Clinical Experience of Anesthesia for Open Heart Surgery - 100 cases / 대한마취과학회지

To evaluate the results of cardiac anesthesia during open heart surgery using cardiopulmonary bypass, the cases of 100 patients from December 1986 to May 1989 were reviewed. The results were as follows: 1) There were 56 patients with congenital heart disease (male 32, female 24) and 44 patients with acquired heart disease (male 14, female 30). 2) The mean age of patients with congenital heart disease was 17.0+/-10.0 years and the mean age of patients with acquired heart disease was 41.2+/-14.6 years. 3) There were 54 cases of acyanotic heart disease and 2 cases of cyanotic heart disease among congenital heart disease, and 41 cases of valvular heart disease. 4) Glycopyroolate and hydroxyzine were mostly used as premedicants and morphine was used in some cases of acquired heart disease. 5) Anesthesia was induced by morphine and diazepam mostly while ketamine was used in some congenital heart disease. 6) The periods of cardiopulmonary bypass and aortic cross clamp in acquired heart disease were twice as long as in congenital heart disease. 7) The lowest body temperature during cardiopulmonry bypass was 26.7+/-2.5 degrees C in congenital heart disease and 24.1+/-3.6 degrees C in acquired heart disease while mean arterial pressure was maintained between 50-80 mmHg. 8) There were 33 cases of complications in 19 patients in which wound infection and arrythmia were most predominant. Four fatalities resulted from 3 cases of low cardiac output syndrome and 1 case of cerebrovascular disease.

The Effets of Independent Lung Ventilation with Unilateral HFJV and CPAP / 대한마취과학회지

The effects of oxygenation of differential independent lung ventilation using HFJV (High Frequency Jet Ventilation) and CPAP (Continuous Positive Airway Pressure) on PaO2 and Qs/Qt were studied during one lung anesthesia in 11 mongrel dogs in left semilateral position with pentobarbital anesthesia. The dogs were divided into two groups. In group A(N = 7), following the conventional two lung ventilation, one lung ventilation, HFJV, one lung ventilation, cpap 5 cmH2O, and CPAP 10 cmH20 were applied sequentially. In group B(N =4), following the conventional two lung ventilation the above applications were reversed. In group A PaO2 revealed a similar increase among a two lung ventilation, CPAP 5 cmH2O, CPAP 10 cmH2O and HFJV. Intrapulmonary shunt showed the similar decrease among two lung ventilation, HFJV and CPAP 10cmH2O, but CPAP 5 cmH2O was higher than CPAP 10cmH2O. Although there were no statistically significant differences in PaO2 and shunt among each step in group B, HFJV showed a greate increase in PaO2, and shunt than one lung ventilation, CPAP 5 cmH 20) 20, and CPAP 10 cmH2O. In conclusion, HFJV proved to be more effective than CPAP 5 cmH2O in increasing PaO2 and decreasing shunt in differential independent lung ventilation. Both CPAP and JFJV should be applied in the deflation phase of the nondependent lung to cause an effective increase in PaO2. HFFV proved to be more effective than CPAP in recruiting the small airway closure.

The Effect of Lithotomy Position on Hyperbaric Tetracaine Spinal Anesthesia / 대한마취과학회지

The effect of hyperbaric tetracaine spinal anesthesia was studied in 40 patients having genitourinary surgery in the horizontal lithotomy position. Patients were randomly assigned to one of two groups, after spinal injection, patients in one group were placed immediately in the supine and horizontal lithotomy position, and patients in the second group were placed immediatley in the supine and horizontal position for 10 minutes and then placed into the horizontal 1thotomy position. There were no statistically significant differences in anesthesia sensory level and heart rate of patients placed immediately in the horizontal lithotomy position compared to the patients kept in the supine position for the first 10 minutes after receiving the spinal anesthetic. The ranges of systolic blood pressure were all within normal limits, although systolic blood pressure showed a difference at 5,10 and 60 minute intervals after anesthesia. We conclude that immediate application of the horizontal lithotomy position can be safely practiced in the anesthesia of genitourinary surgery.