The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery / 대한마취과학회지

BACKGROUND: Conventional pelviscopic surgery requires pneumoperitoneum with CO2 gas insufflation and lithotomy-Trendelenburg position. Pneumoperitoneum and Trendelenburg position may influence intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure. METHODS: Twenty-five patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, lidocaine, rocuronium, and sevoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were measured before and after creation of pneumoperitoneum with an intraabdominal pressure of 12 mmHg, then after 10 minutes and 30 minutes in the 20degrees Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was then calculated. RESULTS: Following creation of pneumoperitoneum, there was a significant increase in peak inspiratory pressure (6 cmH2O), plateau pressure (7 cmH2O), and end-tidal CO2 (5 mmHg), while dynamic lung compliance decreased by 12 ml/cmH2O. Overall, the Trendelenburg position induced no significant hemodynamic or pulmonary changes. CONCLUSIONS: The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters.

The Effects of Temperature Monitoring Methods and Thermal Management Methods during Spinal Surgery / 대한마취과학회지

BACKGROUND: The precise measurement of body temperature during anesthesia is important to prevent hypothermia.The aim of this study was to compare the urinary bladder temperature to the esophageal, nasopharyngeal, rectal and skin temperatures, and to compare three heating methods during spine surgery. METHODS: Forty-two patients with ASA physical status I-II, who were scheduled to undergo spine surgery in the prone position, were included in this study.The patients were randomly divided into 4 groups:Group I was treated without any heating methods; group 2, with fluid-warmers; group 3, with forced air-warmers; and group 4, with a combination of both heating methods.After the induction of anesthesia, the esophageal, nasopharyngeal, rectal, urinary bladder and skin temperature was monitored every 15 minute for 3 hours.The urinary bladder temperature was compared to the esophageal, nasopharyngeal, rectal and skin temperatures. RESULTS: The urinary bladder temperature was found to be higher than the esophageal and the nasopharyngeal temperatures (P < 0.01).The urinary bladder temperature of group 3 was higher than that of group 1 at 180 minutes after induction of anesthesia (P < 0.05).The urinary bladder temperature of group 4 was higher than that of group 1 at 150 minutes (P < 0.05), as well as at 165 and 180 minutes (P < 0.05).The skin temperatures of groups 3 and 4 were higher than group 1 (P < 0.001). CONCLUSIONS: The urinary bladder temperature was higher than the esophageal temperature and correlated with the esophageal, nasopharyngeal and rectal temperatures.During spine surgery in the prone position, a forced air-warmer was found to be the most effective but a combination of all the methods tested was found to be even more effective.

Iatrogenic Atelectasis by Insertion of a Sump Drainage Tube into the Trachea during General Anesthesia : A case report

Atelectasis is a collapse of the lung due to absence of air within the alveoli and is a relatively common complication following surgery under general anesthesia, but severe total or segmental collapses rarely develop during anesthesia and surgery. Total or segmental lung collapses usually result from the compression or obstruction of bronchial pathways by mass lesions, foreign bodies, or secretions such as mucus, blood, or pus. Anesthesiologists must carefully manage patients who develop pulmonary atelectasis because it is sometimes fatal. We experienced iatrogenic pulmonary atelectasis by insertion of a sump drainage tube into the trachea during general anesthesia for laparoscopic splenectomy and diagnosed with fiberoptic bronchoscopy and chest X-ray.

Total Intravenous Anesthetic Management of a Child with Congenital Insensitivity to Pain with Anhidrosis : A case report / 대한마취과학회지

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare hereditary sensory and autonomic neuropathy. CIPA is characterized by inability to sweat, insensitivity to pain, self-mutilation, recurrent episodes of hyperpyrexia, mental retardation, and autonomic nervous system abnormality. Patients with CIPA may undergo surgery because of susceptibility to trauma, bony fracture and osteomyelitis due to insensitivity to pain. We report a child who had undergone anesthesia with total intravenous anesthesia. The anesthetic management of this condition is discussed.

An Anesthetic Experience of Intraoperative Hypercapnia in a Patient with Larsen Syndrome: A case report / 대한마취과학회지

Larsen syndrome is a rare congenital connective tissue disorder which is characterized by multiple dislocation of major joints, typical facial appearance, cervical spine narrowing and instability, and respiratory difficulties secondary to laryngotracheomalacia. We describe a case of general anesthesia for orthopedic operations in female infant consistent with Larsen syndrome. The patient showed hypercapnia intraoperatively, but recovered without any sequelae.

Effects of Edrophonium and/or Pseudocholinesterase for the Reversal of Mivacurium-Induced Paralysis in vitro / 대한마취과학회지

BACKGROUND: Mivacurium is a nondepolarizing neuromuscular blocking agent hydrolyzed by pseudocholinesterase. Anticholinesterase used in the reversal of mivacurium-induced muscle relaxation may also inhibit plasma pseudocholinesterase, and delay hydrolysis of mivacurium. In this study, the effects of edrophonium and/or bovine pseudocholinesterase (BpChE) in the reversal of mivacurium were investigated with the rat phrenic nerve-diaphragm preparation. METHODS: Fifty Sprague-Dawley rats (150 - 200 g) were randomly allocated into 10 groups based on the dosage of edrophonium and BpChE. Each animal was anesthetized with thiopental sodium (40 mg/kg I.P.). The phrenic nerve-diaphragm was dissected and mounted in a bath containing an oxygenated Krebs' solution at 32degreesC. The phrenic nerve was stimulated at supramaximal intensity and the single twitch responses and train of four (TOF) ratio were measured. After stabilization of the twitch responses, mivacurium (1ng/ml) was administered incrementally to obtain more than 95% twitch inhibition. Reversal of the mivacurium-induced block by edrophonium (0.01, 0.1, 1, or 10ng/ml) and/or BpChE (0.1 u, or 1.0 u/ml) were tested. A single twitch height more than 75% of the baseline value was considered an adequate reversal. RESULTS: Mivacurium-induced paralysis was recovered more effectively by BpChE 1.0 u/ml than the other groups. Edrophonium improved a single twitch in a dose dependent manner. CONCLUSIONS: Mivacurium-induced paralysis can be more effectively reversed by BpChE than edrophonium. Inhibition of pseudocholinesterase was not observed by increasing the dose of edrophonium.

Effect of Additional Lidocaine on the Onset Time of Vecuronium / 대한마취과학회지

BACKGROUND: Local anesthetics have been shown to interact with neuromuscular blockers. Most local anesthetics decrease neuromuscular transmission and potentiate neuromuscular block from muscle relaxants. The purpose of this study was to examine the effectiveness of lidocaine on the onset time of vecuronium and to compare that with other method such as simply increasing the dose of vecuronium. METHODS: Sixty patients of ASA physical status I or II were induced with thiopental (4-5 mg/kg) and maintained with O2-enflurane (2.5 vol%). They were randomly divided into four groups: Vecuronium (0.1 mg/kg) was administered intravenously in Group C (n = 15), additional lidocaine (1 mg/kg) was given intravenously 1 min prior to administration of vecuronium in Group L (n = 15), increased vecuronium (0.15 mg/kg) was given in Group V (n = 15) and succinylcholine was given in Group S (n = 15), respectively. Neuromuscular blockade was assessed by train-of-four (TOF) at the adductor pollicis muscle with supramaximal stimulation of ulnar nerve (2 Hz, 0.2 ms) every 12 sec. Endotracheal intubation was performed and intubating conditions were evaluated according to the standard scoring method after measuring the onset time (from the end of giving each muscle relaxants to the 90% suppression of the first twitch). RESULTS: The onset time of Group L (122.0+/-11.0 sec) and that of Group V (98.0+/-16.9 sec) were shorter than that of Group C (135.2+/-16.0 sec) (P<0.05), but these were not shorter than that of Group S (42.0+/-6.2 sec). There was no statistical difference between Group L and Group V. Intubating conditions were good or excellent in all groups. CONCLUSIONS: Additional lidocaine for attenuating sympathetic response could accelerate the onset of vecuronium. But the onset time of this method was not shorter than that of simply increasing the dose of vecuroium nor that of succinylcholine.

An Analysis of the Clinical Status of the Brain Death Donors / 대한마취과학회지

BACKGROUND: Since the first successful kidney transplantation from a brain death donor (BDD) was done in 1979, organ transplantations from BDD have steadily increased. The number of BDDs have been increasing year by year. The purpose of this study is to analyze clinical status of organ donor from BDDs. METHODS: We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. RESULTS: The male to female ratio was 3 : 1, and the age distribution was the highest in twenties. The distribution of cause of brain death was the highest in motor vehicle accidents. The distribution of acquired organ was the highest in kidney, heart, liver in order. The distribution of days stayed in ICU before organ donation was the highest in 2 days. The choice of agent for inotropic support of the myocardium is dobutamine. The donors have been transfused with packed red blood cell (PRBC) to maintain the hematocrit between 25~35%. Two units of PRBC should be readily available at all times for transfusion. The failure of organ donation was mainly very poor organ condition. CONCLUSIONS: We wish that these results were made use of bases of status of organ donation from BDDs.