Anesthesia for removal of foreign bodies in bilateral main bronchi / 대한마취과학회지

Foreign body aspiration into the airway causes airway obstruction that may be acutely life-threatening or if undected result in severe lung damage. In case of bilateral bronchial obstruction, the impairment of gas exchange is usually severe enough to threaten the patient's life. And the gas exchange will become worsen during bronchoscopy. So, anesthesia and bronchoscopy for removal of the foreign body should be carried out by skilled personel with appropriate equipment, especially in case of bilateral bronchial obstruction. A 16 month old, cyanotic and dyspneic female infant was brought to operating room for removal of bronchial foreign bodies . The anesthesia was induced and maintained with enflurane(1-2%) -oxygen(100%)- vecuronium using Jackson- Rees breathing system which was connecting to the side arm of ventilating brochoscope. Foreign bodies (peanut), which were two pieces of peanut 4X4X6 mm sized from right and 4X8X12 mm sized from left main bronchus, were sucessfully removed.

The Effect of Esmolol Combined with Nitroglycerin on Cardiac Hemodynamics and Myocardial Oxygen Balance during Cross-Clamping of Thoracic Aorta in Induced Ischemic Canene Heart / 대한마취과학회지

The purpose of this study is to investigate the protective role of esmolol during cross-clamping of descending thoracic aorta on the ischemic myocardium induced by the ligation of the left anterior descending coronary artery(LAD) in dogs. LAD was ligated for 15 min followed by reperfusion. Nitroglycerin with or without esmolol were continuously infused throughout procedure and the thoracic aorta was cross-clamped for 45 mins. Eighteen dogs were divided into three groups; group C-no drug administerd, group N-nitroglycerin(5 ug/kg/min), and group NE-nitroglycerin(5 ug/kg/min) with esmolol(0.5 mg/kg as loading dose following 50 ug/kg/min as maintenance dose). Heart rate(HR), mean arterial pressure(MAP), stroke volume(SV), cardiac index(CI), left ventricular stroke work index(LVSWI), pulmonary capillary wedge pressure(PCWP), triple index(TI), mixed venous oxygen tension of great cardiac vein(PgvO2), Ca-vDO2(carotid arterial oxygen content-great cardiac vein oxygen content) and lactate were measured three times in each group before ligation of LAD(stage 1), 15 minutes after LAD ligation(stage 2) and 45 minutes after cross-clamping of descending thoracic aorta(stage 3). The results were as follows: 1) MAP of group NE at stage 3 was significantly high compared with group C but low compared with group N (P<0.05). 2) SV of group NE at stage 3 was significantly high compared with group C and group N. A significant change was observed between group C and group N(P<0.05). 3) CI, LVSWI, PgvO2 of group NE at stage 3 were significantly high compared with group C but not significantly high compared with group N(P<0.05). 4) HR, PCWP, Lactate level of group NE at stage 3 were significantly low compared with group C and group N. A significant change was also observed between group C and group N(P<0.05). 5) TI, Ca vDO2 of group NE at stage 3 were significantly low compared with group C and group N, but no significant change was observed between group C and group N(P<0.05). These results suggest that esmolol could protect ischemic myocardium from progressive damage via reduction of myocardial oxygen consumption without decrease of cardiac output and left ventricular stroke work index.

The Effects of Surfactant Therapy using High Frequency Jet Ventilation on Lung Lavaged Dogs / 대한마취과학회지

The effects of exogenous surfactant replacement therapy using high frequency jet ventilation (HFJV) on arterial blood gases changes, pulmonary and hemodynamic variables were observed in lungs lavaged dogs with saline. Lungs were lavaged repeatedly with warm physiological saline until PaO2 fall 100 mmHg level. Surfactant 50 mg/kg was administered in experimental group and saline was administered in control group intratracheally using HFJV. During administration of surfactant using HFJV, all the dogs were not hypoxemic and PaCO2 were within normal range. HFJV was done for 1 hour to make even distribution of the surfactant, After that, controlled mechanical ventilation of the initial condition was eontinued for 3 hours. 1n surfactant administered group, our results showed that significant PaO2 improvement were observed and maintained for 3 hours, bur no significant changes were observed in saline administered group. In this study, we suggest that the effects of exogenous pulmonary surfactant administered using HFJV on acute respiratory failure, induced by repeated lungs lavage with saline, were good and HFJV can be used a safe and effective method for the administration of the pulmonary surfactant.