Fatal Renal Rupture as a Rare Complication of Percutaneous Nephrolithotomy / 대한마취과학회지

Percutaneous nephrolithotomy (PNL) is a safe and effective procedure commonly performed to remove renal stones. Although PNL is associated with low morbidity, unexpected complications may occur. We describe here a 44-year-old male patient with recurrent renal stones who experienced a renal rupture and massive bleeding following PNL. Left nephrectomy and intensive treatment did not improve the patient's condition, and he died 14 days later as a result of multi-organ failure.

Cerebral Ischemia Detected by the Bispectral Index during Cardiopulmonary Bypass: A case report / 대한마취과학회지

The bispectral index (BIS) has been developed as a measure for monitoring the hypnotic drug effect. EEG processing results in a BIS scale from 0 to 100, where 100 represents an awake and responsive patient, and the scale decreases when hypnotics are administered. Here we describe two patients in whom the BIS decreased to nearly 0 during cardiac surgery. Postoperatively both patients showed hypoxic brain injury. There are several possible causes for a decrease in the BIS during surgery, including deep anesthesia, hypothermia and cerebral ischemia. In the present cases, cerebral hypoperfusion was the likely cause. During cardiac surgery, hemodynamic changes such as acute hypotension and cardiac arrest can cause cerebral ischemia. Cerebral ischemia develops most commonly during cardiopulmonary bypass (CPB). Therefore, the BIS may be useful for detecting severe cerebral ischemia during CPB, although it has some limitations as a cerebral monitor.

Comparison of the Antiallodynic Effects of Intrathecal Lidocaine and MK-801 on Mechanical Allodynia in Two Neuropathic Pain Rat Models / 대한마취과학회지

BACKGROUND: Neuropathic pain can be induced by nerve injury or inflammation. An N-methyl-D-Aspartate (NMDA) antagonist (MK-801), and a sodium channel blocker (lidocaine) have been found to reduce mechanical allodynia. This study was conducted to determine whether intrathecal lidocaine or MK-801 had an antiallodynic effect on established mechanical allodynia in two well-characterized neuropathic pain rat models. METHODS: Male Sprague Dawley rats (n = 107) were anesthetized, and the left L5 and L6 spinal nerves were ligated (SNL group) or Freund complete adjuvant (FCA) was administrated to the same spinal nerves (FCA group) in order to cause neuropathic pain. A catheter was then implanted into the lumbar intrathecal space. After obtaining the baseline scores, time-effect curves of each drug were established for the antiallodynic effects of lidocaine (30g, 100g and 300g) and MK-801 (1g, 3g, 10g and 30g). The allodynic thresholds for the left hind paw withdrawal to von Frey hairs were assessed and converted to %MPE, and the ED50 value was then calculated using the %MPE. The antiallodynic effects of the two groups were then compared by analyzing the dose-response curves and the ED50 values. RESULTS: Both intrathecal lidocaine and MK-801 resulted in a dose dependent antiallodynic effect. ED50 values and the analysis of dose response curves showed that intrathecal lidocaine provided more effective antiallodynia in the SNL group, whereas intrathecal MK-801 resulted in a greater antiallodynic effect in the FCA group. CONCLUSIONS: In the SNL group, lidocaine had a better effect in reducing allodynic pain, whereas in the FCA group, MK-801 showed a greater antiallodynic effect.

Assessment of Cardiovascular Autonomic Function in Patients with Liver Cirrhosis Using Heart Rate Variability, Blood Pressure Variability and Baroreflex Sensitivity / 대한마취과학회지

BACKGROUND: Liver cirrhosis is associated with several hemodynamic abnormalities, including an impairment of autonomic nervous system reflexes, but very few have compared the disease severity with cardiovascular autonomic dysfunction assessed by spectral analysis of blood pressure and electrocardiogram. The aim of this study was to investigate the relationship between Child-Turcotte-Pugh (CTP) score and autonomic indices in patients with liver cirrhosis using the heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS). METHODS: Fifty patients scheduled for liver transplantation recipients under general anesthesia were enrolled in the study. Beat-to-beat blood pressure and RR interval were measured for five minutes before anesthesia induction. HRV and BPV were estimated by power spectral analysis of RR interval and systolic blood pressure. BRS was estimated by both the sequence method (Sequence BRS) and high frequency (HF) gain of transfer function analysis (HF BRS). RESULTS: Significant inverse correlations between CTP score and Sequence BRS (r = -0.61), HF BRS (r = -0.59), low frequency (LF) and HF power of HRV (r = -0.57, r = -0.46), LF power of BPV (r = -0.37) were found. However, no significant correlations were observed between CTP score and LF/HF ratio of HRV (r = -0.02) and HF power of BPV (r = 0.27). CONCLUSIONS: These results showed that autonomic dysfunction assessed by spectral analysis was associated with increasing severity of liver cirrhosis. Further study will be needed to clarify relationship between our findings and hemodynamic fluctuations during anesthesia for liver transplantation.

Intrathecal Phenol Saddle Block in Bladder Cancer Patients: Two case reports / 대한마취과학회지

We encountered two bladder cancer patients who suffered from perineal pain that was intractable despite the use of adjuvant medication. A phenol intrathecal (saddle) block was performed without any specific complications. The results were excellent and allowed the systemic opiate dose to be reduced by more than 80%. We report our clinical experience, including a brief review of the relevant literature.

Assessment of the Mechanism of Arterial Blood Pressure Change during Sevoflurane Induction: Beat-to-Beat Analysis of Hemodynamic Variables Using a Modelflow Method / 대한마취과학회지

BACKGROUND: A modelflow method provides beat-to-beat analysis of cardiovascular variables based on arterial pulse pressure analysis. In this study, we assessed the mechanism of arterial blood pressure (ABP) change during sevoflurane induction by the analysis of beat-to-beat hemodynamic changes using a modelflow method. METHODS: Beat-to-beat ABP was measured during a stable conscious state (baseline) and vital capacity induction with sevoflurane 6 vol% and oxygen 8 L/min in 18 healthy living liver transplant donors. Alterations of beat-to-beat systolic ABP, mean ABP, diastolic ABP, heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) by sevoflurane induction were estimated noninvasively using a modelflow method simulating aortic input impedance from an ABP waveform. RESULTS: After sevoflurane induction, ABP, SV, CO, and TPR decreased significantly (all P < 0.05), but HR did not change significantly. After tracheal intubation, ABP, CO, and TPR did not change significantly compared with baseline, but HR increased and SV decreased significantly (both P < 0.05). CONCLUSIONS: Using a modelflow beat-to-beat analysis of cardiovascular variables, we found that ABP did not change significantly compared to baseline after tracheal intubation during sevoflurane induction, indicating the counteraction of increased HR and decreased SV, and that the reduction of SV by tracheal intubation suggests the suppression by increased HR and TPR compared with that after sevoflurane induction.

Change of Blood Pressure Variability before and during Sevoflurane Anesthesia / 대한마취과학회지

BACKGROUND: Relatively little is known about the effects of general anesthesia on blood pressure variability (BPV). This study was designed to evaluate the changes of high frequency (HF) and low frequency (LF) of BPV before and during general anesthesia with sevoflurane. METHODS: Beat-to-beat blood pressure was recorded at conscious baseline and during general anesthesia at 2% end-tidal sevoflurane in 17 healthy living-liver transplantation donors. BPV estimated by power spectra of systolic (SBP) and mean blood pressure (MBP) was calculated. RESULTS: Both LF power of SBP and MBP were diminished to 96.2% and 97.1% during sevoflurane anesthesia (5.5 +/- 2.8 to 0.2 +/- 0.2 mmHg2, 6.6 +/- 3.7 to 0.2 +/- 0.2 mmHg2, P < 0.001 for both). However, there were no significant changes of HF power of SBP and MBP during sevoflurane anesthesia. CONCLUSION: Sevoflurane anesthesia reduced noticeably LF power, which was associated with sympathetic vasomotor activity, but not HF power, which represents mostly the mechanical effect of respiration on blood pressure, of BPV.