The Effect of Sevoflurane Anesthesia on the Phase Relationship between Systolic Blood Pressure and Heart Rate / 대한마취과학회지

BACKGROUND: The phase relationship indicates the time delay between the input signal (systolic blood pressure, SBP) and output signal (R-R interval, RRI). In contrast to the awake state, little is known about the effects of general anesthesia on the phase shift. In the present study, we tested the hypothesis that sevoflurane anesthesia causes a phase change between the two signals. METHODS: We assessed changes in phase, coherence, and baroreflex sensitivity between SBP and RRI by the use of transfer function analysis in 50 ASA 1 patients during the awake state and during end-tidal 2% sevoflurane-50% N2O anesthesia. RESULTS: SBP and RRI decreased significantly during sevoflurane anesthesia (P < 0.001). The phase in the low frequency (LF) region remained unchanged, but the phase in the high frequency (HF) region changed significantly from -29.52 +/- 50.70 to 27.28 +/- 80.22 degrees during sevoflurane anesthesia (P < 0.001). Coherence and baroreflex sensitivity between the two signals in the LF and HF regions decreased significantly during sevoflurane anesthesia (P < 0.001, respectively). CONCLUSIONS: We found that in the HF region and not in the LF region, sevoflurane anesthesia provokes the shift of the SBP-RRI phase relationship, suggesting that this change is inconsistent with a vagally mediated response.

Left Atrial Thrombus Diagnosed by Transesophageal Echocardiography Immediately after Induction in a Patient with Middle Cerebral Artery Infarction: A case report / 대한마취과학회지

Stroke is one of the most common causes of death; in particular, cardiac source of embolism may be responsible for 15-20% of ischemic strokes. Here we report a case of left atrial thrombus diagnosed by transesophageal echocardiography (TEE) immediately after induction of general anesthesia in a patient with infarction of the middle cerebral artery. In this case, an emergent craniectomy was cancelled and medical treatment was performed. This case report shows that TEE taken in the operating room may play an important role in the change of treatment plan in a patient displaying acute mental change.

Intrathecal Phenol Saddle Block in Bladder Cancer Patients: Two case reports / 대한마취과학회지

We encountered two bladder cancer patients who suffered from perineal pain that was intractable despite the use of adjuvant medication. A phenol intrathecal (saddle) block was performed without any specific complications. The results were excellent and allowed the systemic opiate dose to be reduced by more than 80%. We report our clinical experience, including a brief review of the relevant literature.