The Incidence of Hypoxia Following the Use of Hypnotics and Analgesics during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. METHODS: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0 microgram/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injection of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after arrival in the recovery room. RESULTS: There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2 +/- 1.8%, for the second group 97.9 +/- 2.6%, and for the third group 92.4 +/- 2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group CONCLUSIONS: We concluded that oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia.

Air Embolism during Spinal Fusion: A case report / 대한마취과학회지

Fatal air embolism can occur during a variety of surgical procedures. We experienced a case of cardiac arrest due to venous air embolism during spinal fusion. A 63-year-old woman underwent spinal fusion for compression fracture on L1 and scolio-kyphosis. Anesthetic induction and initial intraoperative course were completely uneventful until precipitous blood pressure drop occurred, and accompanied by a significant decrease in heart rate and cardiac arrest after use of bone cement. Although more common intraoperative events were presumed and treatment initiated, venous air embolism was considered the etiology of these events when whirring noise was detected by esophageal sthetoscope and a transient decrease in end-tidal carbon dioxide tension was noted by capnometer. We performed cardiac resuscitation with external cardiac compression, various cardiotonic drugs, and removal of air through the right internal jugular venous catheter, but the result was unsuccessful.

Bilateral Reexpansion Pulmonary Edema after Decompression of Intraoperative Tension Pneumothorax: A case report / 대한마취과학회지

Reexpansion pulmonary edema(RPE) is a complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion or atelectasis, and generally believed to occur ipsilaterally when a chronically collapsed lung is rapidly reexpanded by evacuation of large amount of air or fluid. Clinical manifestations of RPE are dyspnea, tachypnea, cyanosis, frothy blood-tinged sputum, wet rale, and expiratory wheezing. Hypotension and decrease in organ perfusion can occur. We experienced intraoperative tension pneumothorax probably due to positive pressure ventilation or pleural injury during central venous catheterization through internal jugular vein. And bilateral RPE combined with acute renal failure occurs after spontaneous decompression of tension pneumothorax with chest tube insertion, even with brief duration of lung collapse.

Clinical Analysis of 200 Renal Transplantations / 대한마취과학회지

BACKGROUND: Since the initial report on anesthesia for the renal transplantation from Peter Bent Brighan Hospital in 1962, the anesthesia for kidney transplantation has been reviewed and discussed by many authors. We have performed 200 renal transplantations from August 1990 to October 1996. No cadaveric donor was used and all except two cases was the first graft. METHODS: Anesthetic procedures in the recipients were as follows; 1) The recipient was dialysed within 24 hrs prior to operation. 2) Premedication was done as glycopyrrolate and fentanyl, or glycopyrrolate and diazepam. 3) Thiopental and vecuronium, or thiopental and succinylcholine were used for anesthetic induction. 4) N2O-O2-relaxant (vecuronium) with halothane or isoflurane were used for maintenance. 5) Neostigmine or pyridostigmine were also used to antagonize against the relaxant. 6) CVP was maintained around 10~17 cmH2O. RESULTS: The results were as follows; 1) The mean ages of donors and recipients were 35.3 and 37.4, respectively. The ratio of male to female of donors and recipients was 1.6 : 1 and 1.6 : 1, respectively. 2) One hundred and ten cases (55.0%) were living unrelated donors and 90 cases (45.0%) were living related donors. 3) Overall graft and patient survival rate was 96.9 and 98.0 at 1 year, 94.1 and 95.1 at 3 years. CONCLUSIONS: Most patients with renal failure have several common problems that are of significance to anesthesiologists, including anemia, bleeding tendency, electrolyte imbalance, acidosis, hypertension, hyper- or hypovolemia, and previous therapy with steroids and immunosuppressants, etc. Therefore anesthesiologists should keep in mind the risk factors above mentioned for the anesthetic management of patients with renal failure.

A Case of Intraoperative Cardiac Arrest due to Anaphylactoid Reaction: A case report / 대한마취과학회지

A number of drug administered during anesthesia can provoke pathologic response by immunologic or nonimmunologic mechanisms. Known drugs involved in hypersensitivity reactions are muscle relaxants, local anesthetics, narcotics, barbiturates, contrast media, protamine and antibiotics. Clinical manifestations of anaphylaxis are diverse, but during anesthesia, cardiovascular collapse is predominate. We experienced a case of anaphylactoid reaction with erythema on upper thoracic region, severe hypotension, tachycardia and ventricular fibrillation. After defibrillation, the patient was recovered. During follow-up, we knew that this patient was exposed aprotinin repeatedly, and suspect the possibility of anaphylactoid reaction due to aprotinin.

Retrograde Tracheal Intubation through Cricothyroid Membrane and Cricotracheal Ligament / 대한마취과학회지

Numerous devices and techniques have been devised to facillitate the difficult endotracheal intubation. Percutaneous retrograde intubation was first described by Waters, who used a Tuohy needle to puncture the cricothyroid membrane and an epidural catheter as a guideline in 1963 and many variations on the technique have been described. Failure to intubate 2 male adult patients were planned retrograde tracheal intubation using the cricothyroid membrane. While the patients were awake, and after adequate local anesthesia was obtained, a 16G Medicut was punctured through cricothyroid membrane. After confirmation of the intratracheal position by aspiration of air into syringe, the opening of the Medicut was directed upward foward the larynx and the epidural catheter was inserted through it and advanced retrograde between the vocal cords and into mouth. The epidural catheter tip was passed through the Murphy's eye from outside to inside and out of the tracheal tube. By keeping the catheter taut and coincidently pulling back, the tube was advanced into trachea. Correct positioning of the tracheal tube inside the trachea was confirmed by end-tidal carbon dioxide monitoring and auscultation. Another 2 male adult patients were intubated by using cricotracheal retrograde approach method. We experienced successful retrograde tracheal intubation without significant complications using an epidural catheter through cricothyroid membrane and cricotracheal ligament in 4 male adult patients who were predicted impossibility of simple orotracheal intubation. (Korean J Anesthesiol 1995; 29: 304~309)

Changes of Vital Sign and Pulmonary Gas Exchange during General Anesthesia for Laparoscopic Cholecystectomy / 대한마취과학회지

Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. Anesthetic problems are mostly due to physiologic changes associated with systemic absorption of the intra-peritoneally insufflated carbon dioxide (CO2). We studied systolic and diastolic arterial pressure, heart rate, arterial blood gas, end-tidal CO2 and peak inspiratory pressure changes in 30 patients who underwent laparoscopic cholecystectomy, before CO2 insufflation (control value), 15 minute after CO2 insufflation, after gall bladder delivery out, 15 minute after CO2 excretion. After CO2 insufflation, systolic and diastolic arterial pressure, peak inspiratory pressure, end-tidal CO2 were increased sigmficantly in comparison to control values (P-value<0.01). Also, in arterial gas analysis, arterial blood carbon dioxide tension (PaCO2) was increased and pH was decreased significantly but arterial blood oxygen tension (PaCO2) was not changed significantly. After CO2 excretion, systolic and diastolic pressure, end-tidal CO2 were increased in comparison to control values (P<0.01) and pH was decreased significantly. But peak inspiratory pressure and PaCO2 were not statistically significant. In conclusion, minute ventilation should be corrected during general anesthesia for laparoscopy with CO2 insufflation according to continuous monitoring of end-tidal CO2 and arterial carbon dioxide tension.

Anesthetia for Pheochromocytoma Resection / 대한마취과학회지

Two patients underwent anesthesia for pheochromocytoma involving adrenal gland and extra- adrenal space. Patient 1 was not diagnosed as pheochromocytoma before surgery and thus proper preoperative evaluation and care was not possible. During surgery and anesthesia, the patient showed a marked blood pressure variation, arrythmia and tachycardia. Pulmonary edema occurred intraoperatively, but subsided with positive end expiratory pressure and the use of diuretics and morphine. Patient 2 was preoperatively diagnosed as pheochromocytoma and was thus given prazosin and nifedipine (for 11 days) preoperatively. Blood pressure and pulse rate throughout the surgery and anesthesia were stable and no intra- and postoperative complication occured. We believe that careful preoperative preparation is essential to minimize intraoperative hemo- dynamic disturbance and their sequelae.

Changes of Vital Sign and Pulmonary Gas Exchange during General Anesthesia for Laparoscopic Cholecystectomy / 대한마취과학회지

Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. Anesthetic problems are mostly due to physiologic changes associated with systemic absorption of the intra-peritoneally insufflated carbon dioxide (CO2). We studied systolic and diastolic arterial pressure, heart rate, arterial blood gas, end-tidal CO2 and peak inspiratory pressure changes in 30 patients who underwent laparoscopic cholecystectomy, before CO2 insufflation (control value), 15 minute after CO2 insufflation, after gall bladder delivery out, 15 minute after CO2 excretion. After CO2 insufflation, systolic and diastolic arterial pressure, peak inspiratory pressure, end-tidal CO2 were increased sigmficantly in comparison to control values (P-value<0.01). Also, in arterial gas analysis, arterial blood carbon dioxide tension (PaCO2) was increased and pH was decreased significantly but arterial blood oxygen tension (PaCO2) was not changed significantly. After CO2 excretion, systolic and diastolic pressure, end-tidal CO2 were increased in comparison to control values (P<0.01) and pH was decreased significantly. But peak inspiratory pressure and PaCO2 were not statistically significant. In conclusion, minute ventilation should be corrected during general anesthesia for laparoscopy with CO2 insufflation according to continuous monitoring of end-tidal CO2 and arterial carbon dioxide tension.

Anesthetic Management for Surgery of the Descending Aortic Aneurysm / 대한마취과학회지

The rupture of the aorta commonly follows major blunt truma to the thorax. It was markdly increased in recent years, paralleling the rising number of vehicular accidents, The patient underwent surgical repair with femoro-femoral partial bypass 40 days after injury. The anesthesia for descending aortic surgery presented problems involving large hemodynamic alterations during thoracic aortic cross-clamping, protection of the heart and brain from large increases in pressure occuring above the cross clamp, and prevention of spinal cord and renal ischemic damage below the cross-clamp. One lung ventilation was also employed with this anesthetic technique. A 23 years old male patient with traumatic aneurysm of descending thoracic aorta was treated successfully.

Anesthetic Management of Renal transplantation / 대한마취과학회지

Pulmonary edema is a recognized comphcation of acute airway obstruction. When pulmonary edema occurs, it usually follows relief of obstruction and is likely to be of noncardiogenic origin. We present a case of noncanhogenic pulmonary edema that occured in a ncy woman who was transfered to our hospital, because of endotracheal intubation failure and unrelieved bronchospasm, during general anesthesia for Cesarian section.

Hydrothorox Following Internal Jugular Vein Catheterization - A case report / 대한마취과학회지

Cannulation of the internaliugular vein was first described by English et al in l969; since then, it has steadily increased in popularity to its present position as one of the methods of choise for CVP monitorimg. But this method of CVP monitoring has some potential compolication such as infection, thrombophlebitis, pneumothorax, hydrothorax, hematoma, air embolism, catheter shearing, nerve injuries & pericardial tamponade, etc. We experienced a case of hydrothorax following internal jugular vein catheterization.

Acute Pulmonary Edema During a Cesarian Section - A case report / 대한마취과학회지

Pulmonary edema may be defined broadly as excessive fluid accumulation in the interstitial and air spaces of the lung. We recently a previously healthy parturient with ritodrine treatment who suddenly developed severe pulmonary edema during a Cesarian Section under Genera) Anesthesia, For this presented cases, we believe that overloading, Ritodrine, oxytocin, ergot derivatives wi11 be the causative factors. We had good result with PEEP, diuretics, and morphines.

Hydrothorox Following Internal Jugular Vein Catheterization - A case report / 대한마취과학회지

Cannulation of the internaliugular vein was first described by English et al in l969; since then, it has steadily increased in popularity to its present position as one of the methods of choise for CVP monitorimg. But this method of CVP monitoring has some potential compolication such as infection, thrombophlebitis, pneumothorax, hydrothorax, hematoma, air embolism, catheter shearing, nerve injuries & pericardial tamponade, etc. We experienced a case of hydrothorax following internal jugular vein catheterization.

Acute Pulmonary Edema During a Cesarian Section - A case report / 대한마취과학회지

Pulmonary edema may be defined broadly as excessive fluid accumulation in the interstitial and air spaces of the lung. We recently a previously healthy parturient with ritodrine treatment who suddenly developed severe pulmonary edema during a Cesarian Section under Genera) Anesthesia, For this presented cases, we believe that overloading, Ritodrine, oxytocin, ergot derivatives wi11 be the causative factors. We had good result with PEEP, diuretics, and morphines.

Anesthetic Management for Thymectomy in the Patients with Myasthenia Gravis-Eight cases report / 대한마취과학회지

Myasthenia Gravis is a chronic disorder of neuromuscular transmission characterized by weakness, fatigue of voluntary muscles, especially exacerbations and remissions, a rare disease in Korea. Special considerations are required in the anesthetic management of the myasthenic patients undergoing surgery under general anesthesia and in the postoperative respiratory management by anesthesi olgists. Authors report 8 cases of anesthesia, using N20-02-Enflurane without using nondepolarizing and depolarizing muscle relaxants for thymectomy, experienced during the year 1986~1990.

Clinical Analyis of Anesthesia for Emergency Operations / 대한마취과학회지

We Performed 1,662 anesthesia for emergency surgery at Maryknoll Hospital from January 1985 to December 1989, these surgeries were analyzed clinically and statistically according to age, sex, preoperative status, insurance and noninsurance, frequency of emergency operation, presence of full stomach, department, operation site, anesthetic techniques and agents, time & duration of anesthesia, amount of transfusion. The results were as follows: 1) More than half of the total cases were patients in the third and fourth decade of age. 2) The ratio of male to female numbered 0.83: 1. 3) According to the A.S.A.classification of physical status, patients in emergency class 1 were 38.5%. 4) The ratio of insurance patients (1,113 cases, 67%) versus noninsurance parients (549 cases, 33%) was approximately 2:1. 5) Emergency surgery was 6.1% of total surgical cases. 6) 6.7% patients of emergency surgery had full stomach. 7) The most frequent emergency operations were done by general surgery (43.5%), and obstetrics & gynecology (28.6%). 8) Most common diseases in order, were appendicitis (457 cases), Cesarean section (335 cases), intracranial hematoma (202 cases), repair of tendon, nerve, vessels (71 cases). 9) The most common anesthetic technique for emergency surgery was general anesthesia (94.6%) followed by spinal anesthesia (3.5%). 10) 47.5 percent of emergency operations were performed during the 6 hours from midday to 6 p. m. 11) The duration of anesthesia was up to 2 hours in 1165 cases (70.1%). 12) The cases requiring transfusion during operation were 21.4% (355 cases) of the total cases (1, 662 cases).

Anesthesia for Thymectomy in Patient with Myasthenia Gravis - Two cases report / 대한마취과학회지

Myasthenia Gravis is a neuromuscular disorder manifested by increasing weakness and fatigability of voluntary muscles with exercise, and partial or complete restoration of function following rest or the administration of anticholinesterase drugs. The anesthesiologists may be called upon to assist in the diagnosis of myasthenis, in treating the patient by artificial ventilation during acute exacerbations, to anesthetise the patient for thymectomy or other surgery. Therefore, the anesthesiologists must be familiar with the diagnosis and treatment of myasthnia gravis to carry on the appropriate therapy. Two cases of anesthesia for thymectomy in myasthenia gravis without using muscle relaxants was experienced, and no respiratory problems were encountered postoperatively.

The Oculocardiac Reflex during Strabismus Surgery in Children / 대한마취과학회지

The oculocardiac reflex is developed by surgical or nonsurgical procedures to the eyeball, induding traction on extraocular muscles, This reflex is a decrease in heart rate, although other arrhythmias, including A-V junctional rhythm, A-V block, ventricular premature beat, and cardiac arrest, have been reported. This is the report of our experience of oculocardiac reflex during strabismus surgery in children at Department of Anesthesiology, Maryknoll Hospital during the period between February, 1986 and January, 1987. The results are as follows : 1) In group l (0.02 mg/kg, atropine sulfate premedication), oculocardiac reflex was developed 15 cases of 42 cases (35.7%), and in group ll (0.01 mg/kg, glycopyuolate premedication), oculecardiac reflex was developed 17 cases of 49 cases (34.7%). Comparing group l with group ll, there were similar effect to prevention of the oculocardiac reflex (p> 0.05). 2) In each group, developing of the oculocardiac reflex following traction of medial and lateral rectus muscles were 30.0% and 26.3% in group l, and 28.2% and 28.2% in group ll respectively. This was not significant statistically. 3) The oculocardiac reflex following traction of extraocular muscles was disappeared soon after stopping surgioal manipulation. And, intravenous administration of anticholinergic or retrobulbar block were not used for prevention of the reflex.

The Oculocardiac Reflex during Strabismus Surgery in Children / 대한마취과학회지

The oculocardiac reflex is developed by surgical or nonsurgical procedures to the eyeball, induding traction on extraocular muscles, This reflex is a decrease in heart rate, although other arrhythmias, including A-V junctional rhythm, A-V block, ventricular premature beat, and cardiac arrest, have been reported. This is the report of our experience of oculocardiac reflex during strabismus surgery in children at Department of Anesthesiology, Maryknoll Hospital during the period between February, 1986 and January, 1987. The results are as follows : 1) In group l (0.02 mg/kg, atropine sulfate premedication), oculocardiac reflex was developed 15 cases of 42 cases (35.7%), and in group ll (0.01 mg/kg, glycopyuolate premedication), oculecardiac reflex was developed 17 cases of 49 cases (34.7%). Comparing group l with group ll, there were similar effect to prevention of the oculocardiac reflex (p> 0.05). 2) In each group, developing of the oculocardiac reflex following traction of medial and lateral rectus muscles were 30.0% and 26.3% in group l, and 28.2% and 28.2% in group ll respectively. This was not significant statistically. 3) The oculocardiac reflex following traction of extraocular muscles was disappeared soon after stopping surgioal manipulation. And, intravenous administration of anticholinergic or retrobulbar block were not used for prevention of the reflex.