Unilateral massive hydrothorax in a gynecologic patient with pseudo-Meigs' syndrome: A case report / 대한마취과학회지

Pseudo-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs' syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome.

Unilateral massive hydrothorax in a gynecologic patient with pseudo-Meigs' syndrome: A case report / 대한마취과학회지

Pseudo-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs' syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome.

Deep hypothermic total circulatory arrest (DHCA) under total intravenous anesthesia for giant basilar aneurysm clipping : A case report

The prevalence of unruptured intracranial aneurysm varies between 3.6% and 6%.Aneurysms in the posterior circulation, inaccessible by normothermic surgical clipping and giant aneurysms require direct surgical clipping under hypothermic circulatory arrest for cerebral protection.The authors describe a case of giant basilar aneurysm clipping requiring deep hypothermic total circulatory arrest under total intravenous anesthesia.The patient was a 43-year-old female with a giant aneurysm at the tip of the basilar artery.Total intravenous anesthesia with propofol (average effect site concentration 4 mcg/ml) and remifentanil (average effect site concentration 3 ng/ml) and deep hypothermic total circulatory arrest were performed.Neurophysiologic function was monitored by electroencephalography, and somatosensory and motor evoked potentials. Cardiac and coagulation profiles showed no significant changes. The aneurysm was successfully clipped but the patient expired. Further collations of clinical experiences should enable the identification of an optimal means of anesthetic management during complex cerebrovascular surgery.

The Effects of Perfluorocarbon on Respiratory Mechanics and Pulmonary Gas Exchange with Methacholine-induced Bronchoconstriction in Cats / 대한마취과학회지

BACKGROUND: Perfluorocarbon (PFC) liquids have high oxygen carrying capacity and relatively low surface tension allowing them to spread evenly through the diseased lung, especially in the case of adult respiratory distress syndrome. But few studies have demonstrated the effects of PFC on a bronchoconstriction model. The aim of this study was to investigate the effects of PFC on pulmonary mechanics and gas exchange in methacholine-induced bronchoconstricted cats using a flow interruption technique. METHODS: Twenty male cats were divided into four groups; control group (group C, n = 5), PFC group (group P, PFC 5 ml/kg, n = 5), methacholine group (group M, 25 microgram/kg/min, n = 5), PFC and methacholine group (group MP, n = 5). Respiratory pressure using a flow interruption technique was measured immediately after stabilizing the heart rate and blood pressure 0, and 15, 30 and 60 min after the start of the intratracheal administration of PFC and/or methacholine infusion, depending on the group. Arterial blood gas analysis was done to compare arterial partial oxygen pressure among the groups at the time of measuring the pressure values. The pressure data was transferred to a personal computer and analyzed using ANADAT software program. Respiratory, airway and tissue viscoelastic pressure were calculated. Statistical analysis was done by ANOVA and statistical significance was defined as P <0.05. RESULTS: Group M and MP showed significantly increased airway pressures compared with group C (P <0.05), but there was no difference among the groups in terms of viscoelastic pressure. Arterial blood gas analysis showed that group P and MP had lower arterial partial oxygen pressures than group C (P <0.05). CONCLUSIONS: This study demonstrates that the intratracheal administration of PFC in a bronchoconstriction cat model increases airway pressure more than tissue viscoelastic pressure, and decreased arterial oxygen partial pressure. We conclude that the intratrachel administration of PFC is not to be recommended in bronchoconstrictive situations.

The Effect of Oral Clonidine Premedication on Changes in Respiratory System Mechanics by Tracheal Intubation / 대한마취과학회지

BACKGROUND: The aim of this study was to evaluate the influence of oral clonidine premedication on respiratory mechanics by tracheal intubation in smokers. METHODS: Thirty male smoker patients were randomly divided into 3 groups. For group 1 (n = 10), l microgram/kg of clonidine was premedicated. For group 2 (n = 10), 2 microgram/kg of clonidine was premedicated. Group 3 (n = 10, control group) was the no premedication group. After anesthetic induction, CMV was applied with a Siemens Servo 900C ventilator, and anesthetic gases were supplied via the low pressure inlet of the ventilator. Tidal volume (10 ml/kg) was fixed during measurements for each patient. End-inspiratory occlusion was applied for at least 3 seconds and tracheal pressure was measured at the distal end of the endotracheal tube. Pressure, flow and volume were monitored and recorded with a Bicore CP-100 pulmonary monitor. Data were measured after 2 (100% O2) and 5 (1.5 vol% enflurane with 50% N2O) minutes of tracheal intubation. Data were transferred to PC and analyzed by processing software (ANADAT). Total respiratory (Rrs), airway (Raw) and tissue (Rve) resistances, along with static (Cstat), dynamic (Cdyn) compliances were calculated. RESULTS: There were no significant differences for Rrs, Raw, Rve, Cstat and Cdyn in the three groups. CONCLUSIONS: Oral clonidine premedication in dosages up to 2 microgram/kg do not affect the changes of respiratory mechanics caused by tracheal intubation in smokers.

The Effect of Oral Clonidine Premedication on Changes in Respiratory System Mechanics by Tracheal Intubation / 대한마취과학회지

BACKGROUND: The aim of this study was to evaluate the influence of oral clonidine premedication on respiratory mechanics by tracheal intubation in smokers. METHODS: Thirty male smoker patients were randomly divided into 3 groups. For group 1 (n = 10), l microgram/kg of clonidine was premedicated. For group 2 (n = 10), 2 microgram/kg of clonidine was premedicated. Group 3 (n = 10, control group) was the no premedication group. After anesthetic induction, CMV was applied with a Siemens Servo 900C ventilator, and anesthetic gases were supplied via the low pressure inlet of the ventilator. Tidal volume (10 ml/kg) was fixed during measurements for each patient. End-inspiratory occlusion was applied for at least 3 seconds and tracheal pressure was measured at the distal end of the endotracheal tube. Pressure, flow and volume were monitored and recorded with a Bicore CP-100 pulmonary monitor. Data were measured after 2 (100% O2) and 5 (1.5 vol% enflurane with 50% N2O) minutes of tracheal intubation. Data were transferred to PC and analyzed by processing software (ANADAT). Total respiratory (Rrs), airway (Raw) and tissue (Rve) resistances, along with static (Cstat), dynamic (Cdyn) compliances were calculated. RESULTS: There were no significant differences for Rrs, Raw, Rve, Cstat and Cdyn in the three groups. CONCLUSIONS: Oral clonidine premedication in dosages up to 2 microgram/kg do not affect the changes of respiratory mechanics caused by tracheal intubation in smokers.

Respiratory Mechanics of Young and Elderly under Enflurane Anesthesia / 대한마취과학회지

BACKGREOUND: The aim of this study was to compare the respiratory mechanics between young and elderly during enflurane anesthesia using flow-interruption technique. METHODS: Fourteen patients were divided into 2 groups; for young aged group (Group Y)(24.9 4.9 years) and old aged group (Group O)(73.4 5.6 years). After anesthetic induction, endotracheal intubation was performed with Univent tube, and then tracheal pressure was measured at the distal end of the tube. 1.5 vol% of enflurane and 0.15 mg/kg of vecuronium were administered to maintain anesthesia. IMV (intermittent mandatory ventilation) was applied with Siemens Servo 900C ventilator and anesthetic gases were supplied via low pressure inlet of the ventilator. Tidal volume (10 ml/kg) was fixed during measurements for each patient. After stabilization of vital signs, respiratory parameters were measured before surgery. End-inspiratory occlusion was applied at least 3 seconds. Pressure, flow and volume were monitored and recorded with Bicore CP100 pulmonary monitor. The data were transfered to a PC and analyzed by a processing software. Total respiratory (Rrs), airway (Raw) and tissue (Rve) resistances, and dynamic (Cdyn) and static (Csta) compliances were calculated. Mann-Whitney U test was used for statistical analysis. RESULTS: There were no statistically significant differences for the Cdyn and Csta values between the two groups. But the values of Rrs, Raw and Rve were higher in the Group O than the Group Y. CONCLUSION: During enflurane anesthesia, the values of Rrs, Raw and Rve were higher in the Group O than the Group Y. To elucidate the exact causes of the above results, further studies are needed.