Intravenous Regional Block of Bretylium: Treatment of Reflex Sympathetic Dystrophy / 대한마취과학회지

BACKGROUND: Interruption of efferent sympathetic fibers is the mainstay of therapy in reflex sympathetic dystrophies(RSD) and be accomplished by temporary or permanent anesthetic blockade of sympathetic ganglia, surgical lesions of the sympathetic trunk, intravenous injecton of guanethidine or reserpine, or by systemic administration of adrenergic blocking drugs. In this study, the effects and the side effects of intravenous regional bretylium for the treatment of RSD were studied. METHODS: Seven patients have been administered with 2.0 mg/kg bretylium in 0.25% lidocaine with 100U of heparin three times weekly. A standard intravenous regional technique was used with 250~300 mmHg tourniquet pressure for 30 minutes. Blood pressure and pulse rate were monitored before injection, 1 minute and 5 minutes after injection, immediately before deflation of tourniquet, 1 minute, 5 minutes and 30 minutes after deflation of tourniquet. Pain and temperature evaluations were made before injection and at 1 week after every injection. RESULTS: The increase in skin temperature and decrease in pain score of the affected limb were noted after the use of bretylium in 5 patients out of 7 patients. These clinical effects probably resulted from bretylium,s ability to accumulate in adrenergic nerves and block norepinephrine release. One patient had hypotension immediately after tourniquet deflation. CONCLUSIONS: Intravenous regional bretylium provides significant pain relief for treatment of RSD.

Percutaneous Tracheostomy: a comparison with standard surgical tracheostomy / 대한마취과학회지

A prospective study was undertaken to compare, in intensive care patients, the safety and utility of a percutaneous tracheostomy teehnique with a surgieal tracheostomy technique. Between March of 1992 and June of 1993 we randomly selected 40 patients of the many who were in need of a tracheostomy. After dividing those patients into 2 groups, we per- formed the procedures. Twenty patients received a standard surgicsl traeheostomy, the other twenty received a percutaneous tracheostomy. We found complications occurring in 6 patients who received the standard surgical tracheostomy while only 1 patient suffered complications from the group having the percutaneous tracheostomy. The most common complications being subcutaneous emphysema, pneumothorax, pnemonia, and hemorrhage. Post-decannulation scar was 3.286+/-1.204mm in percutaneous group, 20.36+/-7.26mm in standard group. In comparison to standard surgical tracheoatomy, percutaneous tracheostomies were rapidly and easily performed and asaociated with significantly fewer complication and small post-decannulation scars.

Percutaneous Tracheostomy: a comparison with standard surgical tracheostomy / 대한마취과학회지

A prospective study was undertaken to compare, in intensive care patients, the safety and utility of a percutaneous tracheostomy teehnique with a surgieal tracheostomy technique. Between March of 1992 and June of 1993 we randomly selected 40 patients of the many who were in need of a tracheostomy. After dividing those patients into 2 groups, we per- formed the procedures. Twenty patients received a standard surgicsl traeheostomy, the other twenty received a percutaneous tracheostomy. We found complications occurring in 6 patients who received the standard surgical tracheostomy while only 1 patient suffered complications from the group having the percutaneous tracheostomy. The most common complications being subcutaneous emphysema, pneumothorax, pnemonia, and hemorrhage. Post-decannulation scar was 3.286+/-1.204mm in percutaneous group, 20.36+/-7.26mm in standard group. In comparison to standard surgical tracheoatomy, percutaneous tracheostomies were rapidly and easily performed and asaociated with significantly fewer complication and small post-decannulation scars.

Hemodynamic and Metabolic Changes during Orthotopic Liver Transplantation in Dogs / 대한마취과학회지

Skilled and experienced anestheia is of great importance for patients undergoing orthotopic liver transplantation, because of multiple preexisting medical problems in such patients as well as the intraoperative problems of rapid hemodynamic, metabolic, and coagulation changes. In this study, the intraoperative hemodynamic and laboratory data were analyzed in ten dogs that underwent an orthotopic liver transplantation procedure by veno-venous bypass using Biopump. Liver transplantation can be divided into three distinct periods: stage I, or preanhepatic stage, which begins with the induction of anesthesia and continues until cross clamping of portal vein and IVC; stage II, or anhepatic stage, which begins at the anhepatic time and continues until the donor liver is reperfused by the recipients circulating blood; and stage III, or postanhepatic stage, which begins at the time of reperfusion and continues until the end of surgical procedure. The hemodynamic changes at the time of IVC and portal vein cross clamping were decreases in CVP, PCWP, and pulmonary artery pressure in spite of using Biopump. The significant metabolic alternations during anhepatic stage were decrease in blood glucose levels and increase in blood lactate levels. The more significant hemodynamic changes occurred at the time of reperfusion. Systolic pressure decreased suddenly to 58+/-6 mmHg and cardiac output decreased to 1.08+/-0.1l L/min. However heart rate, pulmonary artery pressure, CVP, and PCWP did not change significantly. During stage III, hyperglycemia occurred quite frequently. Significant abnormal coagulation chages could not be found, probably because the dogs were healthy. In conclusion, during anhepatic stage, we have to compensate for alternations of fluid balance. At the time of reperfusion, we should prevent severe hemodynamic changes and treat them immediately if they occur. However, it seems that glucose administration is not necessary to the liver recipient during stage II because there is no significant hemodynamic depression due to hypoglycemia at this time and hyperglycemia occurs later.