Hydromediastinum following Internal Jugular Vein Catheterization : A case report / 대한마취과학회지

We report a patient who developed a hydromediastinum associated with the insertion of a central venous catheter. A 32-year-old male, who presented for left nephroureterectomy, had a central venous catheter inserted after general anesthesia. The patient subsequently showed acute respiratory distress after extubation. His right neck was severely edematous and the chest radiograph revealed a widened mediastinal shadow. The exploratory neck incision showed fluid collection at the neck and mediastinum.

Central Venous Pressure and Its Effect on Blood Loss during Hepatic Lobectomy / 대한마취과학회지

BACKGROUND: Some studies reported that lowering central venous pressure (LCVP) during liver resection could significantly reduce the intra-operative blood loss, however it is still controversial concerning LCVP induced renal dysfunction, hypovolemia, hemodynamic instability. This study evaluated the association of low central venous pressure with blood loss during liver resection comparing the control group. METHODS: A total 62 patients aged 20 to 70 underwent hepatectomy by the same group of surgeon were randomized into group L (CVP 10 mmHg, n = 32) during dissection and lobectomy period. Data such as age, sex, concurrent disease, liver resection site (right or left), pre-, intra- and postoperative day 3 hemoglobin, blood urea nitrogen, creatinine, bleeding time, prothrombin time, activated partitial thromboplastin time, intraoperative blood loss, urine output, transfusion volume, length of hospital stay were collected and compared between the two groups and t-test was used for comparison of results. RESULTS: The difference of total blood loss between two groups was 193.6 +/- 432.2 ml (group L; 589.1 +/- 380.8 ml, group C; 782.7 +/- 316.7 ml), however statistically insignificant (P value = 0.1243). Additionally, there were no significant differences in other data including the length of hospital stay. CONCLUSIONS: Our results suggest maintaining CVP under 10 mmHg is not effective in reducing blood loss during liver resection.

Anesthesia for Living Related Liver Transplantation in Argininosuccinic Acidemia: A case report / 대한마취과학회지

We describe our initial experience of the perioperative anesthetic care provided to 8 years old female child with argininosuccinic acidemia undergoing living-related liver transplantation because it is the only available therapy for end-stage liver disease. Induction and maintenance of anesthesia has been conventional method. Arterial catheterized at radial and femoral arteries for continuous blood pressure monitoring and sampling. 18 G central vein catheterization was placed in left subclavian vein for fluid, drug infusion and CVP monitoring. EKG, pulse oxymetry, end-tidal CO2, urine output and body temperature were monitored. CBC, PT, aPTT, serum electrolyte were checked at preanhepatic, anhepatic phase and just after hepatic artery anastomosis. ABGA was checked every 1 hour. The level of serum ammmonia returned to normal range without protein restriction. We describe this case and a brief review of the literature.

Comparison of Hemodynamic Data obtained from a Pulmonary Artery Catheter vs. Esophageal Doppler during Liver Transplantation / 대한마취과학회지

BACKGROUND: The measurement of cardiac output is an essential part of anesthetic practice in patients undergoing liver transplantation. A thermodilution technique, using a pulmonary artery catheter is currently accepted as the gold standard in clinical practise. However, its use is associated with several limitations. METHODS: An esophageal doppler monitor was compared with the thermodilution technique in 22 patients undergoing split graft transplantation from a living donor. Six measurement were taken during liver transplantation, 1) control, 2) dissection phase, 3) anhepatic phase, 4) reperfusion phase, 5) after hepatic artery anastomosis, and 6) end of surgery. RESULTS: Significant difference were observed between the two measurement at all times studied with a strong correlation, except at the end of surgery (r > 0.4). CONCLUSIONS: The use of esophageal doppler monitor results in cardiac output measurements which are considerably different from those obtained using thermodilution, but a strong correlation exists between two methods. Thus the use of esohageal monitoring can be recommended in patients undergoing liver transplantation for trend monitoring.

The Effect of Discharge Decision-Making of the Intensivist on Readmission to the Intensive Care Unit / 대한구급학회지

BACKGROUND: Patients readmitted to intensive care unit (ICU) have significantly higher mortality. The role of intensivists to judge when to discharge from ICU may be important. We performed this study to assess the effect of intensivist's discharge decision-making on readmission to ICU. METHODS: Data were collected prospectively from patients admitted to ICUs (group 1). Another data were collected retrospectively from the patients' record (group 2). Discharge of the patients in group 1 were based on intensivist's discharge decision-making but not in group 2. We encouraged deep breathing and expectoration to patients of group 1 at risk of pulmonary complication during ICU stay and used a guideline for making discharge decisions. Readmission cause, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple organ dysfunction syndrome (MODS) score of readmitted patients were evaluated. RESULTS: Readmission rate of group 1 was lower than that of group 2 (p<0.05). The mortality of readmitted patients in each group was higher than that of non-readmitted patients (p<0.05). Respiratory disease was the major cause of readmission. In non-survivors of readmitted patients, APACHE III score on initial discharge and readmission, MODS score on initial admission, discharge and readmission were higher than those of survivors (p<0.05). CONCLUSIONS: Readmission rate was lower when intensivists participated in discharge decision- making. ICU readmission was associated with higher hospital mortality and longer ICU stay. MODS and APACHE III score at first discharge and readmission were significant prognostic factors of the outcome in readmitted patients.