Anesthetic Management of Laparoscopic Adrenalectomy for Pheochromocytoma / 대한마취과학회지

Currently-available imaging techniques provide accurate localization of a tumor in patients with pheochromocytoma. The precision of this information allows the use of a more selective surgical approach to the tumor, such as by laparoscopy. We describe a case of a 54-year-old female who underwent resection of pheochromocytoma by a laparoscopic approach. Two events resulted in significant hemodynamic changes; the creation of the pneumoperitoneum and adrenal gland manupulation. Preoperative preparation with alpha-adrenergic blocking agents and adequate fluid loading before insufflation attenuated intraoperative cardiovascular changes, while titration of sodium nitroprusside and phentolamine allowed easy and quick control of the hemodynamic aberrances related to these processes. As a result, the operation was carried out safely, and the postoperative course was unremarkable.

Atrial Fibrillation Developed after Induction of General Anesthesia in an Elderly Patient: A case report / 대한구급학회지

It is known that the incidence of arrhythmia related to anesthesia and operation is significantly higher in thoracic surgery such as cardiac, lung operation than any other operation, and atrial fibrillation is the most common arrhythmia among these arrhythmias. Besides operative sites, age and underlying cardiac problem such as hypertension, cardiomegaly can be important risk factors for intra, post-operative atrial fibrillation in non-thoracic surgery. Through many investigations, we can find that age is the most important because age related anatomical, physiological cardiac changes make elderly patients more susceptible to development of atrial fibrillation. In this case, we report atrial fibrillation that occurred after induction of general anesthesia in an elderly patient undergoing open reduction of upper arm fracture.

Comparion of Single Bolus with Divided Doses of Rocuronlum for Tracheal intubation / 대한마취과학회지

BACKGROUND: Onset of rocuronium is rapid but relatively large doses are needed to achieve a suitable intubating condition. So we compared the single bolus injection with divided injection of rocuronium about tlie onset time, intubation time and intubating condition. METHOD: Thirty patients were divided into three groups of 10 each randomly. Patients in group I were given a single dose of 0.6mg/kg rocuronium. Those in group 2I or 3 received 0.06 mg/kg or 0.09 mg/kg as priming dose followed by 0.54 mg/kg and 0.81 mg/kg as intubating dose 3 min. later. The train of four responses of adductor pollicis muscle was recorded using Paragraph(Utah Medical Product Inc. Midvale Utah, U.S.A.) every 10 seconds. The trachea was intubated by one clinician who was blinded to the muscle relaxant administered when he thought the patients were suitable for intubation, and he recorded the intubating conditions. The endotracheal intubation time and twitch height at the moment was recorded by other clinician. The onset time was recorded when the post tetanic count is marked as '0'. RESULT: The onset time of group 1, 2, and 3 were 90.0+/-22.lsec, 109.0+/-35.0 sec and 85.0+/-35.0 sec. respectively. Endotracheal intubation times were 77.0+/-10.6sec, 60.0+/-10.0sec and 44.0+/-5.2sec respectively. CONCLUSION: There was no differences about onset time between single and devided injection with same total dose or incremental dose of 0.9mg/kg. But the intubation time was faster in priming group with dose dependent manner, and the intubating conditions were excellent to good in all patients.