Effect of Preoperative Renal Function on Preioperative Renal Function and Clinical Parameters in Liver Transplanted Patients / 대한마취과학회지

BACKGROUND: Liver transplantation (LT) has become the treatment of choice for advanced liver disease. However, renal dysfunction often complicates the course of liver transplant recipients. The preoperative serum creatinine level have been shown to be an important predictor of a short-term graft and patient survival rates and the need for perioperative dialysis. This study examined the impact of the pretransplant renal function on the anesthetic characteristics and renal function after LT. METHODS: Patients undergoing LT were divided two groups according to the creatinine (Cr) level at time of LT. The following information was collected for each patient: age, etiology, weight and height, serum Cr, Cr clearance, patient survival, and cause of death. The laboratory data was collected at preoperative day, operation day and postoperative 1, 7, 30 days and 6 months. The hemodynamic profile was collected during LT. RESULTS: There were 27 patients in the renal dysfunction (RD) group. Ascites, total blood transfusion and fluid administration was significantly higher in the RD group. The hemodynamic parameters were similar in both groups. The BUN and Cr levels were significantly higher in the RD group in the perioperative period. At the preoperative period, the AST, ALT, bilirubin and prothrombin time was significantly higher in the RD group. The postoperative ICU stay and mortality rate was higher in the RD group. CONCLUSIONS: A pretransplant renal dysfunction is the result of deterioration in the liver function in the preoperative period, and indicates a greater requirement of blood and fluid during surgery.

Effect of Intraarticular Ketamine after Knee Arthroscopy / 대한통증학회지

BACKGROUND: This study was designed to demonstrate the peripheral effect of ketamine on the synovia of the knee joint and evaluate the analgesic effect of an intraarticular ketamine injection following knee arthroscopy. METHODS: In a double blind randomized study, 80 ASA class 1 or 2 patients were selected for elective arthroscopic knee surgery. The patients received either 20 ml of normal saline (Group C, n = 19), 20 ml of 0.5% ropivacaine (Group R, n = 21), 1 mg/kg of ketamine mixed with 20 ml of normal saline (Group K, n = 20) or 1 mg/kg of ketamine mixed with 20 ml of 0.5% ropivacaine (Group RK, n = 20), intraarticularly, just prior to wound closure. Postoperative pain was evaluated using a visual analogue scale (VAS 0 to 100) score at 1, 2, 6, 12, 24 and 48 hours after the intraarticular injection, with the side effects found in the four groups also evaluated. The patients' requests for rescue analgesic were recorded, total doses of tarasyn calculated and the overall patient satisfaction also evaluated. RESULTS: The difference in the VAS scores for all time periods was not significant. The number of patients receiving rescue analgesics and the total doses received in Group C were greater than those for the other groups, but this was not significant. No side effects were observed in any of the patients. CONCLUSIONS: Ketamine and local anesthetics have been reported to have peripheral analgesic effects, with variable duration in the measurements of pain and hyperalgesia. However, we failed to demonstrate a peripheral analgesic effect on postoperative arthroscopic pain.

Electrolyte and Gas Analysis from Dorsal Vein of Hand during General Inhalational Anesthesia / 대한구급학회지

BACKGROUND: To assess the acid-base status and to measure PO2 and PCO2, arterial blood gases (ABG) has been checked usually. We compared the venous blood gases (VBG) from dorsal vein of hand to ABG from radial artery, and tried to determine whether venous blood gas analysis (VBGA) could be the alternative of ABGA. METHODS: Thirty patients who needed continuous arterial pressure monitoring were chosen. At the completion of stability of HR and BP after induction of general inhalational anesthesia, the ABG from radial artery and VBG from dorsal vein of hand were compared. RESULTS: Laboratory findings were as follows (mean+/-SD): arterial pH, 7.44+/-0.04; venous pH, 7.43+/-0.04; arterial HCO3-, 25.56+/-2.39 mmol/L; venous HCO3-, 25.51+/-2.09 mmol/L. The mean values of arterial and venous PO2 were significantly different (247.8+/-48.9 mmHg versus 187.8+/-41.6 mmHg), but the arterial and venous PO2 values were significantly correlated (r=0.706). The PCO2 (r= 0.883), pH (r=0.912), and HCO3- (r=0.901) values, and base excesses of arterial and venous blood (r=0.926) were highly correlated. Also, arterial and venous serum electrolyte (sodium, potassium, and calcium) were highly correlated. CONCLUSIONS: Venous blood gas analysis from dorsal vein of hand can be effectively used as the alternative method to evaluate the acid-base status, PO2, and PCO2, instead of ABGA during general inhalational anesthesia.

The Effect of Lithotomy-Trendelenburg Position and Carbon Dioxide Insufflation on the Distance from the Upper Incisor to the Carina / 대한마취과학회지

BACKGROUND: The carbon dioxide (CO2) insufflation and lithotomy-Trendelenburg position are required in the laparoscopic gynecologic surgery. However, they can change the distance from the upper incisor to the carina. This may increase the risk of endobronchial intubation. METHODS: Nineteen patients, aged 29-50 yr, who were undergoing laparoscopic surgery were enrolled. We measured the distance from the upper incisor to the carina of them with fiberoptic bronchoscope. Measurements were taken in the each point of lithotomy position, lithotomy-Trendelenburg position, and lithotomy-Trendelenburg position after CO2 insufflation. RESULTS: The average distance from the upper incisor to the carina was 23.1 +/- 1.4 cm in the lithotomy position (0 degree) and was significantly decreased to 22.6 +/- 1.4 cm in the lithotomy-Trendelenburg position (15 degrees) (P<0.05). After CO2 insufflation into the abdominal cavity, the mean distance in the lithotomy-Trendelenburg position (15 degrees) was significantly decreased to 22.1 +/- 1.4 cm (P<0.05). CONCLUSIONS: The lithotomy-Trendelenburg position and CO2 insufflation decrease the distance from the upper incisor to the carina.

Unpredicted Sudden Onset of Postobstructive Pulmonary Edema Complicating Adenotonsillectomy in a Child / 대한마취과학회지

We present the case of a 4-yr-old child who experienced pulmonary edema during adenotonsillectomy. The pulmonary edema occurred unexpectedly around 50 minutes into the operation. We suggest that postobstructive pulmonary edema can occur soon or sometime after the resolution of a chronic airway obstruction.

Prader-Willi Syndrome: A case report / 대한마취과학회지

The Prader-Willi syndrome (PWS) is a rare disorder characterized by infantile hypotonia, subsequent obesity with hyperphagia. Hypogonadism, cryptorchidism, delayed psychomotor development, short status, strabismus, myopia, scoliosis, kyphosis and temperature regulation abnormality are other features. The cause of this syndrome is unknown, but a disturbance in the hypothalamus has been postulated because of the various manifestation of the syndrome. The major genetic mechanism giving rise to PWS is a paternal deletion of about the same size in the 15q11-q13 region, that occurs in 70% of the cases. The principal problems related to anesthesia are those that are secondary to the patient's hypoglycemia, skeletal muscle hypotonia and obesity. An 20-month-old boy with PWS was scheduled for surgical correction of bilateral undescended testes. The trachea was intubated with the aid of succinylcholine 7.5 mg intravenous injection. Muscle relaxation was facilitated with intermittent intravenous administration of atracurium (total dose 8 mg). No prolonged effect of muscle relaxants was observed during anaesthesia. High grade fever (38-39 degrees C) was present during anaesthesia.

Comparison of Blood Pressure Measured at the Aortic Cannula Sideport and within the Ascending Aorta after Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Arterial pressure measured in a peripheral artery sometimes underestimates central arterial pressure after discontinuation of cardiopulmonary bypass (CPB) for reasons that are still unclear. Therefore, the sideport of the aortic cannula is often used for measurement of central pressure because it is accessible and is near the ascending aorta. This study was designed to assess whether blood pressure measured at the sideport of the aortic cannula mirrors blood pressure measured within the ascending aorta. METHODS: Blood pressure was compared in 21 patients 5 minute after discontinuation of CPB at two sites: at the tip of the 23-gauge needle that points distally at a 25degrees to 30degrees angle to the blood flow within the ascending aorta and at the sideport of the aortic cannula. The effects on the sideport-to-aorta pressure differences and wave contour were tested by placing a clamp at the proximal and distal end of the arterial line (aortic cannula sideport-oxygenator tube) of the CPB circuit. RESULTS: There were no statistical differences between systolic, diastolic and mean blood pressure measured at the sideport and ascending aorta when the clamp was applied to the proximal end. The average sideport-to-aorta systolic pressure differences (0.3+/-3.1 mmHg ranged from -5 to 6 mmHg), diastolic pressure differences (-0.9+/-2.1 mmHg ranged from -4 to 4 mmHg) and mean pressure differences (-0.5+/-1.0 mmHg ranged from -2 to 2 mmHg) were not significantly different. No statistical differences were noted between pressures measured at the two sites when the clamp was applied to the distal end of the arterial line. CONCLUSIONS: It is concluded that the pressure measured at the sideport of the aortic cannula reflects the pressure in the ascending aorta after discontinuation of CPB.

Effect of Local Warming of the Injection Site and Forearm on Propofol-Induced Pain / 대한마취과학회지

BACKGROUND: Propofol often causes pain when injected into small peripheral veins, but the pain can be minimized by using a larger vein. This study was designed to determine whether local warming of the injection site and forearm before propofol injection is effective in reducing pain. METHODS: Sixty adult patients undergoing general anesthesia for an elective surgery were randomly allocated to one of two groups. All were unpremedicated and had an 18-gauge cannula inserted into a cephalic vein on the wrist. Patients in group 1 (n = 30) received 1% propofol at room temperature. Patients in group 2 (n = 30) received 1% propofol after local warming (36-37 degrees C) of the injection site and forearm using a forced-air warming system (Bair Hugger(R)). For each patient, the pain during injection of the propofol solution was graded as none, mild, moderate, or severe. RESULTS: Overall the incidence of pain was significantly reduced in group 2 (36.7%) compared with group 1 (66.7%). No patients complained of pain at the injection site and forearm in group 2. However, there was no significant difference in the incidence or severity of pain on the elbow and axilla between the two groups. CONCLUSIONS: We found that local warming applied to the injection site (wrist) and forearm before propofol injection is significantly effective in reducing pain at the injection site and forearm, but there was no improvement of pain on the elbow and axilla when injecting.

Anesthetic Management using Laryngeal Mask Airway during Reconstructive Surgery of Trachea Cancer: A case report / 대한마취과학회지

The laryngeal mask airway (LMA) is new method for maintaining the airway and has many advantages such as easy insertion without muscle relaxant, decreasing cardiovascular change, decreasing damage of pharynx and larynx and useful in difficult intubation. It has being increasingly used in the management of difficult airway problems, but has not been widely used in tracheal surgery. A 59 year old woman with tracheal stenosis due to tracheal tumor was admitted for tracheal reconstruction. The stenotic lesion was 5 cm above the carina and the length of the stenotic segment was 2 cm. Anesthetic management should be focus on maintenance of the airway and adequate ventilation with the number 3 sized LMA during the tracheal resection. The tracheal segmental resection and primary end-to-end anastomosis were performed without serious hypoxia and hypercarbia. We discuss the advantages and limitations of the LMA in tracheal surgery.

Comparison of Effects of Propofol-Succinylcholine and Thiopentone-Succinylcholine on the Serum Potassium / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the effect of propofol with succinylcholine and thiopentone with succinylcholine on serum potassium concentration during induction of general anesthesia. METHODS: Forty patients scheduled for elective surgery were allocated at random into two groups, one to receive propofol with succinylcholine or other to receive thiopentone with succinylcholine. We measured serum potassium concentration at preinjection and at 1, 5 and 10 minutes after injection of propofol with succinylcholine or thiopentone with succinylcholine respectively. RESULTS: There was significant increase in the serum potassium concentrations at 1, 5 and 10 minutes after injection of propofol-succinylcholine and thiopentone-succinylcholine compared with those before injection in two groups. No significant difference in serum potassium concentrations was observed between the two groups. CONCLUSIONS: The changes in serum potassium due to injection of propofol and succinycholine were very similar to those found during injection of anesthesia with thiopentone and succinylcholine. It was reassuring that such small changes of serum potassium occur when propofol-succinycholine and thiopentone-succinylcholine were used and that these changes within normal ranges were unlikely to be of clinical significance.

The Effects of Sodium Nitroprusside and Prostaglandin E Induced - Hypotension to Baroreceptor Reflex / 대한마취과학회지

This study was Uesigned to evaluate the reflexive heart rate response to acute blood loss during sodium nitroprusside and prostaglandin E1 induced-hypotension in isoflurane anesthetized dogs. The results were as follows: 1) Reflexive increase in heart rate during induced hypotension was significantly greater in sodium nitroprusside than prostaglandin E1. 2) Reflexive increase in heart rate during induced hypotension was significantly greater prostaglandin E1 induced-hypotension than during that wih sodium nitroprusside. From these results, it suggest that prostaglandin E1 induced-hypotension provides a safer margin than with sodium nitroprusside when rapid bleeding occurs during anesthesia and surgery.

The Effects of Sodium Nitroprusside and Prostaglandin E Induced - Hypotension to Baroreceptor Reflex / 대한마취과학회지

This study was Uesigned to evaluate the reflexive heart rate response to acute blood loss during sodium nitroprusside and prostaglandin E1 induced-hypotension in isoflurane anesthetized dogs. The results were as follows: 1) Reflexive increase in heart rate during induced hypotension was significantly greater in sodium nitroprusside than prostaglandin E1. 2) Reflexive increase in heart rate during induced hypotension was significantly greater prostaglandin E1 induced-hypotension than during that wih sodium nitroprusside. From these results, it suggest that prostaglandin E1 induced-hypotension provides a safer margin than with sodium nitroprusside when rapid bleeding occurs during anesthesia and surgery.

A Study on the Effect of Waste Anestheic Gases on the Sister Chromatid Exchanges of Peripheral Lymphocytes in Operating Room Personnel / 대한마취과학회지

The authors examined the induntivity of sister chromatid exchanges (SCE) in peripheral lum-phocytes on the personnel working in the operating room and analyzed the factors associated with it to obtain data for their monitoring health status. The results obtained were as follows; 1) Average inductivity of SCE in peripheral lymphocytes of operating room perssonnel exposed to anesthetic gases was 7.85 per cell; it was significantly higher than in those who were not exposed (p0.05). 5) It is possible that the high inductivity of SCE in operating room personnel who both with drink and smoke was due to more the influence of their smoking than their drinking.

The Eligibility Study of Anesthesia and Surgery for HBs Antigen Positive Patients / 대한마취과학회지

There are many article about hepatitis B antigen vaccination and protection against the hepatitis B viruses for medical people, however there are no article about surgical patients who had hepatitis B surface antigen. This study was performed to evaluate the eligibility for anesthesia and surgery of hepatitis B surface antigen positive patients by comparing pre-and post-operative liver function tests. Thirty hepatitis B surface antigen positive patients who were scheduled for surgery were selected for this study and another thirty hepatitis B surface antigen negative patients who were also scheduled for surgery were selected for the control group. AS result were concluded that the hepatitis B surface antigen positive patient who doesn't have active hepatitis is eligible for anesthesia and surgery.