Needle Depth to Lumbar Plexus in Lumbar Plexus Block by Posterior Approach and Its Relation with Body Indices in Korean / 대한마취과학회지

BACKGROUND: Lumbar plexus block by posterior approach has been used for thigh and hip surgery and unilateral low back pain and/or low extremity pain control. We measured the needle depth from the skin to the lumbar plexus and its relation with body indices in Korean. METHODS: Forty-eight (male 35, female 13) patients with unilateral low back pain and/or low extremity pain received lumbar plexus block by the posterior approach known as "psoas compartment block". We measured the distance from the skin to the lumbar plexus with the aid of a nerve stimulator and evaluated its relation to body mass indices such as weight, height, abdominal circumference and body mass index (BMI; kg/m2). RESULTS: The distance described above was 7.42 +/- 0.82 cm (range 6.0-9.5 cm) in males and 7.18 +/- 1.24 cm (range 5.3-10.0 cm) in females. Its relation to body weight was greater than with other body indices. The Pearson's coefficient between the distance and body weight was 0.745 in males and 0.842 in females. The predicted distance (cm) was 4.23 + 0.0471 x weight (kg) in males (adjusted R2 = 0.532) and 1.25 + 0.0975 x weight in females (adjusted R2 = 0.682). CONCLUSIONS: Body weight is the most important factor for prediction of the distance from the skin to the lumbar plexus. The distance was about 6-10 cm in korean patients.

The Role of Growth Factors to Rabbit Chondrocytes and Subtypes of Collagen in Three Dimensional High Density Culture

Cartilage is commonly used autogenous material for aesthetic and reconstructive surgery and major donor sites of cartilage are ear, nasal septum, and rib. As the cartilage correlates with ossification and can be used for joint reconstruction. Many growth factors influencing growth and differentiation of chondrocytes have been reported, and matrix composition produced by chondrocytes may vary in types and quantity according to culture duration. Initially the chondrocytes in culture aggregate, then secrete type I collagen. Type II collagen is produced during differentiation process, and synthesis of type X collagen is the last step. In this study, chondrocytes were isolated from ear cartilage of the New Zealand white rabbit weighing 400 gm. We performed high density culture using penicylinder and pellet method. The cells were polygonal in morphology and viable under the inverted microscope. This experiment was designed to evaluate the effect of IGF-I, TGF- p, and b- FGF on the synthesis of collagen in chondrocyte culture. Optimal concentration of growth factors was determined using H-thymidine incorporation into DNA. After the addition of optimal concentration of each growth factors in experimental groups, the uptake of H-proline was measured. Only IGF-I showed a statistically significant increase of collagen synthesis. We observed how subtypes of collagen were influenced by growth factors in two culture methods and by differing the addition timing of growth factors. SDS-PAGE was adopted for subtyping of collagen. All subtypes of collagen were found in both culture methods and all growth factors facilitated the production of type II and type X collagen and may be devoted to the differentiation of chondrocytes. Immunohistochemical staining for type I, and type II collagen was examined to confirm the above result. In pellet culture, type II collagen was stained densely in response to the addition of three kinds of growth factors. The results of penicylinder culture showed similar outcome to those from pellet cultured group. From the above results, we concluded as follows; First, IGF-I generally influence the synthesis of type I and II collagen. Second, TGF beta increased the synthesis of collagen. Third, b-FGF increased the synthesis of type II and type X collagen. We concluded that IFG-I is the only growth factor which is effective regardless of culture duration and method. TGF- beta and b-FGF, which are potent mitogen, facilitate the secretion of collagen.

Fat Embolism after Bilateral Total Knee Replacement Arthroplasty: A case report / 대한마취과학회지

Fat embolism is a significant complication following total joint arthroplasty. Fat embolism syndrome has both pulmonary and neurologic manifestations that can be life threatening. But, with appropriate fluid management, adequate ventilation, and the prevention of hypoxemia, outcome is usually excellent. We experienced fat embolism following bilateral total knee replacement. A 65-year-old woman had a surgery under general anesthesia. There was no specific anesthetic problems during the operation. After bilateral tourniquet release, O2 saturation decreased to 85% and neurologic symptom was developed. With adequate supportive treatment including mechanical ventilation, she was cured without complication.

Effect of Patient Position with Spinal Anesthesia on the Heart Rate, Arterial Blood Pressure and Arterial Blood Gas Change / 대한마취과학회지

BACKGROUND: Anorectal procedures are performed in the prone jack-knife or lithotomy position. The effect of lithotomy and prone jack-knife position on the heart rate, arterial blood pressure and arterial blood gas has not been compaired. METHODS: 39 consecutive patients who underwent surgery for anorectal disease were performed saddle block. They were randomly classified into two groups: prone jack-knife position(J; n=19) and lithotomy position(L; n=20); patients with cardiovascular disease were excluded. The two groups were well matched for age, gender, weight and height. After spinal anesthesia, heart rate(HR), blood pressure(BP), and arterial blood gases(ABG) including pH, PaO2, PaCO2, HCO3- were measured in the supine position to establish a base line. After position change to either jack-knife or lithotomy, HR, BP(systolic, mean and diastolic) at 10, 20, and 30 minutes and ABG at 20minutes were measured again in each group. The two groups were then compared and any changes were recorded. Premedication was not perfomed in both group. Statistical analysis was performed by Mann-Whitney U test; significance was set at P <0.05. RESULTS: There were no differences between the two groups in terms of baseline HR, BP and ABG. However, HR at 10, 20 and 30 minutes after position change in the L group were increased compared with those of J group(deltaHR (number/minute) at 10 minutes: +3.2+/-7.0(L) versus - 2.8+/-4.9(J), P <0.05, 20 minutes: +5.6+/-7.4(L) versus - 1.8+/-5.2(J), P <0.05, 30 minutes: +6.4+/-8.4(L) versus - 1.2+/-6.0(J), p <0.05), and systolic BP at 30 minutes was increased in the J group(deltaBP: +4.0+/-9.0 mmHg(L) versus +10.1+/-9.9 mmHg(J), p <0.05). 3 patients in the J, and 2 in the L group had complaint of headache and/or upper arm discomfort. CONCLUSION: HR was increased in the lithotomy position, systolic BP at 30 minutes after position change was increased in the J group. But the differences were not so significant clinically. Another parameters were no differences between the two groups. Therefore there is no supiriority in lithotomy or jack-knife position on HR, BP and ABG when anorectal procedure is undergone under spinal anesthesia.

Anesthetic Management for Pheochromocytoma with Enflurane ; 2 Cases / 대한마취과학회지

Pheochromocytoma is a functioning tumor occurring in the chromaffin tissue and catecholamines from the tumor cell lead to the symptoms such as hypertension, palpitation and headache. Among the problems arising in the anesthetic management, the excessive secretion of catecholamines by the induction of anesthesia and the tumor mass manipulation causes a hypertensive crisis and the arrhythmia. Also, after the removal of the tumor mass, it must be remembered that a profound hyptension may follow due to abrupt lowering of catecholamine level. We experienced two cases of anesthetic management of pheochromcytoma using enflurane. In one case of sufficient preoperative management, it was performed uneventfully without symptoms such as hypertensive crisis and arrhythmia during the anesthetic management. But, in the other case with insufficient preoperative management, the patient was unstable due to hypertnesive crisis, premature contractions of the ventricle and tachyarrhythmia during the anesthetic management.

Autonomic Hyperreflexia - Case report / 대한마취과학회지

Autonomic hyperreflexia in spinal cord lesion is due to interruption of inhbitory im from higher centers. Especially, dramatic disturbance is seen in cord lesions above the fifth thoracic se and consist of hypertension, bradycardia and sweating. Sometimes marked hypert results in fatal cerebral hemorrhage or subarachnoid hemorrhage ao that the anesthesic gets used to its control and treatment. In current methods of control of hypertension, there are general anesthesia with halothane or enflurane, spinal anesthesia and ganglionic blockers. Ganglionic blockers, such as hexamethonium, drsmatically suppress marked arterial hypertension, also. We have experienced 3 cases of tetraplegic patients. Two cases given local anesthesia developed autonomic hyperreflexia but one case given general anesthesia did not have the hyperreflexia.

Cardiac Arrest after Changing Position / 대한마취과학회지

Positional change under the anesthesia may cause marked hypotension, particularly in the critically ill patient. Therefore, positional change must be accomplished slowly and gently, and blood pressure observed throughout the procedure. Basic components for the safe positioning is knowledge, forethought, teamwork and housekeeping. Patients with paraplegia, quadriplegia, or a critical illness may require intravenous vasopressor drug before turning, and the lightest possible level of anesthesia is used. The authors experienced a case of cardiac arrest after changing position of a paraplegic patient under general anesthesia. The patient was resuscitated.

A Statistical Observation of Paraplegia Patients in 112 Cases / 대한마취과학회지

This was a statistical observation of paraplegia patients who underwent operation at National Veterans Hospital from January 1975 to Mary 1981. The data was analyzed according to anesthetic technique, anesthetic agents, site of injury and etiology of injury. The results were as follows: 1) Only 24 cases or 21 % of the total needed anesthesia during operation. 2) The most common anesthetic technique was inhalation with circle absorption method.(32 cases, 29%) 3) Halothane was used as the main anesthetic.( 17 cases, 53%) 3) The most common etiology of injury was vertebral fracture( 35 cases, 59%) 5) The most common site of injury was lower thoracic.(T2-T1) (33 cases, 56%) 6) The total number of surgical operations performed numbered 59 out of 112 cases as classified in Table 1.

Cardiac Arrest in the Operating Room / 대한마취과학회지

This is a report of cardiac arrests which occurred in the operating room of National Medical Center from Jan. 1, 1970 to Dec. 31, 1976. All kinds of operations were performed in this hospital, butlopen heart surgery was excluded from this study. During this period 22, 825 surgical operations were done and 74 cardiac arrests occurred among them. Overall incidence of cardiac arrest was 1: 308 (0. 32%) and 43% of cardiac arrests were successfully resuseitated.

Survey of Patient in the Intensive Care Unit for Last 11 Years / 대한마취과학회지

We have analyzed 2,080 patients who were admitted to the ICU for intensive care during a period of 11 years from April, 1965, when the ICU was opened, to December, 1975. The results are as follows: l. In 11 years, the total number of patients was 2,080 which was 2.5% of 84,933 patients who were admitted to NMC. Among them, operative cases were 724 (35%) and nonoperative were 1, 356(65%). 2. Male patients were more than female Patients (1. 3: l. ) 3. In age groups, the 20 decade had the highest number. 4. The number of patients from Internal Medicine Dept, was highest. 5. Total occupied bed days were 7,497 and majority of patient were in less than 3. 6 days. 6. The patients from the medical department have gradually decreased, but from the surgical department they showed increased pattern. 7. Drug intoxication was the commonest disease among patients. 8. Total mortality rate was 45%, and the highest mortality rate occurred in 30-39 age group.