A management of a pulmonary thromboembolism patient under monitoring of VigileoTM monitor (pulse contour cardiac output monitor) : A case report

Pulmonary embolism (PE) is an uncommon but, highly lethal condition that is a leading cause of death. However, prompt diagnosis and treatment can dramatically reduce the mortality rate and morbidity of PE. Unfortunately, the diagnosis is often missed because of vague and nonspecific symptoms. We report a case of pulmonary thromboembolism (PTE) which was developed during surgical preparation for pelvic bone and sacro-iliac joint reduction surgery after induction of general anesthesia. We monitored and treated efficiently the PTE patient under monitoring of VigileoTM monitor (pulse contour cardiac output monitor) in operating room and intensive care unit. After complete resolving of PTE, the surgery was reperformed with VigileoTM monitoring without any complications. We suggest that the VigileoTM monitor is simple and minimal invasive method to monitor the hemodynamic status in management of PTE patient.

Optimal dosages of propofol and remifentanil for minimizing hemodynamic changes during laryngeal microscopic surgery / 대한마취과학회지

BACKGROUND: Laryngeal microscopic surgery (LMS) is stressful to the patient due to intubation and suspension laryngoscopy. The aim of this study was to determine the optimal dosages of propofol and remifentanil for minimizing hemodynamic changes during LMS. METHODS: Eighty outpatients undergoing LMS were randomly divided into four groups. In all patients, endotracheal intubation was done with an effect-site concentration of propofol at 3 or 4microgram/ml. Group I (propofol 3microgram/ml) and II (propofol 4microgram/ml) patients received remifentanil 0.5microgram/kg and an infusion at 0.1microgram/kg/min. Group III (propofol 3microgram/ml) and IV (propofol 4microgram/ml) patients received remifentanil 1.0microgram/kg and an infusion at 0.2microgram/kg/min. Hemodynamic changes and bispectral index (BIS) values during intubation and suspension laryngoscopy were compared among the groups. In addition, extubation time, emergence time, and state of recovery (Steward score) were compared. RESULTS: After intubation and suspension laryngoscopy, the mean arterial pressure (MAP) was significantly lower than baseline values in groups II and IV (P < 0.05). After suspension laryngoscopy, the heart rate (HR) was significantly lower than baseline value in group II (P < 0.05). Extubation time was significantly shorter in groups I, II, and III compared to group IV, and the time for responding to verbal commands was significantly shorter in groups I and II compared to group IV (P < 0.05). The incidence of hypotension was higher in group IV than in the other groups (P < 0.05). CONCLUSIONS: The results suggest that an effect-site concentration of propofol at 4microgram/ml with remifentanil 0.5microgram/kg and infusion of 0.1microgram/kg/min provide proper anesthesia with minimal hemodynamic changes during LMS.