Acute Renal Artery Thromboembolism during Abdominal Aortic Bypass Graft Surgery / 대한마취과학회지

Acute occlusion of the artery to a single functioning kidney is a rare but surgically correctable cause of acute renal failure. A young-aged woman with acute renal failure and anuria due to a thromboembolism of the right renal artery was surgically treated 2 hours after the onset of anuria. Revascularization resulted in the reversal of renal failure and complete recovery of renal function. An aggressive diagnostic and therapeutic approach is important whenever occlusion of the renal artery is suspected during surgery in Takayasu arteritis patients.

Clinical Evaluation of Serum Magnesium Concentration and Its Related Effects after Prophylactic MgSO4 Administration during Orthotopic Liver Transplantation / 대한마취과학회지

BACKGROUND: Mg++ is an important control factor for transport of K+, Na+, Ca++ and also has been known for having an antiarrhythmic and inotropic action on the heart. Orthotopic liver transplantation is a complex surgical procedure with significant physiologic alterations resulting in electrolyte imbalances. Therefore, the goal of this study was to evaluate the effects of prophylactic MgSO4 administration on intraoperative serum magnesium concentration and its related clinical outcomes. METHODS: 19 patients receiving liver transplants were divided into two groups. Both groups received normal saline (300 ml/3 hr) right after anesthetic induction. MgSO4 (35 mg/kg) was mixed with saline in the experimental group but not in the control group. Serum magnesium concentration was measured four times during surgery. We also checked the total transfused units of packed cells and CaCl2 requirement, the severity of postreperfusion syndrome and base deficit. RESULTS: Serum magnesium concentration significantly decreased in the control group at the postanhepatic stage. The experimental group showed less prominent symptoms of postreperfusion syndrome and less need for potassium supply, but both groups did not reveal any differences in the amount of transfusion and CaCl2 requirement. CONCLUSIONS: We confirmed that our prophylactic administration of MgSO4 (35 mg/kg) may be considered a safe dose showing not only prevention of hypomagnesemia but also a decrease in the potassium requirement and in the severity of postreperfusion syndrome. However, routine administration of MgSO4 might cause disadvantageous effects, so more appropriate indications can be prepared after further clinical research.

Effect of Bilateral Superior Cervical Sympathectomy on Focal Cerebral Infarction Induced by Autologous Blood Clot in Rabbits / 대한마취과학회지

BACKGROUND: Many reports suggest that cervical sympathectomy improves cerebral blood flow. But the basal & medial areas of brain are innervated bilaterally, so unilateral sympathectomy may not improve the outcome of infarction of those areas effectively. Actually it was reported that only bilateral, not unilateral cervical sympathectomy increased the blood flow of thalamus which known to be innervated bilaterally, and also reported that unilateral sympathectomy did not reduce the infarct size of caudate nucleus. So we studied the effect of bilateral superior cervical sympathectomy on focal cerebral infarction. METHODS: Twenty rabbits were divided into two groups. In the sham-operated control group (n=10), focal infarction was achieved by administering an autologous blood clot into the internal carotid artery after exposure of bilateral superior cervical sympathetic ganglia. In the sympathectomy group (n=10), bilateral superior cervical sympathetic ganglia were excised following embolization. Seven hours after embolization, brains were sliced into 2 mm coronal sections, stained with 2,3,5-triphenyltetrazolium chloride, and infarct sizes were determined via image analysis. RESULTS: There were no differences in the physiologic variables between two groups. The percentage of infarct size was significantly greater in the control group as compared to the sympathectomy group in both cortex (23+/-8% vs 12+/-5%, respectively; P<0.05) and subcortical area (35+/-8% vs 17+/-8%, respectively; P<0.05). CONCLUSIONS: These results suggest that bilateral superior cervical sympathectomy may reduce the infarct size of subcortical area as well as of cerebral cortex measured at 7 hours following induction of focal cerebral infarction.

Effect of Hemodilution on Brain Damage after Focal Cerebral Ischemia in Rabbits / 대한마취과학회지

BACKGROUND: Hemodilution after focal cerebral ischemia increases cerebral blood flow to ischemic brain tissue and reduces neurologic injury. With rare exceptions, most studies have reduced hematocrit (Hct) to no less than 30%. We studied the effect of moderate hemodilution (hematocrit 27%) on cerebral infarct volume after focal cerebral ischemia in rabbits. METHODS: Twenty rabbits were divided into a control group (n = 10) and a hemodilution group (n = 10). In the control group, cerebral infarction was induced by embolization of the middle cerebral artery using an autologous blood clot without hemodilution. In the hemodilution group (n = 10), hemodilution of around hematocrit 27% was achieved by exchanging arterial blood with 10% hydroxyethyl starch 1 hour before embolization of the middle cerebral artery in the hemodilution group. Seven hours after embolization, coronal brain slices were made with 2 mm thickness at 1 cm from the frontal pole and stained with 2% 2,3,5-triphenyltetrazolium chloride. The infarct volume was quantitated by image analysis of photography of the infarcted area. RESULTS: The infarct volume of the cerebral hemisphere (25.9 +/- 8.9%), subcortex (16.3 +/- 3.1%) in the hemodilution group was significantly smaller than in the control group (34.9 +/- 8.9%, 19.3 +/- 5.1%) (P<0.05), but, in the cortex, the difference of infarct volume is not statistically significant between the control group (23.5 +/- 11.9%) and the hemodilution group (15.6 +/- 2.7%). CONCLUSIONS: These results indicate that moderate hemodilution (hematocrit 27%) reduces neurologic injury after focal cerebral ischemia.

Effect of NG-nitro-L-arginine Methyl Ester Pretreatment on Spinal Cord Damage by Aortic Occlusion in Rabbits / 대한마취과학회지

BACKGROUND: Production of nitric oxide (NO) radicals may contribute to neuronal injury. We examined that the inhibition of NO synthase (NOS) could improve postischemic neurologic outcome after spinal cord ischemia in rabbits. Also, we measured cGMP as a marker of NOS activation in control and experimental groups. METHODS: Spinal cord ischemia in rabbits was induced by aortic occlusion with aneurysm clip at the level just below branching of left renal artery. Five minutes before aortic occlusion, saline (control group, n=10) or a NOS inhibitor NG-nitro-L-arginine methyl ester (10 mg/kg, L-NAME group, n=10) was injected intravenously. After 15 min ischemia and 1 hour reperfusion, animals were sacrified and the spinal cords were extruded for the measurement of cGMP by enzymeimmunoassay. For neurologic examination, the same procedures of ischemia/reperfusion and drug injection were done, except that rabbits were perfused for 4 hours (control-4 and L-NAME-4, n=8 at each group) or 48 hours (control-48 and L-NAME-48, n=8 at each group) after aortic occlusion. RESULTS: L-NAME (10 mg/kg) increased mean systemic arterial pressure accompanied by bradycardia, and reduced cGMP significantly. Control-4 animals showed better neurologic function than L-NAME-4 animals (p<0.05), however, there was no significant difference of neurologic outcome between control-48 and L-NAME-48 groups. CONCLUSION: Intravenous administration of L-NAME prior to spinal cord ischemia/reperfusion diminishes the extent of postischemic neuronal spinal cord damage at the early postreperfusion period.

Effect of NG-nitro-L-arginine Methyl Ester Pretreatment on Spinal Cord Damage by Aortic Occlusion in Rabbits / 대한마취과학회지

BACKGROUND: Production of nitric oxide (NO) radicals may contribute to neuronal injury. We examined that the inhibition of NO synthase (NOS) could improve postischemic neurologic outcome after spinal cord ischemia in rabbits. Also, we measured cGMP as a marker of NOS activation in control and experimental groups. METHODS: Spinal cord ischemia in rabbits was induced by aortic occlusion with aneurysm clip at the level just below branching of left renal artery. Five minutes before aortic occlusion, saline (control group, n=10) or a NOS inhibitor NG-nitro-L-arginine methyl ester (10 mg/kg, L-NAME group, n=10) was injected intravenously. After 15 min ischemia and 1 hour reperfusion, animals were sacrified and the spinal cords were extruded for the measurement of cGMP by enzymeimmunoassay. For neurologic examination, the same procedures of ischemia/reperfusion and drug injection were done, except that rabbits were perfused for 4 hours (control-4 and L-NAME-4, n=8 at each group) or 48 hours (control-48 and L-NAME-48, n=8 at each group) after aortic occlusion. RESULTS: L-NAME (10 mg/kg) increased mean systemic arterial pressure accompanied by bradycardia, and reduced cGMP significantly. Control-4 animals showed better neurologic function than L-NAME-4 animals (p<0.05), however, there was no significant difference of neurologic outcome between control-48 and L-NAME-48 groups. CONCLUSION: Intravenous administration of L-NAME prior to spinal cord ischemia/reperfusion diminishes the extent of postischemic neuronal spinal cord damage at the early postreperfusion period.

Peripheral Effect of Morphine on Mechanical Allodynia in a Rat Model of Neuropathic Pain / 대한마취과학회지

BACKGROUND: The therapeutic effect of morphine on neuropathic pain states was controversial, but there are some reports that systemic morphine reduced pain. Recently, many investigators have reported that locally administered morphine alleviated pain in local inflammatory pain model. Therefore, we designed this study to evaluate the peripheral effect of morphine and its antagonism by naloxone in rats experiencing neuropathic pain. METHODS: Neuropathic pain was produced by tightly ligating the left 5 th and 6 th lumbar spinal nerves of male Spraw-Dawley rats. To evaluate the systemic effect, morphine 200 microgram was injected into the unaffected right paw. Morphine 50, 100 and, 200 microgram were injected into the affected left paw. Naloxone 5, 10 and 20 microgram were injected into the affected left paw ten minutes before morphine 200 microgram was injected into the affected left paw. Before and after drug injection, mechanical allodynia was quantified by the foot withdrawal frequency to von Frey filaments of 5.50 g or 1.48 g, applied to the affected left paw. RESULTS: Morphine 200 g injected into the unaffected right paw did not affect the foot withdrawal frequency on the affected left paw. Morphine 100 and 200 microgram decreased the foot withdrawal frequency. In rats with morphine 200 microgram injected into the left paw, naloxone 5, 10, and 20 microgram increased foot withdrawal frequency. Conclusion: These data represented that morphine injected into the affected paw dose-relatedly reduced mechanical allodynia via peripheral effect and pretreatment of naloxone significantly antagonized the morphine effect.

The Effect of Intraperitoneal Hyperthermic Perfusion on the Postoperative Liver Function in Cancer Patient / 대한마취과학회지

BACKGROUND: Intraperitoneal hyperthermic perfusion (IPHP) has been introduced in clinical practice to improve the survival of cancer patients. But despite of this advantage, postoperative hepatic dysfunction may occur more severely after IPHP than general anesthesia. The protective mechanism of liver is destroyed by hyperthermia as the result. The purpose of this study is to evaluate the effect of intraperitoneal hyperthermic perfusion on the postoperative liver function in cancer patients. METHODS: Sixty patients with ovarian cancer were divided into two groups; 30 patients undergone only radical hysterectomy (control group), and 30 patients undergone radical hysterectomy combined with IPHP (IPHP group). Anesthesia was performed with enflurane-N2O-O2 in both groups. Serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and albumin levels were evaluated before anesthesia, 1, 3, 5, 7, 10 and 14th days after surgery on both groups. RESULTS: Postoperative SGOT levels were increased on 1, 3, 5, 7, 10 and 14th days in both groups, and on 1, 3 and 5 days postoperatively were increased more significantly in IPHP group than control group, but there were no significant difference between both groups after post-operative 7 days. SGPT levels were increased more significantly on 1, 3 and 5 days postoperatively in IPHP group than control group. Albumin levels were decreased more significantly on 1 and 3 days postoperatively in IPHP group than control group. CONCLUSION: We consider that postoperative liver function in cancer patients is influenced by the intraperitoneal hyperthermic perfusion.

Anesthestic Experience for Hepatic Retransplantation: A case report / 대한마취과학회지

Orthotopic liver transplantation has been an established medical therapy for almost any end-stage liver disease. In spite of improved survival rates following transplantation, acute or chronic allograft failure requiring hepatic retransplantation still occurs with an incidence of 9% to 22%. We experienced one case of anesthesia for liver retransplantation in 30-year-old male patient with posttransplantation hepatic arterial thrombosis. He had taken primary liver transplantation due to hepatocelluar carcinoma 15days before retransplantation. The operation was finished successfully after 10hours of anesthesia with anhepatic time of 65 minutes. Careful attention was paid to eletrolyte balance, blood coagulation function as well as cardiovascular and respiratory function. Hemodynamic value was relatively stable throughout the operation and postoperative mechanical ventilatory support was required for about 15 hours.

The Influence of Varying Dose and Lockout Interval on Patient-controlled Analgesia Using Meperidine / 대한마취과학회지

BACKGROUND: The lockout interval is a safe guard to prevent patients from taking additional dose before the full effect of the preceding dose. Therefore, it should correlate with the time-to-peak effect of the opioid selected. The time-to-peak effect of meperidine is known to be different from that of morphine and fentanyl. But there have been few reports about the influence of varying lockout interval on IV-PCA using meperidine. So we studied the influence of varying lockout interval with constant hourly maximum dose on IV-PCA using meperidine. METHODS: This study included sixty patients undergoing low abdominal surgery under general anesthesia. After administration of initial dose of meperidine (0.5 mg/kg) they were randomly assigned to three groups according to the lockout interval; Group 1 (6-min lockout interval, 0.2 mg/kg bolus dose), Group 2 (9-min lockout interval, 0.3 mg/kg bolus dose), Group 3 (12-min lockout interval, 0.4 mg/kg bolus dose). We examined NRS pain score, sedation score, satisfaction score, PCA measurements and the incidence of side effects during 24 hours. RESULTS: There were no significant differences in NRS pain score, sedation score, satisfaction score, the amount of meperidine consumed, injections/attempts ratio and the incidence of side effects among three groups. The numbers of injections and attempts were significantly higher in Group 1 than in Group 2 and Group 3 (P<0.05). CONCLUSIONS: The lockout intervals chosen for this study (6-min, 9-min, 12-min) do not influence pain, side effects, satisfaction and meperidine consumption in IV-PCA using meperidine when hourly maximum dose is constantly 2 mg/kg.

Brachial Plexus Palsy after Thoracoscopic Sympathectomy: A case report / 대한마취과학회지

We experienced a complication of brachial plexus palsy secondary to operative position during thoracoscopic thoracic sympathectomies. His general health was excellent and no previous histories vulnerable to peripheral nerve systems were observed. The thoracic sympathectomies were done under general anesthesia. The patient was placed left lateral position with his right arm abduced 150o on padded arm board. An operation was lasted 2 hours and 30 minutes at this position because of severe right apical lung adhesion. The controlateral side was performed same procedure and lasted 20 minutes. After the patient recovered from the anesthesia, the patient had a complete paralysis of right arm. There was also slightly diminished sensation to pinprick on the arm and hand. Neurologic examination and EMG study revealed brachial plexus palsy. Nerve blocks and physiotherapy were performed to treat brachial plexus injuries. His motor functions were improved day by day and he was discharged with a complete range of motion against gravity on 14th. postoperation day. However, there were loss of muscle powers against some resistances and tingling sensations of fingertips. Two months later, he was recovered completely and there was no residual disabilities.

Does Heparin Reduce Neurologic Injury in Rabbits That Occurs From Air Emboli? / 대한마취과학회지

BACKGROUND: Neurological injury after cerebral air embolism may be due to thromboinflammatory responses at sites of air-injured endothelium. Because heparin inhibits multiple thromboinflammatory processes. we hypothesized that heparin would decrease neurological impairment after cerebral air embolism. METHODS: Anesthetized rabbits received either heparin (n=14) or saline (n=13), 5 minutes before air injection (150 microliter/kg). Heparin was given as a 200 IU/kg bolus and followed by a constant infusion of 75 IU/kg/h for 2 hours. Equal volumes of salines were given to saline group. Two hours later, anesthesia was discontinued. Rabbits were neurologically evaluated 24 hours after air embolism. RESULTS: Heparin group had significantly less neurological impairment at 24 hours (34 14) than saline controls (52 8) (p=0.0013). CONCLUSIONS: When given prophylactically, heparin decreases neurological impairment caused by severe cerebral arterial air embolism.

The Effect of Desmopressin Acetate on Coagulation in Rabbits Subjected to Severe Hemorrhagic Shock / 대한마취과학회지

BACKGROUND: Desmopressin acetate (DDAVP) may improve hemostasis in congenital or acquired disorders of coagulation and reduce operative blood loss in patients undergoing surgical procedures. The effects of DDAVP on coagulation in hemorrhagic shock were studied in rabbits subjected to severe hemorrhage. METHODS: 20 rabbits were bled to shock and infused lactated Ringer's solution simultaneously so that the mean arterial pressure were maintained above 50 mmHg. Animals were randomly received DDAVP 0.3 ug/kg (group Dl), 3 ug/kg (group D10) or saline (group S) over 15 minutes. Bleeding time and factor VIII coagulant activity (FVIII:C) were measured before, after shock and 45 minutes after DDAVP or saline infusion. RESULTS: After shock, bleeding time was not changed but FVIII:C was decreased significantly in all groups. After saline or DDAVP infusion, bleeding time was not changed in group S and group Dl, whereas shortened in group D10 from 107.5+/-11.3 second to 87.5+/-17.5 second (P<0.05). After saline or DDAVP infusion, FVIII:C was decreased in group S and group Dl (P<0.05), but not changed in group D10. CONCLUSIONS: Infusion of DDAVP 3 ug/kg shortens bleeding time and causes an increase of FVIII:C than other groups in rabbits resuscitated from hemorrhagic shock.

The Comparison of the Effects of Pentastarch or Normal Saline Infusion on the Shock Resuscitation / 대한마취과학회지

Volume replacement is a vital therapy in patient with circulatory shock, but the type of fluid that should be infused remains in controversy. This study is designed to compare the cardiopulmonary effects of a colloid solution and a crystalloid solution in dogs subjected to severe hemorrhagic shock. Twelve dogs were bled into shock and mean arterial pressure(MAP) were maintained at 60 mmHg for 1 hour followed by further hemorrhage to 40 mmHg for additional one hour, Animals were randomized to fluid challenge with 10% pentastarch(group P) or 0.9% normal saline(group S) to restore MAP. Complete hemodynamic and blood gas parameters and plasma lactate concentration were measured at pre-shock, during shock and after resuscitation for 2 hours. Cardiac function and hemodynamic stability were restored to higher level than the control level on the completion of fluid challenge with each type of solution, but hemodynamic parameters decreased as time goes after resuscitation. Especially in group S, hemodynamic parameters decreased more significantly and rapidly than group P. Considering the relation of left ventricular stroke work index(LVSWI) and pulmonary capillary wedge pressure(PCWP), the cardiac performance was well maintained to normal level in group P during post-resuscitation period, but rapidly deteriorated in group S. There was a significant increase in intrapulmonary shunt fraction with pentastarch that was maximal on the completion of fluid challenge but which normalized over the next 1 hour. Assessment of tissue perfusion was measured by mixed venous oxygen tension(PVO2) and plasma lactate concentration. In group P, PVO. was restored to higher than the control level and maintained to the cantrol level during post-resuscitation period, but in group S, it was not restored to control level at the completion of fluid challenge, moreover after then, it decreased progressively. Plssma lactate concentration was recovered to control level in group P at the completion of fluid challenge, but in group S, it was recovered lately. It means that tissue perfusion was more rapidly and effectively restored in group P than group S. In conclusion, infusion of pentastarch at severe hemorrhagic shock restored the hemodynamic parameter more rapidly and maintained cardiac performance more effectively during post-resuscitation period than normal saline. Infusion of pentastarch also maintained tissue perfusion more effectively but it increased intrapulmonary shunt fraction transiently.

The Effect of Decrease in Cardiac Output on End-Tidal CO2 and Difference between Arterial and End-Tidal CO2 Tension / 대한마취과학회지

Capnogram, monitoring of end-tidal CO2, has been a popular tool for assessment of ventilatory status during modern anesthesia. A normal curve on capnogram suggests normal CO2 production, adequate circulation, and adequate ventilation. Level of end-tidal CO2. is different from that of arterial CO2 even in normal individual. The difference is originated from alveolar dead space gas which dilute concentration of CO2 from normal alveoli. In clinical situation, the major factor which determines alveolar dead space is low pulmonary blood flow. Decrease of alveolar capillary perfusion from low cardiac output is the most important cause of low measure of end-tidal CO and large difference between arterial CO2 and end-tidal CO2 concentration in perioperative period. To understand the effect of cardiac output on end-tidal CO2 tension and the difference between arterial CO2 tension and end-tidal CO2 tension, We measured cardiac output before and dutiag administration of nitroglycerine and sodium nitropruside for relieve of myocardial load before aortic clamping in 30 male patients undergoing aortic recontructive surgery under endotracheal anesthesia for repair of infrarenal aortic obstruction. We also measured arterial CO2 tension, and end-tidal CO2 tension at the time of 10% decrease(phasel), 15% decrease(phase2)and 20% decrease(phase3) of cardiac output respectively. Measured values were statistically analyzed to evaluate correlation between cardiac output and end-tidal CO2 tension. The results are as follows: 1) Decreases of cardiac output brought about significant decrease in end-tidal CO2 in all phases compared to control value(p<0,05). 2) Decreases of cardiac output brought about significant increase in the difference between arterial- end-tidal CO2. tension in all phases compared to control value(p<0.05). 3) Changes in cardiac ourput correlated with changes in end-tidal CO2 tension significantly(p=0.0001, r=0.61, slope=2.01). 4) Changes in cardiac ourput correlated with changes in differences between arterial-end-tidal CO2 tension significantly(p=0.0001, r=-0.59, slope=-1.63). In conclusion we suggest that measurement of end-tidal CO2 tension, especially difference between arterial and end-tidal CO2 tension, may be a useful indicator for detection of cardiac output change during operation.

Anesthesia for Liver Transplantation / 대한마취과학회지

We experienced one case of anesthesia for liver transplantation in 32-year-old male patient with liver cirrhosis. The liver donor was 27-year-old male patient who was diagnosed brain death due to car accident. The operation was finished successfuly for 12 hours with intensive monitoring and treatrnent with using TEG and RIS. Patient was transfered to ICU after operation with intubated state. Extubation was done 2 days after operation and patient discharged without complication about 2 months later.

Clinical Evaluation of the Neruomuscular Blocking Effect of Isoflurane / 대한마취과학회지

Isoflurane, which has only recently been introduced into clinical practice, is a nonflammable halogenated ether used as an inhalation anesthetic. It has pharmacological, physical, and clinical properties similar to those of halothane and enflurane: however, it differs from botn in several important aspecs. The potent neuromuscular blocking action of sioflurane in desirable, because it reduces the requirement for muscle relaxants and allows lower doses of anesthesis. To quantitatively clarify the neuromuscular blocking effect of isoflurane, neuromuscular function was monitored by "Train of Four" stimulus with and without administration of muscle relaxants under halothane and isoflurane anesthesis, respectively, in 60 patients. The patients were divided into 4 groups(halothane anesthesia without muscle relaxants, halothane anesthesis with muscle relaxants, isoflurane anesthesia without muscle relaxants and isoflurane anesthesia with muscle relaxants). Twich responses of thenar muscle were monitored and analysed for the value of maximaum twich depression by halothane and isoflurane anesthesia, respectively, and the onset time, degree of maximal neuromuscular blockade, duration of action and recovery index of pnscuronium bromide under halothane and isoflurane anesthesia, respectively. The results were as follows: 1) Isoflurane exhibited a neuromuscular blocking effect 2,3 times more potent than halothane. 2) Neuromuscular depression by halothane and isoflurane was not accompanied by "fade". 3) The recovery time from nuromuscular blockade by succinylcholine in isoflurane anesthesia was increased significantly compared with halothane anesthesia. 4) The duration of action and the recovery index were increased significantly in isoflurane anesthesia compared with halothane anesthesia.

Anesthetic Management for Pheochromocytoma / 대한마취과학회지

Pheochromocytoma are functioning tumors which arise in chromaffin tissue of adrenal gland. The signs and symptoms of pheothromocytoma results from the release of the highly potent amines, epinephrine and norepinephrine by the tumors. This tumor release both epinephrine and norepinephrine into the blood stream for distribution to distant sites of action. Circulating norepinephrine produces widespread vasoconstriction, causing increased peripheral resistance and resulting in increased systolic, diastolic and mean arterial pressures. The direct effect on the heart is to increase the rate and force of contraction. As important effect is the reduction of plasma volume caused by prolonged increases in circulating norepinephrine and epinephrine. These adrenergic aminess have prominet metabolic as well as hemodynamic effects. The increase oxygen consumption and elevation of blood glucose and lactic acid level caused by epinephrine are much more marked than the increase produced by comparable amounts of norepinephrine. Anesthetic management of pheochromocytoma should considered prevent serious alterations in blood pressure. So, We present the case of anesthetic management for pheochromocytoma which control of hypertensive crises by the use of a intravenous infusion of sodium nitroprusside.

Acute Pulmonary Edema during Cardiopulmonary Resuscitation - A Case Report / 대한마취과학회지

Acute pulmonary edema associated with direct current shock is a rare complication. Pulmonary edema with an increase in heart size following direct current shock have been previously reported and confirmed. The cause of this complication is unknown. This is not due to a sudden increase in the cardiac output with the establishment of sinus rhythm. It has been most commonly noted in the presence of mitral or aortic valvular diseases or ventricular dysfunction. It is likely that acute alteration or disparities in atrial or ventricular mechanical function consequent to electrical discharge precipitate pulmonary congestion. This is a case report of acute pulmonary edema following cardioversion with direct current shock which caused ventricullar fibrillation during tonsillectomy. He was treated with oxygen, iuretics, digitalis, steroid, dopamine and PEEP (positive end expiratory pressure). The patient recovered uneventful ventilation.

Bilateral Tension Pneumothorax during Induction of Anesthesia / 대한마취과학회지

Inhalation anesthesia oy endotracheal intubation is commonly used in current anesthetic tech nique. But the increased use of endotracheal tubes in inhalation anesthesia expose the patients to the consequence of increased pressure in the tracheobronchial tree sometimes to a great extent than is true of a patient in whom intubation is not done. In addition, disposable plastic units has been introduced to obviate hazards of cross infection in anesthesia and inhalation therapy and which do not stretch after full inflation. Pressure exceeding 250 cm water may develop within seconds when the plastic units are inadvertently overfilled with gases. Such high pressures transmitted to the airways are harmful. Immediate, prompt and adequate management of the bilateral tension pneumothorax are essential, otherwise the patient becomes rapidly fatal. A case of bilateral tension pneumothorax, which occurred due to a excessive pressure to the airway by use of disposable plastic units was reported.