Analysis of the indicators of frequent exacerbation of chronic obstructive pulmonary disease / 中华疾病控制杂志

@# Objective To investigate the relationship between multiple blood indexes and frequent exacerbation of chronic obstructive pulmonary disease (COPD). Methods 102 patients with COPD were selected and divided into frequent exacerbation group (≥ 2 times/year, 55 patients) and infrequent exacerbation group (< 2 times/year, 47patients), according to the frequency of acute exacerbation in one year. The relationship between multiple indicators in blood routine and blood gas analysis and frequent exacerbation of COPD was explored by independent sample t test, 2 test, and multiple Logistic regression analysis. A retrospective study was conducted. Results Neutrophils count (NEU), neutrophils ratio (Neut%), and neutrophil-to-lymphocyte ratio (NLR) of frequent exacerbation group were significantly higher than those of infrequent exacerbation group, while lymphocytes (LY), lymphocytes ratio (LY%) were lower (All P<0.05). OR(95% CI) of NLR was 3.483(1.170-10.373)，and OR(95% CI) of partial pressure of carbon dioxide in artery (PaCO2) was 1.124(1.053-1.201).NLR and PaCO2 were risk factors for frequent exacerbation of COPD. Increase of NLR and PaCO2 led to an increasing risk of frequent exacerbation of COPD ( All P<0.05). Conclusions The levels of NLR and PaCO2 in COPD patients with frequent exacerbation are higher than those in patients with infrequent exacerbation. As a consequent, NLR and PaCO2 could be considered risk factors for frequent exacerbation of COPD.

Value of CD5L and PaCO2 in predicting the survival of patients with severe asthma and mechanical ventilation / 国际检验医学杂志

Objective To investigate the value of CD5 molecule-like protein(CD5L) and partial pressure of CO2 in arterial blood(PaCO2) in predicting the survival of patients with severe asthma and mechanical ventilation.Methods From Jan.2013 to Jan.2016,a total of 38 patients with severe asthma and mechanical ventilation were enrolled.Acute Physiology and Chronic Health EvaluationⅡ(APACHE II)were used to assess the severity.Enzyme linked immunosorbent assay was used to detect serum levels of CD5L at admission and 6 h after treatment.PaCO2 were also detected.Pearson correlation analysis was used to analyze the correlation between APACHEⅡ score and CD5L and PaCO2 levels.Receiver operation characteristic(ROC) curve was used to evaluate the value of CD5L and PaCO2 in predicting the survival of patients.Results APACHEⅡscores of survival patients were significantly higher than dead patients(P<0.05).CD5L level of survival patients after treatment was significantly lower than dead patients,while PaCO2 level was significantly higher(P<0.05).APACHEⅡ score was negatively correlated with serum CD5L level(r=-0.347,P<0.05),while positively correlated with PaCO2 level(r=0.573,P<0.05).ROC curve analysis showed that serum CD5L and PaCO2 were with predictive value for prediction the survival of patients,with sensitivity of 93.33%,specificity of 75.00%,accuracy of 89.47%,positive predictive value of 93.33%,and negative predictive value of 75.00% for CD5L,and those for PaCO2 were 90.00%,87.50%,89.47%,97.42% and 70.00%.Conclusion With the decreasing of CD5L level and increasing of PaCO2 level,severity of disease in patients with severe asthma and mechanical ventilation could be more serious condition,indicating poor prognosis.CD5L and PaCO2 could be with fine predictive value of survival of patients with severe asthma and mechanical ventilation.

Application of PRVC in laparoscopic surgery / 实用医学杂志

Objective To monitor and compare the breathing mechanics on PC,VC and PRVC during pneumoperitoneum,and to discuss the significance of the clinic use of PRVC.Method Ninety laparoscopic cholecystectomy patients were equally divided into 3 groups (PC,VC,PRVC).Levels of PES,PAWM,PAP,PaCO2,ETCO2,TV MAP and HR were detected before pneumoperitoneum,and at 5,10,15 and 20 minutes postpneumoperitoneum.Results Pneumoperitoneum made three respiratory patterns with different levels of PAWM,PAP,and PES.PES post-pneumoperitoneum in the VC model was obviously higher than that in the PC and PRVC group.At 10 min post-pneumoperitoneum,levels of PaCO2 and ETCO2 increased obviously in the PC and VC group(P ＜ 0.05).Levels of PaCO2 and ETCO2 were increased in the PC group,but TV level post-pneumoperitoneum was significantly lower than that in the other two groups (P ＜ 0.05).Level of PaCO2 and ETCO2 were increased in the PC and VC group post-pneumoperitoneum,along with increases of MAP and HR (P ＜ 0.05).Levels of MAP and HR in the PRVC group post-pneumoperitoneum were significantly lower than those in the PC and VC group (P ＜ 0.05).Conclusion PRVC mode can effectively reduce the increases of pneumoperitoneum-induced PAWM,PAP,PES,without the unusual increase of PaCO2 and ETCO2 during surgeries,contributing to the stability of vital signs of perioperative patients.

Comparison of arterial-to-end-tidal carbon dioxide tension difference during cardiac surgery in children with cyanotic or acyanotic congenital heart disease / 临床麻醉学杂志

Objective To estimate the arterial-to-end-tidal carbon dioxide tension difference (Pa-ET CO 2 )in children with cyanotic or acyanotic congenital heart diseases;evaluate whether hyper-ventilation can reduce the tension difference or not;analyze the effect of sevofleurane on Pa-ET CO 2 . Methods One hundred and twenty patients (male 60 cases,female 60 cases,aged 1 month-6 years, ASA class Ⅱ or Ⅲ)undergoing selective cardiac surgery were randomly divided into 6 groups (n =20 each)based on right-to-left or left-to-right intracardic shunts:group A1,cyanotic with sevoflurane of 0.5 MAC;group A2,cyanotic with sevoflurane of 1.0 MAC;group B1,acyanotic with sevoflurane of 0.5 MAC;group B2,acyanotic with sevoflurane of 1.0 MAC;group C1,cyanotic with no inter-vention factors;group C2,acyanotic with no intervention factors.All the children received general an-aesthesia after placing an intravenous and arterial catheter.The value of PET CO 2 ,SpO 2 ,PaCO 2 , SaO 2 ,Hct and temperature(nasopharyngeal temperature and rectal temperature)were obtained before operation,after hyperventilation(the control groups without hyperventilation)and five minutes before surture sternum.Results The values of Pa-ET CO 2 were more than the normal one in six groups before operation.The value of Pa-ET CO 2 in group B1 was less than that in group A1,that in group B2 was less than that in group A2 and that in group C2 was less than that in group C1 before operation (P <0.01).Compared with the time point before operation,the values of Pa-ET CO 2 in groups A1,A2,B1 and B2 decreased significantly after hyperventilation (P < 0.05 or P < 0.01 ).Moreover, this reduction was more significant in groups B1 and B2.Compared with the time point before operation, the values of Pa-ET CO 2 in groups B1,B2,C2 increased significantly (P <0.01)and that in groups A1, A2,C1 decreased significantly (P <0.05)at 5 minutes before surture sternum.There was no statisti-cal difference at three different time points between group A1 and A2,B1 and B2.Conclusion The value of Pa-ET CO 2 in cyanotic children increased more significantly than that in acyanotic children.Hy-perventilation can reduce the value of Pa-ET CO 2 especially in acynanotic children with pulmonary con-gestion.The concentration (from 0.5 MAC to 1.0 MAC)of sevoflurane had little effect on the value of Pa-ET CO 2 .

Arterial blood gas levels in high altitude Kashmiri population, India.

Background: The valley of Kashmir lies at an average height of 1730 m above the sea level with a barometric pressure of 624 mmHg. The fall in atmospheric pressure at higher altitude decreases the partial pressure of inspired oxygen and hence the driving pressure for gas exchange in the lungs. At sea level the normal range of PaCO2 is 35 mmHg to 45 mmHg and at 1500m above sea level (barometric pressure 634 mmHg), the predicted normal PaO2 in a healthy young adult is approximately 80 mmHg; this contrasts with a value close to 95 mmHg at sea level. On these grounds this study was undertaken to formulate normal ABG values for this place as it lies at a higher altitude. Methods: The study was undertaken to measure "arterial blood gases" (ABG) in ethnic Kashmiri population and consisted of a sample of one hundred healthy Kashmiri subjects of either sex after proper inclusion and exclusion by spirometrically measuring Vital Capacity and Forced expiratory volume in one second/Forced vital capacity (Fev1/FVC). A modified Allen's test was performed to check for adequate collateral circulation ruling out Ischemia. Results: The average mean PaO2 of 78.51 ± 4.40 mmHg and the average mean PaCO2 of 33.37 ± 2.38 mmHg was obtained of the volunteers of both the sexes. The average mean pH of males (7.43 ± 0.02) was significantly lower than the mean pH of females (7.45 ± 0.021). Conclusions: The present study might provide useful base line normal values of Arterial Blood Gases for the local population and will be beneficial to the clinicians.

The influence and correlation analysis between PaCO2 and PET CO2 in prone position surgery / 临床麻醉学杂志

Objective To investigate the correlation between arterial carbon dioxide partial pressure (PaCO2 )and end-tidal carbon dioxide partial pressure (PET CO2 )in prone position operation and calculate the value of PaCO2 according to the PET CO2 .Methods Forty patients with ASA Ⅰ orⅡ undergoing spinal surgery were selected,and the values of PaCO2 and PET CO2 as basic value (T0 ) after induction of general anesthesia in supine position monitor and record the value of PET CO2 and PaCO2 in prone position after 30 min (T1 ),60 min (T2 )and 90 min (T3 ).The correlation between PaCO2 and PET CO2 in each time point were analyzed,and the equation of PaCO2 (y)and PET CO2 (x) with curve fitting and difference of PaCO2 and PET CO2 were calculated.Results There was significant correlation between PaCO2 and PET CO2 in the supine and prone position,their correlation coefficients were r 0 =0.84,r 1 =0.88,r 2 =0.84,r 3 =0.82 (P <0.01).The Pa-ET CO2 was (5.3±2.1)(T0 )in supine position and (6.6± 2.1 )mm Hg (T1 ),(5.8 ± 2.2 )mm Hg (T2 ),(5.9 ± 2.1 )mm Hg (T3 )in prone position.The equation in each time point PaCO2 (y)and PET CO2 (x)were y0 =1.1 x0 +2.5,y1 =1.1 x1 +2.3,y2 =1.1 x2 +2.4,y3 =1.1 x3 +4.6,and the Pa-ET CO2 was 3.7-8.7 mm Hg. There was no significant difference between PaCO2 and PET CO2 at T1-T3 .Conclusion Whenever in prone position or supine position,PET CO2 and PaCO2 have significant correlation in prone position and supine position.The overall range of Pa-ET CO2 is 3.7-8.7 mm Hg,and the PET CO2 can be as indica-tor to estimate PaCO2 in prone position.

Effects of esomeprazole premedication on gastric pH during laparoscopic surgery / 대한마취과학회지

BACKGROUND: The use of CO2 for pneumoperitoneum during laparoscopic surgery provokes a decrement in the gastric pH. Since the incidence rate of PONV increases after laparoscopic surgery, the possibility of lung aspiration of gastric juice with a low pH during a postanesthetic emergence may increase and this could be fatal for the patient. We conducted this study to determine the effects of esomeprazole premedication on inhibiting the decrement of the gastric pH during laparoscopic surgery. METHODS: 40 adult patients with no underlying diseases were chosen and 20 patients each were grouped as C (the control group) and E (the esomeprazole group). In both group, 0.2 mg glycopyrrolate was given intramuscularly 30 minutes prior to the surgery. In group E, esomeprazole was given orally 2 hours prior to the surgery. The pH, PaCO2, and PETCO2 were measured via pH probe, an ABGA and an capnogram at preinsufflation and 15, 30 and 60 minutes after the CO2 insufflation and right before CO2 exhaustion (predeflation). RESULTS: Comparing the measurements of the gastric pH between group E and group C, all the results showed a significant increase in group E (P < 0.05). The difference of the PaCO2 and PETCO2 in the two groups was not significance. CONCLUSIONS: In contrast to the decrease in the gastric pH as the PaCO2 and PETCO2 increased in group C, the gastric pH in group E remained high until the end of the surgery despite the increase in the PaCO2 and PETCO2. Esomeprazole premedication seem to have an effect for inhibiting the gastric pH decrement regardless of the increase in the PaCO2 and PETCO2 during laparoscopic surgery.

Effect of PaCO_2 Modulating During Operation on Post-Operative Cognitive Function of Patients Undergoing OPCAB / 上海第二医科大学学报

Objective To observe the effect of PaCO_2 modulating during operation on post-operative cognitive function of patients undergoing off-pump coronary artery(OPCAB). Methods Thirty patients undergoing OPCAB were randomly divided into traditional group (G_ 1 , n=15) and modulated group (G_ 2 , n=15). During operation, PaCO_ 2 in G_ 1 maintained 35 mmHg to 39 mmHg with relatively fixed ventilation parameters setting, and PaCO_ 2 in G_ 2 ranged from 40 mmHg to 45 mmHg by adjusting ventilation parameters. Continuous cardiac output index (CCI), SvO_ 2 , regional cerebral O_ 2 saturation (rSO_ 2 ) and PaCO_ 2 were recorded before distal anastomosis(T_ 1 ), at 5 min of the first distal vessel anastomosis(T_ 2 ), second distal vessel anastomosis(T_ 3 ) and third distal vessel anastomosis(T_ 4 ), and 20 min after the completion of coronary artery anastomoses. HDS-R and ADL were used to examine the patients' cognitive function. Results There were no significant differences in pre- and post-operative HDS-R and pre-operative ADL scores between groups. The score of post-HDS-R in G_ 1 was obviously lower than that of pre-HDS-R (P

Anesthetic management for video-assisted laser operation under rigid bronchoscopy / 中国微创外科杂志

Objective To discuss the management of anesthesia for video-assisted laser operation under rigid bronchoscopy.Methods A retrospective review was made on anesthetic records of 15 cases of video-assisted operation under rigid laser bronchoscopy in this hospital from September 2002 to December 2006.According to the ASA classification,there were 7 cases of class Ⅱ,7 cases of class Ⅲ,and 1 case of class Ⅳ.The diagnosis included 13 cases of tumor and 2 cases of cicatricial stricture.All the patients had a forced expiratory volume in 1 second(FEV1) predicted lower than 70%. By using intravenous fast induction,the propofol,fentanyl,and vecuronium or rocuronium were injected successively.Then a rigid bronchoscope was inserted into the trachea under orthoptic laryngoscope.During the operation a total intravenous anesthesia(TIVA) was maintained.Before induction and 5～10 min after operation,we monitored artery blood gas(ABG) levels.Immediately following the operation the end-tidal CO2 pressure(PETCO2) was measured.Results Hemodynamics parameters were not significantly different between preoperatively and intraoperatively.During the operation,the pH value was 45 mm Hg in 5.All the patients presented normal blood pressures and heart rates. Conclusions During video-assisted laser operation under rigid bronchoscope,anesthesia with normal frequency jet-ventilation and artery blood gas monitoring is safe and reliable.

Comparison of Arterial and End-Tidal CO2 Tension by Position and Time Changes during Hip Replacement Arthroplasty in Elderly Patients / 대한마취과학회지

BACKGROUND: Hip replacement arthroplasty (HRA) is highly traumatic and performed in a lateral position for several hours and dead-space ventilation may increase. So, the difference between arterial and end-tidal PCO2 was investigated depending on the changes in the patient's posture during HRA in elderly patients. METHODS: Forty-three patients scheduled for a HRA were divided into two groups; Adult Group (n = 21, A-Group) and Elderly Group (n = 22, E-Group). Mean arterial pressure (MAP), heart rate (HR), PaO2, PaCO2, and end-tidal carbon dioxide tension (P(ET)CO2) were simultaneously measured at 10 min after anesthesia in a supine position (S[10]), at 30 min intervals from 30 min (L[30]) to 180 min (L[180]) in a lateral position and at 10 min in a supine position after the end of surgery (ES[10]) in both groups. The PaCO2-P(ET)CO2 gradient (P[a-ET]CO2) and dead space ventilation (Vd/ Vt) were calculated. RESULTS: At S(10), P(a-ET)CO2 in the A- and E-Groups was 7.0 +/- 5.0 and 7.2 +/- 3.3 mmHg respectively. From L(30) to ES(10), the P(a-ET)CO2 and the ratio of Vd/Vt in both groups increased significantly and progressively (P < 0.05 vs the control value) and the slope in the E-Group rose two times as compared to that in the A-Group. The correlation coefficient between P(a)CO2 and P(ET)CO2 was very significant from S(10) to L(90) and ES(10) in the A-Group, and from S(10) to L (60) in the E-Group (P < 0.01). CONCLUSIONS: For maintaining adequate ventilation of the elderly patient during HRA, PaCO2 should be measured intermittently along with the position changes after anesthesia in addition to the constant monitoring of PETCO2.

Correlation of Tracheal Cross-sectional Area with Parameters of Pulmonary Function Test in COPD / 결핵

BACKGROUND: Maximal expiratory flow rate is determined by the size of airway, the elastic recoil pressure and the collapsibility of airway in the lung, and one of major functional impairments of emphysema, which represents COPD, is the obstruction of expiratory flow. Neverthless, expiratory narrowing of upper airway may be recruited as a mechanism for minimizing airway collapse, and maintaining lung volume and hyperinflation by an endogenous positive end-expiratory pressure in patients with airflow obstruction. We investigated the physiologic role of trachea in respiration in emphysema. METHOD: We collected 20 patients with emphysema (which was diagnosed by radiologic and physio logic criteria) from January to August in 1997 at Seoul Municipal Boramae Hospital, and chest roentgenogram, high resolution computed tomography(HRCT), and pulmonary function tests including arterial blood gas analysis and body plethysmography were done from each patient. Cross-sectional area of trachea was measured according to the respiratory cycle on the level of aortic arch by HRCT and calibrated with body surface area. We compared this calibrated area with such parameters of pulmonary function tests as PaCO2, PaO2, airway resistance, lung compliance and so on. RESULTS: Expiratory cross-sectional area of trachea has significant correlation with PaCO2 (r=-0.61, p0.05 with PaCO2, r=0.26, p>0.05 with PaO2, and r=0.44, p>0.05 with minute ventilation). Minute ventilation has significant correlation with tidal volume (r=0.45, p0.05). Cross-sectional area of trachea doesn't have any significant correlation with other parameters of pulmonary function such as FEV1, FVC, FEV1/FVC, peak expiratory flow, residual volume, diffusing capacity, airway resistance, and lung compliance, whether the area is expiratory or inspiratory. CONCLUSION: Cross-sectional area of trachea narrowed during expiration in emphysema and its expiratory area has significant correlation with PaCO2, PaO2, and minute ventilation.

Influences of the Intrapulmonary R-->L Shunt on PaO2 and PaCO2 after Instillation of Exogenous Pulmonary Surfactant to Premature Neonates with Respiratory Distress Syndrome

PURPOSE: We are inclined to analyze the relationship between the intrapulmonary right-to-left shunt and the PaO2/PaCO2 after endotracheal single-dose surfactant instillation to premature neonates with respiratory distress syndrome within 6 hours after birth. METHODS: From Jan. 1993 to Jun. 1995, we have conducted a clinical trial of surfactant replacement therapy to the premature neonates with respiratory distress syndrome at the neonatal intensive care unit of InHa University Hospital. The surfactant group (n=17) was given Surfactant-TA and mechanical ventilator care, but the control group (n=22) was treated with only mechanical ventilator. We analyzed umbilical arterial blood gases and estimated respiratoy indexes before and after treatment. RESULTS: 1) The QSP/QT decreased initially in the surfactant group, but significantly increased 24 hours after treatment in the control group (40.6+/-4.7%, P0.5) resulted in a decrease in PaO2 and also a significant relationship was found between the QSP/QT and the PaO2. However, there was no significant relationship between the QSP/QT and the PaCO2.

The Effects of Variable F1O2 on Arterial Blood Gases / 대한마취과학회지

Assessment of the adequacy and effectiveness of oxygen therapy is a matter of clinical evaluation and blood gas measurement as long as the administration of oxygen is consistent and predictable. Normal variances in the distribution of ventilation and pulmonary blood flow make the measurement of alveolar oxygen concentrations impratical and complex. To certify the relationship between the fractional inspired oxygen concentration (F1O2) and arterial oxygen tension(PaO2), we performed the blood gas analysis of the anesthetized surgical patients whose inspired oxygen concentrations were 20 to 100% (compressed medical-O2). This paper reports our findings and a discussion of their possible significance. Results were as follows ; 1) There were no differences in systolic, diastolic and mean arterial pressure in the range of 0.2 to 1.0 of F1O2. 2) There was no clinically significant difference in heart rate from 0.2 to 1.0 of F. 3) In the arterial blood gas analysis, PaCO2 and pHa revealed normal value from F1O2 0.2 to 1.0 but PaO2 progressively increased significantly. Patients didn,t reveal arterial hypoxemia and acid-base imbalance from 0.2 to 1.0 of F1O2.

Changes in Arterial and Mixed Venous Carbon Dioxide Tension and Hemodynamic States after Sodium Bicarbonate during Hemorrhagic Shock / 대한마취과학회지

Recently, several investigators have begun to question the routine use of sodium bicsrbonate in metabolic acidosis, based on a failure to clearly demonstrate the efficacy of alkali therapy, which includes the production of carbon dioxide and variability of the effect on hemodynamic state. We studied the use of sodium bicarbonate in a canine model of hemorrhagic shock to determine its effect on arterial, mixed venous blood gases and hemodynamic states. Nine adult mongrel dogs were anesthetized with pentothal sodium and mechanical ventilation was adjusted to maintained the PaCO2 at 30 to 35mmHg. Ar Swan-Ganz catheter was inserted via a right femoral vein and the right femoral artery was cannulated for continuous pressure monitoring and intermittent blood sampling. 30 minutes after hemorrhagic shock, sodium bicarbonate (1mEq/kg) was administered and 1, 5, 15, 30 and 60 minutes after administration of sodium biearbonate we analyzed the arterial, mixed venous blood gases and measured hemodynamic states. The results were as follows, 1) The arterial carbon dioxide tensions(PaCO2) of 1,5,15,30 and 60 minutes after administration of sodium bicarbonate were 44,42,41,42 and 46mmHg which increased significantly compared to control value, 33mmHg. 2) The mixed venous carbon dioxide tensions(PvCO2) ofr 1, 5, 15, 30 and 60 minutes after administration of sodium bicarbonste were 57, 55, 56, 55 and 55mmHg which also increased significantly compared to control value, 46mmHg. 3) The mean arterial pressures of 1, 5, 15, 30 and 60 minutes after administration of sodium bicarbonate were 61, 60, 64, 68 and 70mmHg which increased significantly compared to control value, 50mmHg, but there were no increasements of cardiac output. It is undesirable to use sodium bicarbonate routinely during hemorrhagic shock because the use of sodium bicarbonate in metabolic acidosis increased arterial and mixed venous carbon dioxide tension and did not show the improvement of hemodynsmic derangement.

End Tidal CO2 Monitoring with Salter Divided Nasal Cannula in Post-extubated Spontaneous Breathing Patients / 대한마취과학회지

For the evaluation of the correlation between the ETCO2 and the PaCO2 in post-extubated spontaneously breathing patients, we tested 30 patients in recovery room with Salter Divided Nasal Cannula, which have permanent bamer in the face piece and a dual tubing set that allows end tidal sampling from one nare and oxygen delivery to the other. When the wave form of capnogram looked regular and normal, the value of ETCO2 was recorded and the arterial blood was taken from the radial artery to analize blood gas immediately. The results were as following; 1. The mean value of PaCO2 was 42.0+/-4.8 mmHg. 2. The mean value of P(ET)CO2 was 39.3+/-5.1 mmHg. 3. The value of P(ET)CO2 acquired with Salter Divided Nasal Cannula hase close positive correlation with the values of the PaCO2. (PaCO2=0.75 x P(ET)CO2+/-12.64, r=0.79, p<0.001)

The Use of the Maplson Type D in Febrile Pediatric Patients / 대한마취과학회지

The Mapleson type D is one of the non-rebreathing systems used in pediatric general anes- thesia. Because it doesnt have soda lime, the fresh gas tlow (FGF) must be adjusted to the patient's size, body temperature and the anesthetic technique to prevent CO2 retention. We have used the FGF of 2-3.5 L/min according to patient's body weight, whether or not the patient has a fever. So, we examined arterial blood gas analysis in 3 pediatric patients with fever. We suggest that if a patient has a fever, it is desirable to inmease FGF to 5 L/min to prevent CO2 accumulation or acidosis.

Changes in End Tidal CO2 before and After Release of Tourniquet / 대한마취과학회지

In 24 healthy adult patients having orthopedic surgical procedures requiring the use of a tourniquet under general anesthesia with controlled mechanieal ventilation, we have deter- mined ehanges in end tidal CO2(PetCO2) and arterial blood gas values before and after release of tourniquet. After deflation of tourniguet, PETCO and PaCO2 increased significantly with the maximal elevation occuring within two minutes. The pH level decreased significantly and maximally within three minutes. There was statistically significant linear correlation between PCO and PaCO2 Sugesting prediction of the PaCO2, level by monitoring the PetCO2 level. On these findings, hyperventilation may be indicated to facilitate the return of PaCO2 and pH to baseline just before and for several minutes after tourniquet release, especially in patients with increased intracranial pressure. In conclusion, we recommend noninvasive monitoring of the PetCO2 level instead of invasive measure-ment of the PaCO2 level.

Comparison of the End-Tidal PCO2 Measurements Sampled at the Distal and Proximal Ends of the Endotracheal Tube in Adults / 대한마취과학회지

To determine whether the site of gas sampling affects end-tidal gas measurements in adult patients during anesthesia, end-tidal pCO2(PetCO2) was measuredcontinuously from the distal and proximal ends of the endotracheal tube(SHERIDAN) in 33 adults ventilated with Drager anesthesia ventilator. These data were compared with simultaneous arterial PCO2 (PaCO2) measurements. The study was commenced after each patients was ventilated no less than 15 minutes at the desired ventilator settings. Gas was continuously aspirated at 230 ml/min. for measurement of the PetCO2 using SARA Cap.A.G,Capnometer'sampled from the distal and proximal ends of the endotracheal tube for 3-minutes of each sampling port, alternativiely measured at 5 minutes interval. And each measurement was repeated twice and calculated mean values. The results were as follows: The mean PetCO2 sampling from the distal end was 31.6+/-2.4 mmHg. and the proximal end was 31.0+/-2.3mmHg. The difference between two results was statistically not significant(p> 0.05). The correlation coefficients of PetCO2 vslues for the distal end and the proximal end samplings to the PaCO2 values were r =0.48 and r=0.45 respectively, and statistically significant(p< 0.05) We concluded that the measured PetCO2 sampled from the distal end of the ETCO cuffed endotracheal tube' does not show any statistically significance to the proximal one. However, distally sampled PetCO2 measurements were more approximate PaCO2 measurements than proximally sampled one.

Clinical Observation of Intrathecal Meperidine Anesthesia and the Effect of Added Epinephrine / 대한마취과학회지

Intrathecal meperidine produces a profound analgesia, because meperidine has a high lipid solubility and a structure similar to local anesthetics. This study was undertaken to evaluate the anesthetic effect and complications of intrathecal meperidine anesthesia and the effect of added epinephrine. Two percent meperidine 30 mg (Group I) and 2% meperidine 30 mg with 0.3 mg epinephrine (Group II) in 20% D/W were injected intrathecally in each of 30 cases scheduled for simple and short surgical procedures. The results are as follows: 1) Systolic blood pressure and pulse rate decreased significantly from 10 minutes to 1 hour after intrathecal meperidine injection, compared with the value before anesthetic administration, but did not require special medical treatment. 2) The onset time of block of T, sensory dermatome in the meperidine injection group (Group 1) and the added epinephrine mixed injection group (Group II), were 5.3+/-1.4 minutes and 6.6+/-2.1 minutes, and duration were 58.5+/-10.5 minutes and 74.1+/-16.4 minutes respectively. Therefore, the onset time of motor nerve blok were 5.5+/-2.6 minutes and 8.9+/-1.6 minutes, and then their duration were 65.7+/-11.4 minutes and 79.7+/-13.4 minutes respectively. 3) PaO decreased and PaCO2 increased significantly 1 hour after meperidine injection without any serious problem. 4) Complications, such as nausea, pruritus and urinary retention, were observed in many patients without any serious problem.

The Effectiveness of the Use of ETCO2 Cuffed Tracheal Tube for the Measurement of End Tidal CO2 Tension / 대한마취과학회지

To evaluate the relationship between arterial and ent tidal carbon dioxide teneion, we use ETCO2cuffed tracheal tude. Twenty five patients were selected for the study. The anesthesia was induced by pentothal sodium 4-5mg/kg, succinylcholine 1-1.5mg/kg After intubation, anesthesia was maintained by halothane, nitrous oxide and oxygen. The patients were ventilated mechanically with tidal bolume 10 ml/kg and respiration rate 12/min When anesthesia was stabilized, end tidal cardon dioxide tension were measured at proximal and distal site of ETO2cuffed tracheal tube. The arterial blood sample were taken for arterial carbon dioxide tension from radial artery simultaneously. The results were as follows: 1) Both the end tidal carbon dioxide tension at proximal and distal sites of the tube showed close correlationship with arterial carbon dioxide tension 2) There was no statistical significant difference in carbon dioxide tension between proximal and distal site of ETCO2cuffed tracheal tube.