Effects of small tidal volume and positive end-expiratory pressure on oxygenation in pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation / 영남의대학술지

BACKGROUND@#The purpose of this study was to investigate whether tidal volume (TV) of 8 mL/kg without positive end-expiratory pressure (PEEP) and TV of 6 mL/kg with or without PEEP in pressure-controlled ventilation-volume guaranteed (PCV-VG) mode can maintain arterial oxygenation and decrease inspiratory airway pressure effectively during one-lung ventilation (OLV).@*METHODS@#The study enrolled 27 patients undergoing thoracic surgery. All patients were ventilated with PCV-VG mode. During OLV, patients were initially ventilated with TV 8 mL/kg (group TV8) without PEEP. Ventilation was subsequently changed to TV 6 mL/kg with PEEP (5 cmH₂O; group TV6+PEEP) or without (group TV6) in random sequence. Peak inspiratory pressure (P(peak)), mean airway pressure (P(mean)), and arterial blood gas analysis were measured 30 min after changing ventilator settings. Ventilation was then changed once more to add or eliminate PEEP (5 cmH₂O), while maintaining TV 6 mL/kg. Thirty min after changing ventilator settings, the same parameters were measured once more.@*RESULTS@#The P(peak) was significantly lower in group TV6 (19.3±.3 cmH₂O) than in group TV8 (21.8±3.1 cmH₂O) and group TV6+PEEP (20.1±3.4 cmH₂O). PaO₂ was significantly higher in group TV8 (242.5±111.4 mmHg) than in group TV6 (202.1±101.3 mmHg) (p=0.044). There was no significant difference in PaO₂ between group TV8 and group TV6+PEEP (226.8±121.1 mmHg). However, three patients in group TV6 were dropped from the study because PaO₂ was lower than 80 mmHg after ventilation.@*CONCLUSION@#It is postulated that TV 8 mL/kg without PEEP or TV 6 mL/kg with 5 cmH₂O PEEP in PCV-VG mode during OLV can safely maintain adequate oxygenation.

Effects of small tidal volume and positive end-expiratory pressure on oxygenation in pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation / 영남의대학술지

BACKGROUND: The purpose of this study was to investigate whether tidal volume (TV) of 8 mL/kg without positive end-expiratory pressure (PEEP) and TV of 6 mL/kg with or without PEEP in pressure-controlled ventilation-volume guaranteed (PCV-VG) mode can maintain arterial oxygenation and decrease inspiratory airway pressure effectively during one-lung ventilation (OLV).METHODS: The study enrolled 27 patients undergoing thoracic surgery. All patients were ventilated with PCV-VG mode. During OLV, patients were initially ventilated with TV 8 mL/kg (group TV8) without PEEP. Ventilation was subsequently changed to TV 6 mL/kg with PEEP (5 cmH₂O; group TV6+PEEP) or without (group TV6) in random sequence. Peak inspiratory pressure (P(peak)), mean airway pressure (P(mean)), and arterial blood gas analysis were measured 30 min after changing ventilator settings. Ventilation was then changed once more to add or eliminate PEEP (5 cmH₂O), while maintaining TV 6 mL/kg. Thirty min after changing ventilator settings, the same parameters were measured once more.RESULTS: The P(peak) was significantly lower in group TV6 (19.3±.3 cmH₂O) than in group TV8 (21.8±3.1 cmH₂O) and group TV6+PEEP (20.1±3.4 cmH₂O). PaO₂ was significantly higher in group TV8 (242.5±111.4 mmHg) than in group TV6 (202.1±101.3 mmHg) (p=0.044). There was no significant difference in PaO₂ between group TV8 and group TV6+PEEP (226.8±121.1 mmHg). However, three patients in group TV6 were dropped from the study because PaO₂ was lower than 80 mmHg after ventilation.CONCLUSION: It is postulated that TV 8 mL/kg without PEEP or TV 6 mL/kg with 5 cmH₂O PEEP in PCV-VG mode during OLV can safely maintain adequate oxygenation.

Effect of neuromuscular blockade reversal by pyridostigmine on spectral entropy values during recovery from desflurane anesthesia: a prospective, randomized, double-blind, controlled trial / 대한마취과학회지

BACKGROUND: According to several studies investigating the relationship between muscle activity and electroencephalogram results, reversal of neuromuscular blockade (NMB) may affect depth of anesthesia indices. Therefore, we investigated the effect of pyridostigmine on these indices via spectral entropy. METHODS: Fifty-six patients scheduled for thyroidectomy or parotidectomy were included in this study and randomized into two groups. At the start of skin suturing, the desflurane concentration was adjusted to 4.2 vol% in both groups. Following this, the pyridostigmine group (group P, n = 28) was administered pyridostigmine 0.2 mg/kg mixed with glycopyrrolate 0.04 mg/kg, while the control group (group C, n = 28) received normal saline. Entropy values (response entropy [RE] and state entropy [SE]), train of four (TOF) ratio, and end-tidal desflurane concentration were recorded from point of drug administration to 15 minutes post-drug administration. RESULTS: Mean RE values at 15 minutes, when the maximum effect of pyridostigmine was anticipated, showed a statistically significant difference between groups (53.8 ± 10.5 in group P and 48.0 ± 8.8 in group C; P = 0.030). However, mean SE at 15 minutes showed no significant difference between the two groups (P = 0.066). At 15 minutes, there were significant differences in the TOF ratio between the two groups (P < 0.001). CONCLUSIONS: NMB reversal by pyridostigmine significantly increased RE values but not SE values. This finding suggests that spectral entropy may be a useful alternative tool for monitoring anesthetic depth during recovery from anesthesia in the presence of electromyogram activity.

Adequate analgesic regimen would be required after minimally invasive colorectal surgery

No abstract available.

Effect of recruitment maneuver on arterial oxygenation in patients undergoing robot-assisted laparoscopic prostatectomy with intraoperative 15 cmH₂O positive end expiratory pressure / 대한마취과학회지

BACKGROUND: This randomized, controlled study was designed to compare the effects of recruitment maneuvers (RMs) with a 15 cmH₂O positive end-expiratory pressure (PEEP) on the systemic oxygenation and lung compliance of patients with healthy lungs following robot-assisted laparoscopic prostatectomy (RALP). METHODS: Sixty patients undergoing a RALP with an intraoperative 15 cmH₂O PEEP were randomly allocated to an RM or a Control group. The patients in the RM group received a single RM through the application of a continuous positive airway pressure of 40 cmH₂O for 40 s 15 min after being placed in the Trendelenburg position. The arterial oxygen tension (PaO₂, primary endpoint) and the pulmonary dynamic and static compliances (secondary endpoints) were measured 10 min after the anesthetic induction (T1), 10 min after establishment of the pneumoperitoneum (T2), 10 min after establishment of the Trendelenburg position (T3), 10 min after the RM (T4), 60 min after the RM (T5), and 10 min after deflation of the pneumoperitoneum in the supine position (T6). RESULTS: The intergroup comparisons of the PaO₂ showed significantly higher values in the RM group than in the Control group at T4 and T5 (193 ± 35 mmHg vs. 219 ± 33 mmHg, P = 0.015, 188 ± 41 mmHg vs. 214 ± 42 mmHg, P = 0.005, respectively). However, the PaO₂ at T6 was similar in the two groups (211 ± 39 mmHg vs. 224 ± 41 mmHg, P = 0.442). Moreover, there were no statistical differences between the groups in the dynamic and static compliances of the lungs at any time point. CONCLUSIONS: The arterial oxygenation of the patients with a healthy lung function who had undergone a RALP with intraoperative 15 cmH₂O PEEP was improved by a single RM. However, this benefit did not last long, and it did not lead to an amelioration of the lung mechanics.

The effect of nerve preservation methods on rat sciatic nerve structures studied with Synchrotron small-angle X-ray scattering (SAXS)

BACKGROUND: Synchrotron small-angle X-ray scattering (SAXS) is a very useful technique for experimental study of the nano-structure of the nervous system of animals. The study was designed to evaluate nerve preservation methods for the measurement of SAXS patterns. METHODS: Normal sciatic nerves extracted from male Sprague- Dawley rats were preserved in saline (N = 2), formalin (N = 2) or liquid nitrogen (N = 2) for 1 day, followed by measurement of SAXS patterns. SAXS patterns of normal sciatic nerves (N = 3) extracted just before the initiation of the experiment were used as controls. The study was carried out using the 4C1 beamline at Pohang Accelerator Laboratory in Korea. Incoming X-rays were monochromatized at 11 keV using a double multilayer (WB4C) monochromator with beam size of approximately 0.5 (V) × 0.8 (H) mm2. The exposure time was set at 60 sec, and 8 to 12 images per sample were acquired at a 0.5 mm interval. RESULTS: The periodic peaks of interfibrillar space between collagen fibrils were undetectable. The periodic peaks of the myelin sheath and collagen fibers were weakly detected or undetected in the nerves preserved in normal saline or formalin. The periodic peaks and intensity of the myelin sheath, collagen fibers, and interfibrillar space between collagens in the nerves preserved in liquid nitrogen were comparable to those of nerves in the ex vivo state. CONCLUSIONS: The study results indicated that preservation of nerves in liquid nitrogen is adequate for measurements with SAXS. However, saline and formalin preservation techniques were inadequate for SAXS measurement.

Catecholamine-Induced Cardiomyopathy associated with Neuroblastoma and Treated with Extracorporeal Membrane Oxygenation as a Bridge to Recovery / 대한구급학회지

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.

Catecholamine-Induced Cardiomyopathy associated with Neuroblastoma and Treated with Extracorporeal Membrane Oxygenation as a Bridge to Recovery / 대한중환자의학회지

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.

Structural analysis of a ligatured rat sciatic nerve in the ex vivo state using synchrotron small-angle X-ray scattering (SAXS)

BACKGROUND: To understand the fundamentals of neural tissue injury, experiments on the nano-structured nerve system of animals are essential. This study was designed to reveal the nanostructure changes of an isolated ligatured rat sciatic nerve using the synchrotron small-angle X-ray scattering (SAXS) technique. METHODS: Male Sprague-Dawley rats (weighing approximately 250 grams) were used in this study. The SAXS patterns of 1 week after ligatured nerves (N = 5) and the normal sciatic nerves (N = 5) for the control were acquired after extracted approximately 15 mm before the experiment. Experiments were conducted at the 4C1 beam line at the Pohang Accelerator Laboratory in Korea. The exposure time was 60 sec, and 8 to 12 images per sample were acquired in 0.5 mm intervals, including the regions above, around and below the ligatured position. RESULTS: The periodic peaks of the myelin sheath and the interfibrillar space of collagen completely disappeared at the ligatured position. Farther from the ligatured point, weak and quite different SAXS patterns were observed for the myelin sheath and interfibrillar space. However, the collagen fiber peaks appeared at all positions, although they were weaker near the ligatured position. CONCLUSIONS: The ligature treatment totally destroyed the myelin sheath and interfibrillar space of collagen. In addition, retrograde degeneration developed 2 mm above the ligatured site. The myelin sheath and interfibrillar space of collagen were damaged 6 mm below the ligatured site. However, the collagen fiber structure was not significantly affected by the ligature, indicating a much different structural organization.

Detrimental complications due to improper antithrombotic management in the preoperative period: report of two cases / 대한마취과학회지

No abstract available.

Forearm extravasation injury during robot-assisted low anterior resection / 대한마취과학회지

No abstract available.

Forearm extravasation injury during robot-assisted low anterior resection / 대한마취과학회지

No abstract available.

Treatment of Idiopathic Persistent Hiccups with Positive Pressure Ventilation: A Case Report

A 41-year-old male patient presented with idiopathic persistent hiccups. The hiccups did not respond to pharmacologic treatments including cisapride, omeprazole, and baclofen. Phrenic nerve block was also ineffective. However, the persistent hiccups were successfully treated with short-term positive pressure ventilation using a short-acting muscle relaxant.

Successful use of percutaneous cardiopulmonary support in patients with cardiogenic shock due to myocardial infarction: Report of two cases

Percutaneous cardiopulmonary support (PCPS) is accepted as a very helpful mechanical support available for patients with cardiogenic shock unresponsive to medical treatment and intra-aortic balloon pump (IABP). Although the indication criteria or guidelines for the application of PCPS have not been established, several reports demonstrate that the early initiation of PCPS allows for good clinical outcomes in patients suffering cardiogenic shock. We experienced two patients that required PCPS before and after emergent cardiotomy to correct ventricular septal defect and left ventricular rupture due to myocardial ischemia, respectively. Herein, we report these cases to emphasize that the early application of PCPS is essential to improve the clinical outcomes in patients with severe cardiogenic shock.

Administration of Vitamin C in a Patient with Herpes Zoster: A case report

Herpes zoster as a result of reactivated varicella-zoster virus is characterized by vesicular eruptions on skin and painful neuralgia in the dermatome distribution. Pain during an acute phase of herpes zoster has been associated with a higher risk of developing postherpetic neuralgia. The current therapies for herpes zoster including analgesics and sympathetic nerve block as well as antiviral agents are important to alleviate pain and prevent postherpetic neuralgia. However, in some cases, the pain does not respond well to these treatments. We had a case in which a patient with herpes zoster did not respond to conventional therapy so we attempted to administer intravenous infusion of vitamin C which resulted in an immediate reduction in the pain.

Target-controlled infusion of remifentanil for conscious sedation during spinal anesthesia / 대한마취과학회지

BACKGROUND: The aim of this study was to define the optimal target concentration of remifentanil which effectively achieves conscious sedation without significant vital sign changes and side effects during spinal anesthesia. METHODS: Sixty patients underwent spinal anesthesia with 0.5% hyperbaric bupivacaine (8-16 mg), and were infused with a target controlled infusion (TCI) of remifentanil at 1.0 ng/ml (group R10, n = 15), 2.0 ng/ml (group R20, n = 15), 3.0 ng/ml (group R30, n = 15), and 3.5 ng/ml (group R35, n = 15). Observer's assessment of alertness/sedation (OAA/S) scale, the bispectral index (BIS), anxiety levels and infusion rate of remifentanil were monitored during the operation. RESULTS: OAA/S scale was significantly lower in groups R30 (3.96) and R35 (3.34) than groups R10 (4.31) and R20 (4.26). Incidence of intraoperative respiratory depression events, post operative nausea and vomiting were significantly higher in group R35 than the other groups. There were no significant differences in BIS, anxiety level and incidences of recall of the operative procedure among the groups. CONCLUSIONS: We conclude that the TCI of remifentanil at 3.0 ng/ml produces an effective sedation and anti-anxiety effects without significant side effects during spinal anesthesia.