Change of Hemodynamic Parameters and Plasma Catecholamine Level during Laparoscopic Cholecystectomy / 대한마취과학회지

In the last decade, advances in laparoscopic equipment have allowed the development of laparosopic surgical treatment for gynecologic affection. Intraabdominal endoscopy can be extended safely for cholecystectomy. Patients undergoing laparoscopy under general anesthesia exhibit various hemodynamic and blood gas change. To analyze the physiologic mechanisms of these hemodynamic effect of laparoscopic surgery during general anesthesia, the change of mean arterial blood pressure, heart rate, end tidal carbon dioxide and plasma catecholamine were studied. Ten patients undergoing cholecystectomy by means of laparoscopy were selected randomly. Measurements of the above parameters were made about 10 minutes after tracheal intubation when the conditon of the patients stabilized(control), shortly after completion of insufflation of peritoneal cavity with carbon dioxide, 30 minutes after insufflation of carbon dioxide and after deflation of carbon dioxide. There were significantly increased mean arterial pressure, end tidal carbon dioxide, plasma epinephrine, norepinephrine during CO2 insufflation into peritoneaf cavity and increased there after with deflation of CO from the peritoneal cavity in laparoscopic cholecystectomy. In conclusion, these hemodynamic parameter changes seem to be correlated to the increased catecholamine release which was caused by sympathetic stimulation during the laparoscopic cholecystectomy.

Anesthesia for Open Heart Surgery in Patient with Cold Agglutinin / 대한마취과학회지

Cold agglutinins are serum antibodies activated at low temperature to produce red blood cell agglutination and hemolysis. Hypothermic cardiopulmonary bypass has potential danger to patient with positive cold agglutinin titer. We report a successful anesthesia for mitral valve replacement surgery in a patient who has high cold agglutinin titer. To avoid problem, the cold agglutinin titer was reduced by plasmapheresis and hypothermia was maintained above the critical temperature. There was no severe complication except mild hemoglobinuria.