We experienced a case of unexpected sudden cardiac arrest, which developed during the anhepatic phase of living-related liver transplantation. The patient was a 56-year old man diagnosed with liver cirrosis. He had stable angina and congestive heart failure. Preoperative EKG, chest x-ray, arterial blood gas analysis and vital signs were all within normal limits. Cardiac echography was normal except for left atrial enlargement and diastolic dysfunction (grade I). Coronary angiography showed no coronary stenosis. About 10 min after the inferior vena cava had been clamped, the sinus rhythm changed suddenly to ventricular tachycardia. Lidocaine was administered and the PA catheter removed immediately but ventricular fibrillation and asystolic cardiac arrest followed. Cardiac rhythm returned about 15 min after the onset of asystole, followed by supraventricular tachycardia (up to 180 beats/min). The EKG suddenly returned to a normal sinus rhythm. He had no further episodes of arrhythmia and recovered without complication.
Angina, Stable ; Arrhythmias, Cardiac ; Blood Gas Analysis ; Catheters ; Coronary Angiography ; Coronary Stenosis ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Arrest ; Heart Failure ; Humans ; Lidocaine ; Liver Transplantation* ; Liver* ; Middle Aged ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Thorax ; Ultrasonography ; Vena Cava, Inferior ; Ventricular Fibrillation ; Vital Signs

From 39 eyes of 31 cases which received the cataract operation performed under the surface anesthesia by 2 specialists, 2 senior, 1 third and 1 first year residents at Red cross Society, the following results were obtained. 1. The maximal value of intraocular pressure was 19.0mmHg, minimal value, 11.5mmHg and the average, 14.9mmHg just before the cataract operation. 2. The rupture of the capsule was 21.4% and the loss of vitreous body, 7.1% in intraocular lens extrations. 3. The degree of anteior projetion of the eyes had not direct relationship with the intracapsular lens extraction. 4. All patients who received the cataract operation were required sufficient akinesia sedation. 5. Within normal intraocular pressure, the intraocular pressure didn't seem to have any effect to the loss of vitreous body.
Anesthesia ; Cataract* ; Humans ; Intraocular Pressure* ; Lenses, Intraocular ; Red Cross ; Rupture ; Specialization ; Vitreous Body

Brainstem auditory response abnormalities directly reflect disturbance of neural function rather than the underlying anatomic cause of that disturbance. The test has advantage in detecting lesions that alter electrophysiology but do not produce detectable alterations of radiodensity, displace surrounding structures or change vascular supply and permeability. A sequence of seven low-amplitude potentials that occur in the initial 10 msec following click signals can be recorded from scalp electrodes in 44 patient with focal brain lesions using computer averaging techniques. The potentials, termed auditory brainstem responses, are thought to be the far-field reflection of electrical events originating in the auditory pathway during its course through the brainstem. We have studied auditory brainstem evoked potential responses in a variety of focal brain lesions and found them to be of assistance in evaluating the localization of pontomedullary, pons, midbrain, thalamus, subcortical and functional recovery. 1) Distortion of early components (type I) was occured in the brainstem lesions. 2) Distortion of late components (type II) was developed in the diencephalon or subcortical lesions. 3) Distortion of all components (type III) was developed in the brainstem and diffuse brain contusions. 4) Serial recordings provided information about the evolution of brain stem lesions and good functional recovery marker.
Auditory Pathways ; Brain Injuries ; Brain Stem* ; Brain* ; Diencephalon ; Electrodes ; Electrophysiology ; Evoked Potentials* ; Evoked Potentials, Auditory, Brain Stem ; Humans ; Mesencephalon ; Permeability ; Pons ; Scalp ; Thalamus

Brainstem auditory response abnormalities directly reflect disturbance of neural function rather than the underlying anatomic cause of that disturbance. The test has advantage in detecting lesions that alter electrophysiology but do not produce detectable alterations of radiodensity, displace surrounding structures or change vascular supply and permeability. A sequence of seven low-amplitude potentials that occur in the initial 10 msec following click signals can be recorded from scalp electrodes in 44 patient with focal brain lesions using computer averaging techniques. The potentials, termed auditory brainstem responses, are thought to be the far-field reflection of electrical events originating in the auditory pathway during its course through the brainstem. We have studied auditory brainstem evoked potential responses in a variety of focal brain lesions and found them to be of assistance in evaluating the localization of pontomedullary, pons, midbrain, thalamus, subcortical and functional recovery. 1) Distortion of early components (type I) was occured in the brainstem lesions. 2) Distortion of late components (type II) was developed in the diencephalon or subcortical lesions. 3) Distortion of all components (type III) was developed in the brainstem and diffuse brain contusions. 4) Serial recordings provided information about the evolution of brain stem lesions and good functional recovery marker.
Auditory Pathways ; Brain Injuries ; Brain Stem* ; Brain* ; Diencephalon ; Electrodes ; Electrophysiology ; Evoked Potentials* ; Evoked Potentials, Auditory, Brain Stem ; Humans ; Mesencephalon ; Permeability ; Pons ; Scalp ; Thalamus

An increasing interest in intravenous anesthetic techniques has resulted from the availability of more efficacious intravenous agents, possible discomfor of the patient on endotracheal intubation and the concern over anesthetic pollution in the operating room. This study was done to investigate the effect of intravenous anesthesia with ketamine on the respiratory system by comparing arterial blood gas analysis before and after the procedure. Analysis of arterial blood for PCO2, PO2, pH, and excess were carried out. Heart rate and blood pressure were monitored on 15 patients in ASA class l for diagnostic or short procedures. Each patient was premedicated with atropine 0.01mg/kg and valium 0.2mg/kg intramuscularly 30 minutes before the procedure. ketamine was administered intravenously 1.0~1.5 mg/kg or intramuscularly 3~5mg/kg for induction of anesthesia. The anesthesia was maintained with ketamine 0.5~1.0mg/kg and valium 0.1mg/kg ever 5 to 10 minutes. The results of this study showed that ketmine anesthesia seemed not to cause any untoward effect on respiratory function. In other words, ketamine seems to be a safe and good intravenous anesthetic agent for diagnostic or short surgical procedures.
Anesthesia ; Anesthesia, Intravenous* ; Atropine ; Blood Gas Analysis ; Blood Pressure ; Diazepam ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Intubation, Intratracheal ; Ketamine* ; Operating Rooms ; Respiratory System

Midazolam, a water soluble benzodiazepine, was compared with diazepam as the changes of eardiopulmonary function during sedation under the spinal anesthesia in elderly patients. The results were as follows; I) Cardiovascular effect. At the conclusion after diazepam 0.05 mg/kg(Group D) or midazolam 0.02 mg/kg(Group M) injection, systolic, diastolic pressure and heart rate were significantly decreased(P<0.05) in the both group from 3 min to 30 min, but maintained within normal range. However, it is not significant difference that each group. 2) Respiratory effect. SaO decreased significantly at 3 min. in M-group after midazolam injection but there was not significant difference from change in D-group. Respiratory rate, pH and PaCO2 were not significantly changed between D-group and M-group. However, PaO2 was significantly decreased(p<0.05) within normal range at 3 min. in M-group after midazolam IV and significant difference between both groups. From the above results, We have concluded that IV administration of small dose of diazepam or midaaolam during spinal anesthesia had a little changed in cardiopulmonary function. However, sedative effect was efficient.
Aged* ; Anesthesia, Spinal* ; Benzodiazepines* ; Blood Pressure ; Diazepam ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypnotics and Sedatives ; Midazolam ; Reference Values ; Respiratory Rate

The study was designed to investigate the effect of serum glucose, insulin and insulin resistance on the risk of prostate cancer (CaP) and on the clinicopathological characteristics in Korean men. Subjects were retrospectively recruited from 166 CaP patients underwent radical prostatectomy and 166 age-matched benign prostatic hyperplasia (BPH) patients. The serum was taken on the morning of the day of operation and insulin resistance was assessed by homeostasis model assessment insulin resistance index (HOMA-IR). Men in highest tertile of insulin was associated with 55% reduced odds of CaP than those with the lowest tertile (OR = 0.45, 95% CI = 0.23-0.89, P = 0.022). The patients in highest tertile of insulin had a more than 5.6 fold risk of locally advanced stage than those in the lowest tertile (OR = 5.62, 95% CI = 1.88-16.83, P = 0.002). Moreover, the patients in the highest tertile HOMA-IR group was associated with an increased risk of locally advanced stage than the lowest tertile group (OR = 3.10, 95% CI = 1.07-8.99, P = 0.037). These results suggest that elevated insulin and insulin resistance are associated with the advanced pathological stage of prostate cancer in Korean patients.
Aged ; Asian Continental Ancestry Group ; Blood Glucose/analysis ; Humans ; Insulin/*blood ; *Insulin Resistance ; Male ; Middle Aged ; Neoplasm Grading ; Odds Ratio ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/etiology/*pathology ; Republic of Korea ; Retrospective Studies ; Risk Factors

The scimitar syndrome, a rare complex anomaly, is defined as an anomalous right pulmonary venous drainage, partial or complete, to the inferior versa cava. The shape of the Turkish curved sword (scimitar) huts provided the name of this syndrome. Additional characteristics of this syndrome such as hypoplasia of the right lung and of the right pulmonary arterial tree, anomalous arterial supply of the right lung from the aorta, dextrocardia and bronchial anomalies are common. Recently we experienced a case of scimitar syndrome (adult form) in a 19-year-old woman patient, so we report the case with a brief review of the literature.
Aorta ; Dextrocardia ; Drainage ; Female ; Humans ; Lung ; Scimitar Syndrome ; Young Adult

BACKGORUND: To choose optimal potassium free solutions in chronic renal failure patients, we studied the effects of 0.45% or 0.9% saline solutions on the serum sodium concentrations of patients undergoing kidney transplantation surgery. METHODS: Sixty two patients, ASA physical status iii iV, undergoing kidney transplantation surgery, were allocated to receive either 0.45% saline (n = 26) or 0.9% saline solutions (n = 36). The patients received 2 L of 0.45% or 0.9% saline solutions with a CVP of 10 mmHg prior to a renal vein anastomosis. Serum sodium and potassium concentrations were measured before (Na0, K0) and after the administration of 2 L of 0.45% or 0.9% saline solutions (Na2, K2), respectively. RESULTS: Serum sodium concentrations decreased after the administration of 0.45% saline solutions, and after administrating 2 L of 0.9% saline, the serum sodium concentrations increased in patients with baseline serum sodium concentrations lower than 136 mEq/L. When we administered 0.9% saline, which had a sodium concentration lower than the serum sodium concentration, the serum sodium concentration measured after 2 L of 0.9% saline infusion proportionally decreased in patients with baseline serum sodium concentration greater than 136 mEq/L (P<0.001). CONCLUSiONS: For ideal fluid selection in chronic renal failure patients, this study suggests a 0.45% saline solution for chronic renal failure patients with a baseline serum sodium concentration below the normal range and a 0.9% saline solution for patients with a baseline sodium concentration within the normal range.
Humans ; Kidney Failure, Chronic* ; Kidney Transplantation ; Potassium ; Reference Values ; Renal Veins ; Sodium Chloride ; Sodium*

BACKGROUND: The purpose of this study is to evaluate the patients' general perception about the analgesics and the effects of the preoperative education about analgesics and patient-controlled analgesia (PCA). METHODS: One hundred patients scheduled for elective gastrectomy were randomly allocated into two groups. In control group (n = 50), patients were given conventional preanesthetic visit with questionnaire survey on PCA one day before operation. In study group (n = 50), patients were sufficiently explained about postoperative analgesia and PCA by anesthesiologist and given precise explanation sheet about PCA. Total amounts of drug used in PCA as well as rescue analgesics, the pain scores, and side effects were compared. RESULTS: 62.2% of patients had much information from various sources that analgesics effects positively in the recovery phase, but actually 73.7% of patients considered that analgesics do not seem to have any influence on the recovery after operation. There was no difference between the amounts of total PCA used, rescue analgesics, and the pain scores. However, the educated patients complained less dizziness at postoperative days (POD) one. Also, the number of patients excluded from study due to the PCA discontinuation secondary to related side effects was less in educated patients (P = 0.025). CONCLUSIONS: Preoperative education about analgesics and PCA failed to demonstrate significant decrease in the amount of analgesics and of pain scores. However, it lowered the incidence of PCA discontinuation due to side effects.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics* ; Dizziness ; Education* ; Gastrectomy ; Humans ; Incidence ; Passive Cutaneous Anaphylaxis ; Postoperative Care