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*

The correlation of ventilatory support with sex, age, operation time, aortic cross clamp time was studied in 274 patients undergone open heart surgery after dividing them into total, congenital heart disease, acquired heart disease groups. 1) Ventilatory support time was not significantly different between male and female. 2) In total group, ventilatory support time increased significantly with an increase of pump time, aortic cross clamp time (p<0.05) and age (p<0.01). 3) In congenital heart disease group, ventilatory support time increased significantly with an increase of operation time (p<0.05), pump time, aortic cross clamp time (p<0.001). 4) In acquired heart disease group, ventilatory support time increased significantly with an increase of age (p<0.001).
Anesthesia* ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart* ; Humans ; Male ; Thoracic Surgery*

A number of recent reports have described the usefulness of the epidural injection of narcotics for the relief of postoperative pain. But the epidural use of narcotic agonist-antagonist, nalbuphine hydrochloride, has not been reported. To study the effect of epidural nalbuphine hydrochloride for postoperative pain relief, we divided 73 patients into 5 groups randomly: 3 mg nalbuphine hydrochloride in 10 ml saline (group 1, n=9); 4 mg nalbuphine hydrochloride in 10 ml saline (group 2, n=14); 5 mg nalbuphine hydrochloride in 10 ml saline (group 3, n=21); 3 mg morphine in 10 ml saline (group 4, n=16); 4 mg morphine in 10 ml saline (group 5, n=13). The results were as follows 1) The onset time of analgesic effect were average 15~20 minitues in all groups 2) The durations of analgesia of epidural nalbuphine groups were (average; 5~7 hours) significantly shorter than morphine groups (average; 31~32 hours). 3) The degree of analgesia were same between 5 groups 4) The complications were nausea, vomiting and pruritus in all groups, but the frequency of pruritus in morphine groups was more than nalbuphine groups (p<0.05). 5) Urinary retention was observed only in morphine groups. In conclusion, the result of our study suggests that nalbuphine hydrochloride be better agent than morphine in terms of complication for postoperative pain relief but the duration of action is shorter than morphine, when injected epidurally.
Analgesia ; Humans ; Injections, Epidural ; Morphine ; Nalbuphine* ; Narcotics ; Nausea ; Pain, Postoperative* ; Pruritus ; Urinary Retention ; Vomiting

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*