Comparison of emergence agitation between sevoflurane/nitrous oxide administration and sevoflurane administration alone in children undergoing adenotonsillectomy with preemptive ketorolac / 대한마취과학회지

BACKGROUND: Sevoflurane anesthesia commonly causes emergence agitation (EA) in children. One previous study has reported that the use of nitrous oxide (N2O) during the washout of sevoflurane may reduce EA by decreasing the residual sevoflurane concentration, while many animal studies suggest that N2O poses a potential risk to children. The present study was designed to compare EA in children assigned to receive sevoflurane with N2O (group N) or sevoflurane alone (group S). METHODS: We enrolled 80 children aged 3-10 years. Anesthesia was induced with 5 mg/kg thiopental sodium, 0.6 mg/kg rocuronium and 0.5 mg/kg ketorolac, and was maintained with 50% N2O and sevoflurane in group N or with sevoflurane alone in group S. The sevoflurane concentration was adjusted with a bispectral index (BIS) of 40-60. After completion of the surgery, N2O and sevoflurane were simultaneously discontinued and replaced with oxygen (O2) at 6 L/min. End-tidal sevoflurane concentration (Et Sevo) (%), BIS at the end of surgery, Et Sevo at recovery of self-respiration and emergence profiles were recorded. EA occurrence, pain score and rescue fentanyl consumption were assessed in the postanesthesia care unit. RESULTS: Et Sevo was significantly lower in group N (1.9%) than in group S (2.3%) at the end of surgery. However, there were no differences in Et Sevo at recovery of self-respiration, emergence times, the incidence of EA, pain score or dose of rescue fentanyl between the groups. CONCLUSIONS: In children undergoing adenotonsillectomy with preemptive ketorolac, anesthetic maintenance using sevoflurane alone does not affect the incidence of EA or emergence profiles compared to anesthetic maintenance using sevoflurane with N2O.

The effects of hydrogen sulfide under sevoflurane administration against ischemia and reperfusion injury in isolated rat heart / 대한마취과학회지

BACKGROUND: Hydrogen sulfide (H2S) produces a protective effect against myocardial ischemia and reperfusion injury. Sevoflurane, which is used for anesthesia in cardiac problem patients, also has a protective effect. This study is designed to reveal the effects of H2S under sevoflurane using rat hearts. METHODS: The hearts were Langendorff-perfused, subjected to 30 minutes ischemia and 60 minutes reperfusion. Group I was a control group. The other groups were pretreated for 15 minutes before ischemia as follows: 1.6% sevoflurane for group S; 18.5 microM H2S S for group H; and 1.6% sevoflurane and 18.5 microM H2S simultaneously for group HS. Hemodynamics and the infarct size were measured. RESULTS: Group HS presented depressed hemodynamics during pretreatment. LV function in group HS achieved better recovery than group I after reperfusion. The infarct size of groups S, H and HS was smaller than group I, while there were no differences between groups S, H and HS. CONCLUSIONS: Exogenous H2S did not enhance the preconditioning effects of sevoflurane. Rather, the results suggest that H2S under sevoflurane might depress hemodynamics.

Antihistamine Pretreatment to Reduce Incidence of Withdrawal Movement After Rocuronium Injection

The purpose of this study was to determine the effectiveness of antihistamine therapy for withdrawal movements caused by rocuronium injection. One hundred seventy one ASA I-II adults undergoing elective surgery were randomly assigned to one of two groups. Patients in the control group (Group C) were premedicated with 2 mL normal saline, and those in the antihistamine group (Group A) were pre-medicated with 2 mL (45.5 mg) pheniramine maleate. After the administration of thiopental sodium 5 mg/kg, rocuronium 0.6 mg/kg was injected. Withdrawal movements were assessed using a four-grade scale. The administration of antihistamine reveals lower grade of withdrawal movement after rocuronium injection.

Comparison of bispectral index (BIS) and entropy in patients with cerebral palsy during sevoflurane induction / 대한마취과학회지

BACKGROUND: Demand of anesthesia for patients with cerebral palsy is more increasing. But there is still lacking in clinical research regarding how BIS and entropy reflect well on sedative and hypnotic state in patients with cerebral palsy. METHODS: Fifteen patients with cerebral palsy (Group CP) and fifteen patients without cerebral palsy (Group NL) scheduled for elective orthopedic surgery were included in the study. Induction of anesthesia was done by having the patient inhale 1 vol% sevoflurane and 100% oxygen using a total fresh gas flow of 8 L/min. Simultaneously BIS, state entropy (SE), response entropy (RE), end-tidal sevoflurane concentration were recorded every 15 seconds till there was no self respiration. When end-tidal sevoflurane concentration had not risen any more for 30 seconds, we increased inhaled sevoflurane concentration in 1 vol% increments. End point of recording was when self respiration was lost or the time sevoflurane concentration reached 8 vol%. RESULTS: No significant differences in RE, SE, BIS at baseline and end point were found between the two groups. No significant difference in the time reach end point was found between the two groups. BIS, SE and RE correlated with end-tidal sevoflurane concentration in the two groups. CONCLUSIONS: The authors found no significant difference in the entropy values between patients with CP and normal patients. Also, the entropy values could be interpreted like BIS in patients with CP. And BIS showed a stronger correlation with end tidal sevoflurane concentrations than entropy.

Epidural Anesthesia for a Cesarean Section in a Parturient Patient with Congestive Heart Failure and Respiratory Insufficiency: A case report / 대한마취과학회지

We report a case in which epidural anesthesia was successfully administered during a cesarean section of a 35 years old parturient patient with severe congestive heart failure and respiratory insufficiency at 33 weeks of gestation. The patient had a past history of mitral regurgitation and mitral valve prolapse treated by mitral valve replacement ten years prior. When limited motion of the prosthetic mitral valve developed, congestive heart failure recurred and was aggravated by the pregnancy. In addition, the patient presented with symptoms of respiratory insufficiency including NYHA III dyspnea, orthopnea, severe pulmonary hypertension (systolic pulmonary arterial pressure: 112 mmHg) due to severe aortic regurgitation, pleural effusion and pulmonary edema on admission. Four-days after admission, with premature labor pain and fetal distress, the patient underwent an emergency cesarean section. Due to the orthopnea, the patient could not breathe in the supine position, and we chose to give epidural anesthesia at a sitting position for preserving self-respiration and to prevent a ventilation-perfusion mismatch that would possibly develop during general anesthesia. Moreover, we could control postoperative pain and maintain a minimal, gradual hemodynamic change throughout the epidural anesthesia. During surgery, the hemodynamic instabilities were controlled by the use of dopamine, dobutamine, ephedrine and milrinone. We safely finished the cesarean section under epidural anesthesia and the patient was sent to the intensive care unit postoperatively to manage congestive heart failure and respiratory insufficiency.

Use of Dietary Supplements in Presurgical Patients / 대한마취과학회지

BACKGROUND: Several survey reported that use of dietary supplements including herbal medicine was common in the preoperative period. The use of such remedies has implications for the anesthesiologists because of the potential for drug interactions and side effects. Little information is available on the frequency of use in the surgical population in Korea. This study was purposed to find out the frequency and predictors of the use of dietary supplements in presurgical patients. METHODS: A questionnaire was distributed to all patients at the preoperative visit from May 2006 to August 2006. The questionnaire inquired as to basic demographics, use of dietary supplements, the name and number of dietary supplements used, reasons to take the dietary supplements, and whether the patient had informed anesthesiologist of the use. RESULTS: A total 1,072 completed surveys showed that overall 37% of presurgical patients reported the use of dietary supplements. Less than half of the patients told their anesthesiologists that they were using dietary supplements. The most commonly used dietary supplements were ginseng, soy, glucosamine, garlic, prunus mume, mushroom, siberian ginseng, fish oils, aloe, ginger, and gingko in order of incidence. Young age was predictor associated with lower use of dietary supplements. CONCLUSIONS: Use of dietary supplements is common in the preoperative period in Korea. Documentation of the use of these products in the perioperative period is important to consider the potential interaction of dietary supplements with medical medicine or anesthetics.

The Effect of Lidocaine Spray before Endotracheal Intubation on the Incidence of Cough and Hemodynamics during Emergence in Children / 대한마취과학회지

BACKGROUND: Cough and hyperdynamic reaction cause considerable discomfort, and they may lead to postoperative surgical complication. To reduce coughing and hemodynamics during emergence, the efficacy of laryngotracheal spraying with lidocaine before intubation is not clear, particularly, in children. We investigated such effect during emergence from general anesthesia, in children. METHODS: Children were studied in a double blind manner: 105 ASA physical status I-II, aged 2-16 yrs, undergoing tonsillectomy and adenoidectomy. Patients were randomly grouped into three (A, B, and C) by the lidocaine spray before endotracheal intubation: 4% lidocaine to the group A (n = 32), 10% lidocaine to the group B (n = 36), and normal saline to the group C (n = 37). The same dose (2 mg/kg) of lidocaine was applied. During emergence, patients were observed their cough and hemodynamics. RESULTS: Lidocaine spray, irrespective of concentration, did not significantly diminish the cough and the hemodynamic reaction across the groups before and after the extubation as well as in the recovery room (P value = 0.44, 0.86, 0.17). CONCLUSIONS: These findings support that the laryngotracheal spraying with lidocaine (2 mg/kg of 4% and 10%) before endotracheal intubation does not reduce the cough and hemodynamic reactions during emergence from general anesthesia in children.

Iatrogenic Aortic Dissection Following Mitral Valve Replacement: A case report / 대한마취과학회지

Iatrogenic aortic dissection (IAD) is a life-threatening complication that can occur during open heart surgery, therefore IAD requires early diagnosis and prompt management. We describe here a case of IAD that occurred during mitral valve replacement. The transesophageal echocardiography (TEE) evaluation revealed features indicative of acute aortic dissection and the tear was successfully repaired by interposition of a graft.

Effects of Ischemic Preconditioning and Propofol on Cardiac Function and Coronary Flow following Cold Cardioplegia and Reperfusion in Isolated Rat Heart / 대한마취과학회지

BACKGROUND: The interaction between ischemic preconditioning (IPC) and propofol-induced cardioprotective effects during prolonged cold ischemia has not been studied yet. The purpose of this study is to investigate the effects of ischemic preconditioning and propofol on cardiac function and the development of endothelial injury after 4 hours of cold cardioplegia and reperfusion. METHODS: After suspension of the isolated heart on the Langendorff perfusion system, we took a stabilizing period for 15 minutes, perfusion period for 15 minutes, global cold (4oC) ischemic period for 4 hours, and then reperfusion period for 60 minutes. There were 4 groups: (1) CONTROL group, no intervention; (2) IPC group, two 2-minute total coronary occlusions interspaced with 5 minutes of normal reperfusion; (3) PROPOFOL group, propofol (2micrometer) was infused during reperfusion period; (4) BOTH group, ischemic preconditioning and postischemic propofol treatment group. The measurements of cardiac performances, such as left ventricular developed pressure (LVDP), rate of ventricular pressure generation (dp/dt), and heart rate (HR) was obtained at pre- and postischemic periods. For the evaluation of endothelial injury during reperfusion period, coronary flow responses to bradykinin were tested. Infarct size was measured using the triphenyl tetrazolium stain. RESULTS: IPC, PROPOFOL, and BOTH groups showed better outcome of LVDP, dp/dt, HR, and flow responses to bradykinin than CONTROL group did. But there is no statistically significant difference in variables among the three groups. CONCLUSIONS: Ischemic preconditioning and postischemic propofol have cardioprotective effect respectively but no additive effect after 4 hours cold cardioplegia and reperfusion.

Effects of Interscalene Brachial Plexus Block Combined with Patient Controlled Analgesia in a Patient with CRPS: A case report / 대한마취과학회지

Complex regional pain syndrome (CRPS) is a condition characterized by regional pain, sensory alterations, motor dysfunction, and abnormality in body temperature, sudomotor activation, skin color changes and regional edema which often appears in the extremities after the onset of a noxious event. CRPS is a disabling disorder with an unknown mechanism. We present a CRPS case which is extremely resistant to conventional pharmaceutical and other therapeutic treatments in the left upper limb, which was treated successfully with continuous interscalene brachial plexus block (BPB).

Total Spinal Anesthesia following Epidural Block for Correction with Ilizarov Apparatus in an Achondroplasia Patient: A case report / 대한통증학회지

Epidural analgesia using an epidural catheter is an effective method to relieve the pain during the rehabilitating procedure for postoperative orthopedic patients. Total spinal anesthesia is one of the possible complications of epidural catheterization which can lead to a life-threatening condition. Achondroplasia is the most common form of short-limbed dwarfism resulting from a failure of endochondral bone formation. In patients suffering with short stature syndrome like achondroplasia, the incidence and risk of total spinal anesthesia during epidural anesthesia may increase because of the technical difficulty and structural anomaly of the spine. We report here on a 35-year old female patient with a height of a 115 cm. She was diagnosed as achondroplasia and she had a previous Ilizarov operation; both tibial lengthening and correction of valgus were done. No specific event occurred during epidural catheterization. Immediately after the injection of a test dose via epidural catheter, the patient became hypotensive, drowsy and showed weakness of both her upper and lower extremities. The symptoms were disappeared after 40 minutes. The catheter was removed on the next day. We concluded that the total spinal anesthesia was caused by intrathecal injection of local anesthetics through the epidural catheter, and the anesthesia then migrated into the subarachonoid space.

The Optimal Administration of Epidural Droperidol to Reduce the Side Effects of Epidural Opioid / 대한마취과학회지

BACKGROUND: Epidural opioids are used for the treatment of postoperative pain, but the incidence of side effects like nausea, vomiting, and pruritus is high. The aim of this study was to determine the optimal method for administering epidural droperidol to reduce the side effects of epidural opioids. METHODS: A randomly sampled group of 145 patients that had undergone abdominal or lower leg surgery under general anesthesia were divided into the four groups. All patients received morphine 4 mg, fentanyl 500microgram and 0.2% ropivacaine 100 ml using a 2-day epidural infusion pump, and morphine 1 mg, fentanyl 50 mg and 0.2% ropivacaine 10 ml by epidural bolus. Group 1 patients (control group, n = 40) did not receive epidural droperidol. Group 2 patients (n = 35) received 2.5 mg of droperidol as an epidural bolus. Group 3 patients (n = 35) received 2.5 mg of droperidol as a continuous infusion. Group 4 patients (n = 35) received 1.25 mg of droperidol as an epidural bolus and 1.25 mg of droperidol as a continuous infusion simultaneously. Nausea, vomiting, and pruritus were assessed and recorded by a blind observer 1, 6, 24, and 48 hours after the bolus epidural administration of droperidol. RESULTS: There was no significant difference between the four groups in terms of the intensity of sedation, nausea, vomiting, and pruritus. The incidence of nausea and vomiting in groups 2, 3, and 4 at 1 hour, in groups 2 and 4 at 6 hours, and in groups 3 at 48 hours was significantly lower than in control group. The incidences of pruritus in groups 2, 3, and 4 at 6 hours, and in groups 3 and 4 at 24 and 48 hours were significantly less than that of the control group. CONCLUSIONS: Epidural bolus droperidol is effective at reducing nausea, and vomiting during the early postoperative stage. Continuous epidural droperidol is also effective at reducing the pruritus during the late postoperative stage.

Comparisons of Myocardial Protective Effects of Sevoflurane at Different Concentrations against Ischemia in Isolated Rat Heart / 대한마취과학회지

BACKGROUND: Sevoflurane, a newly developed halogenated inhalation anesthetic agent shows myocardial protective effects against global ischemia like other inhalation agents. We investigated differences between pharmacologic preconditioning effects at various concentrations of sevoflurane. METHODS: Forty male Sprague-Dawley rats were subdivided into 4 groups (each n = 10). All groups underwent the same procedure (Langendorff preparation, 30 minutes ischemia and 60 minutes reperfusion) except for the concentrations of sevoflurane. The control group received no sevoflurane treatment. The sevo 1.6% group was given 1.6% sevoflurane before ischemia, the sevo 205% group was given 2.05% sevoflurane before ischemia, and the sevo 2.5% group was given 2.5% sevoflurane before ischemia. Hemodynamic parameters of all groups were recorded through a thin, saline-filled latex balloon and a transducer. Coronary flows were also measured. All hearts were stained by triphenyl tetrazolium to measure infarct size. RESULTS: The sevoflurane administered groups showed higher left ventricular end systolic pressures and lower left ventricular end diastolic pressures than the control group after ischemia and reperfusion. The dP/dtMAX of the sevoflurane administration groups showed a more rapid recovery pattern after ischemia than the control. But no differences were found between the sevoflurane administered groups. Infarct sizes in the sevoflurane administered groups were smaller than those in the control group, and there were no significant differences between the sevoflurane administered groups. CONCLUSIONS: Sevoflurane (even below one MAC) administration before myocardial ischemia has a superb cardioprotective effects, i.e., rapid recovery of left ventricular fuctions, less stiffness development, and a reduced infarct size. There were no significant differences between the sevoflurane administered groups.

Comparison of the Myocardial Protective Effects of Desflurane and Sevoflurane against Global Ischemia and Reperfusion Injury in Isolated Rat Heart / 대한마취과학회지

BACKGROUND: Desflurane and sevoflurane have been shown to induce pharmacologic preconditioning in experimental studies. The present study was aimed at comparing the myocardial protective effects of these two halogenated anesthetics in terms preconditioning induction. METHODS: Three groups of Sprague-Dawley rat hearts (n = 10 each) were perfused with oxygenated modified Kreb's solution using a Langendorff perfusion device. All groups underwent 30 minutes of global ischemia and 60 minutes of reperfusion after a stabilization period of 30 minutes. Before ischemia, hearts underwent a preconditioning period consisting of either no inhalation for 20 minutes (control group), or 15 minutes of either MAC desflurane or sevoflurane followed by 5 minutes of washout. Left ventricular end systolic pressure (LVESP), left ventricular end diastolic pressure (LVEDP), heart rate (HR) and maximal rate of change of ventricular pressure (dP/dt) were measured at after inhalation, before ischemia, and 5 minutes, 30 minutes and 60 minutes after reperfusion. Coronary sinus effluent also was measured. Infarct size was measured by triphenyl tetrazolium staining. RESULTS: LVESP and dP/dt were decreased in the control group, but remained unchanged in the desflurane and sevoflurane groups during the reperfusion period. LVEDP was increased in all groups, but the magnitude of the increase was smaller in the desflurane and sevoflurane groups than in the control group during the reperfusion period. HR was increased in the control group, but remained unchanged in the desflurane and sevoflurane groups during the reperfusion period. Coronary blood flow was decreased in all groups. Infarct size for the two anesthetics were smaller than in the control group. Differences in hemodynamics was observed between the desflurane and sevoflurane group at any time. CONCLUSIONS: Desflurane and sevoflurane had similar myocardial preconditioning effects in isolated rat heart.

Preventive Effects of Propofol Aganinst the Elevation of Intracellular Ca2+ and Reactive Oxygen Species Induced by Lysophosphatidic Acid in Endothelial Cells / 대한마취과학회지

BACKGROUND: This study was performed to examine 1) whether propofol prevented the increases in intracellular calcium and radical oxygen species (ROS) induced by lysophosphatidic acid (LPA) in endothelial cell; 2) whether these two types of increases were mediated by common underlying mechanisms. METHODS: Intracellular Ca2+ ([Ca2+]i) and H2O2 were measured in endothelial cell line (ECV 304) using a laser scanning confocal microscope. The cells, cultured and serum-starved on round coverslips, were incubated with various concentrations of propofol for 30 minutes, and then stimulated with various concentrations of LPA. The samples were excited by a 488 nm argon laser and images were filtered by a 515 nm longpass emission filter. The results were expressed as relative fluorescence intensity (RFI) and fold stimulation (fold). RESULTS: LPA increased in intracellular ROS in the endothelial cell in a dose-dependent manner. In addition, LPA-induced increase in ROS were alleviated by ROS scavengers such as Aspergillus niger catalase and n-(2-mercaptopropionyl)-glycine (2-MPG). LPA also increased in [Ca2+]i in a dose-dependent fashion. Propofol prevented LPA-induced increase in ROS and [Ca2+]i whereas 2-MPG did not affect the change of calcium level induced by LPA application. CONCLUSIONS: These results suggested that propofol prevented the increases in intracellular calcium and ROS induced by LPA in endothelial cell, and these two types of increases might be mediated by different underlying mechanisms.

Renal Dysfunction Following On-pump versus Off-pump Coronary Revascularization / 대한마취과학회지

BACKGROUND: Renal dysfunction is a serious complication that sometimes occurs after on-pump coronary artery bypass grafting. Recently, the off-pump coronary artery bypass (OPCAB) is used. We investigated whether this practice can reduce renal compromise. METHODS: Eighty patients underwent CABG surgery between March 2001 and March 2002. Among these, 50 patients received CABG with cardiopulmonary bypass (CPB) and 30 patients received OPCAB. The data collected included age, gender, history of diabetes, history of hypertension, history of congestive heart failuere, preoperative serum creatinine (PreCr) level, peak postoperative serum creatinine (Peak PostCr) level, preoperative and postoperative left ventriclular ejection fraction, preoperative ACE inhibitor use, perioperative angiography with contrast dye. Perioperative changes in creatinine clearance (DCrCl) were calculated using changes in the pre and postoperative serum creatinine values. Moderate postoperative renal dysfuntion was defined as a peak postoperative creatinine value of greater than 1.5 times and below 2.0 times the preoperative creatinine value. Severe postoperative renal dysfunction was defined as a peak postoperative creatinine of more than twice the preoperative creatinine value. RESULTS: Moderate renal dysfunction was observed in 10% of patients in the on-pump group and in 17.6% of the patients in the off-pump group. Severe renal dysfunction was observed in 6.7% of patients in the on-pump group and in 5.9% of the patients in the 0ff-pump group. Multivariate liner regression analysis showed that the preoperative and immediate postoperative creatinine clearance are associated with postoperative renal dysfuntion in both groups. CONCLUSIONS: In this retrospective study, we could not confirm that OPCAB reduces perioperative renal dysfunction more so than CABG with CPB. Diabetes was found to be significantly associated with postoperative renal dysfunction in CABG with CPB.

Use of an Epidural Catheter Placed Through a Fiberoptic Bronchoscope for Topical Anesthesia of the Larynx and Trachea in a Case of Difficult Intubation: A case report / 대한마취과학회지

Fiberoptic bronchoscope guided tracheal intubation is more popular in patient with expected difficult intubation by conventional laryngoscopy. We report a case of smooth fiberoptic bronchoscope guided tracheal intubation under local anesthesia. A 10% lidocaine spray 2-3 puffs of pharyngolaryngeal topical anesthesia and 2% lidocaine injection through a 19 gauge epidural catheter (ARROW(R)) placed over the fiberoptic bronchoscope suction channel for laryngeal and tracheal anesthesia were sufficient to prevent pain, coughing and nausea.

Use of an Epidural Catheter Placed Through a Fiberoptic Bronchoscope for Topical Anesthesia of the Larynx and Trachea in a Case of Difficult Intubation: A case report / 대한마취과학회지

Fiberoptic bronchoscope guided tracheal intubation is more popular in patient with expected difficult intubation by conventional laryngoscopy. We report a case of smooth fiberoptic bronchoscope guided tracheal intubation under local anesthesia. A 10% lidocaine spray 2-3 puffs of pharyngolaryngeal topical anesthesia and 2% lidocaine injection through a 19 gauge epidural catheter (ARROW(R)) placed over the fiberoptic bronchoscope suction channel for laryngeal and tracheal anesthesia were sufficient to prevent pain, coughing and nausea.

The Combined Effect of Desflurane and Milrinone on the Function of the Isolated Rat Heart / 대한마취과학회지

BACKGROUND: Desflurane depresses the contractile function of the myocardium. It also causes direct coronary vasodilation. Milrinone, a phosphodiesterase III inhibitor, usually increases myocardial contractility and also has vasodilatory activity. Some inhalation anesthetic agents, such as isoflurane, are safely combined with phosphodiesterase III inhibitors clinically, but milrinone sometimes causes significant hypotension by reducing systemic vascular resistance. The purpose of this study was to evaluate the effect of the combined use of desflurane and milrinone on the function of the isolated rat heart. METHOD: Thirty isolated rat hearts were divided into two groups. [Group 1 (n = 15): desflurane, Group 2 (n = 15): desflurane and milrinone] They were perfused continuously with modified Krebs' solution in a Langendorff retrograde perfusion apparatus. After measuring the control values of the hemodynamic and oxygenation parameters in each group, we administered 6.6 vol% of desflurane to both groups and added sequential perfusion of modified Krebs' solution containing 0.5, 1.0, and 1.5mug/ml of milrinone in Group 2 and then measured the parameters and analyzed them statistically. RESULTS: Baseline measurements in both groups were not statistically different. In Group 1, desflurane significantly decreased LVP (55+/-5 mmHg), dp/dt (557+/-65 mmHg/sec) and MVO2 (71.2+/-16.3 ml/g/min) after 15 minutes. CF (13.9+/-3.1 ml/g/min) and DO2 (176.7+/-43.4 ml/g/min) were increased after 15 minutes. There was no further change after this. In Group 2, desflurane decreased LVP (53+/-18 mmHg), dp/dt (558 90 mmHg/sec) and MVO2 (72.0+/-11.0 ml/g/min) and increased CF (14.2+/-1.9 ml/g/min) and DO2 (175.3+/-29.1 ml/g/min). But, there was no significant difference in the effects of desflurane between the two groups. Milrinone restored LVP, dp/dt and MVO2 to the baseline level, but not with dose-dependency. Desflurane-induced elevated CF and DO2 did not show further changes. CONCLUSIONS: These findings suggest that milrinone increased myocardial contractility and restored the desflurane-induced myocardial depression of the isolated rat heart without further increase of oxygen consumption from the baseline control value. In addition, no additive effects was observed on coronary blood flow when these two agents were used in combination.

Anesthetic Management for Sequential Bronchoalveolar Lavage in a Patient with Pulmonary Alveolar Proteinosis: A case report / 대한구급학회지

Pulmonary alveolar proteinosis is a rare disease of unknown etiology characterized by the remittent or progressive accumulation of lipid-rich proteinaceous material within the alveolar space in the absence of inflammatory response. The removal of lipoproteinaceous material from the alveolar can the only means of effectively treating the progressive hypoxemia in pulmonary alveolar proteinosis. Bronchoalveolar lavage using a double-lumen endotracheal tube is an accepted modality for treatment of pulmonary alveolar proteinosis. We had utilized sequential bronchoalveolar lavage successfully for the treatment of a 51 year-old male patient with pulmonary alveolar proteinosis. There was no hypoxemia and unstable hemodynamics during the procedure. We conclude that the procedure will be safely performed by careful monitoring.