One Case of Anesthetic Management for a Cesarian Section in a Patient with Acute Fatty Liver of Pregnancy / 대한마취과학회지

Acute fatty liver of pregnancy is a uncommon complication of late pregnancy which may progress to hepatic failure, encephalopathy, disseminated intravascular coagulopathy, and death. A 65 kg 29-yr-old female at 35 weeks gestation complained of epigastric discomfort and jaundice 5 days before adimission. She had icteric sclera but other physical findings were non-specific. Anesthetic induction was achieved with thiopental, succinylcholine and vecuronium and the trachea was easily intubated. Maintenance of anesthesia was accomplished with oxygen : nitrous oxide (3 : 2) and 0.8% isoflurane. The Apgar scores were 8 and 10 at 1 min and 5 min, respectively. After the end of surgery, the patient was awakened and she was extubated after she followed verbal commands. She remained stable during her immediate postoperative course, but her vital signs were worse suddenly on postoperative day 3. On postoperative day 5, she was supported by artificial ventilation. The prothrombin time and the partial thromboplastin time were prolonged. Dopamine, dobutamine and norepinephrine were administered for maintaining her cardiovascular function. After that she was managed with artificial ventilation, cardiovascular drugs, fluid and blood products due to multi-organ failure. On postoperative day 25, she expired due to an acute cardiac arrest which was suspected to be due to multi-organ failure.

Comparison of Cerebral Blood Flow Velocities by Transcranial Doppler during Anesthetic Induction: Rocuronium and Succinylcholine / 대한마취과학회지

BACKGROUND: In intravenous administration of a depolarizing neuromuscular blocker, succinylcholine is reported to produce activation of the electroencephalogram and increase cerebral blood flow and intracranial pressure. In this point, rocuronium was recently introduced as a non-depolarizing relaxant, and recommended as a safe alternative to succinylcholine. The purpose of this study was to evaluate the effects of rocuronium and succinylcholine on cerebral blood flow velocities during anesthetic induction. METHODS: Forty patients were randomly assigned into two groups. Group 1 was administrated rocuronium 0.6 mg/kg and group 2 was administrated succinylcholine 1 mg/kg for tracheal intubation after each group had intravenous administration of thiopental 5 mg/kg. The author observed changes of mean arterial pressure, arterial carbon dioxide tension, and middle cerebral arterial blood flow velocities at 5 times: before induction (control), 30 sec after thiopental administration, 30 sec, 60 sec and 90 sec after muscle relaxant administration. RESULTS: Mean arterial pressure decreased more at 30 sec after thiopental administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30 sec after thiopental administration and 60 sec after rocuronium administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30, 60, 90 sec after rocuronium administration compared with succinylcholine administration (P<0.05). CONCLUSIONS: We conclude that rocuronium has little effects on increasing cerebral blood flow. These result suggest that rocuronium have a less effect on increase in cerebral blood flow during neurosurgical anesthesia.