The value of end -tidal carbon dioxide partial pressure in fluid resuscitation in severe acute pancreatitis patients / 中国基层医药

Objective To investigate the value of end-tidal carbon dioxide partial pressure (PET CO2 )in fluid resuscitation in severe acute pancreatitis(SAP)patients.Methods SAP patients under mechanical ventilation with the need of a fluid challenge test were included.Hemodynamic parameter cardiac index(CI)and PET CO2 were conducted before and after the fluid challenge test.The value of ΔPET CO2 was used to predict fluid responsiveness. Results Totally 43 patients with SAP were prospectively recruited.31 patients had volume responsiveness, 12 patients had no volume responsiveness.Compared with no volume responsiveness group,volume responsiveness group led to a greater increase in ΔCI[(0.9 ±0.3)vs.(0.2 ±0.3),t =3.24,P <0.05]and ΔPET CO2 [(4.1 ± 1.9)vs.(0.7 ±1.2),t =4.01,P <0.05].ΔPET CO2 and ΔCI were correlated(r =0.74,P <0.05).The area under ROC curve of ΔPET CO2 was 0.872(95% CI 0.754 ~0.923,P <0.05).An increase of 5% in ΔPET CO2 predicted fluid responsiveness with a sensitivity of 86.7%,and specificity of 89.5%.Conclusion The change of ΔPET CO2 induced by fluid challenge test is an effective way to predict fluid responsiveness in SAP patients.

Hemodynamic Effects of Propofol Anesthesia on Cesarean Section Patients / 대한마취과학회지

BACKGROUND: It is already known that systemic vascular resistance (SVR) is decreased during pregnancy. In addition, one of the large hemodynamic changes when using propofol is also a decrease in SVR, more profoundly than is found with enflurane. It might therefore be suggested that hemodynamic changes are more prominent in cesarean section during propofol anesthesia, compared with enflurane anesthesia. This study was designed to investigate these possible changes by propofol anesthesia. METHODS: One hundred thirty six women for elective cesarean section were involved in this study. They were divided into 2 groups: group E (n = 74), anesthesia with thiopental, enflurane, and N2O, and group P (n = 62), anesthesia with propofol and N2O. All patient were given glycopyrrolate as premedicants. The hemodynamic variables (MAP, HR, CO, CI, SVR, SVRI, SI, and EF) were measured by bioimpedence at the five different time points: at preoperation, after induction, after intubation, during push abdomen, and after delivery. RESULTS: The variables of hemodynamics did not change significantly when both groups were compared, except that MAP, SVR and SVRI at after induction and HR during push and after delivery in group P were lower compared with respective variables in group E. CONCLUSION: From these results, we concluded that there were no significant changes in cardiovascular system (CVS) by propofol anesthesia, compared with enflurane anesthesia in cesarean section patients. It is therefore suggested that propofol anesthesia is safe in considering hemodynamics for cesarean section.

The Effects of Isovolemic Hemodilution on Hemodynamic Changes in Myocardial Ischemia-Induced Dogs / 대한마취과학회지

BACKGROUND: Anesthesiologists often encounter patients who have acute, massive blood loss and severe hemodilution as the result of fluid therapy in the operating room. It is known that patients with normal heart function survive at hemoglobin 4 6 g/dl. Recently, the incidence of elderly patients with ischemic heart disease have been increasing progressively but studies about critical hematocrit level in patients with ischemic heart disease are rare. This study, therefore, was designed to evaluate the hemodynamic response of isovolemic hemodilution in myocardial ischemia-induced dogs. METHODS: In 12 anesthetized dogs, a Swan-Ganz catheter and left ventricle catheter were inserted and hemodynamic parameters were measured as control values. Myocardial ischemia was induced with a left anterior descending (LAD) coronary artery ligation. Thereafter, isovolemic hemodilutions were done several times to set the hematocrit levels of 36%, 31%, 26%, 21%, 16%, and 11%. Records and samples for hemodynamic parameters were obtained after LAD ligation and at each hematocrit level. RESULTS: There were significant decreases in diastolic blood pressures in hematocrits 21%, 16%, 11%, in mean arterial pressures in hematocrits 16%, 11% and in systolic blood pressure in hematocrit 11% (P < 0.05). Oxygen delivery progressively decreased in hematocrits 36%, 31%, 26%, 21%, 16% and 11% (P < 0.05). Oxygen extraction ratios progressively increased and were statistically significant in hematocrits 21%, 16% and 11% (P < 0.05). Arterial blood gases showed metabolic acidosis in hematocrits 16% and 11%. There was decreased PCO2 in hematocrit 11% (P < 0.05). Mixed venous blood oxy-hemoglobin saturation decreased in hematocrit 16% and 11% (P < 0.05). Other variables were not significant. CONCLUSIONS: Blood pressure decreased at hematocrit 16% so it is necessary to maintain a hematocrit level above 21% at least in cardiac depressed dogs.

Changes of Hemodynamics and Nitric Oxide during Liver Ischemia/Reperfusion of Pig / 대한마취과학회지

BACKGROUND: Surgical hepatic inflow obstructions such as the Pringle Maneuver (PM) or hepatic vascular exclusion (HVE) can reduce bleeding during hepatic resection, but ischemia/reperfusion injury of the liver and systemic hemodynamic changes are also inevitable during and after PM or HVE. Nitric oxide plays a pivotal role in ischemia/reperfusion injury. We evaluated hemodynamic changes and changes of nitric oxide during liver ischemia/reperfusion injury excluding the effects of intestinal ischemia. METHODS: Liver ischemia was induced by clamping of the portal triad, infrahepatic and suprahepatic inferior vena cava for 90 minutes. To exclude the effects of intestinal ischemia during liver ischemia, portal and iliac venous blood was bypassed to the jugular vein using a pump. Hemodynamic parameters and nitric oxide were measured serially; before and during ischemia, and after reperfusion. RESULTS: Mean arterial blood pressure (MAP) was well-maintained during ischemia, but after reperfusion, MAP, cardiac output (CO) and stroke volume (SV) significantly decreased (35 - 40, 30 - 40 and 30%, respectively) postischemia. Compared to preischemia, systemic vascular resistance and heart rate did not change after reperfusion. Pulmonary vascular resistance and mean pulmonary arterial blood pressure significantly increased (220 - 250% and 60 - 70%) after reperfusion. Nitric oxide (NO) did not change until 20 minutes after reperfusion, but after 40 minutes reperfusion, NO significantly decreased (20%) compared to preischemia. CONCLUSIONS: After 90 minutes warm liver ischemia/reperfusion causes hypotension induced by decreased CO and SV. Increased PVR seems to be the cause of decreased CO and SV. NO-SVR interaction does not seem to be the cause of postreperfusion hypotension.

Hemodynamic Effects of Combination of General and Caudal Anesthesia in Children / 대한마취과학회지

BACKGROUND: Caudal anesthesia has gained wide acceptance in pediatric anesthesia as a technique for providing postoperative pain relief and reducing general anesthetic requirement for surgical procedures below umbilicus. Although blood pressure has been shown to be well maintained with caudal anesthesia in pediatrics, little is known about the change in hemodynamics with combined general and caudal anesthesia. This study was designed to investigate the hemodynamic changes of combined general and caudal anesthesia for lower abdominal surgery in children. METHODS: Sixty children scheduled for lower abdominal surgery were involved. They were randomly divided into 2 groups: group G (n = 30); anesthesia with enflurane and N2O, and the group GC (n = 30); anesthesia with combined caudal block using 1% lidocaine 1 ml/kg and enflurane. Systolic (SBP), diastolic (DBP), mean blood pressure (MBP), and heart rate (HR) were measured at the 6 different time periods; at before induction (T1), just before skin incision (T2), just after skin incision (T3), 5 min (T4), 10 min (T5), and 30 min (T6) after skin incision. RESULTS: There were no significant differences in variables of hemodynamics between both group. Compared with the values at T1, those of SBP, DBP, and MBP at T2, T3, T4, T5, and T6 were decreased in both groups. However, there were no difference in those values at the same time periods between the two groups. The values of SBP, DBP, and MAP at T3, T4, T5, T6 in group G were higher compared with those at T2. CONCLUSIONS: From these results, we concluded that there were no significant changes in hemodynamics by combined general and caudal anesthesia in pediatric patients.

The Hemodynamic Effect of Nerve Block by Cranial Pinning in Brain Surgery Patients / 대한마취과학회지

BACKGROUND: It is already known that the cranial pinning causes a sudden increment of blood pressure and heart rate which is harmful especially in brain surgery patient. These changes may be reduced by local infiltration at the sites of cranial pinning. This study was designed to investigate the hemodynamic effects of nerve block by cranial pinning and compare them with the effects of local infiltration at the pinning site. METHODS: Forty patients of brain surgery with cranial pinning were involved. After general anesthesia with isoflurane and 50% N2O, they were divided into 2 groups randomly: the control group (n = 20), had local infiltration at each pinning site with 1% lidocaine 2 ml, and the study group (n = 20), had nerve block of the supraorbital, and supratrochlear, and postauricular branches of the great auricular nerve with lidocaine 2 ml, the auriculotemporal nerve with lidocaine 2.5 ml, and the greater and lesser occipital nerves with lidocaine 2.5 ml. The hemodynamic variables(systolic, diastolic, mean blood pressure, and heart rate) were measured at the 3 different points just before cranial pinning, and 1 min and 5 min after cranial pinning. RESULTS: The values of hemodynamic variables at 1 min after cranial pinning increased in both groups when compared with just before cranial pinning, but there was no difference between the two groups. The increased values at 1 min were not high clinically, and returned to the levels recorded before cranial pinning by the 5 min recording time in both groups. CONCLUSION: From these results, we concluded that nerve block could also reduced the harmful hemodynamic effect of cranial pinning.

Hemodynamic Effects of Hepatic Cooling and Portal Decompression during Hepatic Resection with Portal Triad Clamping / 대한마취과학회지

BACKGROUND: Portal triad clamping (PTC) during hepatic resection (Pringle maneuver, PM) can afford reduced intraoperative bleeding and bloodless surgical field. But inflow obstruction of blood to liver during PM can bring hemodynamic changes to the patient. This study was designed to evaluate the hemodynamic changes before, during and after PM application during hepatic resection. We also compared the hemodynamic effects of hepatic cooling before PM with/without portal decompression during PM. METHODS: The patients were divided into three groups; PM (P group, n=9), PM after hepatic cooling with 400 ml of 4oC lactated Ringer's solution (LR) (C+P group, n=13), PM after hepatic cooling and portal decompression with portocaval shunt (C+P+S group, n=7). Systemic vascular resistance index (SVRI), cardiac index (CI) and mean arterial pressure (MAP) were measured before, during and after PM. RESULTS: Portal pressure of C+P+S group (208.3+/-36.6 mmH2O) was lower than P (487.3+/-92.9 mmH2O) and C P (553.6+/-77.0 mmH2O) group during PM. CIs of P and C P group were decreased (15, 13% respectively) during PM. After reperfusion, CIs and SVRIs of P, C+P and C+P+S group were all increased (CI; 33, 26, 50%, SVRI; 30, 40, 50%, respectively) than end of PM. CONCLUSION: PM itself doesn't make abrupt hemodynamic change. Hepatic cooling with 4oC LR (400 ml) before PM increases MAP because of increased SVRI. Reperfusion after PM for 50 minutes, hemodynamic depression could occur by decreased SVRI, especially in case of decompressed portal pressure with portocaval shunt during PM.

Hemodynamic Effects of Hepatic Cooling and Portal Decompression during Hepatic Resection with Portal Triad Clamping / 대한마취과학회지

BACKGROUND: Portal triad clamping (PTC) during hepatic resection (Pringle maneuver, PM) can afford reduced intraoperative bleeding and bloodless surgical field. But inflow obstruction of blood to liver during PM can bring hemodynamic changes to the patient. This study was designed to evaluate the hemodynamic changes before, during and after PM application during hepatic resection. We also compared the hemodynamic effects of hepatic cooling before PM with/without portal decompression during PM. METHODS: The patients were divided into three groups; PM (P group, n=9), PM after hepatic cooling with 400 ml of 4oC lactated Ringer's solution (LR) (C+P group, n=13), PM after hepatic cooling and portal decompression with portocaval shunt (C+P+S group, n=7). Systemic vascular resistance index (SVRI), cardiac index (CI) and mean arterial pressure (MAP) were measured before, during and after PM. RESULTS: Portal pressure of C+P+S group (208.3+/-36.6 mmH2O) was lower than P (487.3+/-92.9 mmH2O) and C P (553.6+/-77.0 mmH2O) group during PM. CIs of P and C P group were decreased (15, 13% respectively) during PM. After reperfusion, CIs and SVRIs of P, C+P and C+P+S group were all increased (CI; 33, 26, 50%, SVRI; 30, 40, 50%, respectively) than end of PM. CONCLUSION: PM itself doesn't make abrupt hemodynamic change. Hepatic cooling with 4oC LR (400 ml) before PM increases MAP because of increased SVRI. Reperfusion after PM for 50 minutes, hemodynamic depression could occur by decreased SVRI, especially in case of decompressed portal pressure with portocaval shunt during PM.

Effects of Sodium Nitroprusside-induced Hypotension under Acute Normovolemic Hemodilution on the Cardiovascular System and Systemic Oxygen Balance in Dogs / 대한마취과학회지

BACKGROUND: To decrease homologuous transfusion and bleeding, Acute Normovolemic Hemodilution (ANH) may be combined with induced hypotension. Tissue oxygen balance may be in danger because of decreased tissue perfusion pressure by induced hypotension and reduced arterial oxygen content by ANH. Thus it is necessary to evaluate effects of induced hypotension combined with ANH on hemodynamics and systemic oxygen balance. METHODS: In 6 mongrel dogs anesthetized with N2O-O2-enflurane and paralyzed with vecuronium, ANH was performed up to half of initial level of hemoglobin with isovolemic pentastarch infusion, and then mean arterial pressure (MAP) was lowered by 30% of the initial value by intravenous administration of Sodium Nitroprusside (SNP). Various hemodynamic parameters were measured before and after ANH and 15, 30, 45 and 60 minutes after induction of hypotension and 15 minutes after the end of hypotension. RESULTS: Heart rate was not changed significantly throughout the study. Central venous pressure increased significantly after ANH but decreased to the initial value after induced hypotension. Systemic vascular resistance showed significant decrease after ANH, more significant decrease after induced hypotension and slight increase after discontinuation of SNP. Cardiac output increased markedly by ANH and maintained during induced hypotension. Oxygen flux decreased significantly after ANH but slightly increased after induced hypotension. Oxygen consumption and Oxygen extraction ratio were maintained throughout the study. There were no acidemia and hypoxemia throughout the study. CONCLUSION: The combined use of ANH and induced hypotension with SNP is safe in the aspect of cardiovascular system and systemic oxygen balance.

The Effects of Continuous Hyperthermic Peritoneal Perfusion (CHPP) on Cardiopulmonary Parameters in the Basis of Systemic Oxygen Balance / 대한마취과학회지

BACKGROUND: Intra-operative application of continuous hyperthermic peritoneal perfusion (CHPP) in advanced cancer has been introduced as an effective and safe method to lessen the complication and enhance the effectiveness of its treatment. But CHPP induced acute change of body temperature and intra-abdominal pressure would produce various abnormal physiologic response. Now, we investigated to evaluate and understand the trend of changes of cardiac and oxygen parameters during CHPP. METHODS: Closed peritoneal irrigation was done with perfusate at temperature 47oC for 90 min under general anesthesia. Cardiac and oxygen parameters were measured at 10 min before CHPP, 30, 60, 90 min after the initiation of CHPP, 30 min after the end of CHPP with Swan-Ganz catheter application. RESULTS: Hemodynamic parameters; Systemic vascular resistance index and mean arterial pressure were decreased trend during CHPP. Pulmonary capillary wedge pressure and cardiac index were increased during CHPP. Oxygen parameters; AaDO2 and shunt fraction were increased during CHPP and O2 index were decreased during CHPP. Oxygen balance; O2 consumption and delivery increased during CHPP. CONCLUSIONS: We confirmed that systemic oxygen consumption and delivery were increased during CHPP but AaDO2 and shunt fraction were increased which could decrease systemic oxygen delivery. We should need more careful monitoring and proper treatment for maintaining stable hemodynamics and systemic oxygen balance during and after CHPP.

Hemodynamic Changes during the Pringle Maneuver in Patients with Abnormal Liver Function / 대한마취과학회지

BACKGROUND: During the Pringle maneuver (PM), the increase of systemic vascular resistance (SVR) and the active constriction of the intrahepatic capacitance vessels could minimize arterial blood pressure change. Pressor reactivity to sympathetic agonists is impaired and blood volume buffering capability is less efficient in a cirrhotic liver. Accordingly, we evaluated the relations between hemodynamics during PM and preoperative liver function test (LFT) by serum aminotransferase and Indocyanine Green (ICG) clearance. METHODS: Twenty-seven patients undergoing hepatectomy with PM were classified into two groups according to the liver function state assigned by serum aminotransferases and ICG clearance test. Sequential changes of hemodynamics were measured with Doppler flowmeter during PM. Hemodynamic data were analyzed by using ANOVA for repeated measurement. Correlation between LFTs were sought using Pearson correlation and logistic regression. RESULTS: During the PM, cardiac output decreased significantly compared to the preclamping period in the abnormal LFT group. There were no significant changes in any other hemodynamic variables in the normal LFT group. When comparing the two groups during PM, mean arterial blood pressures and cardiac output were significantly lower in the abnormal LFT groups compared to the normal LFT groups (P< 0.05). CONCLUSIONS: These differences may suggest that cardiovascular responsiveness to reflex autonomic stimulation during the PM is significantly impaired in patients with abnormal LFT compared with normal LFT subjects.

Transesophageal Echocardiography Monitored Embolic Events during the Total Knee Replacement: Hemodynamic Changes and Embolic Composition / 대한마취과학회지

BACKGROUND: The present study was aimed to determine the alterations of hemodynamics and embolic composition during the course of total knee replacement. METHODS: A retrospective analysis was performed using data acquired from 20 patients who underwent 10 unilateral and 10 bilateral total knee replacement under general anesthesia. Transesophageal echocardiography and Swan-Ganze catheterization were placed following induction of anesthesia, then images and changes were recorded throughout the procedure. All patients were performed using fluted intramedullary rods inserted into an overdrilled femoral entrance hole in conjunction with the application of a tourniquet. RESULTS: We found echogenic emboli in 8 out of 20 patients during cannulation of the femoral canal and performing femoral and tibial saw cuts, then we detected echogenic emboli in all 20 patients during tourniquet deflation. Echogenic emboli consistently filled the right atrium and ventricle with very small size embolic materials for 19 7 minutes during total knee replacement. Heart rate exhibited no change, Mean arterial pressure decreased and mean pulmonary artery pressure increased after tourniquet deflation. After tourniquet deflation, free fatty acid increased in lipid profile. No patient had postoperative complications related echogenic emboli. CONCLUSION: All patients exhibited echogenic emboli during certain stages of total knee replacement. Although all patients were asymtomatic in our study, one should be cautioned when performing total knee replacement in patients with little physiologic reserve and large embolic events.

Hemodynamic Changes on Position Changes in Healthy Adult Measured by Bioimpedance / 대한마취과학회지

INTRODUCTION: The purpose of positioning is to allow the procedure to be performed as simply as possible and to achieve the best possible results free of complications. In a normal person, many investigators have researched the hemodynamic changes during positional adjustments. But the delicate qualitative hemodynamic changes in various positions has not been recorded very much. So we studied the qualitative hemodynamic changes in various positions with a noninvasive bioimpedance method. METHOD: Healthy adult males were studied (n=25). The protocol was that the position changed from supine to head-up, head-down, lithotomy, sitting, right-lateral, prone and Jackknife (J-K) position. Each position was sustained for three minutes. The mean arterial pressure (MAP), heart rates (HR), left cardiac work index (LCWI), systemic vascular resistance index (SVRI), cardiac index (CI), stroke index (SI) and end diastolic index (EDI) were measured with the bioimpedance method and an automated blood pressure device. Result: The contractility of heart expressed by LCWI, CI and SI decreased in head-down, sitting, right-lateral, prone and J-K positions. The preload expressed by EDI decreased in right-lateral and J-K positions. The afterload expressed by SVRI increased in sitting, prone and J-K positions, and decreased in right-lateral position. CONCLUSIONS: These results may be used as reference for anesthesiologist managing many patients of various physical status.

The Effect of Pneumonectomy on Right Ventricular Function / 대한마취과학회지

BACKGREOUND: The pneumonectomy may depress the right ventricular (RV) function transiently. The thermodilution ejection/volumetric catheter is known to be most useful method assessing the changes in RV performance during pulmonary resection. The purpose of this study was to examine the RV function during and immediately after pneumonectomy using thermodilution methods. METHODS: 16 patients undergoing pneumonectomy were studied. After induction of anesthesia, a multilumen thermodilution catheter mounted with a rapid response thermister was inserted. Using computer system, RV ejection fraction (RVEF), cardiac output, and RV end-diastolic volume (RVEDV) were measured when the patient was in lateral position (control), after one lung ventilation (OLV) and the main pulmonary artery ligated, and at the completion of resection. Arterial blood gases were analyzed and pulmonary vascular resistance (PVR) was calculated. RESULTS: Systolic pulmonary blood pressure (SPAP)(28.3 +/- 6.2 mmHg) increased compared to the control (24.6 +/- 5.9) without a significant change of PVR. No statistically significant difference was found in either RVEF or RVEDV at each times. CONCLUSIONS: Our study demonstrate the pneumonectomy do not depress the RV function immediately and RVEF do not show any correlation with PVR or RVEDV.

Hemodynamic Changes during Continuous Hyperthermic Intraperitoneal Perfusion for Gastric Cancer Patients with Peritoneal Seeding / 대한마취과학회지

BACKGREOUND: Hyperthermia is currently effective treatment against numerous cancer gastric cells' seeding on the peritoneal surface and floating in the cancerous ascites. We evaluated changes in hemodynamics during continuous hyperthermic intraperitoneal perfusion (CHPP) to determine strategies for safer general management during this procedure. METHODS: Ten patients with far-advanced gastric cancer were given surgical treatment followed by CHPP with anticancer drug. The body temperature, blood pressure, heart rate, central venous pressure, pulmonary artery pressure, cardiac output, electrolyte and blood gas were measured during pre-CHPP, CHPP and post-CHPP period. RESULTS: The blood temperature reached 39.3 +/- 0.4 degrees C(mean SD) during CHPP. Heart rate increased to 104.4 +/- 14.2 bpm and the cardiac index to 5.3 +/- 1.5 l.min 1.m 2 during CHPP. The mean arterial pressure remained stable during the study period. The systemic vascular resistance index decreased to 996.7 +/- 324.0 dynes.s.cm 5.m2. The mixed venous oxygen saturation fell during the first part of the CHPP period. CONCLUSIONS: This study suggest that the CHPP with anticancer drug may be safe in humans, provided that appropriate monitoring, cooling and technical support are applied.

The Hemodynamic Changes of Alcohol Sclerotherapy in Patients with Congenital Peripheral Arteriovenous Malformation / 대한마취과학회지

BACKGROUND: Arteriovenous malformations (AVMs) are increasingly treated by radiologists using various embolic materials. Because of pain and significant hemodynamic changes that may be associated with this treatment, anesthesiologists are frequently asked to provide anesthesia and supportive care. We evaluated the hemodynamic changes that occurred after absolute alcohol embolization. METHODS: Fourteen patients between 15 and 50 years of age who had arteriovenous malformation were included in this study. 2 to 4 ml of alcohol was injected each time. The hemodynamic parameters were measured before alcohol injection (control) and after 1st to 10th alcohol injection. RESULTS: Blood pressure, heart rate, and cardiac output were significantly increased after 1st to 10th alcohol injection compared with control value. Central venous pressure, pulmonary capillary wedge pressure and systemic vascular resistance were not significantly changed. But pulmonary vascular resistance was significantly increased after 9th and 10th alcohol injection. Systolic pulmonary artery pressure was significantly increased after 4th, 8th, 9th and 10th alcohol injection. CONCLUSIONS: Bolus injection of absolute ethyl alcohol induces short-term significant increases in blood pressure, heart rate and cardiac output probably by severe pain and sympathetic activation that appear to be centrally mediated. The underlying mechanism of cardiovascular event and other systemic effects of intravascular ethanol in this setting need further study.

Analysis of the Right Ventricular Pressure/Volume Relationship and Contractility During Liver Transplantation / 대한마취과학회지

BACKGROUND: Hemodynamic instability is one of the main concerns for anesthesiologists during orthotopic liver transplantation (OLTX). The most troublesome event would be an increase of central venous pressure associated with sudden right ventricular (RV) filling without any change in heart contractility. An acute increase in RV outflow pressure depresses RV contractility and eventually causes overt RV failure. To avoid such disaster, it would be wise to evaluate right heart pressure/volume relationship and assess contractility when anticipating acute increase of pressure in right heart chamber. METHODS: RV function was assessed in 15 patients undergoing OLTX. RV function was monitored using an ejection fraction catheter and a monitor. Complete hemodynamic profile was obtained on regular intervals. Statistical analysis was performed using ANOVA for repeated measures. Correlation between variables were determined by simple regression analysis and ANCOVA. RESULTS: RV end-diastolic volume was in the range of supranormal values. No correlation was observed between right atrial pressure and RV end-diastolic volume index (RVEDVI). There was a significant correlation between stroke index and RVEDVI. RV ejection fraction and E-single were relatively constant throughout the procedure. There was weak negative correlation between E-signle and RVEDVI. CONCLUSION: RV function appeared to be well preserved during OLTX. However, RV contractility tends to decrease in response to RVEDV increase because RVEDV of endstage liver disease might increase to their maximal value. Right heart filling pressure was less reliable clinical indicator of RV preload.

Comparison of Intubation Following Propofol-Fentanyl with Intubation Following Succinylcholine-Thiopental Sodium / 대한마취과학회지

BACKGROUND: This study was performed to determine the effect of a endotracheal intubation & induction of anesthesia using propofol 2.0 mg/kg or 2.5 mg/kg and fentanyl 2 g/kg without succinylcholine chloride. Also we have compared this method with technique using succinylcholine 1.5 mg/kg and thiopental sodium 5 mg/kg. METHODS: They were divided into 3 groups as follows: group 1, succinylcholine 1~1.5 mg/kg and thiopental sodium 5 mg/kg; group 2, propofol 2 mg/kg and fentanyl 2 microgram/kg; group 3, propofol 2.5 mg/kg and fentanyl 2 microgram/kg. Systolic arterial pressure (SAP) and diastolic arterial pressure (DAP), and heart rate (HR) were measured before induction, after induction, after tracheal intubation immediately, at 1, 2, 3, and 5min. after tracheal intubation in all patients. The incidence of adverse effects and the quality of condition for intubation were measured in all patients. RESULTS: There were significant increases in SAP, DAP, HR after intubation in group 1 but significant decreases in SAP, DAP after induction and at 5min. after intubation in group 2 and group 3. The incidence of adverse effects, and the quality of condition for intubation were no significant difference between group 1 and group 3. CONCLUSIONS: From the above result, use of propofol 2.5 mg/kg and fentanyl 2microgram/kg provided a satisfactory alternative to succinylcholine and thiopental sodium for rapid sequence induction of anesthesia.