Anesthetic Management for a Patient with Charcot-Marie-Tooth Disease Using Propofol and Rocuronium / 대한마취과학회지

This case involves a 43-year-old man who had been diagnosed as having Charcot-Marie-Tooth disease (CMTD) 9 years ago and was scheduled to undergo posterior fusion of its spine due to a compression fracture. General anesthesia using propofol was selected as the anesthetic method, in order to avoid the occurrence of malignant hyperthermia due to inhalation anesthetics. The patient was given 100 mg of propofol for anesthetic induction, and then propofol was infused at a rate of 4-5 mg/kg/h with intermittent administration of fentanyl for anesthetic maintenance. Rocuronium 50 mg was injected for endotracheal intubation, and then rocuronium 10 mg was injected at 45 min intervals. There was no delay in awakening, and the patient experienced no problems postoperatively. Intravenous anesthesia using propofol is thought to be a safe and effective method of anesthesia for patients with CMTD.

Anesthetic Experience of a Patient with Chronic Hypoventilation Syndrome: A case report / 대한마취과학회지

Alveolar hypoventilation exists by definition when arterial PaCO2 increases above the normal range of 37 to 42 mmHg, but in clinically important hypoventilation syndromes PaCO2 is generally in the range of 50 to 80 mmHg. The management of chronic hypoventilation must be individualized to the patient's particular disorder, circumstances and need. This is a case report of anesthetic management of a 63-year-old woman with central alveolar hypoventilation (CAH) secondary to cerebral infarction. For hip surgery epidural anesthesia with 0.5% bupivacaine was performed and doxapram was applied to maintain respiratory drive. The anesthetic experience with a brief review of literature is reported.

The Effects of Phenylephrine on Hemodynamics in Patients with Chronic Pulmonary Hypertension Compared to Patients without Chronic Pulmonary Hypertension / 대한마취과학회지

BACKGROUND: Increasing coronary perfusion pressure with phenylephrine is important treatment strategies for right ventricular dysfunction caused by pulmonary hypertension. We compared the effects of phenylephrine on systemic and pulmonary hemondynamics in patients with and without pulmonary hypertension. METHODS: Twenty patients undergoing a valvular replacement were divided into two groups according to pulmonary artery pressure (PAP): control group (mean PAP 25 mmHg, n = 11). When systolic blood pressure decreased below 100 mmHg after the induction of anesthesia, phenylephrine was infused to raise systolic blood pressure up to 30% and 50% over baseline. Hemodynamic variables were measured at each time. RESULTS: Phenylephrine failed to raise systolic blood pressure up to 50% above baseline in more than half of the patients with pulmonary hypertension in contrast to successful increases in all patients without pulmonary hypertension. However, the ratio of PAP to systolic blood pressure was significantly reduced in patients whose systolic blood pressure was successfully increased up to 50% over baseline in the pulmonary hypertension group whereas the PAP concomitantly increased as systolic blood pressure was increased in the control group. CONCLUSIONS: Phenylephrine couldn't increase systolic blood pressure in some patients with pulmonary hypertension unlike in control group and it seemed to occur more often in patients with greater the ratio of PAP to systolic blood pressure. The baseline systemic vascular resistance index was high and cardiacoutput was low in the pulmonary hypertension group and these conditions seemed to restrict the effect of phenylephrine.