The Comparison of the Characteristics of "Nonspecific ST-T Change" Patients in Perioperative Periods / 대한마취과학회지

BACKGROUND: ST changes that do not fulfill the criteria of specific one-ST changes greater or equal to 1 mm and lasting over 1 minute-, are termed as "nonspecific". The term, "nonspecific ST-T change", has not had an important role as a guildeline of treatment. However, the incidence of "nonspecific ST-T changes" is estimated as not so negligible, and the relation to postoperative complications or the role as a coronary prognostic risk value has not been studied so far, so the authors thought to examine the general characteristics and course during the perioperative period of "nonspecific ST-T change" patients to conduct better anesthesia services. METHODS: From January 1st to June 30th in the year 2000, medical charts of patients who underwent an operation in one university hospital under general or regional anesthesia and whose preoperative electrocardiographic finding was "nonspecific ST-T changes" were reviewed. In the preoperative viewing of charts, demographic data, co-existing disease, findings in electrocardiography or echcardiography, and replies of a consultation to a cardiologist were reviewed. In the anesthesia records, nature of conducted anesthesia, agents, operation time and drugs acting on the cardiovascular system were reviewed. RESULTS: Incidence of "nonspecific ST-T changes" patients is 8.24%. Mean age is 54 +/- 16 yrs and the ratio of M : F is about 1 : 2. The number of patients who had other medical diseases was 42, about 27%. The number of patients who underwent a preoperative echocardiography was 64, about 42%. Mean ejection fraction was 65 +/- 7%. The number of patients who consulted a cardiologist preoperatively was 44, about 22% and the majority of them were OK'd as "no problem". Administration of drugs acting on the cardiovascular system was done in 49 cases, about 33%. General anesthesia was conducted in 131 cases, regional anesthesia in 23 cases. CONCLUSIONS: In all cases, operations were performed without specific events or major complications. However more attention and risk evaluation is desirable in "nonspecific ST-T change" patients to conduct safer and more ideal anesthesia.

Anesthetic Management for Cervicothoracic Sympathectomy in a Patient with Congenital Long QT Syndrome / 대한마취과학회지

A 23-year-old female patient was diagnosed with congenital long QT syndrome, discovered when she visited our cardiac department due to chest discomfort, because she had a prolonged QTc interval on ECG, history of syncopal attacks and seizures several times every year, and ingestion of anticonvulsants for several years. It is well known that the long QT syndrome is associated with sudden death secondary to ventricular tachyarrhythmia or fibrillation at a young age. Moreover cardiac arrests during induction, maintenance, and awakening of anesthesia of these patients have been reported, and may be due to asymmetrical adrenergic stimuli in the heart, especially in the unrecognised case. This case report describes the anesthetic management of a patient with congenital long QT syndrome, who presented for cervicothoracic sympathectomy for a more permanent control of life-threatening ventricular arrhythmias, and reviews the related literature.

Preoperative Evaluation of Diabetic Autonomic Neuropathy by Power Spectral Analysis / 대한마취과학회지

Background: The aim of this study is to investigate the changes in the patterns of power spectra of R-R interval variability of diabetic patients who are subject to autonomic neuropathy. Methods: The changes in power spectra of eight diabetic patients were compared with those of eight normal persons while changing positions from supine to Trendelenburg and from supine to standing each. Results: Low, high and total frequency power densities of diabetic patient group were significantly lower than those of control group in resting supine position. Low frequency power density and ratio of low frequency power to high frequency power of control group increased significantly while changing position from supine to standing compared with those of diabetic patient group. And low frequency power density of control group decreased significantly compared with that of diabetic patient group while changing position from supine to Trendelenburg. Conclusions: The decrease in power densities of low, high and total frequency suggest depressed overall autonomic activities in diabetic patient group and significantly decreased changes in low frequency power and ratio of low frequency power to high frequency power while changing positions from supine to standing suggest attenuated sympathetic activity in diabetic patient group, reflecting autonomic changes in diabetic group rapidly.