A Case of Adult Respiratory Distress Syndrome after Massive Blood Transfusion / 대한마취과학회지

A large number of terms has been applied to this clinical and pathophysiologic complex, all of which are encompassed by the designation ARDS. The use of this term,however, should not obscure the fact that the initial insults and mechanisms of lung injury vary and that therapy should be directed not only toward the secondary alterations in pulmonary function but toward the initiating event or events as well. In therapy, the use of continuous positive-pressure ventilaion(CPPV) incorporating PEEP has a well-documented role in the management of patients with ARDS. The veneficial effect of this pattern of ventilation is mainly attributable to the increase in FRC that it produces. As previously discussed, several factors combine to reduce lung volumes in patients with ARDS. Positive end-expiratory pressure overcomes threade by producing a constantly positive distending pressure across the walls of airways and alveoli; this reestablishes their patency and increases FRC. We report a case of ARDS after operation for Vesico-cervical fistula developed in a 34 years old woman and the relevant literature has been reviewed.

The Clinical Investigation of Pediatric Caudal Anesthesia / 대한마취과학회지

Many studies have cited occurrences of severe and long-lasting emotional disturbances of almost every kind after surgical procedures, particularly due to the sedatives or narcotics which were administered to control the post-operative pain. In order to control this post-operative pain, pediatric caudal analgesia was performed in 15 infants and children from the age 2 months to 6 years, who were to undergo lower abdomen, perineum and lower extremity surgery. They were induced with inhalation anesthoeia, using nitrous oxide, oxygen and halothane by mask before and during the block. Following the block, infants and children were turned to supine position and the initial concentration of halothane was reduced. All cases were given 10mg/kg of 1% solution of lidocaine. On examination of the level of the analgesia, 13 out of 15 cases had spread higher level than T10, with effective block for surgical procedures. The identification of the sacral cornu is easy and technical failureis lees in comparison than with the lumbar epidural block for infants and children. Thus we can perform this block successfully for infants and children without any complications or accidents. It is especially helpful in the management of postoperative cases due to the effect in control of the postoperative pain. Thus it gives satisfaction to their parents, nurses and doctors. Despite no follow-up study on postoperative emotional reactions, it was considered that there were minimal occurrences of emotional and behavioral sequelae following the hospital and surgical experiences.