The Effects of the Rate of Increase in Inhaled Isoflurane Concentration on the Circulatory Responses / 대한마취과학회지

BACKGROUND: A rapid increase in isoflurane concentration induces tachycardia and hypertension and increases plasma catecholamine concentration. The current study examined the effects of the rate of increase in inhaled isoflurane concentration on the circulatory responses. METHODS: Unpremedicated sixty three ASA physical status 1 patients, aged 20-40 years, scheduled for elective surgery under general anesthesia were randomly allocated into one of three groups. In each group, the inspired concentration of isoflurane via mask was increased up to 5 vol% at the rate different from other groups. The inspired concentration of isoflurane via mask was increased to 5.0 vol% abruptly (group 1), for 100 seconds (group 2), or 200 seconds (group 3). The target was to produce an end-tidal concentration of isoflurane (ETisof) of 2.6 vol% which was maintained until the end of the study by adjusting the vaporizer setting, when necessary. Heart rate (HR), mean arterial pressure (MAP), ETisof, end-tidal concentration of carbon dioxide, and peripheral oxygen saturation were measured at baseline and every 30 seconds for 5 minutes after inhalation of isoflurane and for 2 minutes after intubation. RESULTS: HR and MAP were significantly increased in all three groups compared with baseline, but significant differences in maximum values were not observed in three groups. There were significant differences among the groups in time from the onset of isoflurane inhalation to the maximal effect on HR and MAP. However, there were no significant differences among the groups of the ETisof at the maximal HR and MAP were seen. CONCLUSIONS: The high concentration of isoflurane transiently increase HR and MAP during inhaled anesthesia induction. However, the rate of increase in inhaled isoflurane concentration does not affect the circulatory responses.

Difference between Arterial Carbon Dioxide Tension and End-tidal Carbon Dioxide Tension in Neurosurgical Patients during Craniotomy / 대한마취과학회지

BACKGROUND: During craniotomy operations, the PaCO2 has therapeutic implications because hyperventilation is often used to lower intracranial pressure. PETCO2 is often used as an estimate of PaCO2, with the assumption that P(a-ET)CO2 is relatively constant. To clarify the relationship between PaCO2 and PETCO2, sixty patients undergoing elective craniotomies were studied. METHODS: Arterial blood gases were measured from 30 minutes after endotracheal intubation to skin closure at an interval of 30 minutes in thirty patients, and at random interval in another thirty patients. PETCO2 was simultaneously determined with infrared capnography(Datex AS/3TM, Filand). RESULTS: The PaCO2 was 31.7+/-3.0 mmHg and PETCO2, 26.3+/-2.5 mmHg, with a P(a-ET)CO2 of 5.5+/-2.7 mmHg(n = 431, range between 0-13.5). There was a significant positive correlation between PaCO2 and PETCO2(r = 0.537, slope = 0.440, P<0.001) and between P(a-ET)CO2 and PaCO2(r = 0.625, slope = 0.555, P<0.001). Although changes in the pooled data of PaCO2 and PETCO2 correlated statistically, comparisons in 43 of 60(71.6%) individuals were not correlated. On comparisons of subsequent measurements, 17.0% of changes in PaCO2 and PETCO2 were in opposite directions. P(a-ET)CO2 had a tendency to increase with time during surgery(slope = 0.0082), but there was no statistically significant difference between the measurements. CONCLUSION: The PETCO2 measured with infrared capnography does not provide a stable reflection of PaCO2 in many patients undergoing craniotomy. Therefore, we concluded that capnography must be used in conjuction with arterial blood gas measurements for monitoring the respiratory acid-base status of mechanically ventilated neurosurgical patients undergoing craniotomy.

A Catheter Fragment in External Iliac Artery Cutted during Femoral Artery Cannulation: A case report / 대한마취과학회지

Arterial cannulation for constant monitoring of arterial pressure and blood gase analyses has become commonplace in the care of the critically ill patients. The radial artery is often regarded as causing a negligible complication risk because of extensive collateral arterial flow in the hand. One of other alternative sites for arterial cannulation is femoral artery. Femoral artery cannulation has a high degree of success in very small, critically ill children. It should be considered an acceptable alternative to small-vessel cannulation when the latter is not technically achievable, or in the unstable patient where rapid establishment of reliable artery access is necessary. Arterial cannulation may cause many complications: arterial catheters can directly injure the vessels, resulting in thrombosis, occlusion, distal embolization or ischemia. Local insertion site complications, such as hematoma, hemorrhage, and infection may occur. Arterial catheter may also be a source of systemic sepsis. We report an unusual case of unintentional release of a catheter fragment into the external iliac artery in a 7-month (7.8 kg) male patient with tetralogy of Fallot, which was inadvertently inserted during right femoral artery cannulation. The catheter fragment was successfully retrieved with the Amplatz Goose Neck microsnare under fluoroscopy without any problems.

A Comparison of Propofol-Fentanyl and Propofol-Ketamine Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: The combination of ketamine and propofol, fentanyl and propofol has been used for anesthesia induction and total intravenous anesthesia. Advantages of using the combination have included hemodynamic stability intraoperatively and superior analgesia. METHODS: Forty patients (ASA physical status 1, 2) scheduled for cesarean section were randomized to either propofol-fentanyl (n=20) (P-F) or propofol-ketamine (n=20) (P-K) group. We checked to the cardiovascular effects of anesthetic induction, neonatal outcome, and maternal recovery time during cesarean section. RESULTS: There were no significant differences in systolic and mean arterial pressure in both groups. Diastolic arterial pressure was increased significantly in both groups at intubation, but degree of increase was less in P-F group. The Apgar scores of the newborn and blood gas analysis of umbilical vein were not significantly different in both groups. Maternal recovery from anesthesia was significantly quicker in P-F group. CONCLUSIONS: Propofol infusion coupled with fentanyl or ketamine would provide good anesthesia instead of inhalational anesthesia for cesarean section without significant adverse effects on both mother and fetus. However, recovery from anesthesia was faster and cardiovascular changes were less with P-F than P-K group.

CT Guided Celiac Plexus Block ( II ) / 대한마취과학회지

Alcoholic celiac plexus blocks have been used to relieve intractable upper abdominal cancer pain. Various techniques have been proposed including the use of the X-ray and CT scanner to improve results and to avoid complications. We used the CT scanner and the X-ray fluroscope for 36 cases of alcoholic celiac plexus blocks to determine the depth and position of the needle without previous diagnostic blocks. Good to excellent pain relief occurred in more than 72% of the patients and the advantages of the use of the CT scanner showed that 1) placement of the needle tip is easily established according to the surrounding anatomical structures. 2) the operator can introduce the needle without anxiety. 3) the time required for block are saved.

Changes of Blood Glucose Levels by infusion of 5% Dextrose in Water and Hartmann`s Solution during Halothane Anesthesia / 대한마취과학회지

This study was attempted to cumpare the effects on blood glucoge of 5% Dextrose in Water (D5W) and Hartmann's solution infused during halothane anesthesia.20 female patients in the state of A.S.A. classification 1 were chosen and divided into 2 groups, i.e. first group D5W. the second group Hartmann's solution. Blood samples were collected on the operating table prior to starting I.V. infusion, after 1/2 hour, 1 hour and 11/2hour from the time 1.V. infusion started. Intravenous fluid was administered at 10 ml/kg/hr. Changes of blood glucose levels were as follows. In the group of D5W, the values of bleed glucose were 83.4+/-13.5 mg% at N.P.O., 198.4+/-33.6 mg% at 1/2 hour, 245.5+/-55.6mg% at 1 hour, and 259.5+/-40.1 mg% at 11/2 hours. In the group of Hartmann's solution, the values of blood glucose were 64.9+/-9,5 mg% at N. P.O., 93.3+/-21.9mg% at 1/2 hour. 99.0+/-15.6mg% at 1 hour, and 105.6+/-24.2mg% at 1 1/2hours.