A Clinical Study of Splanchnic Nerve Block / 대한마취과학회지

BACKGROUND: It is difficult to manage intractable pain from advanced carcinoma of the upper abdomen. One method used to control pain associated with these malignancies is to block the splanchnic nerve. We investigated that VAS (visual analogue scale) difference before and after splanchnic nerve block (SNB) and pain relief day. Also we studied relationship between VAS before SNB and pain relief day. METHODS: A rewiew of 70 patients who took splanchnic nerve block (SNB) from September 1994 to February 1998 was carried out to assess age, sex, primary diseases, pain sites, VAS before and after SNB, date of diagnosis, date of SNB, date of death and pain relief day, etc. RESULTS: Of 70 patients, 44 were males and the remaining 26 were females. The causes of pain were stomach cancer 28 (40%), pancreatic cancer 18 (25%), gall bladder cancer 7 (10%), hepatoma 6 (8.6%) respcectively. Average day from diagnosis to SNB was 272 and average day from diagnosis to death was 341. So, patients died on the average 69 days after they took the splanchnic nerve block in pain clinic. VAS average before SNB was 8.01 and VAS average after SNB was 3.64. Patients felt pain relief during 35 days after SNB. Pain relief day of patients who had lower VAS before SNB was longer than that of patients who had higher VAS before SNB. CONCLUSION: Early application of splanchnic nerve block will make the patients endure the cancer pain more easily.

The clinical survey of ICU patients (1981. 3.1-1991. 2.28) / 대한구급학회지

No abstract available.

A clinical and bacteriologic study of infants and children with urinary tract infection

No abstract available.

Epidural morphine on ventilatory function in chest trauma and thoracotomy patients

Epidural morphine injection was done in nineteen patients who had been admitted from March to August 1990 to the Intensive Care Unit, Severance Hospital, Yonsei Medical Center for respiratory care including ventilator care. Morphine suplphate, 2.67 +/- 0.27 mg was injected one to three times to four patients after chest trauma, and to fifteen patients after thoracotomy. Tidal volume and vital capacity were increased from 4.45 +/- 0.48 and 8.31 +/- 0.50 to 6.91 +/- 0.41 and 12.81 +/- 0.73 mg/kg. However, respiratory rates decreased from 26.07 +/- 1.41 to 20.07 +/- 1.16/min. Inspiratory force increased from -13.40 +/- 1.31 to -26.53 +/- 1.82 cmH2O. Pain score decreased from 9.22 +/- 0.57 to 3.56 +/- 0.83 during this period. PaCO2 did not differ significantly (39.33 +/- 1.13 and 39.48 +/- 1.42 mmHg). Side effects such as pruritis and urinary retention were treated with naloxone 7 approximately 10 ng/kg/min. Mean arterial pressure and pulse rates stayed stable during the study periods. Ventilator hours and ICU stays differed from the control group. However, the duration was not statistically significant. The control group consisted of patients who were admitted during the six months from September 1989 to February 1990 to the ICU for respiratory care, without epidural morphine injection.

The hemodynamic effects of morphine, pancuronium and diazepam during mechanical ventilation / 대한구급학회지

No abstract available.

Intensive care unit outcome prediction by using APACHE II score / 대한구급학회지

No abstract available.

Poisoning patients in intensive care unit / 대한구급학회지

No abstract available.

Continuous Blood Pressure Monitorings during Cardiovascular Opertions in Takayasu`s Syndrome / 대한마취과학회지

We had examined the invasive blood pressure monitoring of superficial temporal, radial and femoral artery in two eases of Takayasus syndrome with mitral regurgitation and acute renal artery infarction. Mitral valve replacement and aorto-renal bypass graft were done by using cardiopulmonary bypass and one-lung ventilation respectively, The results are ; 1) Superficial temporal artery monitoring was more reliable and less fluctuant than femoral and radial artery monitoring in blood pressure. But we dont know the relationship of adequate cerebral perfusion pressure and superficial temporal artery pressure. 2) The femoral artery pressure monitoring was not adequate when the patients had a problem with ascending and descending aorta patency. 3) We had good results in the patient management by the monitoring of superficial temporal artery pressure.

Clinical experiences of fiberoptic bronchoscopy in patients with respiratory failure in the intensive care unit

Seventy-nine fiberoptic bronchoscopies were performed in 46 Patients during 2 years in the Intensive Care Unit of Severance Hospital, Yonsei Medical Center. Bronchoscopies were done more than twice in 13 patients. Forty-three bronchoscopies were done through the orotracheal tube in 27 patients, and narcotics and sedatives such as morphine sulfate, diazepam and lorazepam were added with pancuronium bromide during 52 bronchoscopy procedures in 21 patients. Ventilatory support was accomplished by control mode ventilation for 63 bronchoscopies in 37 patients. Twenty-four patients were from the surgical department, and 37 bronchoscopies were performed in 18 patients in a post-thoracotomy state. Twenty-two patients were nonsurgical patients. We performed 48 bronchoscopies in 26 patients to treat lung haziness, 14 bronchoscopies in 3 patients to confirm the operative anastomosis after pneumonectomy or tracheoplasty, and 11 bronchoscopies to confirm the airway patency and vocal cord movement. We obtained good results from 41 bronchoscopies performed for therapeutic purposes and 28 bronchoscopies done for diagnostic purposes. But in 4 patients with pleural effusion and pneumonia, we could not get any improvement in chest X-ray taken after bronchoscopy. We suggested other procedures in 6 patients for diagnosis or treatment, such as suspension laryngoscopy, thoracentesis, ultrasonogram and laser surgery.

Respiratory Parameters of Pressure Support Ventilation and Synchronized Intermittent Mandatory Ventilation during the Weaning Process / 대한마취과학회지

SIMV (synchronized intermittent mandatory ventilation) is a volume assisted mode which a patient inspiratory demand results in a clinician-controlled tidal volume and flow rate. However, PSV (pressure support ventilation) has the ability to augment spontaneous breaths with a variable amount of inspiratory positive pressure with a clinician-selected level of inspiratory airway pressure. To compare the effects of SIMV and PSV on respiratory function, experiments were performed on 12 stable patients during the weaning process and tidal volume, airway pressure, arterial blood gas tensions, blood pressure, and heart rates were measured during SIMV, and after 2 mins after removal of mechanical ventilation support. The same measurement as SIMV (except mandatory respiratory rates) were performed during PSV. The PSV level was reduced in the 5 cm2O step every 10-15 mins. The results of respiratory parameters and hemodynamic data showed that tidal volume, blood pressure, heart rates, and arterial blood gas tensions were similar, but there were significantly lower ventilatory rates, lower peak airway pressure and lower mean airway pressure during PSVmax than SlMV, and PSV resulted in improved patient comfort. It was concluded that PSV could be used to unload the patients ventilatory muscles and provide an appropriate level of mechanical ventilation support similar to SIMV weaning approaches.

Effect of Extreme Leukocytosis on Arterial Oxygen Tension / 대한마취과학회지

Arterial blood gas analysis has become an integral part of the clinical evaluation of the patient with known or suspected pulmonary disease. However, when the results of the measurements show arterial hypoxemia which is out of proportion to the clinical and X-ray evidence of lung disease, we may consider potential errors in measurement involving the blood gas analyzer or methods of blood sample storage. We experienced spurious hypoxemia in a patient with extreme leukocytosis (220.0 X 10(3)/mm3) secondary to leukemia. The degree of PaO2 decay was blunted by placing the blood on ice.

Changes in Levels of Epinephrine and Norepinephrine before during and after Cardiopulmonary Bypass / 대한마취과학회지

It is believed that catecholamine secretion is increased during cardiopulmonary bypass. However, the periods of maximum increase in catecholamine levels during cardiopulmonary bypass are different among several authors. 15 patients having valvular surgery were studied. Plasma epinephrine and norepine- phrine were determined by high performance liquid chromatography at 8 stages of the operation. During bypass plasma catecholamine levels continued to rise and maximally increased until aortic cross clamp off, and decreased gradually. Norepinephrine also showed the same results initially, but then increased gradually after the end of bypass. During bypass the maximum increases in epinephrine and norepinephrine were sixfold and twofold respectively in comparison with the levels prior to induction, which suggests that the predominant humoral response to cardiopulmonary bypass appears to be adrenomedullary release of epinephrine. The catecholamine levels at the period of aortic cross clamp off was higher than that of the lowest body temperature. There was no correlation between the increases in catecholamines and mean arterial pressure. Temperautures and eatecholamines also showed no correlations.

Chimical Lumbar Sympathectomy - Five cases report - / 대한마취과학회지

Pain is a sensory experience that is subjective and individual. It frequently exceeds its protective function and becomes destructive. We have met one case of causalgia, three cases of Buergers disease, and one case of arteriosclerosis obliterance. They sufferred from persistent pain and exkausted with the marked distrophy of affected limbs. Management of these patient involving lower limbs is a continuing challenge. Many other therapheutic procedures could be tried for these patients, but we tried chemical lumbar sympathectomy for these cases. With respect to the lower extremity, four patients had neurolysis of the 1st, 2nd and 3rd ipsilateral or 2nd and 3rd bilateral lumbar ganglia using 3 to 5 ml pure alcohol for each space under the image intensifier. Immediately after these procedure, rest pain has relieved dramatically in most cases and marked skin temperature rising. This implied increased peripheral blood flow of sympathectomised portion and the relief of rest pain is probably explained by destrcution of the afferent pain fibres running with the sympathetic trunk.

Pulse oximetry during shunt surgery in pediatric patients with tetralogy of fallot

Pulse oximetry is a noninvasive technique for measuring O2 saturation (SpO2) continuously. We applied pulse oximetry to 9 pediatric patients with tetralogy of Fallot during shunt surgery. Arterial oxygen tensions (PaO2) and saturations (SaO2) were also measured at the time of postinduction, just before the shunt, after the shunt and at the end of the operation. The SpO2 and SaO2 levels were identically changed in all 4 periods. The PaO2 was increased a little without statistical significance after the shunt procedure and at the end of the operation compared with the values before the shunt. However, SaO2 values increased with statistical significance after the shunt procedure and SpO2 values also showed similar increases with significance. In conclusion, continuous monitoring of SpO2 by pulse oximetry, instead of PaO2, is a very useful and reliable method to assess the improvement of perfusion after shunt, particularly in cyanotic cases.

High Frequency Jet Ventilation in Tracheal Tumor Surgery / 대한마취과학회지

A 38-year old male patient underwent tracheal reconstruction because of a tracheal tumor. A CT scan showed that the mass was located 5 cm above the carina, the size was 2x1.5cm, and there was a 50% narrowing of the stenotic segment. After endotracheal intubation (1.D. 8mm), a pediatric suction catheter (lenght:40cm, diameter: 2mm) was inserted with a stylet at the side of the tube to pass the stenotic segment with fiberoptic bronchoscopic guidance. Conventional ventilation with an inhalation agent was performed and HFJV was started just prior to the tracheal incision. A driving gas pressure of 1 kg/cm, respiratory rate of 120/min., I:E ratio fo 1:1, and Fio2 of 1.0 were applied through the suction catheter. Ten minutes after HFJV, PaCO2showed 50mmHg. Hypercabia was relieved by increasing the driving gas pressure from 1kg/cm(2) to 1.5 kg/cm(2). HFJV was performed for one and a half hours. During the procedure, blood gas analyses were perfomed frequently and all results revealed an adequate ventilatory status. After completing the end to end anastomosis, conventional ventilation was started until surgery was ended. The patient's course proceeded uneventfully and he was discharged 13 days after surgery.

Sublingual Buprenorphine Versus Intramuscular Meperidine in Post - Operative Pain Relief / 대한마취과학회지

No abstract available.

Roentgenographic Confirmation of Central Venous Catheter Tips through the External and Internal Jugular Veins in Children / 대한마취과학회지

Catheterization of the innominate vein or superior vena cava vein via the external and internal jugular veins was attempted in 68 pediatric patients weighing less than 20 kg in body weight who were scheduled for cardiovascular and pulmonary surgery. Both jugular veins were utilized in 63 cases, of these, and post operative X-ray confirmed a 19% malposition rate. Catheterization was performed in 45 cases throuhg the left external jugular veins and in 18 cases through the right external jugular vein,and the malposition rates were 25% and 6% respectively. The right internal jugular vein, utilized in 5 cases and, all provided successful results. Difficulty was encountered in passing of the catheter in 32% of the cases using both external jugular veins. Catheter curling was noted in 1 cases. No complications were encountered during and after catheterization.

Cardiac Surgery at Yonsei University Medical Center: A 30-year review

This is a 30-year review of 4,059 patients who underwent cardiac operations at Yonsei University Medical Center between September 1, 1956 and August 31, 1986. Of these, there were 1,191 patients with acquired and 2,868 with congenital cardiac lesions, constituting 29% and 71% of the group, respectively. Of 1,191 patients with acquired lesions, the number in each major category and the operative mortality were as follows: closed mitral commissurotomy, 210 and 0.95%; open mitral commissurotomy, 164 and 43%, mitral valve replacement, 370 and 3.5%, aortic valve replacement, 154 and 9.7%; double valve replacement 123 and 2.4%, and coronary artery bypass grafting 94 and 85%. Of 2,868 patients with congenital cardiac lesions, the number and operative major categories were as follows: repair of tetralogy of Fallot, 593 and 93% repair of ventricular septal defect 817 and 7.1%, closure of atrial septal defect 403 and 1.5%, and closure of patent ductus arteriosus, 550 and 1.3%.

Continuous Transsacral Epidural Block in a Patient with Diffuse Idiopathic Skeletal Hyperostosis / 대한마취과학회지

A 79-year-old male patient presented with a continuous transsacral epidural block for the treatment of herpes zoster pain on the right Tll-12 and Ll dermatome levels. However, it was impossible to introduce the Tuohy needle below the subcutaneous tissue. By the C-arm image intensifier, flowing calcifications of the lumbar paravertebral ligaments, except L5-Sl interspace, were observed. Thus, an epidural approach was tried at the L5-Sl interspace, but the Tuohy needle was introduced in the subarachnoid space instead of the epidural space. After an X-ray of the whole spine, diffuse idiopathetic skeletal hyperostosis was diagnosed. The Tuohy needle was introduced into the sacral canal through the second posterior sacral foramen and the epidural catheter was inserted about 15cm in length cephalad through the needle. The pain was controlled by the injection of 1% lidocaine and 0.5% bupivacaine every 3-4 hours continuously After 3 weeks this patient was discharged from hospital without any postherpetic sequelae.

Paraplegia Following Continuous Epidural Block in a Hepatoma Case with Spine Metastasis / 대한마취과학회지

We report a patient with a previously undiagnosed spine metastasis that developed into paraplegia following a continuous epidural block. This is an uncommon and quite rare complication. A 52-year-old male hepatoma case with upper abdominal cancer pain was indicated for a celiac plexus block. A continuous epidural block was performed prior to the celiac plexus block. A Tuohy needle was introduced at the Tll-12 interspace and an epidural catheter was inserted about 15cm in length cephalad through the needle. During the procedure, a saline solution was infused through the Tuohy needle and epidural catheter. The tip of the catheter was expected to be near the T, level. The upper abdominal pain was subsided after the injection of 3 ml of 1% lidocaine and 3 ml of 0.5% bupivacaine via the epidural catheter around noon time. When we made ward rounds that evening, the patient complained of motor weakness and sensory change below T; however, the local anesthetics were injected continuously through the epidural catheter every 4 hours. Next morning, because the patient complained of paraplegia, the epidural injection was discontinued. Under the suspicion of spinal cord compression, a computed tomogram of the thoracic spine was taken. It showed an osteolytic destruction of the right pedicle of T, due to a metastatic tumor. This suggested subclinical tumor invasion to the epidural space. The infusion of saline and local anesthetics through the Tuohy needle and the epidural catheter may increase the epidural pressure and compress the spinal cord. A laminectomy was refused by the family and the patient was discharged from the hospital after 6 treatments of radiotherapy without any improvement. It is advisable to take a spine CT or bone acan in terminal cancer patients before an epidural block, and when paraplegia develops after an epidural block.