clinical examination or radiologic study of abdominal sonography and CT scan. On the brain CT scan which was taken on the third postoperative day, the increase in the amount of hemorrhage in bilateral frontal area was found and cerebral ischemia was observed in the territory of bilateral anterior cerebral artery.

Comparison of Tidal Volume Breathing and Deep Breathing Preoxygenation Techniques for a Cesarean Section / 대한마취과학회지

BACKGROUND: Preoxygenation is routine prior to rapid sequence induction of general anesthesia for a cesarean section. The aim of this study was to evaluate the preoxygenation techniques of tidal volume breathing (TVB) and deep breathing (DB) for a cesarean section. METHODS: One hundred twenty ASA I and II patients scheduled for a cesarean section under general anesthesia participated in the study. Preoxygenation was performed with 5, 7, and 10 L/min 100% oxygen. The following techniques were tested: 1) normal TVB for a 5-min period (TVB/5 min) and 2) DB for a 2-min period (4 DB/0.5 min, 8 DB/min, 12 DB/1.5 min and 16 DB/2 min). Inspired (FIO2) and end-tidal oxygen fraction (FETO2), end-tidal carbon dioxide pressure (ETCO2) and oxygen saturation (SpO2) were measured at 0.5-min intervals. RESULTS: During TVB, FETO2 increased rapidly between 0.5 and 3.5 min and plateaued by 3.5 min at 78.5%, 83.3% and 90.8% with 5, 7 and 10 L/min 100% oxygen, respectively. Four DB/0.5 min increased FETO2 to 64.7%, 67.2% and 72.3% at 5, 7, and 10 L/min 100% oxygen, respectively. As compared with four DB/0.5 min, the values of FETO2 with TVB/1.5 min and TVB/2 min were high at 7, 10 and 5 L/min 100% oxygen. CONCLUSIONS: We concluded that TVB/2 min was more effective than four DB/0.5 min in achieving preoxygenation but eight DB/min could be used in case of an emergent operation.

Effect of PaCO2, PETCO2, P(a-ET)CO2 and Regional Cortical Blood Flow on the Prognosis of Craniotomy Patients / 대한마취과학회지

BACKGROUND: Carbon dioxide is a potent cerebral vasodilator. The change of carbon dioxide partial pressure may influence the intracranial pressure and the patients' neurological outcome. There are few reports about the influence of end-tidal CO2 (ETCO2), arterial CO2 (PaCO2) and its pressure difference P(a-ET)CO2 during a craniotomy on the Glasgow coma scale (GCS) score for evaluation of neurological status. In this study, authors tried to discover the influence of PaCO2, PETCO2, and P(a-ET)CO2 on neurological outcome. METHODS: The data of PaCO2 and PETCO2 and P(a-ET)CO2 during a craniotomy was saved. The correlations between each parameter, the GCS score and rCoBF were analyzed. To prevent a direct effect on carbon dioxide tension, blood pressure and body temperature were maintained within a normal range. At the same time, we inserted a probe of the thermal diffusion flowmetry monitor in the subdural space to monitor the regional cortical cerebral blood flow (rCoBF). All the data was saved simultaneously, at the moment of dura closure. RESULTS: There was a fair correlation between the PaCO2 and PETCO2. A low PaCO2 level correlated well with a good GCS score but, not with PETCO2. The mean P(a-ET)CO2 value was 4.4 +/- 3.1 mmHg. The high P(a-ET)CO2 level correlated well with a poor GCS score. High rCoBF correlated well with a good GCS score. However, the changes of PaCO2 and PETCO2 showed no correlations with the rCoBF. CONCLUSIONS: As a result, if we decrease the PaCO2 level by hyperventilation and increase the rCoBF level through proper management during anesthesia, we can improve the patients' neurological outcome.

The Comparative Effects of Dopamine and Dobutamine on Hemodynamics and Gastrointestinal Perfusion in Resuscitation of Hemorrhagic Shock / 대한마취과학회지

BACKGROUND: Preservation of intestinal perfusion is considered the goal of resuscitation because derangement of gut perfusion is the major factor in multi-organ dysfunction. Gut intramucosal pH measured by tonocap, has been proven to be the sensitive monitor of gut mucosal perfusion. The effects of vasoactive agents on regional blood flow and cellular metabolism remain unclear. This study was done to examine the effects of dopamine or dobutamine on systemic hemodynamics and splanchnic perfusion assessed by gastric intramucosal pH (pHi) during resuscitation of hemorrhagic shock. METHODS: Thirty anesthetized dogs were bled to 30 40 mmHg of mean arterial pressure (MAP) and maintained at the shock state for 90 minutes. Cardiac output and arterial and mixed venous blood gas data was measured for the global assessment of circulation and oxygenation. Gastric intramucosal pH (pHi) and CO2 tension (PrCO2) and the difference of arterial and gastric intramucosal CO2 tension (CO2 gap) were measured for the assessment of splanchnic perfusion. Dogs were resuscitated with shed blood and a crystalloid solution at the maintenance dose (control group, n = 10). Dopamine (4microgram/kg/min, dopamine group, n = 10) or dobutamine (7microgram/kg/min, dobutamine group, n = 10 ) was added from the start of volume replacement and maintained for a follow-up period of 180 minutes. RESULTS: Cardiac index and global oxygen delivery and consumption were increased after resuscitation in all groups. These parameters were significantly higher in the dopamine or the dobutamine groups than in the control group (P< 0.05), and significantly higher in the dopamine group than in the dobutamine group (P< 0.05). The pHi, PrCO2 and CO2 gap were not improved from the values of shock state after volume resuscitation in the control group. The pHi, PrCO2 and CO2 gap were significantly improved from the values of shock state after resuscitation in the dopamine group (P< 0.05), but not differentfrom the control group. The pHi, PrCO2 and the CO2 gap were significantly improved from the value of shock state after resuscitation in the dobutamine group and maintained significantly higher than in the control group for the follow-up period (P< 0.05). Compared to the dopamine group, the pHi increased early and was higher in the dobutamine group (P< 0.05). CONCLUSIONS: We conclude that dobutamine is effective in improving gut mucosal oxygenation during early resuscitation of hemorrhagic shock. Dopamine has little effect on the restoration of gut mucosal oxygenation. Considering the better recovery of cardiac index and global oxygenation parameters in the dopamine group, this finding could be explained by the redistribution of cardiac output or imbalance of oxygen metabolism occuring in the dopamine group.

Comparison of Conventional Chiron 348 pH/blood Gas/electrolytes Analyzer and i-STAT Portable Clinical Analyzer / 대한구급학회지

BACKGROUND: The development of so-called "Point-of-care" (POC) devices for blood or urine analysis has resulted in many systems that are widely used at home or at the bedside. We evaluated the performance of the I-STAT portable clinical analyzer for measuring blood gases (pH, PCO2, PO2) and whole blood electrolytes (sodium, potassium and ionized calcium) with reference to a conventional blood gas analyzer (Chiron 348 pH/ blood gas/electrolytes). METHODS: Thirty samples from the arterial blood were simultaneously analyzed with I-STAT system and with Chiron 348 pH/blood gas/ electrolytes analyzer. Differences between results of two methods were analyzed by paired t-test (p<0.05). RESULTS: PO2, PCO2 and Na measured with I-STAT system and Chiron 348 PH/ blood gas/ electrolytes analyzer showed no significant differences. pH, calculated HCO3, K and Ca measured by two methods showed significant difference, but observed differences would not affect clinical decisions except ionized calcium. CONCLUSIONS: This study shows that blood gas and electrolyte analysis using the I-STAT portable device is comparable with that performed by a conventional Chiron 348 pH/blood gas/ electrolytes analyzer except ionized calcium.

Clinical Survey of Appropriate Cuff Volume and Pressure during General Anesthesia in Pediatric Patients / 대한구급학회지

BACKGROUND: Uncuffed endotracheal tubes are commonly used in pediatrics even when the risk of gastric aspiration is significant. But cuffed endotracheal tubes effectively protect the risk of pulmonary aspiration and completely seal the airway. This study was designed to determine the appropriate cuff volume and pressure with low risk of ischemic injury to children's airway. METHODS: We intubated cuffed endotracheal tube (internal diameter 4.5, 5.0, 5.5 mm) in 90 surgical pediatric patient from 16 to 118 months of age. After intubation, initial cuff volume and pressure were measured at the level of complete sealing in each group. Each group was administrated 50% nitrous oxide and 67% nitrous oxide and measured cuff pressure at 20 minutes, 40 minutes. RESULTS: 1) The mean initial cuff volume and pressure of 4.5 ID tube were 0.59 +/- 0.16 ml and 14.5 +/- 0.31 cmH2O (n=30). 2) The mean initial cuff volume and pressure of 5.0 ID tube were 1.00 +/- 0.38 ml and 14.3 +/- 3.55 cmH2O (n=30). 3) The mean initial cuff volume and pressure of 5.5 ID tube were 1.06 +/- 0.26 ml and 14.28 +/- 2.01 cmH2O (n=30). 4) The cuff pressure increased significantly in the course of time, but no pressure in three groups was above 30 cmH2O. CONCLUSIONS: We could determine the appropriate cuff volume of cuffed endotracheal tube in pediatric patients. Also we concluded that nitrous oxide concentration affect little intracuff pressure in brief operation.

The Effect of Dopamine on Hepatic Blood Flow in Rabbits Undergoing Thoracic Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Infusion of pentastarch, with or without dopamine, has been used for cardiovascular support during epidural anesthesia, especially for maintaining normotension. The purpose of this study was to evaluate the effects of dopamine on hemodynamics, estimated hepatic blood flow, and the extraction ratio of indocyanine green during thoracic epidural anesthesia with the infusion of pentastarch. METHODS: Thirty healthy rabbits, weighing 2.5 - 3.5 kg, were evenly divided into three groups during thoracic epidural anesthesia; The control group received normal saline (10 ml/kg/hr), the pentastarch group received pentastarch (10 ml/kg/hr), and the dopamine group received pentastarch (10 ml/kg/hr) and a dopamine infusion (5 microgram/kg/min). Thoracic epidural block was done at T5 level with 0.4 ml/kg of 1% lidocaine. Hepatic blood flow was estimated by measuring the clearance of indocyanine green according to the constant infusion method before and 30 and 60 minutes after epidural anesthesia. The extraction ratio of indocyanine green, heart rate, mean arterial pressure, central venous pressure and splanchnic vascular resistance were also measured at the same time in the three groups. RESULTS: Heart rates, mean arterial pressures, estimated hepatic blood flow and splanchnic vascular resistance were unchanged but central venous pressure increased significantly at 30 and 60 minutes after epidural anesthesia in the dopamine group. The extraction ratio of indocyanine green remained unchanged 30 and 60 minutes after epidural anesthesia in all groups. CONCLUSIONS: Combined therapy with pentastarch and dopamine infusion can keep the cardiovascular stability, hepatic blood flow and splanchnic vascular resistance constant during thoracic epidural anesthesia in rabbits.

The Effects of Propofol on Cardiac Toxicity of Intravenous Bupivacaine in Rabbits / 대한마취과학회지

BACKGROUND: Propofol is an intravenous anesthetic agent, which has a protective effect on cardiovascular and CNS toxicity of local anesthetics compared with an inhalational agent. Also lipids have a has protective effects on local anesthetic cardiovascular toxicity. So, we had questioned that the protective effect on local anesthetic toxicity comes from the lipid solvent of propofol or propofol itself. METHODS: Eighteen healthy rabbits, weighing 3.0 Kg, were divided into three groups during continuous intravenous infusion of bupivacaine: the control group received normal saline (n = 6), the propofol group received propofol (n = 6), and the intralipid group received intralipid (n = 6). The changes in mean arterial pressure, heart rate and the electrocardiogram were observed during the continuous intravenous infusion of bupivacaine. RESULTS: The onset time of QRS widening and dysrhythmia was significantly prolonged in the propofol group compared with the control and intralipids group. The time required for 25% and 50% decrease in mean arterial pressure and heart rate during bupivacaine infusion was significantly prolonged in experimental groups compared with the control group. In the propofol group compared with the intralipids group, the time required for a 25% and 50% decrease in mean arterial pressure and heart rate were prolonged. CONCLUSIONS: This study suggests that infusion of propofol protection on cardiac toxicity of intravenous infusion by an bupivacaine, the dosage for sedation without cardiovascular adverse effects, is more profound than intarlipids.

Rebounded Response in Propofol Coma Therapy / 대한마취과학회지

Barbiturate has been used for the therapy of increased intracranial pressure (ICP) patients. However, it has some serious side effects such as rebound response or convulsion. According to recent reports, propofol can be used for coma therapy and the therapeutic result has been satisfactory. We used propofol instead of barbiturate in coma therapy and experienced a case of rebound response. On admission day, a 20-year-old female patient received an endovascular embolization for an arteriovenous malformation (AVM) in the left occipital lobe. The next day, she went into a coma and the brain CT showed a massive intracerebral hematoma at the AVM site. The patient was transferred to the operating room for decompressive surgery. At the end of the surgery, the brain edema did not subside. The patient was infused with propofol (4 mg/kg/h) after the surgery for propofol coma therapy. During the 6 day propofol therapy, ICP was effectively controlled under 20 mmHg. After completion of the propofol coma therapy, the patient was revived enough to verbally obey. 16 hours later, ICP increased to more than 30 mmHg and the patient was reinfused with propofol. We experienced a rebound response in propofol coma therapy similar to that in barbiturate coma therapy.

Temperature Difference between the Brain and the Axilla according to the Patients Body Temperature / 대한마취과학회지

BACKGROUND: It is believed that the brain temperature is about 1oC higher than the peripheral temperature. However the result has been mostly obtained in normothermia patients. The objective of this study was to evaluate whether the brain and axillary temperature difference would be increased or decreased in hypothermic patients. METHODS: Sixty-six patients who underwent a craniotomy with implantation of the thermal diffusion flowmetry sensor (SABER 2000; Flowtornics, Phonics, USA) were included in this study. The temperature of the cerebral cortex and axilla were measured simultaneously every 2 hours. The patient groups were divided according to their axillary temperature, hyperthermia (over 38oC: 127 paired data), normothermia (36 38oC: 1626 paired data) and hypothermia (under 36oC: 285 paired data). A total 2048 paired sample data were collected and analyzed. RESULTS: The temperature difference between the cerebral cortex and the axilla was 0.46 +/- 1.04 oC in hyperthermic patients, 0.89 +/- 1.65 C in normothermia patients and 1.04 +/- 0.82 C in hypothermic patients. The temperature difference has statistical significance in each group (unpaired t-test, P > 0.05). CONCLSIONS: Our results demonstrate that the temperature difference in the brain shows a difference according to the patients, body temperature. In normothermia the temperature difference between the brain and the axilla was about 1oC. However in a hyperthermic state, the temperature difference decreased and in a hypothermic state, the temperature difference increased.

The Effects of Intrathecal Ketamine Isomers on Formalin-Evoked Behavior and Spinal c-fos Expression in Rat / 대한마취과학회지

BACKGROUND: This study was designed to investigate the different analgesic potency and the action mechanism of the intrathecal isomers of ketamine. For these purpose, we evaluated the effect of intrathecal ketamine isomers on the behavioral response and the spinal c-fos expression in the formalin tested rats. METHOD: The subjects were divided into 2 groups(NF group, Fgroup). The NF group was designed for the purpose of the drug itself's effect on the induction of c-fos. Saline(NF/saline group), S(+) ketamine(NF/SK group), R(-) ketamine(NF/RK group) and ketamine(NF/K group) were administered intrathecally to be examined by immunocytochemical method. Same drugs were administered in the F group(F/saline, F/SK, F/RK, F/K) and formalin was injected into right hind paw of the rats after 30 minutes of intrathecal drug administration. The number of flinching was counted at intervals of 5 minutes for 60 minutes. In NF and F group, Fos immunoreactive neurons was counted after 2 hours of formalin injection and intrathecal drug injection respectively. RESULTS: In F/saline group, flinching was developed immediately after formalin injection and revealed biphasic response. The number of flinching in F/SK group, F/RK group, F/K group was significantly smaller than that of F/saline group. The number of flinching of F/SK group by comparison of F/SK vs F/RK was significantly smaller, and that of F/K group by comparison of F/RK vs F/K was significantly smaller. There was no significant difference among NF group on the total number of Fos immunoreactive neurons. In F group, Fos immunoreactive neurons increased significantly in comparison with NF group. The total number of Fos immunoreactive neurons in F/SK group, F/RK group and F/K group were significantly smaller than that of F/saline group. Of F group, the number of Fos immunoreactive neurons of F/SK was the smallest and F/K, F/RK followed increasing order. Attenuation of Fos induction by the ketamine isomers was observed in the whole spinal cord of F/SK group and F/K group but in the superficial and deep laminae of F/RK group. CONCLUSION: This study suggests that intrathecal ketamine isomers have an inhibitory effect on pathologic pain and c-fos expression in the rats and different analgesic effect which is lamina specific.

The Inhibition of Stress-Induced c-fos Expression by Superior Cervical Ganglion Block in Rat Brain / 대한마취과학회지

BACKGROUND: Using c-fos expression one of the immediate early gene, as a marker of altered neuronal response, we investigated the effect of superior cervical ganglion block (SCGB) exhibiting the same effect of SGB of human on the activity of several brain regions which are considered as located on autonomic neural pathway and neuroendocrine axis in rat. METHOD: The 48 Sprague-Dawley strain rats were divided into 4 groups, as saline/stress (control) group, SCGB/stress (tested) group, saline group, SCGB group. Superior cervical ganglion block was conducted in the SCGB/stress group and SCGB group while saline/stress and saline group were sham operated. After then restraint stress was imposed on the animals of SCGB/stress group and saline/stress group. And 2 hour after injection (saline, SCGB group) or restraint stress (saline/stress, SCGB/stress group), c-fos protein (Fos) was localized by immunocytochemistry. RESULTS: Much stronger Fos immunoreactivity was induced in the several brain region of control group rats compared to other three groups and the numbers of Fos positive cell count of tested group were significantly decreased in paraventricular hypothalamic nucleus (p<0.01), A5 (p<0.01), raphe pallidus (p<0.05), nucleus tractus solitaius (p<0.01) compared to control group. CONCLUSION: This study demonstrate that superior cervical ganglion block attenuates stress induced neuronal activities of paraventricular hypothalamic nucleus, A5, raphe pallidus, nucleus tractus solitarius.

Transurethral prostatectomy syndrome / 대한마취과학회지

A 70-year-old male was performed TURP (Transurethral resection of the prostate) under the diagnosis of benign prostate hyperplasia. Under general anesthesia, two times of TURP and suprapubic prostatectomy were performed for bleeding control during 8 hours. At the end of the operation, hypotension with bradycardia, severe ST elevation, QRS widening, T wave inversion and ventricular tachycardia on EKG appeared. Under the assumption of the diagnosis of hyponatremia, we treated with NaHCO3 and lasix, but cardiac arrest was followed by cardiopulmonary resuscitation. During postoperative five days, patient's cardiopulmonary status was supported by cardiotonic drugs and mechanical ventilation. We report this case to recall TURP syndrome and its management with the review of the relevant literatures.

Midazolam Compared with Thiopental as an Induction Agent / 대한마취과학회지

This study was performed to evaluate the induction time, hemodynamic responses and local venous complications after intravenous induction with midazolam, comparing with those after intravenous induction with thiopental. Sixty adult surgical patients received either 5 mg/kg thiopental sodium(group I) or 0.2 mg/kg midazolam hydrochloride(group II) as an induction agent. The results were as follows. 1) The induction time(loss of palpebral reflex) of the group II(68.2+/-21.5 sec) was significantly longer than those of group I(29.6+/-8.3 sec) 2) The magnitude of rises in the systolic blood pressure, 1 and 2 minute after intravenous administration of induction agent, of group II were significantly smaller than those of group I. 3) The magnitude of rises in the diastolic blood pressure, 2 minute after intravenous administration of induction agent,of group II were significantly smaller than those of group L 4) The magnitude of rises in the pulse rate, 1 and 2 minute after intravenous administration of induction agent, of group II was not significantly differ from those of group I. 5) In three patients of the group I complained of pain during injection, but no patients of the group II complained of pain. There was no significant difference in the incidence of the postoperative local venous complication.

Right Retrobulbar Hemorrhage during Cardiopulmonary Bypass / 대한마취과학회지

We experienced a case of retrobular hemorrhage during cardiopulmonary bypass. Following factors are suspected as the cause retrobulbar hemorrhage in this patient; l ) Rupture of preexisting AV malformation or aneurysm. 2) Accidental high flow to innominate artery by Coanda effect or miscannulation, 3) Obstruction of right jugular venous drainage and therefore cerebrofacial flow is increased, 4) Increase bleeding tendency during cardiopulmonary bypass. Fortunetely, patient has no neurologic complication and well recovered from retrobulbar hemorrhage.

Changes in Plasma Concentration of Catechloamine during Sodium Nitroprusside-induced Hypotension / 대한마취과학회지

Sodium nitroprusside is used to induce hypotension to decrease bleeding in operation site, Sodium nitroprusside decrease vascular resistance by directly relax arteriolar and venous smooth muscle, to a lesser extent. Hypotension stimulate baroreceptors and increase sympatho-adrenal activity. The function of sympatho-adrenal mdullary system may be monitored by the changes of plasma cancentrations of epinephrine and norepinephrine. To study the relationship between induced hypotension and the catecholamine release, the plasma epinephrine and norepinephrine concentration were measured before, during and after infusion of aodium nitropruaside to rabbits The results were as follows: 1) The mean arterial blood pressure decreased significantly after SNP infusion (5.0 ug/kg/minute) from the control value of 98.1+/-11.9 mmHg to 66.3+/-16.2, 57.9+/-17.9 mmHg in 10 and 20 minutes after SNP infusion (P<0.01) and 78.8+/-12.5 mmHg after discontinuation of SNP infusion. 2) The heart rate increased significantly after SNP infusion from the control value of 149.8+/-12.8 beat/minute to 166.5+/-10.8, 190.4+/-17.6 beats/minute in 10 and 20 minutes after SNP infusion (P<0.05, P<0.01) and the heart rate increased after discontinuation of SNP infusion. 3) The plasma epinephrine concentration increased significantly after SNP infusion from the control value of 181.2+/-91.9 pg/ml to 547.5+/-163.2, 837.5+/-253.6 pg/ml in 10 and 20 minutes after SNP infusion and continued to increase of epinephrine after discontinuation of SNP infusion. 4) The plasma norepinephrine concentration increased significantly after SNP infusion from the control value of 566.2+/-92.6 pg/ml to 1131.3+/-424.7, 1432.5+/-479.2 pg/ml 10 and 20 minutes after SNP infusion and continued to increase after discontinuation of SNP infusion. There was a highly significant correlation between decrease in mean arterial pressure and increase in plasma epinephrine and norepinephrine concentrations.

Anesthesia for Open Heart Surgery in Patient with Cold Agglutinin / 대한마취과학회지

Cold agglutinins are serum antibodies activated at low temperature to produce red blood cell agglutination and hemolysis. Hypothermic cardiopulmonary bypass has potential danger to patient with positive cold agglutinin titer. We report a successful anesthesia for mitral valve replacement surgery in a patient who has high cold agglutinin titer. To avoid problem, the cold agglutinin titer was reduced by plasmapheresis and hypothermia was maintained above the critical temperature. There was no severe complication except mild hemoglobinuria.

Anesthetic Experience of Adrenalectomy with Primary Aldosteronism - Report of two cases / 대한마취과학회지

Primary aldosteronism is a clinical syndrome manifested by hypertension, hypokalemia and hyporeninemia in which autonomous secretion of aldosterone from the adrenal gland increased. Primary aldosteronism caused by aldosterone-producing adenoma is a surgically treatable conditon. For the first case, operation was performed on a 34 year old woman with this condition, under general anesthesia with N2O-O2-Fentanyl. And the other case was 37 year old man Those patients recovered uneventfully.

Enflurane Anesthesia for Surgical Removal of Pheochromocytoma / 대한마취과학회지

A 66 year old male with a suprarenal pheochromocytoma on the left side was treated preoperatively with oral phenoxybenzamine 20 mg, b. i. d. for 2 weeks. The night before surgery, phenobarbital 100 mg & diazepam 5 mg were given orally. One hour before induction, diazepam 10 mg i. m. was given. Preinduction BP was 210/140 and HR was 130/min. After diazepam 20 mg i. v, BP lowered to 200/130 and HR lowered to 126/min. With commencement of sodium nitroprusside i. v. dripping, a BP of 160/100 and HR of 118 were maintained. Following Thiopental sodium 250 mg i. v., mask induction was started with N2O-O2-Enflurane and pancuronium 4 mg i. v., after 5 minutes, a #8.5 tube was intubated and pindolol 0.16 mg was injected to prevent tachycardia. We maintained a tolerable BP and pulse by repeatedly adding a bolus i. v. injection of phenoxybenzamine 1 to 2 mg during tumor manipulation and removal. No arrhythmia was noted throughout the procedure, except tachycardia. After removal of the tumor, with rapid blood transfusion and fluid infusion plus dopamine i. v. dripping, a tolerable BP and pulse was maintained.