Use of Femorofemoral Bypass for Life Saving before the Emergency Replacement of Thrombotic Prosthetic Mitral Valve / 대한구급학회지

Mechanical valves have generally good hemodynamic function and indefinite durability, but they have a higher thromboembolic potential and thus a requirement for permanent anticoagulation, because thrombotic occlusion is a potentially fatal complication of heart valve replacement surgery. We had experienced mitral valve replacement because of thrombosis around the replaced prosthetic valve. The patient's mechanical prosthetic valve was acutely obstructed by thrombosis, and it was a life threatening condition. We performed partial bypass through femorofemoral bypass for life saving. Femorofemoral bypass improved oxygenation and cardiovascular stability, and mitral valve replacement was successfully performed without complication.

Transient Swelling of both Parotid Glands Following General Anesthesia / 대한마취과학회지

Parotid gland swelling in association with general anesthesia is an unusual complication. Benign postoperative parotid swelling should be recognized as a noninfectious, self-limiting process occurring immediately after surgery. This enlargement is non-tender, rubbery in consistency, without crepitus, and may be accompanied by variable salivation. The mechanism of the occurrence remains unknown, but two factors most frequently associated with this phenomenon appear to be physical stimulation or manipulation of the airway or coughing and/or straining. We report bilateral parotid gland swelling in a middle-aged man after surgery under general anesthesia.

Anesthetic Management of Cerebral Subarachnoid Hemorrhage with Intraoperative Electrocardiographic Change Simulating Acute Myocardial Infarction: A case report / 대한마취과학회지

It is now well established that acute subarachnoid hemorrhage secondary to rupture of a cerebral aneurysm can precipitate life-threatening cardiac arrhythmia. We experienced a 60 year old patient with a subarachnoid hemorrhage (neurologic grade III) due to rupture of anterior communicating artery aneurysm who presented with such intraoperative electrocardiographic changes as ST segment elevation and T wave inversion which are hallmark of acute myocardial infarction. The operation was uneventfully ended. On the postoperative laboratory examination about suspected acute myocardial infarction, the patient was found to have normal triple enzyme study and echocardiographic finding. The electrocardiogram three days after subarachnoid hemorrhage due to cerebral aneurysm returned to normal sinus rhythm. This case suggests that this patient's electrocardiographic change simulating acute myocardial infarction is transient change due to subarachnoid hemorrhage.

Induction with Intravenous 0.3 mg/kg Etomidate Maintains Venous Capacitance of Normovolemic Rat / 대한마취과학회지

BACKGROUND: Etomidate is short-acting non-barbiturate intravenous anesthetic with minimal cardiovascular depression. As a small change in venous capacitance significantly alters venous return and thus cardiac output, it is important to know the effects of intravenous anesthetics on venous capacitance. The purpose of this study was to examine the effect of etomidate or pentobarbital (control agent) on venous capacitance. METHOD: All twenty rats (etomidate group: 10, pentobarbital group: 10), weighing 350-450 gram, were anesthetized with pentobarbital 50 mg/kg given intraperitoneally for surgical preparation. Mean arterial pressure (MAP), heart rate (HR), and mean circulatory filling pressure (MCFP) were measured in the awake state(recovered from pentobarbital anesthesia for surgical preparation) as well as during anesthesia with etomidate or pentobarbital. Venous capacitance was assessed before and during anesthesia with etomidate or pentobarbital by measuring MCFP. MCFP was measured during a brief period of circulatory arrest produced by inflating a balloon inserted in right atrium. RESULTS: As compared with MCFP in the corresponding awake state, MCFP was not significantly altered by etomidate but significantly decreased by pentobarbital. As compared with MAP in the corresponding awake state, MAP was not significantly altered by etomidate but significantly decreased by pentobarbital. CONCLUSION: The results suggest that unaltered venous capacitance by etomidate may contribute to a maintained MAP but increased venous capacitance by pentobarbital decrease in MAP of the normovolemic rat.

A Comparison with Infusion of Single Intravenous Anesthetic with Propofol and Fentanyl in Operation of Short Duration / 대한마취과학회지

BACKGROUND: Propofol, a new intravenous anesthetic agent, is now used for brief operation and day surgery for its rapid recovery and controllability. Propofol, rapid acting sedatives hypnotics, is known to no analgesic effect. This study was taken to evaluate the analgesic effect of propofol, compared to those of fentanyl. METHODS: Forty patients (ASA physical status 1, 2) scheduled for surgery of short duration (within 1 hour) were randomly allocated into two groups. Induction of anesthesia was performed by injection of thiopental (5 mg/kg) and succinylcholine (1 mg/kg) and ventilated with O2-N2O (50%) after endotracheal intubation. Maintenance of anesthesia was performed by vecuronium (1 mg/kg) and continuous infusion of propofol (group I) or fentanyl (group II). RESULTS: There was no significant differences in systolic and diastolic blood pressure in both groups. In heart rate, there was significant difference at preincision and postincision between two groups. Time to extubation (4.5 +/- 4.6 vs 6.3 +/- 4.6 min), time to eye open (7.5 +/- 7.1 vs 6.6 +/- 5.4 min), time to complain pain after stop dropping at recovery room (30.5 +/- 8.0 vs 35.5 +/- 17.9 min), the average flow rate of drugs (6.0 +/- 2.2 mg/kg/hr vs 6.7 +/- 2.4 microgram/kg/hr) has no significant difference between two groups. CONCLUSIONS: A single continuous infusion of propofol is applied as one of general anesthesia methods with O2-N2O, muscle relaxants. Propofol has a appropriate and similar analgesic effect compared with fentanyl in operation of little hemodynamic changes and short operation, and rapid recovery compared with fentanyl.

Conventional Intermittent "Top-up" Injections of 0.25% Bupivacaine/Fentanyl vs 0.125% Bupivacaine/Fentanyl during Labor / 대한마취과학회지

BACKGROUND: Conventional intermittent "Top-up" injections (CIT) of fentanyl added to bupivacaine reduces the total amount of local anesthetic required, resulting in less motor blockade, reducing incidence of instrumental deliveries, and improving the quality of analgesia during labor. The purpose of this study was to compare the analgesic efficacy of two different solutions and side effects of them. METHODS: Fifty healthy parturients were divided into two groups: intermittent epidural injections of 0.25% bupivacaine with 0.0005% fentanyl (Group I) and 0.125% bupivacaine with 0.0005% fentanyl (5 microgram/ml) (Group II). We injected 5 ml of each solution to block T10 sensory level of the request of the parturients. Assessments included interval of epidural injection, duration of first and second stage of labor, total dose of bupivacaine, maternal blood pressure, satisfaction, fetal heart rate, and Apgar scores. RESULTS: The interval of epidural injection was 75.7+/-50.6 min in Group I, compare with 57.8+/-27.5 min in Group II (p<0.05). The total dose of bupivacaine was 45.5+/-15.3 mg in Group I, compared with 23.5+/-10.4 mg in Group II (p<0.05). There was no significant difference between the two groups in terms of duration of labor, maternal blood pressure, maternal satisfaction, fetal heart abnormality, or Apgar scores of neonates. No serious side effects were encountered in either group, although two patients in Group I experienced urinary retention. Only one patient in each group experienced nausea and vomiting. CONCLUSIONS: The injection of 0.125% bupivacaine plus fentanyl provides good analgesia during labor. We concluded that lower concentration of bupivacaine was better in consideration of adverse effects of it on fetus and mother.

Anesthetic Management for Repair of Delayed Presentation of Congenital Diaphragmatic Hernia: A case report / 대한마취과학회지

Congenital diaphragmatic hernia (CDH) associated with pulmonary hypoplasia usually presents in early neonatal life. Despite recent advances in perioperative intensive care and neonatal pharmacology, there is still a 53-62% mortality rate. CDH presenting outside of the neonatal period is called CDH delayed presentation, and it is uncommon and the diagnosis is difficult due to misleading clinical signs and symptoms. The prognosis in delayed presentation is determined by complications as strangulation or incarceration of the herniated bowel or stomach, mediastinal shift. A 3 month-old male infant was visited to pediatric department because of irritability. Breath sound were decreased over the left hemithorax and blood gas examination showed hypoxemia. Plain chest X-rays demonstrated intestinal bowel gas shadow in the left hemithorax and had done revealed CDH. An immediate operation was performed. The post-operative course was uneventful and the postoperative chest X-ray returned to normal. She was discharged on the 8th post-opertive day.