A suspected case of air embolism in endonasal surgery using CO2 laser / 대한마취과학회지

No abstract available.

Transient Hypoglossal Nerve Palsy after Septorhinoplasty: A case report / 대한마취과학회지

Hypoglossal nerve palsy is a rare complication after general anesthesia with orotracheal intubation. It can present with symptoms of tongue deviation, dysarthria and swallowing difficulties. We report 33-year-old female who was scheduled to undergo surgery for a nasal bone fracture under general anesthesia, using orotracheal intubation. After surgery, she complained right side tongue deviation and, dysarthria, and was diagnosed with right hypoglossal nerve palsy. The cause of the hypoglossal nerve palsy was assumed to be a complication of the orotracheal intubation. Fortunately, the patient fully recovered 2 weeks after surgery.

Cerebral Infaction during Spinal Anesthesia : A case report / 대한마취과학회지

We experienced a case of acute cerebral infarction during spinal anesthesia. The patient was a seventy years old male with diagnosis of right femur periprosthetic fracture scheduled for a open reduction & internal fixation under spinal anesthesia. Intraoperatively, he developed a mental confusion and his blood pressure decreased from 115/70 mmHg to 80/45 mmHg. After operation, he appeared to have left hemiparesis and left facial palsy. Angiogram revealed thrombus in superior division of the right middle cerebral artery. He expired 3 months after the surgery despite supportive measures.

Unexpected Difficult Intubation due to Lingual Thyroid: A case report / 대한마취과학회지

Lingual thyroid is a rare clinical entity that is due to the failure of the thyroid gland to descend early in the course of embryogenesis. It may be present with symptoms of dysphagia and upper airway obstruction. We report here on the case of a 63-year-old female who was scheduled for an operation for lumbar disc herniation and she could not be intubated. The cause of the airway obstruction was an ectopic thyroid at the base of the tongue, which made visualization of the glottis impossible. Several attempts at endotracheal intubation were unsuccessful. Fortunately, the patient was mask ventilated. We awakened the patient and consulted an otolaryngologist, and she was diagnosed with lingual thyroid. After a week, she was operated on using spinal anesthesia.

Head and Neck Positional Change Causes the Alteration in Endotracheal Cuff Pressure / 대한마취과학회지

BACKGROUND: Endotracheal tube movement due to changes in the position of the head and neck can affect the intracuff pressure and volume. The alteration in the endotracheal cuff pressure after positional changes of the head and neck were examined and compared to that in the neutral position. METHODS: 20 adult male patients undergoing orotracheal intubation for endoscopic sinus surgery under general anesthesia were studied. A reinforced tube (internal diameter 8.0 mm) was used for endotracheal intubation. If the initial intracuff pressure exceeded 22 mmHg, it was set to the adjusted intracuff pressure, defined as an intracuff pressure ranging from 15 to 20 mmHg. After recording the adjusted intracuff pressure in the neutral position, repeated measurements after positional changes to 45 degrees flexed, 45 degrees extended and fully rotated positions of the head and neck were taken. The sealing intracuff pressure and volume required for the elimination of audible air-leaks were re-measured in the neutral position, and the changes in the sealing pressure after positional changes of the head and neck were then repeatedly measured. Lastly, the genuine sealing pressure and volume were measured in the flexed, extended and rotated positions. RESULTS: The adjusted intracuff and sealing pressures were higher in the flexed, extended and rotated positions than in the neutral position (P<0.01). The genuine sealing pressure in flexion and rotation were lower than that in the neutral position (P<0.05). The genuine sealing volumes were smaller in the other positions than in the neutral position (P<0.01). CONCLUSIONS: It is recommended to make genuine sealing pressure of intracuff pressure under direct pressure monitoring after positional changes of the head and neck.

Clinical Evaluation of Univent Tube for One Lung Ventilation / 대한마취과학회지

BACKGROUND: Univent tube(endotracheal tube with a movable blocker), introduced by Inoue et al in 1982, has properties to overcome the disadvantages of double lumen endotracheal tube for one lung anesthesia. This study was performed to evaluate the effectiveness of Univent tube for one lung ventilation. METHODS: Univent tube was inserted to the patients for open thoracic surgery and positioned to the side of bronchus under the guidance of fiberoptic bronchoscope that was scheduled to lung collapse. One lung anesthesia was performed with the inflation of cuff of blocker. Each case was anaylzed with respect to ease or difficulty of positioning of blocker, tube displacement, efficacy of lung collapse and adequacy of single lung ventilation. RESULTS: In the 69 patients out of 80 patients, adequate positioning was performed by first trial. In the two patients, insertion of bronchial blocker was failed that resulted in replacement with a double lumen tube. Observed disadvantages were delayed deflation(10 patients) of affected lung and displacement of bronchial cuff into the main tracheal lumen during position change or surgical manipulation(7 patients). CONCLUSIONS: Univent tube is useful for one lung anesthesia but there are several distinct limitaitons in the safe use.

Comparative Clinical Study of Pofol(Dong-guk Pharm Co.) with Diprivan(ICI Pharm Co.): Evaluation of Efficacy and Safety of Intravenous anesthetics "Pofol" / 대한마취과학회지

Propofol is a new, rapidly effective, short-acting intravenous sedative-hypnotic agent that can be used for induction and maintenance of general anesthesia. This study was performed to evaluate the efficacy and safety of domestic product Pofol in comparison with Diprivan for the management of total intravenous general anesthesia by double blind method. This study was approved by the Clinical Research Committee of SNUH. Test drugs were administered in a double-blinded fashion for the anesthesia. Seventy-four patients(aged 18-60 yr, operation time below two hours) were induced anesthesia with bolus injection of 2 mg/kg of test drug for 20 seconds and then anesthesia was maintained with continuous infusion method by syringe pump. Infusion dose of test drug during maintenance of anesthesia was controlled to maintain the systolic blood pressure measured at ward +/-20%. To evaluate the efficacy of drug, induction dose, mean maintenance dose, time to loss of conciousness after injection of induction dose and awakening time were measured or calculated. To evaluate the safety of drug, pain after injection of drug, recovery condition of patients and adverse events or side effects were recorded. Changes of blood pressure and heart rate were measured and arterial blood gas was also analyzed during perianesthetic period. There were no statistically significant differences in sex, age, weight, duration of anesthesia and ASA physical status distribution between Pofol group(P) and Diprivan group(D). There were no differences in induction dose and mean maintenance dose between P and D (mean+SD, 121+/-25 mg and 0.213+/-0.064 mg/kg/min vs 125+/-27 mg and 0.233+/-0.058 mg/kg/min, respectively). Time to loss of conciousness, time to response and time to orientation after cessation of drug were 14+/-19 sec, 10 min 2 sec+/-5 min 39 sec, 17 min 16 sec+/-9 min 43 sec for P and 14+/-26 sec, 12 min 52 sec+/-8 min 42 sec, 22 min 47 sec+/-14 min 17 sec for D. But there were no statistically differences between P and D, respectively. The incidence of pain after injection was 65.7% for P and 52.7% for D. Recovery from anesthesia was assessed as smooth in 82.9% for P and 91.7% for D. Adverse events during induction were recorded in four patients (apnea(1), opisthotonus(2) and hypotension(1)) for P and in two patients (apnea(1), bradycardia(l)) for D. The number of patients showed adverse events during maintenance of anesthesia and postanesthesia recovery period were same to P and D as 8 patients. Even though the characters of adverse events to P and D were different, the incidence rate was not different between two drugs. These adverse events were resolved without any specific treatment. In conclusion, there were no differences in efficacy and safety between Pofol and Diprivan.

A Clinical Trial on Antihypertensive Effect of Tripamide(Normonal(R))

Antihypertensive effect and side effect of Tripamide(Normonal(R)) was studied in 22 cases of essential hypertension using 15mg once daily regimen for average period of 9 weeks. 1) Antihypertensive effect Average reduction of 25mmHg in systolic and 19mmHg in systolic and 19 mmHg in diastolic pressure was observed and reduction rate was 15.7% and 17.6% respectively. The overall effect rate was 86%. The blood pressure lowered significantly in 1 week of treatment both in systolic and diastolic pressure and the extent of fall in systolic pressure approached near the level of maximum reduction in 2 weeks of administration and that of diastolic after 5 weeks of treatment. 2) Laboratory tests and side effect There was no significant changes in individual and mean value of Na, K, Cl, BUN, creatinine, uric acid, fasting blood sugar, cholesterol, GOT, GPT studied before and after treatment except one case showing elevation of uric acid. No significant side effect was observed during trial except of 2 cases of transient diuretic effect.

The Relationship of Mitral Valve Area Measured by 2-Dimensional Echocardiography with the M-Mode Measurements in Mitral Valvular Stenosis

Mitral valvular orifice area is important for the evaluation of prognosis and treatment of patients with mitral valvular stenosis. Until recently, Gorlin's formula using cardiac catheterization has been utilized in the measurement of mitral valve area, but it is invasive and impractical to examine repeatedly. Recently 2-Dimensional echocardiography appeared to be a practical and useful substitute in measurement of valve area and also it is economical and has no risk to patients. In 31 patients with mitral valvular stenosis examined at the echocardiography room of Busan national University Hospital from March 1982 to March 1983, we measured the mitral valve area with 2-Dimensional echocardiography and evaluated its relationship with the left ventricular functions measured on M-mode echocardiogram. Among many parameters on M-mode measurements EF slope, excursion amplitude and the ratio of left atrial dimension to aortic root dimension were rather helpful for the assessment of severity of mitral valvular stenosis than other parameters. And each relationship with the valve area showed correlation coefficient of 0.60, 0.05 and -0.58, respectively.