, Jae Hee Woo, Chi Hyo Kim, Eun Hee Chun, Hee Jung Baik, Min Hee Choi Patients with Klippel-Feil syndrome require much attention during anesthesia because of congenital abnormalities in head and neck regions and the high probability of neurological damage from cervical spine instability during endotracheal intubation. We report a case of successful endotracheal intubation using a videolaryngoscope in a patient with Klippel-Feil syndrome who experienced difficult transnasal intubation.
Citations
, Chi Hyo Kim, Jong Hak Kim, Choon Hi Lee The infant or child with a difficult airway is easily recognized, either by symptomatology or anatomic features. However, in a small but significant number of cases, a difficult airway is unrecognized during the preanesthetic assessment, and becomes recognized only upon the induction of anesthesia.
We report a case of difficult airway with congenital tracheal stenosis in neonate. We performed tracheal intubation with small sized tube by using technique to bring head forward slightly while trying to advance tube.
, Jong Hak Kim, Chi Hyo Kim, Choon Hi Lee Pneumothorax can occur during general anesthesia by various mechanism.
Because tension pneumothorax may be manifested by unexplained hypotension or wheezing during anesthesia, prompt diagnosis of the complication is often difficult.
The incidence of iatrogenic pneumothorax seems to ve increasing, for the procedure associated with pneumothorax such as internal jugular or subclavian venipuncture, intercostal or interscalene nerve blocks, laparoscopy, operator should be prepated to treat this potential complication without delay.
We presented one case of tension pneumothorax developed during general anesthesia perhaps resulting from inadvertent lung injury during internal jugular vein puncture.
, Jong In Han, Rack Kyung Chung, Gui Yong Lee, Jong Hak Kim, Chi Hyo Kim, Choon Hi Lee The head-down tilt(HDT) position infuses changes in cerebral blood flow, intracranial pressure, hemodynamic and respiratory system. This study was performed to evaluate the changes in cerebral blood flow and the onset of autoregulation according to the different degree of HDT.
The subjects were 12 healthy adult female volunteers. They were divided two groups : 10° HDT(group 1) and 15° HDT(group 2). The systolic, diastolic and mean blood pressure, heart rate, end-tidal CO2 concentration and cerebral blood flow velocity on middle cerebral artery by transcranial Doppler were measured before positioning and 1,2,3,5,7,9,11 minute after positioning.
There was no significant changes in cerebral blood flow velocities statistically according to the HDT under 15 degrees. In group 1, vean arterial blood pressure were increased at 5 minutes and returned to control value at 7 minutes after HDT with statistical significances. Diastolic blood pressure in group 1 were increased at 1 and 2 minutes after HDT with statistical significances. In froup 2, systolic blood pressure were increased at 5,7,9,11 minutes after HDT statistically significantly.
There were no significant changes of cerebral blood flow under less than 15° HDT. But systolic blood pressure were increased with 15° HDT in the healthy adults statistically significantly(p<0.05) not but clinically. So, we suggested that if HDT is required, we should take care of the partients more than 10 minutes after HDT.
, Jong In Han, Rack Kyung Chung, Guie Yong Lee, Chi Hyo Kim, Jong Hak Kim, Choon Hi Lee, Hae Young Choi Pneumocephalus is a pathologic collection of gas within the cranial cavity. Patients undergoing neurosurgical procedures may be at increased risk for the development of tension paneumocephalus if nitrous oxide(N2O) is used during a subsequent anesthetic.
Thirty-seven patients undergoing cerebral aneurysm surgery had a computed tomographic scan of the head performed on or after the day of their surgery. 64 scans were examined for the presence of intracranial air. The magnitude of pneumocephalus was recorded as A-P(mm), width(m),& numbers of section.
Air was seen in all scans obtained in the first three postoperative days, During the second postoperative weeks, the incidence and the size of pneumocephalus decreased. A significant number of patients have an intracranial air collection in the first two weeks after the procedure.
These data indicate that all patients have pneumocephalus immediately after a cerebral aneurysm surgery. This information should be considered in the evaluation of the patient and the selection of anesthetic agents during a second anesthetic in the first 2 weeks after the first procedure.
, Jong In Han, Jong Hak Kim, Chi Hyo Kim, Guei Yong Lee, Choon Hi Lee, Yeon Jin Cho There are controversies about the analgesic effects of intraaarticular morphine and local anethetics bupivacaine. This study sought to compare the effects of saline with mor-phine, bupivacaine with or without epinephrine, administrated intraarticularly upon pos-toperative pan following arthroscopic knee surgery under general anesthesia.
In a double-blined, randommized manner, 40 patients received one of saline(20ml, n=10), morphine(1mg in 20ml NaCl, n=10), bupivacaine(0.25%, 20ml, n=10), bu-pivacaine with epinephrine(0.25%, 20ml, 200ug of epinephrine, n=10) intaarticularly at the completion of surgery. The pain scores by VAS were determined after 1,2,3,4 and 24 hours after intraarticular administration.
There were no significant statistical differences between four groups in the pain score. The maximal pain scores were 37.5 in control group, 48.0 in morphine group, 33.6 in bupivacaine group postoperative 1 hour and 32.9 in bupivacaine with epinephrine group pos-toperative 2 hours. The pain scores were decreased as the time went by and were minimin as 21.4 in control group, 17.6 in morphine group, 11.2 in bupivacaine group and 12.3 in bu-pivacaine with epinephrine group 24 hour postoperatively.
Though there were no significant statistical significances with those doses, there were tendencies that the bupivacaine group with or without epinephrine had the postoperative analgesic effect rather than control group, and morphine group had a slow onset of analgesic ef-fect. So, we should study to decide the dose or volume of the drugs and appropriate time to evaluate for the anagesic effects after knee arthroscopy further.
Nitroglycerin(NTG) can be used intravenously to induced hypotension. NTG has a short plasma half-life, is easy to control, and has no direct toxic effect or toxic metabolites.
The purpose of this study was to evaluate the effects of nitroglycerine-induced hypotension on the hemodynamics during isoflurane-N2O-O2 anesthesia in dogs.
Hemodynamic measurement(left ventricular pressure, aortic pressure, pulmonary wedge pressure, pulmonary artery pressure. heart rate, cardiac output, maximal and minimal dP/dT) were determined in 8 dogs at 30min after induction(baseline values), 15min after isoflurane-N2O-O2 inhalation(1 MAC, FIO2 0.5), 15min after intravenous NTG adminstration and 15min after the termination of isoflurane-NTG.
1) At 15min after isoflurane-N2O-O2 inhalation, left ventricular pressure, aortic pressure, maximal dP/dT values were decreased, and heart rate was increased significantly compared to baseline values. but pulmonary wedge pressure, pulmonary artery pressure, cardiac output and minimal dP/dT did not changes significantly.
2) At 15min after IV NTG administration, left ventricular pressure, aortic pressure, pulmonary wedge pressure, pulmonary artery pressure, cardiac output and miximal dP/dT were decreased, minimal dP/dT was increased significantly compared to the previous values.
3) At the termination of isoflurane-NTG, left ventricular pressure, aortic pressure, pulmonary wedge pressure, cardiac output and maximal dP/dT were increased, minimal dP/dT was decreased significantly compared to the previous values, but left ventricular pressure, aortic pressure and pulmonary wedge pressure were lower than the the baseline valus.
, Guie Yong Lee, Chi Hyo Kim, Young Sook Pae Brain ischemia due to a critical reduction in cerebral blood flow is a common cause of irreversible brain damage. Ischemia is invariably accompanied by an increase in tissue lactate concentration due to anaerobic metabolism of glucose and energy failure.
Despite new insights into the pathophysiologic mechanism of cerebral ischemia, the clinical therapeutics of cerebral ischemia is usually limited to agressive anticoagulation and supportive measures.
But. recently, new pharmacological agents including calcium channel blocking agent, perfluorocarbon, free radical scavenger and opiate antagonist are considered as possible therapeutic application for restoration of blood flow to areas of focal ischemia in both laboratory and clinical trials.
Naloxone, an opiate antagonist, has been reported to improve neurological function, spinal blood flow and somatosensory evoked potentials after spinal injury. Thus, Endogenous opioids might play a role in pathophysiology of central nervous system ischemia and that opiate antagonist might be of benefit in the treatment of experimental stroke.
But, on the other hand. there are many evidences that naloxone is not benefical. So use of naloxone for the treatnebt of ischemia insult is controverial.
Therefore, The present investigation was undertaken to elucidate the effects naloxone on cerebral ischemia by measurement of the cerebral energy metabolites concentration.
Cerebral ischemia was produced in spontaneously hypertensive rat(SHR) by bilateral common carotid artery ligation. Naloxone(1mg/kg) was administered intraperitoneally 30 min after the carotid artery ligation.
The results obtained were as follows :
1) There were no differences in the concentration of APT and lactete between normotensive Sprague-Dawley rats and SHR.
2) In bilateral common carotid artery ligated SHR, the concentration of APT was considerable decreased and that lactate was slightly increased.
3) Naloxon didn'y change the cerebral energy metabolism in ischemic model. These data indicated that naloxone had no benefical effect on cerebral ischemia but for definite conclusion, more controlled experiments must be performed.
Hypercarbia during anesthesia are releated to the severity of airway obstruction, and to the increase of carbon dioxide production and rebreathing.
Even when ventilation appears to be adequate, rebreathing may cause hypercarbia when the dead space of the apparatus is excessive, when very low gas flows(<3.0 L/min) are used in Jackson-Ress or Bain circuits, or as a result of defective carbon dioxide absorption in a circle system.
The purpose of the present study was to determine the effects of head position and intubation method on the arterial blood gas analysis values.
Arterial blood gas analysis (PH, PaCO2, PaO2, oxygen saturation and base excess) were performed at 30 minutes after the endotracheal intubation, 5 minutes before the end of surgery and 30 minutes after endotracheal extubation.
The results were obtained as follows ;
1) At 30 minutes after the endotracheal intubation, the PH, PaCO2, base excess values in group 2 were significantly different from the values in group 1 and 3, the PaCO2 value was highly significant increased in group 2 but the PaO2 and oxygen saturation values had no statistical significance in any group.
2) At the 5 minutes before the end of surgery, the PH, PaCO2, PaO2 values in group 2 were significantly different from the values in group 1 and 3, but the oxygen saturation and base excess values had no satistical signigicance in any group.
3) At 30 minutes after the endotracheal extubation, the PH, PaCO2, PaO2, oxygen saturation, base excess values had no satistical significance in any group
, Youn Jin Kim, Jong Hak Kim, Dong Yeon Kim, Guie Yong Lee, Chi Hyo Kim Vasovagal syncope is one of the most common causes of transient syncope during anesthesia for elective surgery in patients with a history of syncope and requires special attention and management of anesthetics. The causes and pathophysiological mechanism of this condition are poorly understood, but it has a benign clinical course and recovers spontaneously. However, in some cases, this condition may cause cardiovascular collapse resulting in major ischemic organ injury and be life threatening. Herein we report a case and review literature, regarding completing anesthesia safely during an elective surgery of a 59-year-old female patient with history of loss of consciousness due to suspected vasovagal syncope followed by cardiovascular collapse and cardiac arrest, which required cardiopulmonary resuscitation and insertion of a temporary pacemaker and intra-aortic balloon pump immediately after a fine-needle aspiration biopsy of a lung nodule located in the right middle lobe.
, Chi Hyo Kim, Youn Jin Kim, Rack Kyung Chung, Hee Seung Lee, Hee Jung Baik, In Kyung Song Polyuria is occasionally observed during general anesthesia. Usually urine output during general anesthesia is decreased because of anesthetic agents. The authors came across with a case of polyruia during sevoflurane anesthesia which occurred after induction of anesthesia. Polyuria is a nonspecific symptom, but can cause many serious complications. Therefore, it is very important to investigate the cause thoroughly and treat patient appropriately.
, Guie Yong Lee, Jong In Han, Dong Yeon Kim, Rack Kyong Chung, Jong Hak Kim, Chi Hyo Kim, Choon Hi Lee Preoxygenation is recommended in order to prevent hypoxemia with hypoventilation or apnea during induction of anesthesia. The purpose of this study was to determine the duration of preoxygenation required to achieve an end-tidal oxygen fraction(FE'O2) of 0.9 in children and adults.
In 24 healthy children and adults breathing 100% oxygen, end tidal oxygen and carbon dioxide concentration have been measured at 15 seconds interval from the start of liter per minute. The gas sampling line of the Capnomac II(Datex, Helsinki, Finland) was placed in the nasal cavity.
The study showed that all children attained an FE'O2 of 0.9 within 75s of preoxygenation, but adults had not reached an FE'O2 of 0.9 within 180s.
More oxygen wash-in would be expected in children. We suggested that at least 3 min of preoxygenation should be performed before intravenous induction of anesthesia in children.
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