The Effects of Nitrous Oxide on Volume and Pressure of Endotracheal Tube Cuffs during General Inhalation Anesthesia / 대한마취과학회지

BACKGROUND: Many studies have demonstrated that nitrous oxide diffuses into the cuffs of endotracheal tubes and increases cuff volumes and pressures. Such increments of cuff pressure maybe result in damage to the trachea. We evaluated the increase of intracuff pressure, volume and the statistical significance was analyzed with personal computer. METHODS: Fourty-nine patients ranging in age 37+/-15 years, in ASA physical status class 1~2 , they were 26 males and 23 females. They divided into two groups, group I(n=25) were anesthesia with nitrous oxide : oxygen (2 L/min : 2 L/min), group II were(n=24) anesthesia with nitrous oxide : oxygen (4 L/min : 2 L/min). The cuff pressure was measured every 30 minutes and compared with each others and group I and II. RESULTS: Our results suggest that a significant intracuff volume and pressure changes developed between two groups (p<0.05), more significant intracuff pressure changes occured at group II than group I (p=0.001) and significant increment changes according to time and different concentration of nitrous oxide between two groups (p<0.05). CONCLUSIONS: This study was conducted to determine the degree of intracuff pressure and volume changes during general inhalation anesthesia with different concentration of nitrous oxide. These results suggest that a nitrous oxide significantly increases cuff pressure and volume in a concentration and time related fashion.

Effects of Combining Diazepam with Fentanyl administered during Spinal Anesthesia on Hemodynamic Response and Change in SaO2 / 대한마취과학회지

Combining benzodiazepine with opioid has been used for analgesia and sedation during spinal anesthesia, but many authors have warned that combined administration of these drugs produces potent drug interaction that places patients at high risk for hypoxemia and apnea. This study was undertaken to observe the effect of combined use of diazepam with fentanyl on hemodynamic response and change in SaO in twenty healthy adult patients undergone elective surgery with spinal anesthesia. All of the patients were divided into the control and experimental group, and whom spinal anesthesia with 0.5% tetracaine the 12 mg and epinephrine 0.2 mg, were performed. To the control(Group I) and experimental group(Group 2) the combined dose of diazepam 0. 075 mg/kg with fentanyl 1 ug/kg, and diazepam 0.15 mg/kg with fentanyl 2 ug/kg, were given, respectively, by intravenous injection 1 hour after spinal anesthesia started. Blood pressure, heart rate and SaO2 of the two groups were compared at the time before administration of study drugs and 1 min, 2 min, 2 min, 4 min, 5 min, 10 min, 30 min and 60 min after administration of study drugs. The results were as follows. 1) SaO2 was significantly decreased in group 2 than Group 1 after study drugs were administed intravenously. 2) In both group, decrease in SaO2 was significant at the first 5 minutes after intravenous administration of study drugs. 3) SaO2 fell to 90% of the control value after the administration of study drugs in 6 patients of Group 2(60%). 4) Hemodynamic changes after intravenous administration of study drugs were statistically significant but not so clinically in both group. We concluded that combined intravenous administration of benzodiazepine and opioid under spinal anesthesia requires the careful monitoring of hemodynamic response and ventilatory status continuosly with those monitoring devices already in use and pulse oximeter. Availiability of skilled anesthesiologists for airway management and administration of supplemental oxygen are very important in combined intravenous administration of benzodiazepine and opioid.

Axillary Artery Occlusion Following Accidental Injection of Diphenylhydantion via Radial Artery Catheter / 대한마취과학회지

Direct arterial pressure monitoring by means of an intra-arterial catheter has been considered benefit for assessment of the critically ill patients, safe conduct of controlled hypotension and frequent obtaining arterial samples for blood gas analysis. However in stead of these advantages, there would be high incidence of potential complications of arterial catheterization, such as pain, trauma to the artery and surrounding tissues(e. g., nerve), hematoma, infection, thrombosis, and distal embolization of air, clot, pieces of the catheter, and other debris. We have recently experienced an unexpected episode of amputation of the upper extremity resulting from axillary arterial occlusion following accidental injection of diphenylhydantoin through the radial arterial catheter in 57 year old neurosurgical patient. To prevent these serious and unexpected complications following arterial cannulation, we have to keep a continuous interest and vigilance to those who have invasive monitorings and those who are stranger to handle the arterial cannulation.