Usefulness of intraoperative bronchoscopy during surgical repair of a congenital cardiac anomaly with possible airway obstruction: three cases report / 대한마취과학회지

Compression of the airway is relatively common in pediatric patients, although it is often an unrecognized complication of congenital cardiac and aortic arch anomalies. Aortopexy has been established as a surgical treatment for tracheobronchial obstruction associated with vascular anomaly, aortic arch anomaly, esophageal atresia, and tracheoesophageal fistula. The tissue-to-tissue arch repair technique could result in severe airway complication such as compression of the left main bronchus which was not a problem before the correction. We report three cases of corrective open heart surgery monitored by intraoperative bronchoscopy performed during prebypass, and performed immediately before weaning from bypass, to evaluate tracheobronchial obstruction caused by congenital, complex cardiac anomalies in the operating room.

Cardiac arrest following reversal of muscle relaxation by pyridostigmine: A case report

The anticholinesterase pyridostigmine is usually used as a reversal agent of non-depolarizing muscle relaxants in general anesthesia. Most adverse muscarinic effects of anticholinesterases are controlled by anticholinergics; however, there is still a potential for fatal cardiac complications. We report a case of cardiac arrest associated with coronary vasospasm that developed during emergence from general anesthesia in a 61-year-old male patient undergoing uvulopalatopharyngoplasty with preoperatively undiagnosed coronary vasospastic angina. Anticholinesterases should be administered with caution for neuromuscular blockade reversal, especially in patients with coronary vasospastic angina.

Cardiovascular collapse due to right heart failure following ethanol sclerotherapy: a case report / 대한마취과학회지

Ethanol sclerotherapy for the treatment of low-flow vascular malformations can cause catastrophic cardiopulmonary complications, including pulmonary embolism and pulmonary hypertension, that can result in right heart failure and fatal arrhythmias, leading to death. We here report a case of abrupt cardiovascular collapse that developed immediately following ethanol sclerotherapy in 31-year-old female patient who had a large arteriovenous malformation in her leg. Anesthesiologists should be aware of the fatal cardiopulmonary complications that are associated with ethanol sclerotherapy and consider the use of invasive hemodynamic monitoring, such as pulmonary artery pressure monitoring, when large doses of ethanol are required.

Clinical Experiences of Transforaminal Balloon Decompression for Patients with Spinal Stenosis

Lumbar spinal stenosis is a commonly treated with epidural injections of local anesthetics and corticosteroids, however, these therapies may relieve leg pain for weeks to months but do not influence functional status. Furthermore, the majority of patients report no substantial symptom change over the repeated treatment. Utilizing balloon catheters, we successfully treated with three patients who complained persistent symptoms despite repeated conventional steroid injections. Our results suggest that transforaminal decompression using a balloon catheter may have potential in the nonsurgical treatment of spinal stenosis by modifying the underlying pathophysiology.

Sedation and general anesthesia outside of the operating room

BACKGROUND: The aim of this study is to evaluate the status and adverse events of anesthesiologist-administered sedation and general anesthesia, outside of the operating room. METHODS: Patients undergoing sedation and general anesthesia, outside of the operating room, were retrospectively reviewed, during the study period from March to October of 2011. The patient's characteristics, primary diagnosis for the procedure, procedures performed outside of the operating room, adverse events associated with sedation and anesthesia, sedatives/anesthetic agents, and anesthetic time, were all assessed. RESULTS: A total of 429 patient's submitted data on 44 sedation/401 general anesthesia were encountered, during the study period. The range of age varied from 2 months to 83 yrs. Most common primary diagnosis for the procedure, during sedation or general anesthesia, was vascular or neurologic problem, respectively. The most frequently used sedatives or analgesics were propofol alone, during sedation (45%) and propofol with remifentanil, during general anesthesia (60%), respectively. Adverse events occurred in 32%, during sedation and 29%, during general anesthesia. Bradycardia occurred in 16% of sedation and hypotension occurred in 15% of general anesthesia. CONCLUSIONS: Our data suggest that the sedation/general anesthesia for procedures, outside of the operating room, have been performed in a complex situation, various location, and wide age groups. Adequate monitoring, sufficient anesthesia support, including skilled staff and emergency equipments, and appropriate drug for each procedure are needed for the patient's safety.

Postanesthetic torsade de pointes in a patient with unrecognized long QT syndrome: A case report / 대한마취과학회지

Torsade de pointes (TdP) is a devastating form of polymorphic ventricular arrhythmia associated with corrected QT (QTc) interval prolongation. TdP usually terminates spontaneously but frequently recurs and may degenerate to ventricular fibrillation. The present report describes a case of TdP in a patient being transferred to the postanesthetic care unit following an emergency laparoscopic appendectomy. The patient had undergone open heart surgery 1 week before. Retrospective electrocardiogram analysis revealed the patient had QTc and Tpeak-Tend interval prolongation that had gone unrecognized. We believe TdP may have been induced by accentuation of sympathetic nervous system during emergence from general anesthesia.

The effects of sevoflurane with propofol and remifentanil on tracheal intubation conditions without neuromuscular blocking agents / 대한마취과학회지

BACKGROUND: Propofol and remifentanil are used for tracheal intubation in the absence of neuromuscular blocking agents. We hypothesized that the addition of sevoflurane to propofol and remifentanil would improve intubation conditions and provide hemodynamic stability. METHODS: Seventy-six patients scheduled for elective surgery were randomly allocated to be ventilated with either 4% (group I) or 7% sevoflurane (group II) after propofol injection (2 mg/kg). All patients received remifentanil (1 microgram/kg) 30 seconds after administration of propofol. Ninety seconds after remifentanil was given, laryngoscopy and tracheal intubation were performed. Intubation conditions and hemodynamic changes were evaluated. RESULTS: The overall incidence of clinically acceptable intubation conditions was significantly higher in group II (92%) than group I (58%) (P = 0.001). Scores for vocal cord position, coughing, and limb movement were significantly better in group II (P < 0.05). Mean blood pressure remained significantly lower than the pre-induction level throughout the investigation in both groups (P < 0.001), but there was no incidence of bradycardia or hypotension requiring treatment. CONCLUSIONS: Tracheal intubation without neuromuscular blocking agents can be achieved safely and reliably by adding 7% sevoflurane to propofol (2 mg/kg) and remifentanil (1 microgram/kg).

The effect of mitochondrial adenosine triphosphate-sensitive potassium (K(ATP)) channel blocker on ischemic preconditioning in hypoxic-ischemic brain injury model of neonatal rat / 대한마취과학회지

BACKGROUND: A brief episode of cerebral ischemia confers transient ischemic tolerance to a subsequent ischemic challenge that is otherwise lethal to them. This study was purposed to evaluate the effect of mitochondrial adenosine triphosphate-sensitive potassium (KATP) channel blocker on ischemic preconditioning in hypoxic-ischemic brain injury model of neonatal rat. METHODS: Seven-day old Sprague-Dawley rat pups were used. The rats were divided into five groups; control group (n = 91), pretreatment hypoxic preconditioning group (n = 43), pretreatment ischemic preconditioning group (n = 52), hypoxic preconditioning group (n = 39), and ischemic preconditioning group (n = 51). Rats in the pretreatment hypoxic preconditioning group and pretreatment ischemic preconditioning group were treated by an intraperitoneal injection with 5-hydroxydecanoate (60 mg/kg). Thirty minutes after injection, right common carotid artery was temporarily occluded for ten minutes in pretreatment ischemic preconditioning group. Rats in the pretreatment hypoxic preconditioning group and hypoxic preconditioning group underwent hypoxia (8% oxygen/92% nitrogen) for four hours. Twenty-four hours after the preconditioning, rats from all groups were exposed to right common carotid artery ligation followed by 2.5 hour hypoxia. On the 1st day after hypoxic-ischemic brain injury, terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end-labeling (TUNEL) reaction was evaluate as apoptotic markers and triphenyl tetrazolium chloride (TTC) was done to measure necrotic tissue. All rats were sacrificed 2 weeks after hypoxic-ischemia brain injury and the brains were examined for morphologic study. RESULTS: There were no differenced in survival rate, infarct area, number of TUNEL positive cells and morphologic score either between hypoxic preconditioning group and pretreatment hypoxic preconditioning group or between ischemic preconditioning group and pretreatment ischemic preconditioning group. CONCLUSIONS: The results suggests that mitochondrial K(ATP) channel blocker, 5-hydroxydecanoate, does not change hypoxic-ischemic preconditioning in the neonatal rat.

Effect of the Heme Oxygenase Inhibitor on the Hypoxic Ischemic Brain Injury in the Neonatal Rat / 대한마취과학회지

BACKGROUND: The heme oxygenase system catalyzes the conversion of heme to free iron, carbon monoxide and bilirubin. This study was purposed to evaluate the effect of the heme oxygenase inhibitor, Tin protoporphyrin IX (SnPPIX) on the hypoxic ischemic brain injury in a neonatal rat. METHODS: Seven-day old Sprague-Dawley rat pups were used. The rats were divided into two groups; control group (n = 9) and SnPPIX group (n = 6). SnPPIX 50 micromol/kg and the dissolvent were administered respectively intraperitoneally. For hypoxic ischemic brain injury, the right common carotid artery was ligated with 5-0 silk and the rats were put in the moisturized hypoxic gas chamber for 150 minutes. Lipid/N-acetyl aspartate and Lipid/Creatine ratio of 1H magnetic resonance spectroscopy were evaluated on the 1st day and the 7th day after hypoxic ischemic brain injury. All rats were sacrificed 2 weeks after hypoxic ischemic brain injury for morphological study. RESULTS: There were no statistically significant differences between two groups in the result of MRS and Lip/Cr and Lip/NAA ratio on 1th day and 7th day after hypoxic ischemic brain injury. In addition, there was no significant difference in the gross morphological evaluation on the 14th day. CONCLUSIONS: Our results suggest that the pretreatment of the Tin protoporphyrin IX does not affect the degree of brain damage which is caused by apoptosis in the model of hypoxic ischemic brain injury in a neonatal rat.

Anesthetic Implication of Hemoglobin-M: A case report / 대한마취과학회지

Cyanosis in children is most often caused by pulmonary disease, or cyanotic heart disease but is rarely caused by hematological problems such as methemoglobinemia and sulfhemoglobinemia. Abnormal hemoglobins with a reduced oxygen affinity are an exceptionally uncommon cause of cyanosis in children. Hemoglobin-M (Hb-M) is rapidly auto-oxidized into the met-form resulting in the loss of its O2-binding ability. This hemoglobinopathy is inherited in an autosomal dominant pattern and is characterized by marked cyanosis. Hb-M affects the anesthetic management because of the anomalous absorption spectrum of Hb-M in standard pulse oximetry. Sufficient O2 delivery should be maintained by keeping a high FiO2 and intermittently checking the O2 delivery state using arterial blood gas analysis. We reported our experience of the anesthetic management of a patient with hemoglobin M.

The Protective Effect of Ischemic and Hypoxic Preconditioning on Hypoxic-ischemic Brain Injury in the Neonatal Rat: 1H Magnetic Resonance Spectroscopic Study / 대한마취과학회지

BACKGROUND: A brief episode of cerebral ischemia confers transient ischemic tolerance to a subsequent ischemic challenge. We examined the effect of ischemic and hypoxic preconditioning in the neonatal rat. METHODS: Seven-day old Sprague-Dawley rat pups were divided into three groups:control (n = 53), ischemic preconditioning (n = 51), and hypoxic preconditioning (n = 48). For ischemic preconditioning, the right common carotid artery was occluded for 10 min. Rats in the hypoxic preconditioning group were kept under hypoxic (8% oxygen/92% nitrogen) conditions for 4h. Twenty-four hours after the preconditioning, rats from all groups were exposed to the right common carotid artery ligature, followed by 2.5 h of hypoxia. Lipid/N-acetyl aspartate (Lip/NAA) and lipid/creatine (Lip/Cr) ratios from 1H MR spectroscopy and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) were evaluated as measures of apoptosis 1 and 7 days after hypoxic-ischemic injury. RESULTS: In the ischemic and hypoxic preconditioning groups, the Lip/NAA and Lip/Cr ratios and the numbers of TUNEL-positive cells were significantly lower than those in the control group (P < 0.05), but there were no significant differences between the two preconditioning groups. CONCLUSIONS: These results suggest that ischemic and hypoxic preconditioning in the neonatal rat attenuate the apoptosis that is caused by hypoxic-ischemic brain injury.

Anesthesia in a Patient with Brugada Syndrome without a Characteristic ECG Pattern: A case report / 대한마취과학회지

Brugada syndrome is characterized by an ECG pattern of right bundle branch block and ST segment elevation in right precordial leads (V1 to V3), without structural heart disease. However, these ECG manifestations transiently normalize in up to 40% of cases. Brugada syndrome is responsible for up to one half of all sudden cardiac deaths in young adults and they may be worsened by beta blockers. We present the anesthetic management of a patient with Brugada syndrome without the characteristic ECG pattern.

Effects of Nicardipine on Changes of Blood Pressure and Heart Rate during Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Laryngoscopy, tracheal intubation and the suspension laryngoscopy often provoke an undesirable increase in blood pressure and/or heart rate during laryngeal microscopic surgery. Thus, the anesthesiologist's objectives are to maintain sufficient anesthetic depth and to promote rapid awakening. Nicardipine, a direct arterial dilator, can be used to attenuate increasing blood pressure. We investigated the effects of nicardipine on changes of blood pressure and heart rate during laryngeal microscopic surgery. METHODS: Eighty patients of ASA class 1 or 2 scheduled for laryngeal microscopic surgery were randomly allocated into 4 groups. For anesthetic induction, IV propofol 1.5 mg/kg, rocuronium 0.4 mg/kg, and glycopyrrolate 0.2 mg were administered followed by mask ventilation for 5 minutes with isoflurane. One minute before tracheal intubation and suspension laryngoscopy saline, nicardipine 10, 20, or 30microgram/kg was injected in each group. Thereafter we measured blood pressure and heart rate one minute after each procedure. RESULTS: Increases in blood pressure were blunted in the nicardipine 20 and 30microgram/kg group. In the nicardipine 30microgram/kg group, heart rates were significantly increased and facial flushing was observed in two patients. CONCLUSIONS: We suggest that nicardipine 20microgram/kg can alleviate blood pressure increases with little effect on heart rate during laryngeal microscopic surgery. However, although nicardipine 30microgram/kg could blunt blood pressure increases, it produces tachycardia and perhaps overdose.

Effect of Inducible Nitric Oxide Synthase Inhibitor on Apoptosis in Hypoxic-Ischemic Injury of the Neonatal Rat Brain: 1H Magnetic Resonance Spectroscopy Study / 대한마취과학회지

BACKGROUND: Inducible nitric oxide synthase (iNOS) is expressed during the late stage of ischemia and may play an important role in the delayed progression of ischemic brain injury. This study was conducted to investigate the effect of N-(3-[aminomethyl] benzyl] acetamidine (1,400 W), a selective inhibitor of iNOS on hypoxic ischemic injury in a neonatal rat model. METHODS: Seven-day old Sprague-Dawley rats were used. The right common carotid artery was ligated under halothane anesthesia. Three 3 hours after recovery, animals were exposed to 8% oxygen in 92% nitrogen. The treatment group (n = 14) received 7 intraperitoneal injection of 20 mg/kg of 1,400 W. The first dose was given 18 hours after the injury and interval between injections was 8 hours. The control group (n = 13) did not receive 1,400 W. The degree of ischemic damage and apoptosis were evaluated 3 days after injury by 1H magnetic resonance spectroscopy (MRS) and terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end-labeling (TUNEL) staining. The authors obtained Lipid/N-acetyl aspartate (Lip/NAA) and lipid/ creatine (Lip/Cr) ratios as apoptotic markers via 1H MRS, and counted the apoptotic cell number by TUNEL staining in the right hemisphere. Data were analyzed using the unpaired t-test. RESULTS: There were no significant differences in the Lip/NAA or Lip/Cr ratios of the 2 groups, and no significant differences were found in terms of the number of TUNEL positive cells between 2 groups, either. CONCLUSIONS: The iNOS inhibitor investigated did not show protective effects against delayed neuronal damage and apoptosis after the hypoxic-ischemic injury in newborn rats, at least during the 3 days following injury. Our results suggest that NO has different roles in cerebral hypoxia-ischemia according to the stage of neonatal cerebral development.

The Effects of Perfluorocarbon on Respiratory Mechanics and Pulmonary Gas Exchange with Methacholine-induced Bronchoconstriction in Cats / 대한마취과학회지

BACKGROUND: Perfluorocarbon (PFC) liquids have high oxygen carrying capacity and relatively low surface tension allowing them to spread evenly through the diseased lung, especially in the case of adult respiratory distress syndrome. But few studies have demonstrated the effects of PFC on a bronchoconstriction model. The aim of this study was to investigate the effects of PFC on pulmonary mechanics and gas exchange in methacholine-induced bronchoconstricted cats using a flow interruption technique. METHODS: Twenty male cats were divided into four groups; control group (group C, n = 5), PFC group (group P, PFC 5 ml/kg, n = 5), methacholine group (group M, 25 microgram/kg/min, n = 5), PFC and methacholine group (group MP, n = 5). Respiratory pressure using a flow interruption technique was measured immediately after stabilizing the heart rate and blood pressure 0, and 15, 30 and 60 min after the start of the intratracheal administration of PFC and/or methacholine infusion, depending on the group. Arterial blood gas analysis was done to compare arterial partial oxygen pressure among the groups at the time of measuring the pressure values. The pressure data was transferred to a personal computer and analyzed using ANADAT software program. Respiratory, airway and tissue viscoelastic pressure were calculated. Statistical analysis was done by ANOVA and statistical significance was defined as P <0.05. RESULTS: Group M and MP showed significantly increased airway pressures compared with group C (P <0.05), but there was no difference among the groups in terms of viscoelastic pressure. Arterial blood gas analysis showed that group P and MP had lower arterial partial oxygen pressures than group C (P <0.05). CONCLUSIONS: This study demonstrates that the intratracheal administration of PFC in a bronchoconstriction cat model increases airway pressure more than tissue viscoelastic pressure, and decreased arterial oxygen partial pressure. We conclude that the intratrachel administration of PFC is not to be recommended in bronchoconstrictive situations.

The Effect of alpha2 Adrenergic Agonists and Norepinephrine on Mechanical Allodynia by Freund's Complete Adjuvant Induced Inflammation in Rats / 대한마취과학회지

BACKGROUND: The Freund's complete adjuvant (FCA)-induced inflammation may produce allodynia against a touch stimulus. The antiallodynic effects of brimonidine, a new selective alpha2 receptor agonist, and of rilmenidine, a new more selective imidazoline receptor agonist, have not been evaluated in rats with FCA induced inflammation. Therefore, we investigated the sympathetic component of mechanical allodynia after the development of allodynia secondary to FCA-induced inflammation in rats. METHODS: A lumbar intrathecal catheter was implantated in male Sprague Dawley rats. Inflammation was induced by the intradermal injection of 0.15 ml FCA under enflurane anesthesia. Using Von Frey filaments, the antiallodynic effects of intrathecal (I.T.) brimonidine (1, 3 microgram), rilmenidine (30, 100 microgram) and saline were examined. In antagonistic study intrathecal yohimbine 30 microgram and rauwolscine 30 microgram were administered to investigate the reversal of the antiallodynic effect by each agonist. We also examined the effects of intradermal norepinephrine followed by I.T. brimonidin, rilmenidine or saline on the withdrawal threshold of rats secondary to allodynia induced by FCA. RESULTS: I.T. brimonidine or rilmenidine produced dose-dependent antiallodynic effect and which were moderately antagonized by I.T. yohimbine or rauwolscine. Intradermal norepinephrine produced a reduction in the withdrawal threshold in rats. CONCLUSIONS: Our results suggest that a sympathetic component is likely to be involved in the mechanism of allodynia secondary to FCA-induced inflammation.

Airway Partial Obstruction by Internal Hermiation of Armored Endotracheal Tube: A case report / 대한구급학회지

During general anesthesia, intubation with kink-resistant armored tubes permit the anesthesiologist to work some distance from the surgical field during operation on the head and neck or with patients whose unusual position may kink and obstruct a tube not so reinforced. But armored tubes are still subject to number of hazards, including herniation of the intra-luminal cuff or layer into the lumen of the tube. So extra care is required in their use. We report a case of intraluminal herniation of armored tube accompanied with peak inspiratory pressure during general anesthesia.

Effects of Poly (ADP-ribose) Polymerase Inhibitor on Hypoxic-ischemic Injury in the Neonatal Rat Brain: 1H Magnetic Resonance Spectroscopic Study / 대한마취과학회지

BACKGROUND: Poly (ADP-ribose) polymerase (PARP) has been described as an important candidate for mediation of neurotoxicity after brain ischemia. This study was purposed to evaluate the effects of a PARP inhibitor on hypoxic-ischemic injury in the neonatal rat brain. In this study, a highly potent inhibitor of PARP, 3, 4-Dihydro-5-[4-(1-piperidinyl) butoxy]-1 (2H)-isoquinolinone (DPQ) was investigated. METHODS: Seven-day old Sprague-Dawley rat pups were used. The right common carotid artery was ligated under halothane anesthesia. After a recovery period of 3 hours, they were exposed to 8% oxygen at 37degreesC for about 120 minutes. The animals were divided into four groups: the pre-treatment group (n = 13) and post-treatment group (n = 21) were given DPQ 10 mg/kg and the pre-control group (n = 7) and post-control group (n = 14) were given a vehicle for controls. Pre-treatment and pre-control groups were injected 30 minutes prior to the hypoxic injury while post-treatment and post-control groups were injected 30 minutes after the hypoxic period intraperitoneally. The right cerebral hemisphere of the rats were examined with localized (1)H magnetic resonance spectroscopy on day 1 and 7 after the hypoxic insult. Lipid/N-acetyl aspartate (Lip/NAA) and lipid/creatine (Lip/Cr) ratios were used as apoptotic markers. On day 14, the degree of brain injury was scored by morphological changes. RESULTS: In the DPQ treated groups, the Lip/NAA and Lip/Cr ratios were lower than those of the control groups on day 1 after the hypoxic-ischemic injury (P < 0.05). However on day 7, only the ratios of the pre-treatment group were lower than those of the control group (P < 0.05). The degree of morphological changes of the brain injury on day 14 were lower in the DPQ treated groups (P < 0.05). CONCLUSIONS: These results suggest that DPQ exerts a neuroprotective effect in cerebral hypoxic-ischemic injury probably by inhibiting apoptosis especially in the early stage after an insult. Acute inhibition of PARP can have a therapeutic value in preventing ischemic brain injury.

Measurement of Auto-PEEP in Anesthetized Patients Using a Laser-Flex Endotracheal Tube with Changes in Respiratory Rates and Tidal Volume / 대한마취과학회지

BACKGROUND: The aim of the present study was to detect and quantify auto-positive end-expiratory pressure (auto-PEEP) in anesthetized patients using a Laser-Flex endotracheal tube (Mallincrodt, ID, 6.0 mm), by comparing the effects of changes in tidal volume and respiratory rate. METHODS: All patients (n = 30) undergoing elective surgery were anesthetized, paralyzed and intubated with a ID 8.0 mm endotracheal tube (n = 10, control), ID 6.0 mm endotracheal tube (n = 10, group S), or ID 6.0 mm Laser-Flex endotracheal tube (n = 10, group L), respectively. After anesthetic induction, ventilator settings using a Siemens Servo 900C were changed for a tidal volume of 8, 10 ml/kg, respiratory rates of 10, 12 or 14 breaths/min. Peak airway pressure was measured and auto-PEEP was quantified using an end-expiratory occlusion method. Data recorded on the Bicore CP-100 pulmonary monitor was transfered to a PC and analyzed by processing software (ANADAT). RESULTS: In group S and L, peak airway pressure and auto-PEEP were higher than control group and increased during an increase in tidal volume (P < 0.05). But they were increased significantly during an increase of respiratory rate, only when the tidal volume was 10 ml/kg (P < 0.05). CONCLUSIONS: There was an increase of auto-PEEP in anesthetized patients using a Laser-Flex endotracheal tube during incremental changes of tidal volume and respiratory rates.

The Distribution of Medical Personnel and Medical Equipments in the Intensive Care Units in Korea / 대한구급학회지

BACKGROUND: Not much of the fund is invested in the intensive care unit (ICU) in Korean hospitals since the cost of ICU care is set too low compared to the other medical fields as well as to the other part of the world. This study is designed to support the base of an ICU standard guideline in Korea. METHODS: The questionnaire were sent to 73 ICUs and 24 neonatal ICUs (NICU) of 30 hospitals. Twenty-two of them were teaching hospitals and 8 of them were general hospitals. RESULTS: The ratios of ICU bed number to total bed number were 5.0% and 6.0% in teaching hospital and general hospital respectively. The ratios of NICU bed to total bed were 3.4% and 2.0% in teaching hospital and general hospital respectively. Intensivists were kept in 24.6% of ICU and 36.4% of NICU. Residents were kept in 43.1% of ICU and 45.5% of NICU. The utilization of ICU service was 90% for teaching hospital and 86% for general hospital. The utilization of NICU was 89% for teaching hospital and 3% of general hospital. Nurse to patient ratios varied widely. Most ICUs in teaching hospital showed the nurse to patients ratio of 1 : 4 which was about 32% of total ICU. Most NICUs in teaching hospital showed the nurse to patients ratio of 1 : 5 which was around 20% of total NICU. Most of the ICUs were equipped with central piping system for oxygen and compressed air supply, vacuum system and all the necessary medical gadgets such as mechanical ventilators, ECG monitors, defibrillators, pulse oximeters and infusion pumps. CONCLUSIONS: The distribution of medical personnel as well as medical equipments were varied widely. The variation existed between teaching hospital and general hospital as well as within the teaching hospitals. We need to establish a standard, which grades the level of ICU according to the number of keeping physician, nurse-patients ratio, and the types of medical equipments they have.