Isoflurane cracks the polycarbonate connector of extra-corporeal circuit: A case report / 대한마취과학회지

Cardiopulmonary bypass (CPB) is widely used for cardiac surgery by virtue of its proven safety over the course of its use during the past half century. Even though perfusion is safer, incidents still occur. During the repair of a ventricular-septal defect in an 11-month-old infant, we experienced a critical incident related to the potential hazardous effect of volatile anesthetics on the polycarbonate connector of extra-corporeal circuit. The damage to the polycarbonate connector had occurred after spillage of isoflurane during the filling of the vaporizer, causing it to crack and leak. The incident was managed by replacement of the cracked connector during a temporary circulatory arrest. The patient was hypothermic and the time off bypass was less than 1.5 min. There were no neurologic sequelae, the patient made an uneventful recovery. In conclusion, the spillage of volatile anesthetics can cause cracks in the polycarbonate connector of the extra-corporeal circuit, leading to potentially interruption of CPB.

The Efficacy of BIS Monitoring for the Preventing of Withdrawal Movement on the Intravenous Injection of Rocuronium / 대한마취과학회지

BACKGROUND: Arm withdrawal movements are often observed on the administration of rocuronium. This study used the BIS to predict the depth of sedation and the prevention of withdrawal movements. METHODS: With the approval of the institutional review board and the informed consent of the subjects, sixty patients, with ASA physical stati of 1 to 2, were randomized into four groups. After the induction of anesthesia using 0.5 mg/kg of thiopental sodium, each group received 0.6 mg/kg of rocuronium when their BIS values were 85 (Group I), 75 (Group II), 65 (Group III), or 55 (Group IV). The blood pressure, heart rate, BIS value at the time of loss of eyelash reflex, incidence of withdrawal movement and grade, and the correlation between the BIS value and loss of eyelash reflex were observed. RESULTS: No difference were observed in the incidence of withdrawal movement and grade between the four groups. The correlation coefficients of the BIS value and time of loss of eyelash reflex were both 0.33 (P<0.05). CONCLUSIONS: It may be impossible to rely solely on the BIS value to insure patients reach a deep anesthetic state after induction of anesthesia with thiopental. The withdrawal movement on injection of rocuronium can not be prevented with BIS monitoring.

Clinical Review of Post-transplantation Diabetes Mellitus after Liver Transplantation / 대한이식학회지

PURPOSE: Liver transplantation (LT) can cure abnormality of glucose metabolism, but cause altered glucose metabolism with immunosuppressive treatment. Up to now, almost all studies have been performed in cadaveric donor liver transplantation (CDLT). We underwent study in CDLT and also living donor liver transplantation (LDLT) recipients. METHODS: Among 397 adult-to-adult LT recipients between January 1994 and August 2001, we selected 81 patients who could be followed more than 12 months by using the table of random sampling numbers. We reviewed the change of blood glucose and risk factors, complications and survival retrospectively between post-transplantation diabetes mellitus (PTDM) and no PTDM patients. RESULTS: Clinical data showed 34 : 47 in frequency of PTDM to no PTDM. Age, family history of DM, preoperative DM history over 6 months had a significant risk of PTDM. There was no difference of PTDM frequency between CDLT and LDLT and its subgroup. The worse post-transplant graft function causes the more incidence of PTDM (P=0.051). FK506 had higher relation with PTDM than cyclosporine and mycophenolate mofetile (P=0.058). The incidence of DM after operation has been decreased by 6 months, but thereafter no further. There were 18 of De Novo DM among 34 PTDM patients, and only 1 preoperative DM patient improved after LT. Between PTDM and no PTDM group, there were no significant difference of complication rate and 5-year survival rate. CONCLUSIONS: The types of graft would not affect the incidence of PTDM if the graft function were preserved. Other clinical data showed similar results to previous reports.

Analysis for Influencing Factor of the Organ Procurement Rate in Brain Dead Donors / 대한이식학회지

PURPOSE: The number of patients waiting for organ transplantation continues to grow as technical and pharmacological advances increase the success rate of transplantation procedures, while organs are donated by few of the thousands of potential donors who die every year. The organ transplantation continues to be the best treatment for many end-stage diseases of the heart, liver, kidneys, and other organs. Many organ procurement failures have been attributed to a failure to identify patients with nonsurvivable central nervous system injury or disease as potential organ donors or failure to maintain a hemodynamic stability or failure to request consent for donation from next to kin. This study has been done for investigating the factors that influence the organ procurement rate in brain dead donors. METHODS: Of the 259 brain dead donors in the Asan Medical Center, from January 1991 to April 2003, 189 brain dead donors donated solid organs excluding conea. We retrospectively reviewed the medical records and the data of the transplantation center. A hemodynamic stability is defined as systolic blood pressure more than 90~100 mmHg with the use of low-dose vasopressor (dopamine less than 10microgram/ kg/min). RESULTS: From January 1991 to April 2003, the procurement rates of liver, heart, kidney and pancreas were 39% (n=75), 40% (n=76), 97% (n=184) and 17% (n=33), respectively. The procurement rates according to age were 26% in 50 years (n=11). The major. causes of death among potential organ donors were traffic accident (59%) and cerebrovascular events (33%). In traffic accident, the procurement rates of liver, heart, kidney and pancreas were 42% (n=47), 37% (n=41), 98% (n=109) and 16% (n=18), and in cerebrovascular events, 33% (n=21), 38% (n=24), 97% (n=61) and 19% (n=12). Multiple organs were donated in the hemodynamically stable donors. CONCLUSION: Aggressive resuscitation and hemodynamically stabilization of all brain dead donors are important factors that may increase procurement rates.

Clinical Analysis of Post-operative Complications in Gastric Tumors

PURPOSE: The incidence of complications after gastric tumor surgery has been decreasing, because of properly chosen and improved surgical techniques and procedures. But the incidence of several complications that result in relatively high mortality remains stubbornly high. To predict and prevent postoperative complications in gastric tumor treatment, we retrospectively analyzed gastric tumor patients who underwent elective gastrectomy. METHODS: This is a retrospectively study of 1,028 patients with gastric tumor who underwent elective surgery at the Department of Surgery, Ulsan University College of Medicine and Asan Medical Center between January 1999 and December 1999. Non-curative surgery was defined in cases of peritoneal seeding, distant lymph node metastasis and residual tumor in the resection margin. RESULTS: There were no significant differences in age, hemoglobin, albumin, operation time, extent of lymph node dissection, surgical procedure or stage (P>0.05). The complication rate after non-curative resection was higher (11.7%) than that for curative resection (5.9%) (P<0.05). The complication rate was higher (12.3%) in patients who had combined diseases than in those who did not (4.9%) (P<0.05), and was higher (13.2%) in patients who underwent combined resection than in those who did not (5.0%) (P<0.05). CONCLUSION: In patients who had combined diseases and underwent combined resection, the complication rate was significantly higher. But, if more attentive preoperative evaluation and intraoperative caution are exercised in patients who exhibit preoperative risk factors, the incidence of post operative complication is expected to diminish.

A Case of Dandy-Walker Syndrome Associated with Multiple Congenital Anomalies

No abstract available.