[The obstruction of a port catheter during the induction of anesthesia].

A 44-year-old woman receiving home hyperalimetation with an implanted port catheter, was scheduled to undergo resection of ovarian cyst and adhesiotomy. For the induction of anesthesia, fentanyl 0.05 mg, thiopental sodium 200 mg, saline 5 ml and vecuronium 10 mg were given through the port catheter. Although she fell asleep, she kept breathing spontaneouly. It was not possible to give any further drugs through this port catheter, suggesting obstruction of the catheter. The endotracheal intubation was assisted with sevoflurane 5% and suxamethonium 80 mg chloride given through the peripheral vein. Five ml of saline used to flash out thiopental sodium before the administration of vecuronium blomide was not considered to be adequate. An experiment was conducted to investigate how much saline is necessary to wash out completely the drug given previously. The results suggest that more than 10 ml of saline should be given through the port catheter. Various types of central venous catheters are being used. Precise knowledge of each catheter is necessary to use this indispensable central vein route, especially at the crucial timing, such as the induction of anesthesia.

[A case of continuous infusion of milrinone during continuous venovenous hemofiltration causing high plasma concentration of milrinone].

A 79-year-old woman was undergoing chronic hemodyalysis. She received a continuous infusion of milrinone of 0.25 microg x kg(-1) x min(-1) for 77 hours, 0.2 microg x kg(-1) x min(-1) for 39 hours and 0.1 microg x kg(-1) x min(-1) for one hour due to heart failure after mitral valve repair. While receiving continuous infusion of milrinone, she was undergoing continuous venovenous hemofiltration. After infusion of milrinone for three days no arrhythmia was seen except atrial fibliration, but blood pressure remained low. After stopping infusion of milrinone, the plasma concentration of milrinone was 792.7 ng x ml(-1) (therapeutic plasma concentration: 100-200 ng x ml(-1)). Now few data are available regarding the pharmacokinetic of milrinone in patients with severe renal failure and during CVVH. Therefore we should design a dose modification for intravenous milrinone in renal failure patients.

[Occupational exposure of operating room staff to anesthetic gases during inhaled induction--a comparison with intravenous anesthesia induction].

BACKGROUND: The risk of occupational exposure to waste anesthetic gases still remains during inhaled induction. In this study we investigated how much we were occupationally exposed to anesthetic gases during induction period. METHODS: Twenty-six adult patients were induced with sevoflurane 5% using a face mask for three minutes and maintained with sevoflurane 1% after end-tracheal intubations (IH-Group). Twenty-two adult patients were induced with intravenous anesthetics and maintained with sevoflurane 1% after end-tracheal intubations(IV-Group). The concentration of sevoflurane was measured by Multi-gas Monitor 1302 (Bruel & Kjaer: Denmark) every 70 seconds. Sample gas was suctioned from breathing zone of anesthesiologists. All of our operating rooms are equipped with waste gas scavenging system. RESULTS: The peak concentration of sevoflurane is significantly higher in IH-Group (15.91 +/- 22.64 ppm) compared with IV-group (0.36 +/- 0.25 ppm). The period when sevoflurane concentration exceeded 0.5 ppm is significantly longer IH-Group (18.55 +/- 10.51 min.) compared to IV-Group (1.92 +/- 4.56 min.). CONCLUSION: The induction with intravenous anesthetics is a better method in order to reduce occupational exposure of anesthesiologists to anesthetic gases.

[Intensive care management of acute pulmonary thromboembolism].

Three patients with acute pulmonary thromboembolism, who had fallen into cardiopulmonary arrest or severe respiratory failure, were treated and saved in our intensive care unit. Two patients were resuscitated with percutaneous cardiopulmonary support device. Two patients underwent surgical embolectomy and we carefully applied positive pressure ventilation to prevent postoperative reperfusion pulmonary edema. Early diagnosis and treatment are essential for saving critically ill patients with acute pulmonary embolism. However, cardiopulmonary resuscitation is often difficult and unsuccessful. Therefore prophylaxis is strongly recommended especially in patients with known risk factors of venous thrombosis. Since reperfusion pulmonary edema is a serious complication after surgical pulmonary embolectomy, careful postoperative respiratory care is needed.