A Case of Anesthetic Management for a Pregnant Woman with Unruptured Cerebral Aneurysm Undergoing Simultaneous Cesarean Section and Aneurysm Clipping: A case report / 대한마취과학회지

Intracranial aneurysm in pregnancy imposes special consideration for both mother and fetus. During newborn delivery, the risk of aneurysmal rupture should be avoided by careful management. We experienced a case of cesarean section and the clipping of aneurysm in 37 years old pregnant woman at the gestational age of 35 weeks. She had suffered from headache since 30 weeks of gestational age and the ptosis of left eye since 33 weeks of gestational age. Ten millimeter-sized aneurysm of posterior communicating artery was found on the cerebral angiogram. After radial artery cannulation, we anesthetized the woman with nitroprusside infusion, thiopental, succinylchoine and nitrous oxide-oxygen-isoflurane gas mixture. Soon after intubation, systolic blood pressure increased from 140 to 150 mmHg during the infusion of sodium nitroprusside. The delivery of a newborn was done 8 min after induction and clipping of aneurysm was done successfully after the end of cesarean section.

The Effect of Different Dosage of Propofol on Cardiovascular Responses to Tracheal Intubation in Hypertensive Patients / 대한마취과학회지

BACKGROUND: Laryngoscopy and endotracheal intubation are potent stimuli that increase heart rate and blood pressure. Especially, hypertensive patients are more prone to have significant increase in heart rate and blood pressure and cardiac complications such as arrythmia, myocardial ischemia and infarction can lead to fatal situation. This study was designed to evaluate the effectiveness of different dosage of propofol on cardiovascular responses to tracheal intubation in hypertensive patients. METHODS: Sixty hypertensive patients, ASA PS 1 or 2, scheduled for elective surgery were selected randomly. They were divided into three groups(Group 1: propofol 2.0 mg/kg, Group 2: propofol 2.5 mg/kg, Group 3: propofol 3.0 mg/kg, n=20 in each group). Induction of Anesthesia was started with propofol 2.0 mg/kg(Group 1), 2.5 mg/kg(Group 2), 3.0 mg/kg(Group 3) and succinylcholine(1 mg/kg). After tracheal intubation, pancuronium bromide 0.08 mg/kg was injected, 50 % nitrous oxide in oxygen and 2 % enflurane were inhaled. Using noninvasive automatic blood pressure monitor(CRITIKON DINAMAP TM 1846SX, USA), blood pressure(systolic, diastolic, and mean arterial pressure) and heart rate were measured at 4 points; 1) as the control value, on arrival to operating room, 2) 1 minute after tracheal intubation, 3) 3 minutes after intubation, 4) 5 minutes after intubation. RESULTS:In group 3, systolic, diastolic pressure and mean arterial pressure at 1 minutes, 3 minutes, 5 minutes after intubation were less increased than group 1, 2 and blood pressure response was more effectively blunted than heart rate response CONCLUSIONS: we suggested that 3.0 mg/kg of propofol for the induction of anesthesia could blunt hemodynamic changes caused by laryngoscopy and endotracheal intubation in hypertensive patients, but we had to give attention to the side effect until postoperative period.

Clinical Application of Percutaneous Transtracheal Catheter Insertion on Jet Ventilation / 대한마취과학회지

BACKGROUND: High frequency jet ventilation has been extensively evaluated by clinicians and is considered reliable technique for assisted ventilation, occupying a specific place in the wide range of ventilatory support techniques available for anesthesia and critical care. Thanks to the transtracheal high frequency jet ventilator, it is now possible to assure a free laryngeal endoscopic operative field. The transtracheal catheter is introduced percutaneously through the cricothyroid membrane into the trachea and connected to a high frequency jet ventilator. The purpose of this study is to evaluate the application of percutaneous transtracheal HFJV for suspension micro laryngeal surgery under total intravenous anesthesia. METHODS: The patients were divided into two groups. In transtracheal group (group TT, n=7), jet ventilation was done with 14 gauge angiocatheter introduced into the trachea through the cricothyroid membrane and in endotracheal intubation group (group ET, n=7), jet ventilation was done with endotracheal tube which has a 5 mm of internal diameter. RESULTS: The blood pressures were not significantly changed except postincision 5 minute in group ET and TT. The heart rate was not significantly changed in group ET and TT. The arterial blood gases were not significantly changed in group ET and TT. CONCLUSIONS: From the above results, jet ventilation by transtracheal catheter, if properly used, should provide safe airway, an adequate ventilation and improved visual field. So we suggest that transtracheal technique should provide an alternative to conventional endotracheal technique for micro laryngeal surgery.