BACKGROUND: This study was performed to discover how much needle deflection occurs during spinal or epidural block and how it can be reduced. METHODS: A styrofoam block was used to simulate the paraspinal area of the back. A line was drawn perpendicular to the edge. Using the line as a guide, the needles were advanced through the block. Quincke-type needles of 22 and 25 gauge, pencil-type needles of 22 and 25 gauge or Tuohy needles of 17 and 18 gauge were used. Using a block of 6 cm thick, spinal needle was advanced through the introducer with their apertures facing to the same or opposite direction. The deflection from the perpendicular line was measured in mm intervals. RESULTS: Small-gauged and beveled spinal needles had more deflection depending on the block thickness (P < 0.05). However, the deflection of epidural needles was not consistent. When the bevel of the introducer and spinal needle was facing the same direction, the use of an introducer needle decreased the deflection in 22 and 25 G Quicke, and 25 G Whitacre needles (P < 0.05). When facing each other, the deflection was reduced in all the spinal needles (P < 0.05), and reduced more in the 25 G Quicke needles (P < 0.05). CONCLUSIONS: Considering the estimated depth of the spinal canal, needle type, bevel direction, its gauge and the use of an introducer needle, we can take advantage of the deflection phenomenon to reduce post-dural puncture headache and to increase the success rate of a spinal or epidural block.
Needles* ; Post-Dural Puncture Headache ; Spinal Canal

An animal model was used to study the effects of normobaric hyperoxia on pulmonary mechanics and histopathology. Thirty two rats (227+/-46gm) were divided into control (Group 1) in room air and 3 hyperoxic groups (n=8, each). Hyperoxic groups breathed F1O2 0.98 for 24 hr(Group 2), 48 hr(Group 3), and 72 hr(Group 4), respectively. After hyperoxia, rats were intubated through tracheostomy, and inflation and deflation compliances of lung-thorax [CLT(I), CLT(D)] were calculated. Body weight(BW) was measured, and lungs were removed and weighed(LW). The lung specimens were examined microscopically. At the 3rd day of hyperoxia, 5 of 8 rats were died (63% mortality). CLT(I) of Group 4 was low (p<0.05) compared with others, and CLT(D) of all hyperoxic groups were low (p<0.05) compared with control. Mean LW/BW (lung weight divided by body weight) was elevated (p<0.05) in Group 3 and Group 4. Pulmonary pathologic findings such as inflammation, congestion, alveolar and bronchial wall damage, pulmonary edema etc. became apparent (p<0.05) at the 3rd day. We conclude that during hyperoxia pulmonary compliance might be decreased and lung weight might be increased progressively, and pulmonary pathological appearance of normobaric hyperoxia (F1O2 > 0.98) resemble those of adult respiratory distress syndrome (ARDS).
Animals ; Compliance ; Estrogens, Conjugated (USP) ; Hyperoxia* ; Inflammation ; Inflation, Economic ; Lung* ; Mechanics ; Models, Animal ; Pathology ; Pulmonary Edema ; Rats* ; Respiratory Distress Syndrome, Adult ; Tracheostomy

Uncontrolled or inadequately controlled postoperative pain may lead to delayed recovery from surgery, pulmonary complications, and restriction of mobility leading to increased risk of thromboembolism. Standardized regimens for pain management can lead to safer and better pain control. Of these regimens, patient-controlled analgesia, a delivery system with which patients self-administer small, predetermined analgesic doses, produced improved pain relief, greater patient satisfaction, less sedation, and fewer postoperative complications. Anesthesiologists have played an important role to make this pain management feasible. The introduction of acute pain services at hospitals prompted improvements in postoperative pain management in addition to the minimization of related complications.
Analgesia* ; Analgesia, Patient-Controlled ; Humans ; Pain Clinics ; Pain Management ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Complications ; Thromboembolism

INTRODUCTION: One-lung ventilation (OLV), as a model for adult respiratory distress syndrome, was performed in 8 mongrel dogs, which were made a little hypoxemic by adjusting inspired fraction of oxygen (FIO2) in order to know the effect of nitric oxide (NO) on cardiopulmonary hemodynamics and oxygenation during OLV in lateral position. METHODS: Double-lumen endobronchial tube was intubated through tracheostomy. OLV was performed in lateral position by turning to the side where Swan-Ganz catheter tip was located. FIO2 was adjusted to set SpO2 around 85~90%. After stabilization, cardiopulmonary hemodynamic variables and various oxygenation-related parameters were measured respectively at 5 steps: 1) OLV, 2) OLV and 20 PPM of NO inhalation, 3) OLV, 4) OLV and 40 PPM of NO inhalation, 5) OLV. NO (titrated in N2 tank at concentration of 800 PPM) was administered through low-pressure inlet of ventilator and diluted by inspiratory fresh gas. FIO2 setting of ventilator was slightly increased during NO administration to compensate for FIO2 decrease due to NO titration gas (N2) mixing. NO and NO2 concentration was monitored at the inspiratory limb of breathing circuit by a electrochemical analyzer. RESULTS: There were no difference about hemodynamic variables such as blood pressure (BP), pulmonary arterial pressure (PAP), heart rate (HR), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP). Neither were different calculated hemodynamic variables such as systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), pulmonary perfusion pressure (PPP), cardiac index (CI), and right ventricular stroke work index (RVSWI). PaO2/FIO2, AaDO2, and S/T were significantly different between step 3 and step 4. But other oxygenation-related parameters such as O2, O2 flux, and O2 ER extraction ratio were not different. CONCLUSIONS: NO inhalation may have a potential for relieving hypoxemia during OLV of dogs in lateral position.
Animals ; Anoxia* ; Arterial Pressure ; Bays ; Blood Pressure ; Catheters ; Central Venous Pressure ; Dogs* ; Extremities ; Heart Rate ; Hemodynamics* ; Inhalation ; Nitric Oxide* ; One-Lung Ventilation ; Oxygen* ; Perfusion ; Pulmonary Wedge Pressure ; Respiration ; Respiratory Distress Syndrome, Adult ; Stroke ; Tracheostomy ; Vascular Resistance ; Ventilators, Mechanical

We experienced a case of open heart surgery for correction of ventricular septal defect and patent ductus arteriosus in five years old boy with hemophilia A. Factor VIII activity in this patient was 0.7% of normal activity. He received 2,000 unit of factor VIII intravenously for loading dose and has been infused 6 unit/kg/hour for 12 hours before the operation. And his factor VIII activity was 68% in the morning of the operation day. During the operation, he received 6 unit/kg/hour of factor VIII. After intracardiac anomaly was repaired and protamine was injected, we administrated 1000 unit of factor VIII. At that time, his factor VIII was 57%. After operation was done, he received 6 unit/kg/hour of factor VIII during stay in ICU and postoperative 14 days. His factor VIII activity was maintained at 36~104% during stay in hospital. So we report a successful case of perioperative management for the open heart surgery in patient with hemophilia A.
Ductus Arteriosus, Patent ; Factor VIII ; Heart Septal Defects, Ventricular ; Heart* ; Hemophilia A* ; Humans ; Male ; Thoracic Surgery*

We experienced a case of open heart surgery for correction of ventricular septal defect and patent ductus arteriosus in five years old boy with hemophilia A. Factor VIII activity in this patient was 0.7% of normal activity. He received 2,000 unit of factor VIII intravenously for loading dose and has been infused 6 unit/kg/hour for 12 hours before the operation. And his factor VIII activity was 68% in the morning of the operation day. During the operation, he received 6 unit/kg/hour of factor VIII. After intracardiac anomaly was repaired and protamine was injected, we administrated 1000 unit of factor VIII. At that time, his factor VIII was 57%. After operation was done, he received 6 unit/kg/hour of factor VIII during stay in ICU and postoperative 14 days. His factor VIII activity was maintained at 36~104% during stay in hospital. So we report a successful case of perioperative management for the open heart surgery in patient with hemophilia A.
Ductus Arteriosus, Patent ; Factor VIII ; Heart Septal Defects, Ventricular ; Heart* ; Hemophilia A* ; Humans ; Male ; Thoracic Surgery*

BACKGROUND: In children, laryngeal mask airways (LMA) almost always show a tendency to come out of the mouth too much before and during inflating the cuff. We hypothesized that the selection criteria based on body weight seemed to be set too low or inappropriate in children. METHODS: After IRB approval and informed consent from parents, pediatric patients (n = 63; 42 male, 21 female) weighing less than 20 kg, of ASA physical status 1 or 2, and in whom the use of an LMA was not contraindicated, were studied. LMAs were inserted by an experienced investigator and connected to a volume ventilator, and positive pressure ventilation was initiated. Inspiratory and expiratory tidal volume (V(T)) were measured to calculate the fraction of leakage (F(L), %) as ([inspiratory V(T)-expiratory V(T)]/inspiratory V(T)) 100. The larynx was inspected with a fiberoscope (FOB) located just proximal to the aperture bar. For each size of LMA, we divided each group into two subgroups depending on the body weight (4, 7 or 12 kg) and age (2, 9 or 30 months) and compared the FOB finding and F(L) between the two subgroups. In the other 16 patients, LMAs of two different sizes were applied successively to a patient, and its FOB grades were compared. RESULTS: For size 1 LMAs (n = 22), the FOB finding and F(L) were not different between the subgroups. For size 1.5 LMAs (n = 20), patients weighing 7 to 10 kg or aged < 9 months had a better FOB finding (P = 0.007 and 0.0003) than patients weighing 5 to 7 kg or aged > 9 months. For size 2 LMAs (n = 21), FL was correlated with body weight (P < 0.001, r(2) = 0.448) and age (P < 0.001, r(2) = 0.424). In 8 patients of 5 to 7 kg, use of size 1 LMAs had a better FOB grade than that of size 1.5 LMAs (P = 0.031). In the other 8 patients of 10 to 12 kg, there was no difference of FOB grades between the size 1.5 and 2 LMAs. CONCLUSIONS: For patients weighing 5 to 7 kg, the use of size 1 LMAs is recommended. Contrary to adults, a smaller LMA may have to be tried if an LMA size turns out to be inappropriate.
Adult ; Body Weight* ; Child* ; Ethics Committees, Research ; Humans ; Infant* ; Informed Consent ; Laryngeal Masks* ; Larynx ; Male ; Mouth ; Parents ; Patient Selection* ; Positive-Pressure Respiration ; Research Personnel ; Tidal Volume ; Ventilators, Mechanical

A 76-year-old, 148-cm woman was scheduled for right upper lobectomy. A 32 Fr left-sided double lumen tube was placed using a conventional technique. Despite several attempts under fiberoptic bronchoscope-guidance, we could not locate the double lumen tube properly. We thus decided to proceed with the bronchial tube in the right mainstem bronchus. During surgery, 8-cm-long laceration was noted on the posterolateral side of the trachea. To check the possibility of laceration of the proximal trachea, the double lumen tube was changed to an LMA for use as a conduit for fiberoptic bronchoscopic evaluation in the lateral position. A plain endotracheal tube with the cuff modified and collapsed was re-intubated after evaluation. And then she was transferred to SICU.
Aged ; Bronchi ; Female ; Humans ; Intubation ; Lacerations ; Trachea

Since the advent of positive-pressure mechanical ventilator in respiratory support, barotrauma has become a feared complication. Elevated peak airway pressure is one of the risk factors of barotrauma, so it has been tried how to change ventilator setting to minimize airway pressure. One method is to decrease tidal volume and increase respiratory rates. Therefore we studied changes of airway pressure, compliance and resistance of the total respiratory system according to change tidal volume and respiratory rates. We selected 23 patients over the age of 15 and with no respiratory problem. And we excluded patients received thoracic and abdomen surgery because airway pressure might be changed by surgical manipulation. The patients without premedication were ventilated during 5 minutes with 50% oxygen, N2O and isoflurane(1.0 vo1%) by closed circuit ventilator(Physio-Flex(TM)) after slow intravenous injection of thiopental sodium, fentanyl and vecuronium. Then we intubated with I.D. 8 mm sized endotracheal tube for men and with I.D. 7 mm for women. Minute ventilation(100 ml/kg), concentration of isoflurane(1.0 vo1%), gas flow rate and I:E ratio(1:2) were maintained constantly during controlled ventilation and we increased respiratory rates stepwise by 2 bpm from 8 to 24 bpm and decreased tidal volume to maintain minute ventilation. At 10 minutes after change of ventilator setting, we checked peak airway pressure, plateau airway pressure, arterial and end-tidal CO2 tension. And then we calculated compliance and resistance of the total respiratory system. Peak airway pressure and compliance decreased according to decreasing tidal volume and increasing respiratory rates, but arterial CO2 tension and resistance were not changed. We concluded that METHOD of decreasing tidal volume and increasing respiratory rates decrease peak airway pressure and keep minute ventilation to prevent hypercarbia.
Abdomen ; Arterial Pressure ; Barotrauma ; Compliance* ; Female ; Fentanyl ; Humans ; Injections, Intravenous ; Lung ; Male ; Oxygen ; Premedication ; Respiration, Artificial* ; Respiratory Rate* ; Respiratory System ; Risk Factors ; Thiopental ; Tidal Volume* ; Vecuronium Bromide ; Ventilation ; Ventilators, Mechanical

BACKGROUND: Subclavian cannulation is useful for the patients who need long-term maintenance of central venous catheters, but the inadequate location of catheters produces some complications. In pediatric populations, the abnormal placement of subclavian catheters in the internal jugular vein (IJV) is frequent because the angle formed by the subclavian vein and IJV is much larger than in adults. We would therefore propose a technique which will increase the location ratio of subclavian catheters in the superior vena cava (SVC). METHODS: One hundred twenty three patients who received elective or emergent operations were divided into 4 groups which consisted of the 'neck rotation away from the cannulation site' group (RA), 'neck rotation toward the cannulation site' group (RT), 'neck tilt away from the cannulation site' group (TA), 'neck tilt toward the cannulation site' group (TT). We cannulated each group and verified the location of the catheter tip in chest PA for each group. RESULTS: The calculation for the ratio of SVC location to the total cannulation of each group (%SVC) was done and the X2 test was done. Total %SVC was 73.2% and %SVC of each group were 64.9% for the RA group, 77.3% for the RT group, 61.8% for the TA group, and 93.3% for the TT group. A considerable difference was found for total %SVC in the X2 test. The location ratio of the TT group was higher than the others and there was no difference found between the RA, RT, TA groups. CONCLUSIONS: We can conclude that tilting the neck toward the cannulation site would produce a higher ratio of SVC location of the subclavian catheter than other neck positions.
Adult ; Catheterization* ; Catheters* ; Central Venous Catheters ; Humans ; Jugular Veins ; Neck ; Subclavian Vein ; Thorax ; Vena Cava, Superior*