Anesthetic Management of Carotid Endarterectomy under EEG and SEP Monitoring / 대한마취과학회지

BACKGROUND: Carotid endarterectomy is a very high risk operation, combined with high incidence of stroke and myocardial infarction. We experienced 36 cases of carotid endarterectomies during the last two years. We reviewed these cases with anesthetic management and neurologic monitoring. METHODS: All of the operations were performed under general anesthesia. 33 cases were monitored by EEG and SEP. We maintained cerebral perfusion during cross-clamping and shunt by normothermia, normocarbia and mild hypertension. RESULTS: 33% of the patients had severe coronary artery stenosis and 41% had severe contralateral carotid artery stenosis preoperatively. During the operation, 10 patients showed transient EEG changes without SEP change or neurologic sequele. The major postoperative complication was myocarial infarction in one patient. There were 3 cases of postoperative cerebral infarction in radiologic findings. One case occurred after myocardial infarction and the other two cases showed no clinical evidence of neurologic deficit. CONCLUSIONS: In anesthetic management of carotid endarterectomy patients, maintaining cerebral perfusion, preventing perioperative myocardial infarction are important and monitoring neurologic function with EEG and SEP should be considered to prevent neurologic deficits.

The Effects on Hemodynamic Stability by Combined Use of Conventional Ultrafiltration and Modified Ultrafiltration in Paediatric Cardiac Surgery / 대한마취과학회지

BACKGROUND: Ultrafiltration, used in pediatric cardiac operations to remove excessive body water, can be separated into conventional and modified techniques according to the connection with the bypass circuit and the time of starting ultrafiltration. Ultrafiltration provides more precise hemodynamic and fluid management immediately after CPB (cardiopulmonary bypass), especially in the pediatric patient. The mechanism by which blood pressure improves remains uncertain. The purpose of this study was to compare the efficacy of ultrafiltration for hemodynamics and reduce the blood consumption amounts in paediatric open heart operations. METHODS: Fourty children undergoing surgical correction of VSD (ventricular septal defect) or ASD (atrial septal defect) were randomly assigned to a ultrafiltration or control group. Conventional ultrafiltration was performed with a polysurphone hemofilter during rewarming of CPB. Modified ultrafiltration carried out in the first 10 to 15 minutes immediately after bypass. In all patients, moderate hypothermic CPB, in the range of 20~25 degrees C body temperature, was performed with nonpulsating flow. RESULTS: Demographic data as well as data from CPB did not differ among the groups. In the ultrafiltration group, significant reductions of the amount of blood transfusion significant increases in systolic pressure and hematocrit were noted in the ultrafiltration group. We have been impressed with what appears to be a marked improvement in hemodynamic status in the modified ultrafiltration process during the first few minutes. CONCLUSIONS: Ultrafiltration has been employed successfully in our hospital, and this study demonstrates that ultrafiltration may help to control water balance, concentration of blood, increase systemic arterial pressure and reduces intraoperative blood transfusion.