No abstract available.
Blood Gas Analysis*

Transcranial cerebral oximetry has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. It has been also used in intraoperative monitoring of aortic dissection and surgical procedures performed under deep hypothermia and circulatory arrest. During disending aortic arch exposure, sudden cerebral oxygen saturation change from 63% to 48% was detected. After therapeutic bypass, cerebral oxygen saturation was increased to 65%. During aortic arch repair, deep hypothermic circulatory arrest with retrograde cerebral perfusion was applied for 130 min and cerebral oxygen saturation slowly decreased from 65% to 52%. Patient was discharged from hospital without neurologic complication and cognitive funtion disturbance.
Aorta, Thoracic ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Hypothermia ; Monitoring, Intraoperative ; Oximetry ; Oxygen* ; Perfusion

BACKGROUND: Esmolol has been applied to lower myocardial oxygen consumption and creates a quieter operative field by reducing systemic blood pressure and heart rate but can cause a certain amount of hemodynamic instability during minimally invasive direct vision coronary artery bypass graft (MIDCAB). The aim of this study was to compare the hemodynamic differences between two methods; inducing hypotension and bradycardia between esmolol infusion alone, and concomitant use of neostigmine during MIDCAB anesthesia. METHODS: Twenty MIDCAB patients were randomly allocated into two groups, group E (n = 10) receiving esmolol 0.3 mg/kg/min, group EN (n = 10) receiving esmolol 0.2 mg/kg/min and neostigmine 1.0 mg for induced hypotension and bradycardia during coronary anastomosis. The hemodynamic parameters were evaluated 10 minutes after induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes before the end of anastomosis (T3) and 10 minutes after the end of anastomosis (T4). Data were analyzed by ANOVA test for intragroup comparisons, and by T-test for intergroup comparisons with significance set at a P value of < 0.05. RESULTS: Heart rate significantly decreased at T3 in both groups and more in group EN. Systolic blood pressure decreased at T3 in both groups and there were no group differences but more episodes of extreme hypotension in group E. The cardiac index significantly decreased at T3 in both groups and more in group E. There was a small but significant increase in pulmonary capillary wedge pressure at T3 and T4 in group E and no change of central venous pressure in both groups. CONCLUSION: Concomitant use of neostigmine during esmolol infusion produces more reliable induced hypotension and bradycardia than esmolol infusion alone for MIDCAB anesthesia in terms of prevention of myocardial ischemia and easiness of anastomosis technique.
Anesthesia* ; Blood Pressure ; Bradycardia* ; Central Venous Pressure ; Coronary Artery Bypass ; Heart Rate ; Hemodynamics ; Humans ; Hypotension* ; Myocardial Ischemia ; Neostigmine* ; Oxygen Consumption ; Pulmonary Wedge Pressure ; Transplants

The relationship between end-tidal carbon dioxide tension(PECO2) as measured by infrared analysis(Datascope Accucap, U.S.A.) and arterial carbon dioxide tension(PaCO2) during general anesthesia was systemically examined in fifty relatively healthy patients(ASA class 1). Body temperature was measured to determine the variation in PaCO2 minus PECO2. The results were as follows: 1) The mean PEzCO2 was 26.2+/-0.7 torr. 2) The mean PaCO2 was 31.6+/-0.8 torr. 3) The average of PaCO2 minus PECO2 was 5.1+/-0.6 torr. 4) PaCO2 was directly related to PECO2. An equation was obtained by simple regression analysis to predict PaCO2. PaCO2=0.899. PECO2+7.57(r=0.715; p<0.01). 5) Body temperature (between 34.3 degrees C and 37.9 degrees C) was not related to PaCO2 minus PECO2 (r=0.1). I thought that measurement of PECO2 is very simple and a guideline of ventilation of the patients in anesthesis and ICU.
Anesthesia, General ; Body Temperature ; Carbon Dioxide ; Humans ; Ventilation

A clinical survey was performed on 342 patients under the age of 15 years who were admitted to the respiratory intensive care unit(RICU) between January and December, 1985. The results were as follows 1) The total number of RICU patients in 1985 was 610, and 342(56.1%) were pediatric patients. 2) The ratio of male to female was 55%(188 cases) to 45%(154 cases). 3) The most prevalent age group was 1 to 5 years of age, 145 cases(42.4%). 4) Of the 342 patients, 308 were chest surgery patients(90.1%), 30 were pediatric surgery (8.8%), 2 were neurosurgery, one was a general surgery and one was a plastic surgery patient. 5) The mortality rate was 3.5%(12 cases) which was significantly decreased from the 1984 rate of 5.9% Neonates experienced the highest mortality rate(l0.5%), but this decreased with aging. 6) The mortality rate according to procedure was 2.6%(8 cases) in chest surgery, 10%(3 cases) in pediatric surgery, and 100%(1 case) in general surgery and increased as the length of ventilatory support time increased. 7) The duration of ventilatory support was 57.93 hrs in chest surgery, 68.86 hrs in pediatric surgery and 59.75 hrs on average. Ventilatory support of 12~24 hrs was required in 115 (33.6%) cases. 8) The types of ventilators used were Bourns(132 cases, 38.6%), Bennet MA-1 (47 cases, 13.7%), Roche (45 cases, 13.2%), Bear-Cub(40 cases, 11.7%), etc. 9) The two major causes of death were low cardiac output syndrome(5 cases) in chest surgery and sepsis (2 cases) in pediatric surgery.
Aging ; Cardiac Output, Low ; Cause of Death ; Female ; Humans ; Infant, Newborn ; Critical Care* ; Male ; Mortality ; Neurosurgery ; Sepsis ; Surgery, Plastic ; Thorax ; Ventilators, Mechanical

BACKGROUND: Activated clotting time (ACT) and thromboelastography (TEG) are generally accepted as adequate measures of the coagulation system for monitoring of the cardiac system. Aprotinin is alleged to affect ACT and TEG. We performed this study to see if the determination of ACT and TEG can provide a basis for the assessment of coagulation and the prediction of postoperative hemorrhage in cardiac surgical patients treated with aprotinin. METHODS: Twenty patients undergoing cardiac operation were studied. The values (control) of ACT and TEG were obtained just after induction of anesthesia. Each patient was fully heparinized and received aprotinin, 2,000,000 KIU added to the prime solution. At the end of the procedure, protamine, 3 mg/kg was given for the neutralization of heparin. Measurement of ACT and TEG were made 20 minutes after the administration of protamine, at the end of surgery, and 1 hour after transfer to ICU. The values were compared with the amount of hemorrage collected by chest tubes 1 hour, 2 hours and 8 hours after transferred to ICU. RESULTS: The values of ACT at 20 minutes after protamine administration and at the end of surgery significantly (P < 0.05) increased compared with the values of control, but the values in ICU did not show significant change. All values of TEG significantly (P < 0.05) changed compared with the values of control. No single variable of ACT and TEG showed correlation with the amount of hemorrhage through chest tubing postoperatively. CONCLUSIONS: The results indicate that neither ACT nor TEG predict the amount of postperative hemorrhage in aprotinin-treated patients having cardiac surgery. Therefore the TEG results should be interpreted cautiously because of the high rate of unreliable results.
Anesthesia ; Aprotinin* ; Chest Tubes ; Hemorrhage* ; Heparin ; Humans ; Postoperative Hemorrhage ; Thoracic Surgery ; Thorax ; Thrombelastography*

No abstract available.
Cardiopulmonary Bypass* ; Diagnosis*

BACKGROUND: Induction of general anesthesia in patients with cardiac disease must guarantee hemodynamic stability and should result in a satisfactory anesthetic level. The purpose of this study was to analyze the hemodynamic effects of midazolam/sufentanil in comparison with etomidate/sufentanil used for induction of anesthesia in patients with cardiac disease. METHODS: All the patients (n = 30) in the study were about to undergo cardiac surgery and were divided into the midazolam group (n = 15) and etomidate group (n = 15). The induction dose of midazolam was 0.18 mg/kg, etomidate 0.3 mg/kg, vecuronium 0.15 mg/kg, sufentanil 3 microgram/kg, hemodynamics and oxygenation were recorded in the awake state (pre-induction), and 10 minutes after intubation (post-intubation). RESULTS: The etomidate group had a shorter time of anesthetic induction, and some myoclonic movement (13%) was observed. After intubation, reductions of heart rate (13.8%), mean arterial pressure (18.4%), cardiac index (14.8%), left ventricular stroke work index (9.7 - 38.5%), oxygen delivery index (7.43%), oxygen consumption index (10.3%), and Qs/Qt (25.6%), and an increase in central venous pressure (0 - 50%) were observed in both groups. Decreases in right ventricular stroke work index and mean arterial pressure were observed in the midazolam group, but no change in right ventricular stroke work index and a decrease in mean arterial pressure was observed in the etomidate group. In the midazolam group the values of right ventricular stroke work index and mean arterial pressure were significantly lower than in the etomidate group. The heart rate of the midazolam group in patients with CABG were significantly lower than in the etomidate group. CONCLUSIONS: The results of this study shows that etomidate was found to be as reliable and effective an agent for induction as midazolam.
Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Central Venous Pressure ; Etomidate ; Heart Diseases* ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam ; Oxygen ; Oxygen Consumption ; Stroke ; Sufentanil ; Thoracic Surgery ; Vecuronium Bromide

Many trials to get informations from arterial waveforms have been done. But it was not so simple as expected because of normally fluctuating characteristics of arterial waveform due to respiration, extracardiac neuro-humoral control, etc. By using power spctral analysis we can figure out powers of these extrinsic contribting factors as well as contours of individual pulse wave by harmonic analysis. The purpose of this study is to compare the results of power spectral analysis and some basic parameters of arterial waveform before and after anesthesia to establish the basic changes during halothane anesthesia. The analog informations, obtained from patients undergoing operation with radial artery cannulated for continuous monitoring, was obtained from analog output of the Cardiocap monitor. It was transformed to digital information by A/D converter and saved to IBM compatible computer with mathcoprocessor. The data was processed offline by the signal analysis software DADiSP version 1.05 with the same computer. Results of mean arterial pressure, heart rate, dp/dt, low frequency peak, high frequency peak and harmonic pulse contour analysis were compared before and after anesthesia. We could conclude that halothane anesthesia diminishes all powers of harmonic components of arterial wave and powers of extrinsic components that affect low frequency area.
Anesthesia* ; Arterial Pressure ; Chromonar ; Halothane* ; Heart Rate ; Humans ; Radial Artery ; Respiration

We studied the cardiovascular and neuromuscular effects of Norcuron (a new nondepo larizing muscle relaxant) in ASA Claas I patients under halothane and nitrous oxide ane-sthegia. The onset time of Norcuron was 1.06+/-0.27 win, and Clinical duration of action time was 41.49+/-5.53 min and recovery index was 16.38+/-2.30 min and total duration of action time was 67.04 +/-14.42 min.. after volus injection Norcuron 0.1 mg/kg. Norcuron did not change mean arterial presaure, heart rate and histamine secretions and had not arrythmogemic effect on heart rhythm. We conclude that vecuronium bromide (Norcuron) produces a excellent neuromuscular blockade of short duration with little cardiovascular changes and histamine releaae.
Halothane ; Heart ; Heart Rate ; Histamine ; Humans ; Neuromuscular Agents* ; Neuromuscular Blockade ; Nitrous Oxide ; Vecuronium Bromide*