The Anesthesia for Outpatient Facial Chemical Peeling Using Ketamine and Midazolam / 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.

Clinical Observation in 20 Cases with Intubation Granuloma / 대한마취과학회지

Endotracheal intubation has been widely used for general anesthesia and patency of airway. But intubation granuloma may be developed after intubation. From Feb. 1986 to Jun. 1993, the authors encountered 20 cases of intubation granuloma in Korea University Hospital and following results were obtained. 1) The incidence of intubation granuloma was 0.017%. 2) The age range was from 24 to 49 years. 3) The ratio of male to female was 1 to 19. 4) All cases located at posterior one third of vocal cord, 6 cases were bilateral, 14 were unilateral, of them 10 were in the right sides. 5) Eleven cases were occurred after caesarian section, and the ineidence of which was 0.134% . 6) Hoarseness was the main symptom in 18 cases. 7) The duration from intubation to development of symptom was 15 days to 4 months.

A Microbiological Study in the Humidifiers of the Mechanical Ventilators / 대한마취과학회지

Nosocomial infection represent a significant cause of patient morbidity and mortality, especially in the ICU and nosocomial pneumonia that cause high mortality may arise from contaminated respiratory equipments. This study was done to investigate the relationship of micro-organisms in upper respiratory tract and ventilatory equipment, especially humidifier. The total number of cases in this study was 20 and the specimen for bacteriologic culture were taken from the pharynx, the distilled water and the inner wall of humidifier and toilet of trachea at the 0, 4, 8, 12, 24, 48 hours after initiation of mechanical ventilation. The results obtained from the bacteriologic culture were as follows. 1) The most frequently found organism at the pharynx was Pseudomonas aeruginosa and next was Coagulase Negative Staphylococcus, followed by Streptococcus viridans, Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus group D, Enterobacter agglomerans, Acinetobacter spp. 2) The most frequently found organism at the trachea was Pseudomonas aeruginosa and next was Klebsiella pneumoniae followed by Coagulase Negative Staphylococcus, Streptocoecus viridans, Pseudomonas picketti, Staphylococcus aureus and no growth in 5 cases. 3) The most frequently found organism in the fluid of humidifier was Pseudomonas aeruginosa and next was Pseudomonas picketti, Klebsiella pneumoniae, Streptococcus group D and no growth in 2 cases. 4) The most frequently found organism at the pharynx was Pseudomonas aeruginosa and next was Pseudomonas picketti, Klebsiella pneumoniae, Streptococcus group D, Serratia liquefacines, Acinetobacter spp and no growth in 3 cases. 5) The number of isolated organisms in the fluid of humidifier was 3 at 0 hour and 18 after 48 hours and at the wall 2 at 0 hour and 15 after 48 hours. 6) The number of same organism that was isolated between the pharynx and trachea was 13 among 15 cases and between the wall and fluid of humidifier was 15 among 16 cases and between trachea and fluid of humidifier was 10 among 14 cases.

A case report of fiberoptic intubation in neonate with cleft palate lateral synechia syndrome / 대한마취과학회지

An one day old female baby was admitted to the Pediatric department of Korea University Anam Hospital for the evaluation of her facial anomaly. She was born by spontaneous vaginal delivery at term weighing 3.8 kg. On initial examination, she was noted to have congenital trismus and have cleft lip and palate. Bands of fibrous tissue were noted to extend from the superior alveolar part to inferior part at decidual molar tooth region and allowed oral opening of only 5 mm. She was transfered to the Plastic Surgery department under the diagnosis of cleft palate lateral synechia syndrome for resection of her synechial bands. In the operating room ECG, pulse oximeter and precordial stethoscope were applied to the patient and then, anesthesia was induced with , O2, N2O and enflurane. The 60 cm Olympus fiberscope with an external diameter of 2 mm was used and well lubricated 3.0 mm uncuffed endotracheal tube was threaded over the fiberscope through the oral cavity. The fiberscope was advanced into the midtrachea, then the endotracheal tube was passed over the fiberscope into the trachea After securing of the endotracheal tube, two lateral synechial bands were surgically divided. She tolerated oral feedings on postoperative 5 days without difficulty and discharged from the hospital on postoperative 6 days.

A case report of quadriparesis following general anesthesia / 대한마취과학회지

We experienced a case of postoperative quadriparesis secondary to operative position in a patient with pre-existing, asymtomatic,cervical neurilemmoma. The patient was admitted with chronic otitis media for mastoidectomy on right side. There was no specific event throughout operation and anesthesia but developed quadriparesis one hour after arrival on ward. With magnetic resonance imaging, the patient was dignosed to have cervical neurilemmoma. On seventh postoperative day the patient had second operation,cervical laminectomy and tumor removal. Ten days after second operation he was discharged without any complication. Eight months later he had mastoidectomy on the left side and was discharged without any sequale.

Anesthetic Management for Whole-Lung Lavage in a Patient with Pulmonary Alveolar Proteinosis / 대한마취과학회지

Pulmonary alveolar proteinosis is characterized by the remittent or progressive accumulation of lipid-rich proteinaceous material within the alveolar sacs in the absence of inflammatory response. Whole-lung lavage is the only consistent treatment for pulmonary alveolar proteinosis. We have utilized whole-lung lavage for the successful treatment of a 62 year-old female patient with pulmonary alveolar proteinosis. There was no persistent complication during the procedure and the postanesthetic recovery except temporary fever and hypoxic event. The patient was symptomatically, physiologically, and radiologically improved within days after the procedures.

A Case Report of Profound Hypotension during Vaginal Hysterectomy in a Geriatric Patient / 대한마취과학회지

An anesthesiologist should keep in mind the various risk factors during anesthetic man- agement of geriatric patients. Unlike young patients, elderly patients may manifest more than one pathophysiologic process associsted with progressive degenerative changes in various organs. The successful anesthetic management requires detailed information about the cause and severity of the underlying disease, thorough understanding of geriatric specific hemodynamic particularities, and more careful monitoring by experienced personnel. We experienced a case of profound hypotension during general anesthesia for vaginal hysterectomy in a 67 year-old female patient. Anesthesia was induced with thiopental-vecuronium and was maintained with nitrous oxide, oxygen and enflurane. One hundred and five minutes after the induction, profound hypotension and bradycardia with S-T segment depression developed without specific events and were corrected by vigorous therapeutic managements. She discharged from the hospital on 7th postoperative day without complications.

A Case Report of Anaphylactoid Reaction to Dextran 40 / 대한마취과학회지

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.

A Case Report of Profound Hypotension during Vaginal Hysterectomy in a Geriatric Patient / 대한마취과학회지

An anesthesiologist should keep in mind the various risk factors during anesthetic man- agement of geriatric patients. Unlike young patients, elderly patients may manifest more than one pathophysiologic process associsted with progressive degenerative changes in various organs. The successful anesthetic management requires detailed information about the cause and severity of the underlying disease, thorough understanding of geriatric specific hemodynamic particularities, and more careful monitoring by experienced personnel. We experienced a case of profound hypotension during general anesthesia for vaginal hysterectomy in a 67 year-old female patient. Anesthesia was induced with thiopental-vecuronium and was maintained with nitrous oxide, oxygen and enflurane. One hundred and five minutes after the induction, profound hypotension and bradycardia with S-T segment depression developed without specific events and were corrected by vigorous therapeutic managements. She discharged from the hospital on 7th postoperative day without complications.

A Case Report of Anaphylactoid Reaction to Dextran 40 / 대한마취과학회지

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.