The Optimal Depth of Central Venous Catheter by Using Transesophageal Echocardiography for Pediatric Patients / 대한마취과학회지

BACKGROUND: Incorrect positioning of central venous catheter leads to serious complications. To prevent these complications, catheter tip should be at the superior vena cava and right atrial junction. METHODS: We studied 60 right internal jugular catheterizations in infants and children undergoing surgery for congenital heart disease. To confirm the optimal depth of central venous catheter, we measured the distance from the skin puncture site to subclavian vein-right atrial junction using transesophageal echocardiography. RESULTS: The measured distance highly correlated with the patient height. Based on these data, following guideline could avoid intra-atrial placement in 94% of the time: optimal depth of insertion (cm) = 2.5 + (0.06 x height). CONCLUSIONS: We postulate that initial using a simple practical guideline could prevent malposition of central venous catheter.

The Differences in Bispectral Index according to Age during Sevoflurane Anesthesia in Children Aged 1-7 Years / 대한마취과학회지

BACKGROUND: The bispectral index (BIS) was developed for adults, and the influence of neuronal and physiologic brain maturation on BIS in pediatric patients is unknown. The aim of this study was to evaluate BIS during anesthesia, using the same sevoflurane with respect to age in young children. METHODS: Forty-two pediatric patients, aged 1-7 years, were enrolled in this study. Without premedication, anesthesia was induced with atropine, thiopental, and rocuronium and maintained with 2.0-2.5% sevoflurane and 50% N2O-50% O2. After induction, a pediatric BIS sensor was applied and monitored throughout the maintenance of and emergence from anesthesia. RESULTS: BIS was analyzed in different age groups; 1-2 yr (n = 14), 3-4 yr (n = 13), 5-7 yr (n = 15). Operation and anesthesia times were similar forthe three age groups. Mean BIS values from ten minutes after skin incision to just before sevoflurane cessation (BISmean) were 67.0 +/- 6.2 for 1-2 yr, 50.5 +/- 9.4 for 3-4 yr, and 39.8 +/- 6.9 for 5-7 yr, and these values were significantly different for the three age groups. No significant differences were observed for extubation times, or times to a BIS value of 70 or 90 during anesthesia recovery. CONCLUSIONS: When monitoring BIS in children aged 1-7 yr during anesthesia with sevoflurane, the BIS trend rather than the absolute value is more important and the BIS data, especially in children under 3 years of age, should be interpreted cautiously.

Anaesthetic Management of an Adult with a Modified Fontan Procedure in Noncardiac Surgery: A case report / 대한마취과학회지

Given improvements in the diagnosis and treatment of congenital heart disease, more patients with heart disease reach adolescence or adulthood and require noncardiac surgery. Since 1971, the Fontan operation has been widely used for the management of tricuspid atresia and a variety of univentricular heart malformations. Although the life expectancy of these patients has increased, few reports are available on their anaesthetic management when a noncardiac operation is indicated. We report on the anaesthetic management of a 40-years-old male patient scheduled for permanent pacemaker insertion who underwent a modified Fontan procedure at the age of 27 years for pulmonary stenosis, common atrioventricular cushion defect, and for corrected transposition of the great arteries

A Statistical Analysis of the Causes of Cancellation of Elective Operation / 대한마취과학회지

BACKGROUND: An elective operation is cancelled by many causes. Cancellation of the operation bothers patients physically and emotionally; also it affects the patient's family emotionally. If we know the causes of cancellation, we can prevent them. In addition we can provide better quality medical service. METHOD: We examined all patients scheduled for an operation in An - am Hospital, Korea University from August 3rd, 1999 to September 19th, 1999 and from September 16th, 1999 to December 6th, 1999. We counted the number of operations which were cancelled on the day of operation and put together the causes of cancellation after asking surgical employees. RESULTS: The total numbers of scheduled patients was 2,494 and cancelled patients was 512. The overall cancellation rate was 20.5%. The most common cause was departmental, 48.4%; abnormal laboratory results, 24.8%; patients denial, 9.6%; inadequate preparation, 7.0%; overtime, 5.5%; or a change to local anesthesia, 4.7%. In the departmental causes, 52% was due to an excessive schedule (129/248); 32.3% to delayed admission (80/248); 8.9% to clerical error (22/248); 4.4% to operator problems (11/248); and 1.6% to delayed transfer (4/248). In the abnormal laboratory results, 27.6% were due to the medical causes (35/127); 23.6% to LFT (30/127); 23% to an EKG (23/127); 18% to a chest roentgenogram (18/127); 8.7% to a URI (11/127); and 5.5% to hypertension (7/127). CONCLUSIONS: Overall the cancellation rate of elective surgery was 20.5%. The most common cause was departmental (48.7%), and abnormal laboratory results (24.8%) was next.

Does Perioperative Monitoring of the Train-of-Four Response Influence the Frequency of Postoperative Residual Curarization in Propofol Anesthesia? / 대한마취과학회지

BACKGROUND: Sometimes hypoxemia occurs in the postoperative recovery room because of postoperative residual curarization (PORC). Some reports show that postoperative residual curarization is common. PORC occurs after the use of the long-acting muscle relaxants. It has been recommended to use intermediate-acting muscle relaxants and a TOF monitor to decrease PORC. The purpose of this study was to examine whether the use of the TOF monitor during propofol anesthesia affects the incidence of postoperative residual curarization. METHODS: 38 ASA I or II patients were divided randomly into two groups of 19 each. They received propofol-fentanyl-nitrous oxide for anesthesia. Pancuronium (80 100 microgram/kg) was used to facilitate tracheal intubation and additional doses were used to maintain surgical relaxation. The requirement for incremental doses of pancuronium and adequacy of recovery following reversal were assessed, either with (control group:n = 19) or without (experimental group:n = 19) TOF monitoring. Fifteen minutes after the arrival at the recovery room, neuromuscular function was assessed clinically and by using TOF. RESULTS: There were no statistical differences in body weight, age, or duration of operation between the two groups. There was no statistical difference in the total dose of pancuronium and total dose of pancuronium relative to body weight and duration of operation. There were statistical differences in TOF ratio in the recovery room (0.73 vs. 0.86). The incidence of PORC was 47% in the control group and 5% in the experimental group. CONCLUSIONS: Though the monitoring of TOF did not effect the dose of muscle relaxant, it may have reduced the incidence of PORC. However, the PORC had no clinical significance because the mean TOF ratio in the two groups was over 0.7 and there were no clinical signs of residual muscle weakness.