A Study of a Separated Bronchial Blocker / 대한마취과학회지

BACKGROUND: Compared with blockers mounted on the endotracheal tube, (a conjugated blocker), studies about blockers that are independent of a single-lumen tube, (a separated blocker) are rare. This study's object was to find several characteristics about these new blockers. METHODS: We compared the peak and plateau airway pressures in intubated patients (n = 30) with, (group EB) and without, (group E) blockers. We measured the depth of the blockers and the pressures of the balloon of the blockers. Balloon pressures were measured twice outside and inside of the E-tube with 7 ml of air. All of these measurements were done in the supine position with 1 L/min flow rate. The frequency of malposition, the score of the lung collapse, and bronchial mucosa change were checked thereafter. RESULTS: The peak airway pressures of group EB were significantly higher than those of group E (p < 0.05). However, the plateau pressures of both groups were not different. The depth of the blockers was 52.0 +/- 1.8 cm, and the balloon pressures of the blockers were 124 +/- 22 and 139 +/- 20 mmHg, respectively. Six patients needed additional bronchoscopy because of malposition. The lung collapse score was good in 17 patients, fair in 10 patients, and poor in 3 patients. There was not any severe bronchial mucosa damage. CONCLUSIONS: Understanding the characteristics of these new blockers, we can consider the use of them in some situations in which the use of a double-lumen tube is impossible or inconvenient.

Cardiovascular and Respiratory Instability Induced by Excessive Packing during Lower Abdominal Surgery: A case report / 대한마취과학회지

Retractor and packing usually aid to expose the surgical field and fascilitate surgical procedures. but excessive packing can impede venous return and reduce cardiac output. We experienced severe hypotension and ventilatory difficulty associated with excessive packing and traction in a patient undergoing radical hysterectomy. After removing the packing and extracting the intestine exterior to abdominal cavity, patient's ventilatory condition improved immediately and cardiovascular stability was achieved.

The Effects of Intraperitoneal CO2 Insufflation and/or Reversed Trendelenburg Position on Airway Pressure and Compliance / 대한마취과학회지

BACKGROUND: We studied the effects of intraperitoneal CO2 insufflation and/or the reversed Trendelenburg position on airway pressure and compliance of the total respiratory system. METHODS: We selected and randomly allocated eighty adults to a control group C or laparoscopy group L. Without premedication, propofol and vecuronium were injected for anesthesia. In the supine position we checked peak and plateau airway pressures, and calculated the dynamic and static compliance of the total respiratory system. We only used 10o reverse Trendelenburg position in group C, and used both 10o reverse Trendelenburg position and abdominal CO2 insufflation in group L. Afterwards, we checked airway pressure and compliance and compared them between groups. RESULTS: In group C, there was no change in airway pressure and compliance. But in group L, peak airway pressure (13.9 +/- 2.4 vs 21.0 +/- 3.3 cmH2O) and plateau airway pressure (11.7 +/- 2.1 vs 18.9 +/- 3.2 cmH2O) were increased and dynamic compliance (47.7 +/- 9.1 vs 30.6 +/- 5.9 ml/cmH2O) and static compliance (58.4 +/- 12.4 vs 13.1 +/- 7.3 ml/cmH2O) of the total respiratory system were decreased. CONCLUSION: In a laparoscopic cholecystectomy, intraabdominal insufflation of CO2 raises airway pressure and reduces compliance of the total respiratory system. Reverse Trendelenburg position itself does not affect airway pressure and compliance.

The Effect of Cuff Volume of Laryngeal Mask Airway on Cuff Pressure and Ventilation / 대한마취과학회지

BACKGROUND: The cuff inflation of laryngeal mask airway (LMA) with excessive volume of air may injure soft tissue and nerves around hypopharynx because of high cuff pressure. But it is not well known about adequate cuff volume of LMA. The cuff inflation of LMA in hypopharynx accomodate pharynx, so various injection volume may differ in sealing effect. This may influence ventilation. This study was proposed to investigate the effect of cuff volume on cuff pressure and ventilation when LMA inserted. METHODS: Fifteen male patients were inserted with #4 LMA, fifteen female patients were inserted #3 LMA. For male patients, 10, 20, 30 and 40 ml of air were injected into cuff of LMA and 10, 15, 20 and 25 ml for female patients. Cuff pressure, minute ventilation and airway pressure were randomly measured. RESULTS: Volume of injected into cuff and cuff pressure of LMA were closly related. But minute ventilation and airway pressure were not related with injected air volume of LMA. CONCLUSION: Excessive volume of air injected to LMA cuff was not beneficial to ventilation. So minimal sealing cuff volume under maximal recommended volume of LMA may reduce the incidence of complications associated with high cuff pressure.