Endoscopic Thyroidectomy via Axillary Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A hypertrophic scar of the anterior neck is the leading complaint of patients who underwent conventional thyroid surgery. In order to minimize the postoperative scars, endoscopic thyroidectomy via axillary approach was tried. SUBJECTS AND METHOD: Thirty-nine cases (female 37, male two, average age 36.3 yrs) with either benign unilateral thyroid nodule or cyst underwent endoscopic thyroidectomy. Under general anesthesia, less than 7 cm of skin incision was made in the axilla of the same side and subcutaneous tunnel was made over the clavicle. Specially created retractor was placed within the tunnel between platysma and sternocleodomastoid muscle, and under rigid endoscope (4 mm, 5 mm ; 0degrees, 30degrees) thyroidectomy was performed. RESULTS: There were 35 cases of thyroid nodulectomy, one case of isthmusectomy, and three cases of subtotal lobectomy. Complete enucleations with the intact capsule were 13 cases, 24 cases with partial rupture of the capsule, and two cases with incomplete removal of the capsule. The mean operative time was 112.5 minutes. Postoperative complications included one case of postoperative bleeding, two cases of delayed wound healing, three cases of paresthesia of shoulder and arm, and five cases of hypertrophic scar of the axilla. For all cases, hospitalization period was two days. CONCLUSION: Endoscopic thyroidectomy via axillary approach has an excellent cosmetic advantage; however, the procedure requires longer operation time of about three times the conventional method. Operation time can be reduced with the development of more versatile surgical tools. However, limited thyroidectomy surgery can not be avoided.

A Statistical Analysis of Postoperative Deaths in the Hospital / 대한구급학회지

Introduction: Anesthesia deaths are rare, while deaths due to surgical or other risk factors are more frequent. The goal of this analysis is to evaluate risk factors associated with postoperative mortality. METHODS: We have analyzed 34,200 surgical patients between 1990 and 1996 through records of anesthesia. The following informations were recorded; age of patients, physical status, site of operation, time of death, primary cause of death. RESULTS: The results are as follows; 1) Of 34,200 surgical patients, 119 died in the hospital. 2) The postoperative mortality rose progressively with age and was highest above 70 years. 3) Within 48 hours, the mortality was 36.1% of total deaths, declined progressively thereafter. The patients who had head operations exceeded 45% of deaths during this period. Eight days after the operation the mortality rate was 34.2% of total deaths and the patients who had an elective operation of the abdomen were 60.8%. 4) 34.2% patients of the total deaths had brain damages. Of these, 79.5% showed physical status V and had an emergency head operation and 47.5% were 50~60 years of age. 17.5% and 13.2% of deaths were due to sepsis and respiratory insufficiency and 48.6% of these two categories were physical status II, III and had an elective operation and 55.5% were above 60 years. CONCLUSION: The postoperative mortality was highest in the patients who had an emergency head operation and primary cause of death was brain damage. The patients of above 60 years, had a physical status II, III, had an elective abdominal operation were succeptable to sepsis and respiratory insufficieny.

Effects of Augmented Minute Ventilation on Cardiovascular and Ventilatory Changes during the Laparoscopic Cholecystectomy under General Anesthesia / 대한마취과학회지

BACKGROUND: The pneumoperitoneum created by CO2 insufflation during laparoscopic cholecystectomy has several potential hemodynamic and respiratory consequences. The purpose of this study is to investigate the effects of augmented minute ventilation on cardiovascular and ventilatory changes and to prevent hypercarbia due to CO2 insufflation during laparoscopic cholecystectomy. METHODS: Thirty-six patients were divided into three groups according to the level of minute ventilation. The three groups were: control group C (minute ventilation 100 ml/kg, respiratory rate 12 per minute), group R (MV 150 ml/kg, RR is 18 per minute) and group V (MV 150 ml/kg, tidal volume is 1.5 times as much as group C). We repeatedly measured mean arterial pressure , pulse rate , arterial blood gas analysis and end tidal carbon dioxide and peak inspiratory airway pressure before CO2 insufflation, 15 and 30 minutes after CO2 insufflation and 15 minutes after CO2 deflation. RESULTS: During CO2 insufflation, MAP significantly increased but PR showed little changes in all three groups. PaCO2 and PetCO2 increased in group C, whereas in group R and V, they remained unchanged during CO2 insufflation. But the level of PaCO2 in group V decreased more than in the other two groups after CO2 deflation,. PIP in group V increased 3 times as much as the control value. CONCLUSIONS: These results suggest that augmented minute ventilation in group R and V, prevented hypercarbia during CO2 insufflation and increasing the tidal volume in controlled ventilation was more effective than increasing respiratory rate after CO2 deflation.

A Case of Hypoxic Encephalopathy Following Anesthesia for a Patient with Ludwig`s Angina / 대한마취과학회지

Ludwig's Angina is the term given to the symptoms resulting from infection of the submandibular space and is characterized especially by extreme edema of the floor of the mouth. Airway obstruction and respiratory difficulty is common due to edema of the mouth, tongue, and the glottis, from mediastinitis due to spread, or from septicemia or pneumonia. Thus it is necessary for the anesthetist to attend to specific management of airway maintenance. A 49 year old male had an operation for incision and drainage under balanced anesthesia. After the operation, posthypoxic myoclonus due to anoxia for three minutes appeared while in the recovery room. The patient, controlled by oxygen supply and diazepam and antiepileptics, has recovered from the seizures, but has not recovered from intention myoclonus and speech disturbance, which are slowly improving. This report describes this case of posthypoxic myoclonus following anesthesia and reviews the literatures.

Pulmonary Edema during General Anesthesia for Cesarean Seetion of Pre-eclampsia Patient / 대한마취과학회지

Our hospital has been experienced pulmonary edema during general anesthesia for cesarean section of pre-eclampsia. But, the patient recovered rapidly without complication. Therefore, we think that before anesthesia, accurate laboratory data and careful attention are needed for general anesthesia of pre-eclamsia.

A Case of Acute Hhperpyrexia during Diethyl Ether Anesthesia: A Case report / 대한마취과학회지

The authors have experienced a case of acute hyperpyrexia with convulsion during diethyl ether anesthesia, which is rare and its etiology not well known.

Clinical Evaluation of Fluothane Anesthesia for Cesarean Section / 대한마취과학회지

In 97 cases of uncomplicated Cesarean section proceeding under 0.5% fluothane anesthesia with N2O and O2, 2.5% Pentothal sedium(clinical induction doses) was enough until umbilical cord clamp without any supplemental doses but muscle relaxation from succinylcholine might not be potentiated with 0.5% fluothane. On the other hand, Apgar score and postpartum uterine contractility was depending upon duration of anesthesia but it was not so serious problem. Also, anesthesia induction and recovery was rapid, and post operative pulmonary and other complication, even vomiting, did not occur. Conclusively, it is interesting that low concentration of fluothane with nitrous oxide are probably ideal anesthesia method for Cesarean section.