The Depth of Insertion for Left-Sided Double-Lumen Endotracheal Tube is Correlated with the Height and the Length of Sternocleidomastoid Muscle / 대한마취과학회지

BACKGREOUND: When a double-lumen endotracheal tube (DLT) is used for one-lung ventilation, its position should be accurate. But only a few studies has been performed about how to predict the depth of insertion for DLT preoperatively. The purpose of this study is to investigate which physical measurements are correlated with the depth of insertion for left-sided DLT and how the depth of insertion for DLT can be explained with these physical measurements. METHODS: After placing a 5 cm-high pillow under the patient's head, we intubated left-sided disposable DLT (BronchocathTM, Mallinckrodt medical Ltd, USA) in 65 adults. We tape-measured sternocleidomastoid muscle (SCM) length and sternal length. We positioned the proximal margin of the bronchial cuff of DLT just below carinal bifurcation through fiberoptic bronchoscope, and recorded the depth of insertion for DLT at the upper incisor level. RESULTS: The depth of insertion for DLT was correlated with both height (y=3.96+0.15x, r2=0.51, p=0.0001) and SCM length (y=16.73+0.82x, r2=0.49, p=0.0001). Sternal length (r2=0.11, p=0.0081) was weakly correlated with the depth of insertion for DLT. The best regression model was depth of insertion for DLT (cm)=6.88+0.09 height (cm)x0.46 SCM length (cm). CONCLUSIONS: The depth of insertion for DLT is correlated with SCM length as well as height. So we may use them in predicting the depth of insertion for DLT.

Comparison of the Optimal Depth of the Internal Jugular Venous Catheterization between Right and Left / 대한마취과학회지

BACKGROUND: The purpose of this study was to measure and compare the optimum depth of the internal jugular venous catheterization between the right and left side. METHODS: Forty-four patients were enrolled for this study and divided into two groups (22 patients each). The optimum depth of the catheterization was calculated using the sum of two component (A and B); the advanced length of the catheter from the level of the cricoid cartilage (A) and the distance from the catheter tip to the junction of the superier vena cava and right atrium (B). RESULT: The optimum depths of the internal jugular venous catheterization were 16.0 1.0 cm (right) and 18.4 1.5 cm (left) respectively. Left side was significantly longer than right side (p<0.05). In this study, we experienced some complications; arterial punctures (5 cases) and migration of the catheter to the opposite subclavian vein (1 case). Five complications were associated with left internal jugular venous cannulation and one was associated with the right side cannulation. CONCLUSION: We concluded that the optimum depth of the internal jugular venous catheterization was longer in the left side than in the right side.

Acute Normovolemic Hemodilution Decreases Transfusion Requirement in Spinal Surgery / 대한마취과학회지

BACKGROUND: Acute normovolemic hemodilution (ANH) is known as the easieat and most economical and the quality of autologous blood saved by it is the best of all methods of autotransfusion. To investigate the efficacy of ANH, we studied whether it could reduce the transfusion requirement in spinal surgery. METHODS: Forty patients were randomly divided into 2 groups. In the hemodilution group (n=20), 2 or 3 units of autologous blood were procured immediately before or after anesthetic induction while Ringer's lactate and pentastarch were infused to maintain normovolemia. All patients received deliberate hypotension induced by labetalol. Perioperative changes of hemoglobin, hematocrit and platelets, the transfusion requirement and the amount of postoperative drainage were compared between each group. RESULTS: Perioperative changes of hemoglobin, hematocrit and platelet showed no significant differences between each group. Less packed RBC were used in the hemodilution group (1.9 2.0 units) than in control group (5.9 6.8 units) (p<0.05). In the control group, 4 patients were transfused with fresh frozen plasma (mean 4.8 units), 3 patients with platelets (mean 13 units) and 1 patient with cryoprecipitate (10 units) while only one patient was transfused with 3 units of fresh frozen plasma in the hemodilution group. Postoperative drainage was significantly less in the hemodilution group (1,494 488 ml) than in the control group (2,476 1,730 ml). CONCLUSION: ANH seems to decrease the transfusion requirement in spinal surgery. Reduction of postoperative wound drainage appears to play an important role in that.

Effects of Phenylephrine Induced Hypertension on the Cerebral Hemodynamics in Dogs / 대한마취과학회지

BACKGROUND: Induced hypertension has long been considered a potential adjunct to the management of focal cerebral ischemia. Whether induced hypertension causes an increase in cerebral blood flow(CBF), dependent on cerebral perfusion and/or an intracerebral redistribution of CBF by a vasoconstrictive effect of vasoconstrictor is controversial. In this study, effect of phenylephrine induced hypertension on the cerebral hemodynamics and mechanism of reduced ischemic area were studied. METHODS: Six mongrel dogs weighing between 13 and 18 kg were anesthetized with halothane 0.5 vo1%-N2O 1 L/min-O2 1 L/min. Ventilation was controlled to maintain PaCO2 within 35~40 mmHg. Cerebral blood flow was measured and calculated by the posterior sagittal sinus outflow method. Cerebral metabolic rate for oxygen(CMRO2) was calculated. Intracranial pressure(ICP) was also measured. Phenylephrine was infused to increase mean arterial blood pressure(MAP) to a level 30% above baseline value and MAP was held constant for 20 minutes before CBF, ICP, CMRO2 determination. These parameters were measured at 10, 20 minutes after induced hypertension. RESULTS: Induced hypertension resulted in increased MAP and decreased heart rate. There were no differences between baseline, hypertension 10 min, and hypertension 20 min in terms of PaCO2, PaO2, hematocrit and temperature. CBF was not changed after induced hypertension(39.1+/-9.7 vs 40+/-10 vs 40.2+/-10.1 ml 100g(-1) min(-1) (meanv+/-SD) at baseline, hypertension 10 min, hypertension 20 min, respectively). Cerebral metabolic rate was not changed also after induced hypertension. ICP increased after induced hypertension significantly(20.5+/-12.5 vs 26+/-15.3 vs 29.8+/-17 mmHg at baseline, hypertension 10 min, 20 min, respectively). CONCLUSIONS: Phenylephrine is a cerebral vasoconstrictor and that causes redistribution of cerebral blood flow to ischemic brain area.

Clinical Evaluation of Univent Tube for One Lung Ventilation / 대한마취과학회지

BACKGROUND: Univent tube(endotracheal tube with a movable blocker), introduced by Inoue et al in 1982, has properties to overcome the disadvantages of double lumen endotracheal tube for one lung anesthesia. This study was performed to evaluate the effectiveness of Univent tube for one lung ventilation. METHODS: Univent tube was inserted to the patients for open thoracic surgery and positioned to the side of bronchus under the guidance of fiberoptic bronchoscope that was scheduled to lung collapse. One lung anesthesia was performed with the inflation of cuff of blocker. Each case was anaylzed with respect to ease or difficulty of positioning of blocker, tube displacement, efficacy of lung collapse and adequacy of single lung ventilation. RESULTS: In the 69 patients out of 80 patients, adequate positioning was performed by first trial. In the two patients, insertion of bronchial blocker was failed that resulted in replacement with a double lumen tube. Observed disadvantages were delayed deflation(10 patients) of affected lung and displacement of bronchial cuff into the main tracheal lumen during position change or surgical manipulation(7 patients). CONCLUSIONS: Univent tube is useful for one lung anesthesia but there are several distinct limitaitons in the safe use.

The Present Status of Organ Transplantation in Korea Focusing on Heart Transplantation / 대한마취과학회지

No abstract available.

Effects of Various F1O2 on Central and Mixed Venous Oxygen Saturation during Mechanical Ventilation / 대한마취과학회지

BACKGROUND: It is invasive and accompanies various risks to insert pulmonary artery catheter in order to measure mixed venous oxygen saturation (SvO2) that is associated with patients clinical course and prognosis. If there is relationship between central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation, we can use the central venous oxygen saturation instead of mixed venous oxygen saturation to monitor and treat patients. METHODS: We inserted the Swan-Ganz catheter in 20 patients (male 8, female l2) scheduled for undergoing open heart surgery and accomplished the blood gas analysis of the radial arterial blood, central venous blood and mixed venous blood during postoperative respiratory care in intensive care unit at F1O2 1.0, 0.6 and 0.4 in order. RESULTS: There was no significant difference between central venous blood and mixed venous blood in respect to pH, PCO2, PO2. except the mixed venous blood pH at F1O2 0.6 that is greater than the central venous blood pH at F1O2 0.6. Central venous oxygen saturation and mixed venous saturation were not significantly different and showed the following close relationship: SvO2(%)=15.41+0.80XScvO2 (R=0.88, p<0.05). In respect to the difference according to the variation of F1O2, the SO2 and PO2 at F1O2. 1.0 were higher than the SO2 and PO2 at F1O2 0.6 and 0.4, but the differnce between F1O2 0.6 and 0.4 was not significant. CONCLUSIONS: We might conclude that central venous oxygen saturation might be replaced for the mixed venous oxygen saturation in respiratory care after open heart surgery in adults.

The Effect of General and Epidural Anesthesia in Women undergoing Cesarean Section on Power Spectral Components of Heart Rate Variability: Clinical Study / 대한마취과학회지

BACKGROUND: The analysis of beat-to-beat heart rate variability has become a method of assessing the state and health of the autonomic nervous system. Power spectral analysis(PSA) has become one of the most widely used techniques to describe heart rate variability. METHODS: We analyzed the heart rate variability using PSA before and during general and epidural anesthesia in cesarean section. We anesthetized 12 patients by enflurane, and 15 patients by 2% lidocaine via epidural catheter. Automatic computer analysis provided PSA. The PSA contained two major components, a low frequency(LF) at 0.04~0.15 Hz, and a high frequency(HF) at 0.15-0.50 Hz. RESULTS: Before anesthesia, P(LF)(spectral power of LF-unit; sec2/Hz) is 0.06(0.03, 0.34) {median(5 percentile, 95 percentile)}, P(HF), 0.83(0.22, 1.68), total spectral power(Ps), 1.98(O.86, 3.88), and P(LF)/P(HF), 0.67(0.17,1.67) in general anesthesia group. During anesthesia, P(LF) is 0.06(0.03, 0.34), P(HF), 0.12(0.04, 0.76), Ps, 0.43(0.24, 1.71), P(LF)/P(HF), 0.70(0.24, 2.59). In epidural group, before anesthesia, P(LF) is 0.30(0.11, 1.94), P(HF), 0.78(0.14, 1.94), Ps, 1.81(0.58, 5.23), P(LF)/P(HF) 0.47(0.25, 1.34). During anesthesia, P(LF). is 0.14(0.05, 0.41), P(HF), 0.33(0.07, 0.80), Ps, 0.81(0.34, 1.58), P(LF)/P(HF), 0.58(0.22, 1.08). CONCLUSIONS: In general anesthesia, P(LF) P(HF) and Ps during anesthesia showed significant decrease than pre-anesthetic period, but P(LF)/P(HF) did not change. In epidural anesthesia, P(LF)/P(HF) and Ps during anesthesia also decreased, but P(LF)/P(HF) did not change. There were significant differences in degree of decrease in Ps and P(HF) between general and epidural anesthesia, but no differences in and P(LF)/P(HF).

The Effect of General and Epidural Anesthesia in Women undergoing Cesarean Section on Power Spectral Components of Heart Rate Variability: Clinical Study / 대한마취과학회지

BACKGROUND: The analysis of beat-to-beat heart rate variability has become a method of assessing the state and health of the autonomic nervous system. Power spectral analysis(PSA) has become one of the most widely used techniques to describe heart rate variability. METHODS: We analyzed the heart rate variability using PSA before and during general and epidural anesthesia in cesarean section. We anesthetized 12 patients by enflurane, and 15 patients by 2% lidocaine via epidural catheter. Automatic computer analysis provided PSA. The PSA contained two major components, a low frequency(LF) at 0.04~0.15 Hz, and a high frequency(HF) at 0.15-0.50 Hz. RESULTS: Before anesthesia, P(LF)(spectral power of LF-unit; sec2/Hz) is 0.06(0.03, 0.34) {median(5 percentile, 95 percentile)}, P(HF), 0.83(0.22, 1.68), total spectral power(Ps), 1.98(O.86, 3.88), and P(LF)/P(HF), 0.67(0.17,1.67) in general anesthesia group. During anesthesia, P(LF) is 0.06(0.03, 0.34), P(HF), 0.12(0.04, 0.76), Ps, 0.43(0.24, 1.71), P(LF)/P(HF), 0.70(0.24, 2.59). In epidural group, before anesthesia, P(LF) is 0.30(0.11, 1.94), P(HF), 0.78(0.14, 1.94), Ps, 1.81(0.58, 5.23), P(LF)/P(HF) 0.47(0.25, 1.34). During anesthesia, P(LF). is 0.14(0.05, 0.41), P(HF), 0.33(0.07, 0.80), Ps, 0.81(0.34, 1.58), P(LF)/P(HF), 0.58(0.22, 1.08). CONCLUSIONS: In general anesthesia, P(LF) P(HF) and Ps during anesthesia showed significant decrease than pre-anesthetic period, but P(LF)/P(HF) did not change. In epidural anesthesia, P(LF)/P(HF) and Ps during anesthesia also decreased, but P(LF)/P(HF) did not change. There were significant differences in degree of decrease in Ps and P(HF) between general and epidural anesthesia, but no differences in and P(LF)/P(HF).

A Comparison for Tourniquet Pain in Spinal Anesthesia / 대한마취과학회지

BACKGROUND: It has been suggested that the incidence of tourniquet pain is less frequent in patients in whom bupivacaine has been employed for spinal anesthesia than in patients to whom tetracaine has been administrated. The current study was accomplished to compare the incidence of tourniquet pain in patients in whom 0.5% plain bupivacaine spinal anesthesia and 0.5% hyperbaric tetracaine spinal anesthesia were employed. METHODS: The incidence of tourniquet pain was evaluated in 40 patients having orthopaedic surgery of the lower extremities during spinal anesthesia using 15 mg of hyperbaric 0.5% tetracaine(group I) or 15 mg of a plain solution of 0.5% bupivacaine(group II). The drugs were administrated in a randomized fashion. We measured the maximal sensory spread of analgesia to pinprick test, the incidence of tourniquet pain, the sensory anesthesia to pinprick test at time of onset of tourniquet pain and the number of patient treated with IV injection of fentanyl to relieving tourniquet pain. RESULTS: The maximal sensory spread of analgesia mean was higher in patients given hyperbaric tetracaine (T8) than in patients given plain bupivacaine (T9). The incidence of tourniquet pain was significantly greater in patients given hyperbaric tetracaine (65%) than in patients given plain bupivacaine (15%). The incidence of analgesics injection for tourniquet pain was greater in patients given hyperbaric tetracaine (10%) than in patients given plain bupivacaine (none). CONCLUSIONS: In conclusion, the tourniquet pain in surgery of the lower extremities occurs less frequently when plain bupivacaine is employed for spinal anesthesia as compared to hyperbaric tetracaine.

Variables Affecting the Level of Epidural Anesthesia for Cesarean Section / 대한마취과학회지

To determine whether age, weight, height, vertebral column length, body mass index, or abdominal circumference might influence the distribution of sensory analgesia after epidural anesthesia, 100 women presenting for cesarean section were studied. All received 26 mg of 2.0% lidocaine mixed with 8.4% bicarbonate 1 ml/lidocaine 10 ml and 1:300,000 epinephrine, including 3 ml of test dose, through the epidural catheter inserted in L3-4 interspace. While the women lay supine on a horizontal operating table with the air bag under their right hip, 2, 5, 10, 20, and 30 minutes after injection, the cephalad extent of sensory analgesia (loss of sensation of sharpness to pin prick) was determined. Age (31.9+/-3.8 years), weight (69.2+/-9.3 kg), height (158.9+/-4,5 cm), vertebral column length (59.8+/-5.0 cm), body mass index (27.4+/-3.2 kg/m(2)), and abdominal circumference (103.5+/-10.2 cm) did not correlate with the maximum level of sensory analgesia. In conclusion, in parturients of age, weight, height, vertebral column length, body mass index and aMominal circumference of the above values, it is not necerrary to vary dose of injected local anesthetics with changes in any of the patient variables studied.

A Study on the Determination of Extracorporeal Blood Flow Rate for Extracorporeal Carbon Dioxide Removal(ECCO2R) / 대한마취과학회지

Extracorporeal membrane oxygenation(ECMO) is to be recommended when hypoxemia and hepercarbia are refractory to conventional treatments. Neonatal venoarterial(VA) ECMO in the USA is recognized as a therapeutic modality to neonatal respiratory failure and extracorporeal carbon dioxide removal(ECCO2R) in Europe is used for adult respiratory distress syndrome. The partial bypass using the membrane oxygenator aims at lung rest while relieving the hard ventilatory setting on the diseased lung. ECCO2R adopts low-flow venovenous(VV) bapss. VV bypass provides gas exchange without cardiac support. Venous drainage and perfusion catheters are placed in the right atrium or vena cavae via the femoral or internal jugular veins. Compared to VA bypass, the consequences of embolizations are potentially fewer and no major artery is sacrificed in ECCO2R. Highly oxygenated blood flows into pulmonary circulation which may relieve pulmonary hypertension. To evaluate the effectiveness of ECCO2R, we developed an experimental model on 7 mongrel dogs. Under general anesthesia with i. v. pentobarbital, two thin-walled polyurethane tubes in the external jugular vein and the femoral vein were connected with the extracorporeal circuit. Without ventilating the oxygenator duting VV bypass, control hemodynamic and blood gas values under conventional mechanical ventilation(CMV) were obtained. We proceeded to oxygen insufflation(OI), and extra- corporeal CO2 removal (ECCO2R) in that order. Oxygen was delivered at 300ml/min to the animal lung for OI and ECCO2R and was added at 21/min to the oxygenator only for ECCO2R. Hemodynamic parameteres did not vary among CMV, OI and ECCO2R. Arterial PH in CMV was 7.35+/-0.07 and was decreased to 7.19+/-0.05 in OI due to the increase of PaCO (70+/-3 mmHg). PaO2 was remained constant through the experiment. Mixed venous PH in CMV was 7.31+/-0.05 and was decreased to 7.15+/-0.08 in OI, Blood gas analysis values were same between CMV and ECCO2R. Carbon dioxide removal through the lung (V(L)CO2) were 47+/-3 ml/min in CMV, 9+/-3 ml/min in OI and 8+/-2 ml/min in ECCO2R. The amount of carbon dioxide removed via the oxygenator (VoCO2) was 38+/-5 ml/min in ECCO2R. The total amount of CO2 removal (VCO2) between CMV and ECCO2R was same statistically. The bypass flowrate at the lowest E(T)CO2 (end-tidal CO2) was 60+/-9 ml/min, resulting in 35+/-4% of bypass ratio. It can be concluded that ECCO2R can alleviate hypercapnea using a low flow VV bypass and may be used as an altermative of mechanical ventilator in the setting of acute respiratory failure.

Analysis of the Complications of 6 Brain-dead Patients / 대한마취과학회지

Brain death is irreversible coma due to injury of brain hemisphere and brain stem regardless of any treatment. In brain-dead patients, acute respiratory failure frequently results from capillary endothelial damage in the lung and diabetes insipidus and hypothermia occur due to brain stem compression injury. Ultimately, it has been known that the brain-dead patients progress to multiple organ failure. The primary goal of organ donor management is maintenance of optimal physiologic environment for organs prior to recovery. This study is performed for suggesting the guideline of the prediction and management of complications in the brain-dead patient. We analyzed 6 brain-dead patients waiting for organ donation in the intensive care unit. The causes of brain death among the donors consisted of closed head injury in 4 patients, subarachnoid hemorrhage in 1, and drowning in l. AaDO2(alveolar-arterial oxygen tension difference) and PaO2F1O2 (arterial oxygen tension/fractional inspired O2 concentration) were analyzed to demonstrate the progress of respiratory failure. Body temperature, vital signs, urine output, serum osmolality, serum K(+), serum Na(+), AST(aspartate aminotransferase), ALT(alanine aminotransferase), BUN(blood urea nitrogen) and creatinine were also analyzed in all patients. Diabetes insipidus were found in 5 patients and hypothermia in 4 patients. AaDO increased and PaO2/F1O2 decreased in 5 patients with time. Hepato-renal function remained relatively normal during observation. We concluded that brain-dead patients rapidly progressed to acute respiratory failure. It can be suggested that for successeful organ transplantation, organ procurement should be performed as soon as possible after brain death was confirmed.

Neuromuscular Blocking Actions of Mivacurium in Pediatric Patients / 대한마취과학회지

The surgeries based on the outpstient department have increased recently. One of the indications of outpatient surgery is chemical peeling of the face that usually re- quires only deep sedation of short duration. The purpose of this study was to evaluate the effeets of ketamine and midszolam for out patient facial chemical peeling. Fifty-nine unpremedicated patients undergoing chemical peeling of the face were anesthetized with bolus intravenous injection of 1mg/kg of ketamine and 0.1 mg/kg of midazolam. Additional dose of ketamine(10-20mg) was given as needed. During operation, we observed systolic and diastolic blood pressure with noninvasive blood pressure monitor and peripheral oxygen saturation(SpO2) with pulse oximeter. All patients were allowed to breathe spontane- ously without ventilatory support during the operation. There was no case of airway ob- struction and SpO2 value was over 97% in most cases. The systolic and diastolic blood pressure and pulse rate were increased after the injection of ketamine and midazolam. And we observed the untoward effect of anesthetics such as the purposeless movement(6.8%), involuntary phonation(3.4%), skin rash(3.4%) and headache(1.7%). In postoperative analysis about the recall, bad dream, mood, and the degree of satisfaction of this type of anesthesia, the rate of patient's positive acceptance was high(86.4%) and the reeovery time was 58min. We conclude that combination of intravenous ketamine and midszolam can produce satisfactory anesthesia with few complications for outpatient chemical peeling surgery of the face.

The Index of Anesthetic Depth in Enflurane Anesthesia / 대한마취과학회지

It is essential for the safe conduction of anesthsia to monitor the depth of anesthesia during aperation. However no one method has been confirmed to be objective and accurate as yet. Hecently lower esophageal contractility (LEC) has emerged as a means of mesuring anesthetic depth. To evaluate the usefulness as an index of anesthetic depth, the author compared the cardio- vascular signs (blood pressure, heart rate), EMG, EEG, plasma epinephrine and norepinephrine concentrations and LEC, until now known to be relevent to the anesthetic depth, at varing conditions of of no anesthesia, under anesthesia and after stimulation. The subjects were 30 ASA class 1 surgical patients, aged from 20 to 49, who had no specific past midical history and no recent medications. Patients were given thiopental sodium 4 mg/kg and vecuronium 0.1 mg/kg for induction and intubation and respiration controlled with 100% oxygen, then baseline measurements were taken (control) and compard the values of under enflurane anesthesia with 1 minimum alveolar concentration (MAC), 1.7%, (anesthesia) and after surgical stimulation (stimulation) with each other. The results were as follows ; 1) EEG, response rate and frequency of spontaneous LEC, amplitude of provoked LEC, LEC index of under enflurane anesthesia and after stimulation revealed significant differences compared with control but no significant differences between under anesthesia and after stimulation values. 2) Systolic, diastolic, mean blood pressure revelaled significant differences among control, under anesthesia and after stimulation values. 3) Heart rate, EMG, plasma epinephrine and norepinephrine concentrations, amplitude of spontaneous LEC revealed no significant differences among control, under anesthesia and after stimulation values. According to the above results, compared to the control value, EEG, and LEC reflected anesthetic depth under 1 MAC enflurane anesthesia but were meaningless in the evaluation of surgical stimulation. Blood pressure change which revealed significant differences among three values could be judged to be useful as an index of anesthetic depth most commonly applicable in practice.

The Index of Anesthetic Depth in Enflurane Anesthesia / 대한마취과학회지

It is essential for the safe conduction of anesthsia to monitor the depth of anesthesia during aperation. However no one method has been confirmed to be objective and accurate as yet. Hecently lower esophageal contractility (LEC) has emerged as a means of mesuring anesthetic depth. To evaluate the usefulness as an index of anesthetic depth, the author compared the cardio- vascular signs (blood pressure, heart rate), EMG, EEG, plasma epinephrine and norepinephrine concentrations and LEC, until now known to be relevent to the anesthetic depth, at varing conditions of of no anesthesia, under anesthesia and after stimulation. The subjects were 30 ASA class 1 surgical patients, aged from 20 to 49, who had no specific past midical history and no recent medications. Patients were given thiopental sodium 4 mg/kg and vecuronium 0.1 mg/kg for induction and intubation and respiration controlled with 100% oxygen, then baseline measurements were taken (control) and compard the values of under enflurane anesthesia with 1 minimum alveolar concentration (MAC), 1.7%, (anesthesia) and after surgical stimulation (stimulation) with each other. The results were as follows ; 1) EEG, response rate and frequency of spontaneous LEC, amplitude of provoked LEC, LEC index of under enflurane anesthesia and after stimulation revealed significant differences compared with control but no significant differences between under anesthesia and after stimulation values. 2) Systolic, diastolic, mean blood pressure revelaled significant differences among control, under anesthesia and after stimulation values. 3) Heart rate, EMG, plasma epinephrine and norepinephrine concentrations, amplitude of spontaneous LEC revealed no significant differences among control, under anesthesia and after stimulation values. According to the above results, compared to the control value, EEG, and LEC reflected anesthetic depth under 1 MAC enflurane anesthesia but were meaningless in the evaluation of surgical stimulation. Blood pressure change which revealed significant differences among three values could be judged to be useful as an index of anesthetic depth most commonly applicable in practice.

An Experimental Study on the Extracorporeal Carbon Dioxide Removal with a Double Lumen Tube / 대한마취과학회지

Intermittent positive pressure ventilation is used as a respiratory support for acute respiratroy failure. Adult respiratory distress syndrome(ARDS) revealed mortality rate of 70% as yet. Hypoxemia is foremost problem in ARDS. Though various ventilatory support is tried on ARDS, extracorporeal membrane oxygenation(ECMO) is to be recommended when hypoxemia and hypercarbia are refractory to conventional treatments. Neonatal venoarterial (VA) ECMO in USA is recognized as a therapeutic modality for neonatal respiratory failure and extracorporeal carhon dioxide removal(ECCO2R) in Europe is used for adult respiratory distress syndome. The partial bypass using the membrane oxygenator aims at lung rest while relieving the hard ventilatory setting on the diseased lung. VA ECMO can provide circulatory support as well but the right internal jugular vein and the right common carotid artery are ligated for the cannulation of draiaage and perfusion catheters. Recent follow up study shows that VA ECMO may not be completely free from neurologic complications such as embolism in the systemic circulation and ill effects due to the reduction of blood supply to the immature lungs. ECCO2R adopts low-flow venovenous(VV) bypass. It has been reported to be valuable for treatment of neonatal respiratory failure. VV bypass provides gas exchange but no cardiac support. Venous drainage and perfusion catheters are placed in the right atrium or vena cavae via the femoral or internal jugular veins. Compared to VA bypass, the consequences of embolizations are potentially fewer, no major artery is sacrificed. Highly oxygenated blood flows into pulmonary eirculatiom which may relieve pulmonary artery hypertension. Total respiratory support may be obtained by VV bypass, VV bypass requires approximately 20-50% more flow for total respiratory sopport due to recirculation of oxygenated blood. Recently VV bypass is chosen for neonatal resyiratoty failure in USA. They alliveate the entry criteria for ECMO using the parameter of oxygenation index(OI). VV ECCO2R using to-and-fro system is tried also for neonatal respiratory failure in Europe. A double lumen tube was developed to reduce the number of veins to be cannulated during VV bypass. It is constructed with the outer drainage cannula( 14 Fr.) and the inner perfusion cannula( 8 Fr.) whose opening is placed on the left side of outer cannula. If perfusion opening is placed on the right atrium facing the right ventricle, the venous blood can be drained from both superior and inferior vena cavae through several drainage opening. To evaluate the effectiveness of ECCO2R with a double lumen tube, we developed an experimental model of acute respiratory failure on 8 mongrel dogs. Under general anesthesia with i.v, pentobarbital, a double lumen tube was introduced via the right internal jugular vein and it was connected with the extracorporeal circuit. Without ventilating the oxygenator during VV bypass, respiratory failure was induced by hypoventilation. After obtaining control hemodynamic and blood gas values under hypoventilation, we proceed to apneic oxygenation(AO), extracorporeal CO2 removal(ECCO2R) and controlled mechanical ventilation(CMV) in that order. Arterial pH in control was 7.180.09(meanSD), and it was increased to 7.33+/-0.08 and 7.28+/-0.08 in ECCO2R and CMV, respectively. PaCO2 in control was 69+/-9mmHg and it was decreased to 41+/-4mmHg and 47+/-7mmHg in ECCO R and CMV respectively. PaCO2 in control was 62+/-15 mmHg and it was increased in AO, ECCO2R and CMV. Mixed venous blood gas analysis showed the same result as arterial blood gas analysis. There was no difference between ECCO2R and CMV. The bypass flow enough to remove CO2 was 30-50% of cardiac output. It is concluded that ECCO2R using a double lumen tube was effective to control the carbon dioxide tension in arterial blood, and a double lumen tube may permit the simplicity of an operation and patient care as well as minimizing the bleeding during extracorporeal respiratory support.

Effects of Diltiazem on cardiovascular functions and oxygenation during sevoflurane anesthesia in dogs / 대한마취과학회지

Diltiazem was administered by two different dosages with 200 ug/kg 1V+10 ug/kg/min infusion, 400 ug/kg 1V+20 ug/kg/min infusion, in order to assess the interaction between sevoflurane and diltiazem on the cardiovascular function and oxygenation in dogs during inhalation of 1.0 MAC of sevoflurane. Significant decrease in heart rates, mean arterial pressure, pulmonary vascular resistance, systemic vascular resistance, coronary perfusion pressure were observed. Subsequently rate pressure product, as a parameter of myocardial oxygen consumption, decreased with no significant changes of oxygen extraction ration in 1.0 MAC of sevoflurane anesthesia with the above dosages of diltiazem in dogs. The author concludes that concomittent use of diltiazem in clinical doses induced tolerable hemodynamic depression and no untoward effects on oxygenation during maintenance of anesthesia with 1 MAC of sevoflurane. These combination would be safe for anesthetic cares in patient with ischemic heart diseases and coronary arterial diseases in which adequate oxygen supply in the heart is essentially necessary.

Statistical Methods in the Articles of the Journal of the Korean Society of Anesthesiologists from 1981 to 1990 / 대한마취과학회지

The purpose of this study is to investigate the error of using statistics in the articles of the Journal of the Korean Society of Anesthesiologists from 1981 ta 1990 and to present a program that may be of some help correcting the statistical error. We classified statistically the journals into original articIe, review and case report, and original articles into that of usng inferential statistics, descriptive statistics and no statistics. Then, we analyzed the articles of inferential statistics in the aspect of our criteria for statistical errors. The proportion of using erroneous inferential statistics was 80-100% from 1981 to 1986 and it decreased by 60% afterwards. But the proportion was still 67% in 1990. The representative errors are the no statistical analysis in spite of the necessary cases, the p-value only without the description of statistical method and using t test inappropriately in the comparison of more than 3 groups without Bonferroni correction. The other errors in using statistics were confusion between related data and independent data, inadequate numbers for Chi-square test, inapproate follow-up to variance analysis and inapproate parametric test for data in nominal or ordinal scales.

Statistical Methods in the Articles of the Journal of the Korean Society of Anesthesiologists from 1981 to 1990 / 대한마취과학회지

The purpose of this study is to investigate the error of using statistics in the articles of the Journal of the Korean Society of Anesthesiologists from 1981 ta 1990 and to present a program that may be of some help correcting the statistical error. We classified statistically the journals into original articIe, review and case report, and original articles into that of usng inferential statistics, descriptive statistics and no statistics. Then, we analyzed the articles of inferential statistics in the aspect of our criteria for statistical errors. The proportion of using erroneous inferential statistics was 80-100% from 1981 to 1986 and it decreased by 60% afterwards. But the proportion was still 67% in 1990. The representative errors are the no statistical analysis in spite of the necessary cases, the p-value only without the description of statistical method and using t test inappropriately in the comparison of more than 3 groups without Bonferroni correction. The other errors in using statistics were confusion between related data and independent data, inadequate numbers for Chi-square test, inapproate follow-up to variance analysis and inapproate parametric test for data in nominal or ordinal scales.