Histologic Changes of Pulmonary Arteries in Congenital Heart Disease with Left-to-Right Shunt (Part 2): Emphasis on the Significance of Pulmonary Arterial Concentration in the Correlation with Pulmonary Hemodynamics after Repair Ed- The Above is An Altern

We performed this study to assess the correlation of residual pulmonary hypertension in the immediate postoperative period with that in the late follow-up period, to assess the histologic changes of pulmonary arteries (PA) at the time of repair for patients with congenital heart disease consisting of left-to-right shunt, and to clarify the role of lung biopsy in determining the operability and reversibility of pulmonary vascular changes. Lung biopsy was performed during repair in 38 patients, with a wide range of age, who had congenital left to right shunt and pulmonary hypertension. All were Heath-Edward grade III or less. Morphometric study included measurement of medial wall thickness (MWT) and decrease rate of pulmonary arterial concentration (PAC). Mean PA pressure in the immediate postoperative period was measured in all 38 patients. Follow-up cardiac catheterization was performed in 15 patients (average 3.8 years after repair). At operation, 5 patients of this late follow-up group were under 2 years of age and the other 10 were 2 or more. During catheterization, pulmonary hemodynamic reaction was observed both under room air inhalation and after inhalation of hypoxic gas FiO2 0.15. Mean PA pressure and pulmonary vascular resistance (PVR) in the immediate postoperative period had a significant correlation with PA pressure and PVR values before the operation, but not with morphometry, Heath-Edward grade, or with pulmonary hemodynamics in late follow-up. During the late follow-up study, 5 of the 15 patients had pulmonary hypertension (defined as mean PA pressure > or = 15 mmHg) under room air inhalation, and PA hypertension was induced in 4 additional patients after hypoxic gas inhalation. There was no incidence of PA pressure or PVR values registering above the preoperative level. The degree of PA hypertension showed a correlation with the rate of PAC decrease and also with patients' age-at-operation. Multiple regression analysis showed that both the rate of PAC decrease and the age-at-operation contributed significantly to the degree of PA hypertension. Some of the patients over age 2 had a decreased rate of PAC above the regression line, which none of the patients under age 2 experienced. In patients with Heath-Edward grade III or less, residual pulmonary hypertension in the immediate postoperative period was not correlated with histology, but in late follow-up, it was with PAC and the age-at-operation. Therefore, a decrease of PAC is assumed to be a totally or partially irreversible pulmonary vascular change depending on the patient's age-at-operation, while medial hypertrophy is thought to be a reversible pulmonary vascular change. Lung biopsy could play an important role in determining the reversibility of pulmonary vascular obstruction, particularly in patients older than 2 years. Ed- re highlights above: such hyphenation is optional, but if used then it should be applied consistently throughout the paper. As 3 of the 4 entries in the abstract use it, I have maintained it consistently below.

Blood gas and electrolyte changes after tourniquet application in total knee replacement surgery

The tourniquet is widely used in upper and lower extremity surgery in orthopedic practice. However, safe working guidelines for the application of the tourniquet are not clearly defined. The use of a tourniquet is an important step in performing total knee arthroplasty, and it seems plausible that mechanical damage is directly related to the height and the duration of the pressure of the tourniquet applied. Even the tourniquet pressure which is widely accepted in clinical practice, if it is applied for several hours, would permanently damage not only tissues directly under the tourniquet but also the muscles and the nerves distal to the tourniquet. The resultant ischemia to limb produces local changes including hypoxemia, acidosis and hyperkalemia. Relatively little is known about the systemic effects of tourniquet release when the patient is undergoing total knee replacement surgery under a general anesthesia. Therefore, we studied the systemic effects. The results were as follows: 1) Approximately five minutes after the tourniquet was released there was a statistically significant increase in mean heart rate.: 2) Serum potassium levels tended to increase significantly until five minutes while the serum sodium level rose significantly only one minute, and the lactate level rose significantly for only two minutes after tourniquet released; 3) PaCO2 increased for five minutes after tourniquet release and remained elevated for 30 minutes; 4) PaO2 did not change significantly two minutes after tourniquet release; 5) The mean pH dropped to 7.34 and remained low for over five minutes.

Complications of Artificial Airways / 대한마취과학회지

Artificial airways have been widely used to keep patency of airway and apply respiratiory care, however those airways may cause frequent and severe complications. Many etiologic factors have been implicated in the development of these problems with the exact reasons being as yet unknown. The purpose of this study was to assess the incidence, evolution and long-thrm effects of complications following artificial airways and to evaluate the effect of complications following artificial airways and to evaluate the effect of factors in the genesis of those complications. 332 consecutive patients admitted to Intensive Care Unit in Shinchon Severance Hospital over a 6-month period from March to August, 1990 were studied who had been intubated or tracheostomied. 1) Complications following artificial airways occurred in 58 patients among 332 patients and the rate of complication was 17.5% and the total number of complication was 63 cases. 2) There was no significant relationship between the rate of complications and patient's demographic factors, such as age and sex. 3) There was statistic significance between the rate of complications and factors such as frequencies of intubation and drugs used for intubation such as sedatives and muscle relaxants. 4) As frequency of intubation increased once, the rate of complication increased about twice. 5) The rate of complications in the patients without sedatives and muscle relaxants at intubation was 2.34 times greater than in those administered either medications.

Roentgenographic Confirmation of Central Venous Catheter Tips Through the Basilic and External Jugular Veins / 대한마취과학회지

Catheterization of the innominate or superior vena caval vein via the basilic, external jugular and internal jugular veins was attempted in 103 adult and pediatric patients scheduled for cardiovascular and pulmonary surgery. Both basilic veins were used in 43 patients, and malposition of the cathether tips occured in 23% of the cases. The site of malposition was often the ipsilateral internal jugular vein. Both external jugular veins were utilized in 58 cases, and the malposition was 17%. The ipsilateral internal jugular vein was also the most common site of malpogition. Catheter curling was noted in 3 patients. One case of premature ventricular contraction was observed on the E.K.G monitor during catheterization, but disappeared as soon as the catheter was withdrawn. Difficulty was encountered in the passage of the catheter in 9% of the cases using the basilic vein and in 40% using the external jugular vein.