Rupture of the Hidden Intracranial Arteriovenous Malformation during General Anesthesia: A case report / 대한마취과학회지

Rupture of intracranial vessel during general anesthesia dramatically jeopardise patient's state and may lead to death. A sudden cardiovascular change during intubation and extubation in general anesthesia is dangerous, especially in patient with coronary and intracranial vascular disease. Myocardial infarction, congestive heart failure or intracranial hemorrhage can occur in such condition, but these occur rarely. We discovered the rupture of the hidden intracranial arteriovenous malformation in 13 years old female patient after tonsillectomy. We discuss about prognosis, prophylaxis and management of the intracranial arteriovenous malformation rupture during general anesthesia.

Cauda Equina Syndrome following Epidural Anesthesia / 대한마취과학회지

Neurologic complications associated with epidural anesthesia are rare. We describe a case of a cauda equina syndrome after continuous epidural anesthesia and analgesia for cesarean section. An epidural infusion of 0.15% bupivacaine was done at 2 mL/hr by two-day infusor. She developed lower extremities, buttocks and perineal sensory loss, bladder and bowel dysfunction after removal of epidural catheter. Improvement continued through the hospitalization with almost retum to normal bladder function before discharge about 1 month after the injury, but fecal incontinence and perineal sensory loss still remained. Although the mechanism causing such neural injuries are not fully known, it may be suspected that neurotoxicity is dose-dependent and related to the duration of drug exposure.

Cauda Equina Syndrome following Epidural Anesthesia / 대한마취과학회지

Neurologic complications associated with epidural anesthesia are rare. We describe a case of a cauda equina syndrome after continuous epidural anesthesia and analgesia for cesarean section. An epidural infusion of 0.15% bupivacaine was done at 2 mL/hr by two-day infusor. She developed lower extremities, buttocks and perineal sensory loss, bladder and bowel dysfunction after removal of epidural catheter. Improvement continued through the hospitalization with almost retum to normal bladder function before discharge about 1 month after the injury, but fecal incontinence and perineal sensory loss still remained. Although the mechanism causing such neural injuries are not fully known, it may be suspected that neurotoxicity is dose-dependent and related to the duration of drug exposure.

The Time of Neostigmine Antagonism for the Rapid Recovery of Profound Muscle Relaxation in Rabbits / 대한마취과학회지

BACKGROUND: A question was whether it was preferable to give the reversal agent when profound block was present or wait for some spontaneous recovery before antagonizing the block. This study has been conducted to evaluate the reversal effects of neostigmine with divided doses in the rabbits after pancuronium when profound relaxation(PTC=O) or the first twitch of TOF stimulation was appeared (TOF,T1) was confirmed. METHODS: Rabbits(n=60) were randomly allocated to 5 groups. After pancuronium 0.2 mg/kg intravenously, spontaneous recovery was evaluated in group 1. When the profound relaxation(PTC=O) was confirmed at 5 min. after pancuronium, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 2. At that time, neostigmine 10 ug/kg with atropine 4 ug/kg were injected and after 3 min. neostigmine 40 ug/kg with atropine 16 ug/kg were injected in group 3. When TOF, Tl was confirmed, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 4. At that time, neostigmine and atropine were injected in group 5 as the same way of group 3. RESULTS: The mean time from injection of pancuronium to 95% recovery was 98.9 min. in group 1, 60.3 min. in group 2, 50.9 min. in group 3, 71.0 min. in group 4 and 67.1 min. in group 5. The recovery index was significantly reduced when neostigmine was injected at TOF,T1(p<0.05). The recovery time after neostigmine with divided doses was reduced, but there was no significant difference. CONCLUSIONS: The results of present study suggested that total recovery time was reduced when neostigmine was injected earlier with divided doses than single dose unrelated to profound relaxation.

The Hemodynamic Changes during Continuous Hyperthermic Peritoneal Perfusion / 대한마취과학회지

Continuous hyperthermic peritoneal perfusion(CHPP) has been used for patients with advanced gastric cancer and peritoneal seeding. Changes in hemodynamic, arterial blood gas, acid-base balance, electrolytes and body temperature were evaluated in 10 patients with advanced gastric cancer during CHPP. 1) Cardiac index, heart rate and mean arterial pressure were significantly increased. Systemic vascular resistance index was significantly increased at 10 min. after start of CHPP and signihcantly decreased after 30 min. Central venous pressure was very increased during CHPP. 2) Arterial oxygen tension was gradually decreased and arterial carbon dioxide tension was not changed. Significant metabolic acidosis was developed during CHPP. 3) Sodium was significantly increased and ionized calcium was significantly decreased. Potassium was not changed. 4) Temperature of midesophagus was increased mean 3.8 degrees C at 50 min. after start of CHPP. In conclusions there were significant changes in hemodynamics, arterial blood gas, acid-base balance, electrolytes and body temperature during CHPP. We should need complete preparation, careful monitoring and attention during and after CHPP.

Uptake of Inhalation Anesthetics at the Different Inflow Rate in Semiclosed Circuit / 대한마취과학회지

Any factor which increases rebreathing (such as a decrease in inflow rate or an increase in ventilation) or increase uptake (such as an increase in solubility or in cardiac output) will lower the inspired anesthetic concentration. This in turn, will be reflected in an slower rate of anesthesia induction. In a circle absorption system, the inspired anesthetic concentration may be reduced from the inflowing concentration by rebreathing of anesthetic depleted gas. Semiclosed system, most widely used modern anesthetic system was tested to determine what effect the inflow rate had on the rate of rise of anesthetizing alveolar concentration of halothane and enflurane. The results were as follows: 1) High fresh gas inflow rate put the inspired anesthetic concentration close to that of inflow more rapidly. 2) In halothane anesthesia with 4 and 6 L/min of fresh gas flow, the anesthesia induction time was about 20 and 15 minutes respectively. But there was marked delay of the development of anesthesia by 2 L/min of fresh gas fiow. 3) In enflurane anesthesia, the anesthesia induction time was within about 10 minutes without respect to inflow rate. With these results, in general inhalation anesthesia with halothane or enflurane when a semiclosed technique and 100% oxygen are employed, a total gas flow at 4 to 6L per minute is recommended to establish a satisfactory induction and maintenance level of anesthesia.

Measarement of Drop Factor of IV Infusion Set with Infusion Pump / 대한마취과학회지

Accurate and reliable administration of intravenous infusion is necessary for a variety of different therapies including constant heparin, parenteral nutrition, cardiotonic and vasoactive mediciation and chemotherapy. For these purposes, drop counting is a common practice and a convenient way to measure the flow rate and the dose rate, but it is an unreliable and unexact method because the intravenous infusion sets from various manufacturers deliver different-sized drops depending on the rate of formation of the drops, properties of the particular fluid and physical characteristics of the intravenous infusion sets. This study evaluated the actual drop factor (DF) of a variety of intravenous infusion sets (10 IV Sets : 5 marked and 5 unmarked DF) at a low flow rate setting (20 ml/hr for pediatric and 40 ml/hr for adult) using a peristaltic fluid pump and distilled water, The measured Df is obtained by dividing the collected fluid volume per hour (ml/hr) by the number of drops per minute (drops/min) on the peristaltic fluid pump setting. The results ware as follows : 1) The actual DF values of the marked lV sets were 2 sets (DF= 1) 0.91 +/-0.04 and 0.97+/-0.03,2 sets (DF=3) 3.04+/-0.08 and 3.14+/-0.04 and 1 set (DF=4) 3.00+/-0.05. 2) The actual DF values of 5 lV sets with an unmarked DF ranged from 3.04+/-0.05 and 4.80+/-0.06. 3) The percent deviation of the actual DF values from the theoretical values of DF= 1,3,4 and the unmarked DF sets were -6.5+/-3.0, 3.0+/-1.6, -24.1 and 0.7+/-15.7 (-23.6~20.1)% respectively. 4) Among the physical factors influencing flow rate the size of the inlet orifice size of the intra-venous infusion s('t was a major one. 5) The majority of intravenous infusion sets from various manufacturers in the ROK are unmarked with respect to DF or drops perml.