Intraoperative Management of Myocardial Ischemia with Transesophageal Echocardiography during Coronary Bypass Surgery / 대한마취과학회지

BACKGROUND; Regional wall motion abnormalities(RWMA) detected by intraoperative transesophageal echocardiography(TEE) are thought to be sensitive indicators of myocardial ischemia. The present study was undertaken to elucidate management of RWMA with an immediate regraft in the area of RWMA or conventional drug therapy. METHOD; Twenty-six patients undergoing coronary artery bypass graft surgery were examined with TEE. After induction of anesthesia, TEE probe was inserted into esophagus and connected to Echo system. LV short axis views at the mid-papillary muscle level were viewed and recorded. TEE showed postbypass RWMA in 6 cases and one patient who did not have the TEE developed postbypass RWMA viewed by the epicardial echocardiography. Regraft was performed at the area of RWMA in 3 patients. The remainder was treated with intraaortic balloon pump(IABP) and/or inotropics. RESULTS; The patients with regraft showed an immediate improvement of the new RWMAs. The patients treated with IABP and/or inotropics had improvement of hemodynamics but did not show any improvement of the RWMAs. All seven patients developed hypotension and ST segment changes. All patients with the conventional treatment and two out of 3 regraft patients developed the postoperative myocardial infarctions. CONCLUSIONS; In conclusion this study demonstrated that patients experiencing persistent RWMA would be more likely to have myocardial infarction than those having only transient changes and that TEE would be an excellent tool for early detection of myocardial ischemia and might improve treatment of ischemic events.

The Use of Pressure-Limit Control Accessary for Anesthetic Drager Infant Ventilator in Pediatric Patients with Congenital Heart Disease / 대한마취과학회지

Pressure-limit ventilators are used because it is believed that they decrease the incidence of pulmonary gas leaks and chronic lung disease. The disadvantage of pressurelimit ventilators is that there is no automatic compensation for changes in compliance and resistance of the lung and the chest wall. Consequently, if lung compliance decreases, tidal volume will decrease and blood gases will worsen. The aim of this study is to find the adequacy for the oxygenation and ventilation of volume-limit ventilator with pressure-limit control accessary in pediatric patient with congenital heart disease. The pressure-limit control accessary for anesthetic ventilator(AV-E, North America Drager, Bedford, USA) in 36 pediatric patients undertaken open heart surgery and thoracotomy, retrospectively, were employed. The patients were divided into 3 groups according to their body weights. The respiratory rate of group I ( or = 5, or = 10, < 20 kg, n=8) was 15/min. The patients were divided into another 2 groups, A(n=30) or B(n=6), with the supine or lateral, respectively according to the operation position. The results showed all the values of arterial blood gases almost within normal limits, except one patient in each group. We concluded that anesthetic Drager infant ventilator with pressure-limit control accessary was useful during controlled ventilation, and this is suitable for the prolonged operation in pediatric patients with the supine or lateral position.