Alternating asystole and atrial fibrillation after infusion of propofol and remifentanil with target-controlled infusion / 대한마취과학회지

No abstract available.

Alternating asystole and atrial fibrillation after infusion of propofol and remifentanil with target-controlled infusion / 대한마취과학회지

No abstract available.

Cardiac arrest with pulmonary edema in a non-parturient after ergonovine administration recovered with extracorporeal membrane oxygenation: A case report / 대한마취과학회지

Ergonovine have been used for the prevention and treatment of postpartum or postabortion hemorrhage. Although this modality has been considered relatively safe in the obstetric patients, there were a few cardiac events associated with this drug in the post-delivery or post-abortion patients, especially in patients with cardiovascular risk factors. We experienced cardiac arrest in a non-parturient with no discernible risk factors. Although resuscitated, she also suffered from pulmonary edema with unstable hemodynamics and low oxygenation. To manage the patient, extracorporeal membrane oxygenation was used and she recovered successfully without cardiopulmonary complications. Therefore, we recommend that when ergonovine is chosen as a modality, special caution should be paid to the pulmonary events, as well as cardiac, especially when administered by intravenously even in patients with no cardiovascular risk factors. If cardiac events occur, extracorporeal membrane oxygenation or other measures, such as intra-aortic balloon pump can be helpful when conventional cardiopulmonary resuscitation is not effective.

Neurogenic pulmonary edema following intracranial coil embolization for subarachnoid hemorrhage: A case report / 대한마취과학회지

Neurogenic pulmonary edema (NPE) is a well-known complication of acute central neurologic injury, particularly aneurysmal subarachnoid hemorrhage. Both increased intracranial pressure and severe over-activation of the sympathetic nervous system seem to be pathogenetic for the onset of NPE. Although intracranial endovascular therapy is minimally invasive, it may affect brain stem regions and result in sympathetic activation. We now report the case of a 70-year-old woman who suddenly developed pulmonary edema during coil embolization of a ruptured aneurysm. During the intervention, oxygen saturation declined suddenly and a chest radiograph revealed pulmonary edema. The delayed appearance of NPE in this patient implies a risk for sympathetically mediated NPE during endovascular therapy.

Resolution of atrial fibrillation with induction of general anesthesia: A case report

Atrial fibrillation is one of the most common arrhythmias in everyday life, and it is responsible for substantial mortality and morbidity in the general population.When atrial fibrillation is first noticed and it persists for a long time, it will be more difficulty to control and it will recur more often.A 58-year old female patient was scheduled for surgery due to the increased size of an intracranial arteriovenous malformation.During the preparation of anesthesia, we noticed the presence of atrial fibrillation.After about 2 hours of sedation and consultation, we decide to proceed with the surgery. With the induction of anesthesia by using thiopental sodium, we observed the rapid conversion of atrial fibrillation to sinus tachycardia.During the maintenance of anesthesia, the patient showed normal sinus rhythm and the surgery was completed without complications.

Management of diabetes insipidus during anesthesia for brain germinoma resection in a child : A case report

Diabetes insipidus caused by impaired production or reduced responses to vasopressin, can occasionally be seen postoperatively in neurosurgical patients, but rarely occurs during anesthesia and surgery. An 8-year old female patient with suprasellar germinoma was scheduled for tumor resection. Anesthesia was induced smoothly and maintained mainly with sevoflurane. Several hours after anesthesia and surgery, urine output was increased with increased serum sodium concentration, indicating the occurrence of diabetes insipidus. To prevent sodium increase and replace fluid loss, 2.5% dextrose half saline was used. Though sodium concentration did not increase further, the concomitant increase of glucose complicated anesthetic management. After the completion of anesthesia and surgery, serum sodium increased further but then gradually returned to normal with conservative management. The patient was discharged without any complications.

Pulmonary Edema after Catastrophic Carbon Dioxide Embolism during Laparoscopic Ovarian Cystectomy

Laparoscopy is a surgical procedure used both for diagnosis and for various treatments. A rare but sometimes fatal complication of laparoscopy is pulmonary embolism with CO2 resulting in pulmonary edema. During laparoscopic gynecological surgery in a 29-year-old woman who had previously undergone lower abdominal surgery, the end-tidal CO2 suddenly increased from 40mmHg to 85mmHg and then decreased to 13mmHg with hemodynamic deterioration. These events are characteristic of a CO2 embolism. When this occurred, CO2 insufflation was immediately stopped and the patient was resuscitated. The patient's condition gradually improved with aggressive treatment, but the clinical course was complicated by bilateral pulmonary edema. This case of pulmonary edema was soon resolved with supportive management. The formation of a CO2 embolism during laparoscopy must be suspected whenever there is a sudden change in the end-tidal CO2. In addition, the possibility of pulmonary edema should be considered when a CO2 embolism occurs.

Comparison of various tests designed to assess the recovery of cognitive and psychomotor function after ambulatory anesthesia / 대한마취과학회지

BACKGROUND: Few studies have been conducted to evaluate the reliability of the various tools used to assess cognitive and psychomotor recovery after ambulatory anesthesia. Therefore, this study was conducted to compare the sensitivity and reliability of simple, standard tests used to measure postoperative cognitive and psychomotor functions. METHODS: Twenty-seven patients admitted for same day surgery were included in this prospective, randomized study. While in the preanesthetic unit, each patient was asked to perform three different standard psychometric tests, the digit symbol substitution test (DSST), digit span test (DST), and perceptual speed test (PST), to evaluate cognitive and psychomotor functions. The results were then used as baseline values that were subsequently compared to results obtained when patients repeated the tests at 15, 30 and 60 min after extubation. In addition, the observer's assessment of alertness and sedation was evaluated. RESULTS: The DSST scores were significantly lower than the baseline scores at 15 and 30 min after extubation, with a performance ratio of 64.9 and 89.2, respectively (P < 0.05). The DST scores had returned to preanesthetic levels at 30 min post-anesthesia and the PST scores were found to be significantly higher than the baseline scores at 30 and 60 min post-anesthesia. CONCLUSIONS: DSST is a more sensitive indicator of residual drug effect following anesthesia than the other tests evaluated in this study. In addition, a learning effect was obvious when the PST was administered.

Effect of Nalbuphine on Emergence Agitation and Recovery after Desflurane Anesthesia in Children for Strabismus Surgery / 대한마취과학회지

BACKGROUND: Emergence agitation frequently occurs after desflurane anesthesia in children.Nalbuphine, because of its sedative and analgesic properties, might be useful for the management of this side effect.We studied the effect of nalbuphine on recovery characteristics and emergence agitation after desflurane anesthesia in children for strabismus surgery. METHODS: 41 patients (3-14 yr) scheduled for pediatric strabismus surgery were included.All children received ketamine 0.5 mg/kg intravenously before entering the operating room.After intravenous induction with thiopental and rocuronium to facilitate endotracheal intubation, patients were randomly assigned to receive saline, or nalbuphine 0.2 mg/kg respectively. Anesthesia was maintained with desflurane 4-6% with N2O : O2 = 2 : 1.At the end of anesthesia, time to cough, extubation, movement, eye opening and discharge were recorded.Emergence agitation was recorded by three point rating scale. RESULTS: Agitation scores were significantly different between the two groups (P < 0.01).Time to extubation and movement were similar between two groups.Time to eye opening was significantly increased in nalbuphine group (P < 0.05).But, there was no difference in time to discharge from the recovery room to the ward between the two groups. CONCLUSIONS: In children undergoing strabismus surgery with desflurane anesthesia, nalbuphine 0.2 mg/kg administered immediately after induction reduced incidence of emergence agitation without delaying discharge from recovery room.

The Effect of Combined Fentanyl and Ketamine Administration in the Monitored Anesthetic Care of Ambulatory Strabismus Surgery / 대한마취과학회지

BACKGROUND: Monitored anesthetic care can provide patient safety and optimal surgical conditions. However, propofol and fentanyl decrease the hypoxic ventilatory response and heart rate. Ketamine has less respiratory depression and blocks bradycardia. Furthermore, ketamine can reduce the amount of opioid use but it delays discharge in the outpatient anesthesia. Therefore, this study retrospectively examined the effects of combined fentanyl and ketamine administered during monitored anesthetic care on the use of opioids, cardiorespiratory side effects, and patient discharge. METHODS: The anesthetic room, the recovery room and day surgery center records of ambulatory strabismus surgery with monitored anesthetic care was reviewed by anesthesiologists from Oct. 2004 to July 2005. The patients were classified as those receiving either fentanyl (F group: n = 32) or fentanyl and ketamine (FK group: n = 19) with a propofol infusion. The fentanyl dose used, the need for airway support, anticholinergics and naloxone were compared. The stay in the recovery room and the day surgery center was also examined. RESULTS: The FK group used significantly less fentanyl than the F group (P < 0.05). Although airway support was needed, there was less anticholinergics and naloxone used in the FK group, but this difference was not significant. The stay in recovery room and the day surgery center were similar. CONCLUSIONS: Co-administered ketamine reduces the amount of fentanyl-needed, but it does not reduce the need for airway support and anticholinergics. In addition, co-administered ketamine does not affect the number of days in the recovery room and day surgery center.

The Evaluation of Plasma Substitutes Effect Using Thromboelastogram in Radical Hysterectomy / 대한마취과학회지

BACKGROUND: Various plasma substitutes are used for the correction of hypovolemia caused by blood loss. It is known that plasma substitutes themselves have some adverse effects on blood coagulation. We performed this study to show the actual effect of plasma substitutes on blood coagulation in clinical hypovolemic situation caused by blood loss. METHODS: 60 patients scheduled for radical hysterectomy were grouped by the plasma substitutes infused; group C, S, V and P correspondingly infused with Hartman's solution, Salinhes(R), Voluven(R) and Pentaspan(R). Thromboelastograms (TEG) at 15 minutes after induction of anesthesia (T(0)), after 15% blood loss of the estimated blood volume (T(1)) and just after infusion of the plasma substitutes (T(2)) were compared among the groups and changes with the time course within each group were investigated. RESULTS: Compared to group C, MA, A60, coagulation index, CL60 (parameters of TEG) were decreased and LY60 increased in group S and P while group V presented no significant changes. Hypercoagulability and reduced fibrinolysis were observed for T(1); for T(2), group C showed decrease in k-time, LY60 and increase in alpha angle, CL60. Group S presented decrease in MA, A60 compared to T0 and decrease in CL60 and increase in LY60. CONCLUSIONS: Surgery and blood loss accelerated coagulation and reduced fibrinolysis. These were aggravated after crystalloid infusion. In contrast, coagulability was reduced and fibrinolysis augmented after infusion of HES except HES 130/0.4/6.

Anaphylactic Reaction after Thiopental Sodium Injection -A case report- / 대한마취과학회지

A 43-year-old female was admitted for a laparoscopic surgical procedure. Her past history included two uneventful general anesthesias, but anaphylactic shock due to an unknown drug occurred during her third surgery. Induction was performed with thiopental sodium, but an immediate anaphylactic reaction developed with cardiovascular collapse. We resuscitated the patient and she recovered without any complication.

Clinical Analysis of Outpatient Anesthesia in Children with Middle Ear Ventilation Tube Insertion / 대한마취과학회지

BACKGROUND: Pediatric outpatient anesthesia is beneficial because it is more comfortable to children and more convenient for families, but delayed discharge causes distress for parents and children and increases health care personnel workload. Therefore, we examined past medical records to evaluate factors affecting discharge time in pediatric outpatient anesthesia. METHODS: We reviewed the anesthetic and post-anesthetic care records of 119 children who required ventilation tube insertion for ambulatory surgery, and who were anesthetized and monitored by an anesthesiologist between June 2001 and February 2004. Data were classified according to the anesthetic technique and agents used, duration of operation and anesthesia, and complications in the recovery room. We then examined the relationships between these factors and discharge time. RESULTS: Compared to intravenous anesthesia, endotracheal anesthesia increased anesthesia time (P <0.05), but not discharge time. Ketamine dosage was found to be closely correlated with discharge time (P <0.01), and complications in the recovery room delayed discharge time (P <0.05). CONCLUSION: We conclude that excessive ketamine use and postoperative complications delay discharge in pediatric outpatient anesthesia. More attention should be paid to minimize ketamine use and reduce postoperative complications so as not to delay discharge in pediatric outpatient anesthesia.

Anesthetic Experience in a Patient with Positive Intradermal Skin Test to Muscle Relaxants: A case report / 대한마취과학회지

Muscle relaxants are the most common cause of anaphylaxis during anesthesia. An intradermal skin test is commonly used to investigate the cause of anaphylaxis. A 46-year-old man was scheduled for percutaneous nephrolithotripsy. He had a history of a positive intradermal skin test to muscle relaxants for general anesthesia. After injection of thiopental sodium, anesthesia was induced, which gradually deepened with increments of sevoflurane in 100% oxygen. Tracheal intubation was performed smoothly, without adjunct muscle relaxant. After stabilization, a small dose of vecuronium was administered, but the blood pressure transiently decreased, and the oxygen saturation was decreased from 98 to 92% for 30 minutes. No muscle relaxant was used thereafter, and the anesthesia was maintained with sevoflurane, nitrous oxide and oxygen with intermittent propofol administration. Surgery was completed uneventfully, and the patient recovered without any adverse reaction. To prevent anaphylaxis, the use of a suspicious causative agent should be avoided.

Subcutaneous Emphysema and Pneumothorax Occurred during Patient Transfer to Intensive Care Unit: A Case Report / 대한구급학회지

A 48 years old female patient was scheduled for emergency surgery due to bleeding after intracerebral aneurysmal clipping under general anesthesia. Previously checked chest X-ray taken just a few hours before surgery showed no abnormal finding and she didn't show any sign of pneumothorax or hemothorax including dyspnea, tachypnea or cyanosis. Surgery was uneventful. After the completion of surgery, patient was transferred to the neurosurgical intensive care unit with intubation. During transfer, patient showed bucking and signs of subcutaneous emphysema around chest, shoulder and face. Oxygen saturation was low when she admitted to the neurosurgical intensive care unit, so the ventilator care was started. The patient's oxygenation were getting worse progressively, so we checked chest AP several times and one of the chest X-ray taken at that time revealed no vascular and lung marking on the left lung field suggesting pneumothorax. Emergency chest tube drainage was performed. She recovered dramatically and three days later, ches X-ray showed the complete resorption of the pneumothorax.

The Effect of Enflurane on the Tracheal Smooth Muscle Contracted with Electrical Field Stimulation in the Guinea Pig / 대한마취과학회지

BACKGORUND: inhalation anesthetics have been known as bronchodilators, and there are reports that enflurane has some relaxing effects on tracheal smooth muscles. However, there are not so many reports on the ACh release in the postganglion nerve endings. We tried to evaluate the effect of enflurane on the contraction of the tracheal smooth muscle in the postganglion nerve ending in guinea pigs. METHODS:isolated tracheal preparations of guinea pigs were used and contractions were induced by electrical field stimulation (3 Hz & 30 Hz). in the pilocarpine- enflurane group, pilocarpine (10(-5) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the gallamine-enflurane group, gallamine (10(-6) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the enflurane 1 MAC group and 2 MAC group, contractions were induced by electrical field stimulation before and after administration of enflurane. The percentile contraction to the contraction induced by acetylcholine (10(-4) M) were evaluated. RESULTS: The potentiation of the contraction which was induced by electrical field stimulation was observed by enflurane administration and with prior administration of pilocarpine (10(-6) M), with prior administration of gallamine (10(-5) M). There was no potentiation of contractions, but potentiation of the contraction was observed with enflurazne (2 MAC, 30 Hz). CONCLUSiONS:Enflurane potentiates the contraction induced by electrical field stimulation in guinea pig tracheal smooth muscle. These findings seem to be related with prejunctional M2 receptor in the postganglionic nerve endings.