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 postanesthetic nausea and vomiting during the recovery period was regarded as one of the almost inevitable and undesirable sequelae of surgery and anesthesia. With the progress of anesthetic technics and agents the incidence of this complication has been reduced. The analysis of the incidence of postanesthetic nausea and vomiting that occurred in the postanesthetic recovery room was performed on 4239 patients who received general inhalation anesthesia from Nov. 1988 to Apr. 1989 in Seoul National University Hospital. The overall incidences of postanesthetic nausea and vomiting were 0.4% and 0.5% of 4239 patients, respectively. Although the use of isoflurane among anesthetics was followed by slightly lower incidence significant. The incidence was not significantly related to sex, operation site, and the department of surgery. The incidence decreased much more than before, but because nausea and vomiting can produce undesirable complications they should be carefully prevented and treated.
Anesthesia ; Anesthesia, Inhalation ; Anesthetics ; Humans ; Incidence ; Isoflurane ; Nausea* ; Recovery Room ; Seoul ; Vomiting*

No abstract available.

Fluid resuscitation is a basic treatment in hemorrhagic shock. We compared the circulatory responses to fluid resuscitation of 10% pentastarch with those of fresh whole blood and plasmanate in hemorrhagic shock. Eighteen mongrel dogs were bled 24 ml/kg and replaced by equivalent amounts of fresh whole blood(n=6, group B), pentastarch(n=6, group P) and plasmanate(n=6, group PL). Hemodynamic measurements and calculations were performed before and after bleeding and after volume therapy. The decrease of hematocrit and platelet count after volume replacement indicate that hemodilutional effect was maximum 30 min after volume therapy and significantly greater in group P than PL(p<0.05). Central venous pressure(CVP), pulmonary capillary wedge pressure(PCWP) and cardiac index(CI) were increased to 146-189%, 146-172% and 146-175% in group P, respectively during 60 min. These changes were significantly greater than group B and PL(p<0.05). There was delayed recovery of mean arterial pressure in group PL(92% 30 min after volume therapy) compared with group B and P(92% and 93% 5 min). Also group P and PL showed significant prolongation in prothrombin time and partial thromboplastin time during experiment(120 min) and these were significantly more prolonged in group P than PL(P<0.05). And group P showed similar O transport and O extraction ratio to those of group B. The increases in plasma catecholamine were observed after hemorrhage, but no significant changes 5 and 30 min after volume therapy. This suggests that the neurohumoral response to hemodilution was not marked. Mixed venous O2 saturation(SvO2) was directly proportional to CI during experiment(r=0.69, p<0.01), indicating that SvO2 can represent CI during shock and volume therapy. In conclusion, l0% pentastarch is useful as a substitute for fresh whole blood or plasmanate.
Animals ; Arterial Pressure ; Blood Transfusion, Autologous* ; Capillaries ; Dogs* ; Hematocrit ; Hemodilution ; Hemodynamics ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; Partial Thromboplastin Time ; Plasma ; Platelet Count ; Prothrombin Time ; Resuscitation* ; Shock ; Shock, Hemorrhagic*

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*

Ten percent pentastarch is a low-molecular weight hydroxyethyl starch with greater on- cotic pressure and shorter intravascular persistence than 6% hetastarch The purpose of this study was to determine the safety and efficacy of pentastarch as a plasma-volume expand- er as compared to plasmanate infusion in patients undergoing heart surgery. We were par- ticularly interested in assesaing hemodynamic responses and effects of pentastarch on bleeding and coagulation, and prospectively studied 24 patients undergoing open heart surgery or coronary revascularization. 12 patients were randomized to receive 10ml/kg of either plasmanate(group I) or 10% pentastarch(group II) and simultaneously to predonate the blood as the same amounts of colloid solution. Hemodynamic and coagulation profiles were measured after induction of anestheaia and 5min and 30min after following colloid infusion. The effects of colloid infusion with pentaatarch on hemodynamic profiles(heat rste, mean arterial p ure, mean pulmonary arterial preasure, cardiac index, pulmonary capillary wedge pressure, central venous pressure, systemic venous resistsnce, pulmonary venous resistance) were not significantly different from those of plasmanate. The studies for five patients in plasmanate group were stopped because of severe hypotension during colloid infusion. The decrease in hemoglobin and platelet count were significantly greater in the pentastarch group than in the plasmanate group. Changes in PT, aPTT, serum osmolarity, PaO2 and PvO2, were similar between tbe two groups. We conclude that pentastarch is a safe and effective colloid as similar to plasmarate to use as a plasma-volume expander.
Central Venous Pressure ; Colloids ; Heart* ; Hemodynamics* ; Hemorrhage ; Humans ; Hydroxyethyl Starch Derivatives* ; Hypotension ; Osmolar Concentration ; Platelet Count ; Prospective Studies ; Pulmonary Wedge Pressure ; Starch ; Thoracic Surgery*

Ten percent pentastarch is a low-molecular weight hydroxyethyl starch with greater on- cotic pressure and shorter intravascular persistence than 6% hetastarch The purpose of this study was to determine the safety and efficacy of pentastarch as a plasma-volume expand- er as compared to plasmanate infusion in patients undergoing heart surgery. We were par- ticularly interested in assesaing hemodynamic responses and effects of pentastarch on bleeding and coagulation, and prospectively studied 24 patients undergoing open heart surgery or coronary revascularization. 12 patients were randomized to receive 10ml/kg of either plasmanate(group I) or 10% pentastarch(group II) and simultaneously to predonate the blood as the same amounts of colloid solution. Hemodynamic and coagulation profiles were measured after induction of anestheaia and 5min and 30min after following colloid infusion. The effects of colloid infusion with pentaatarch on hemodynamic profiles(heat rste, mean arterial p ure, mean pulmonary arterial preasure, cardiac index, pulmonary capillary wedge pressure, central venous pressure, systemic venous resistsnce, pulmonary venous resistance) were not significantly different from those of plasmanate. The studies for five patients in plasmanate group were stopped because of severe hypotension during colloid infusion. The decrease in hemoglobin and platelet count were significantly greater in the pentastarch group than in the plasmanate group. Changes in PT, aPTT, serum osmolarity, PaO2 and PvO2, were similar between tbe two groups. We conclude that pentastarch is a safe and effective colloid as similar to plasmarate to use as a plasma-volume expander.
Central Venous Pressure ; Colloids ; Heart* ; Hemodynamics* ; Hemorrhage ; Humans ; Hydroxyethyl Starch Derivatives* ; Hypotension ; Osmolar Concentration ; Platelet Count ; Prospective Studies ; Pulmonary Wedge Pressure ; Starch ; Thoracic Surgery*

For autologous transfusion, intraoperative salvage technique with Cell Saver Apparatus was used in open heart surgery. Seventy-eight patients were involved in this study and divided into two groups. They were group of salvage(n=58) and non-salvage(n=20). In each group, they were also divided into four groups of CHD(who underwent surgery of congenital heart disease), UNDO(who underwent first-valvular surgery or repair of dissecting aneurysm), REDO(who underwent redo-valvular surgery) and CABG(who underwent coronary artery bypass surgery) according to the degree of blood loss during surgery. Amount of blood obtained from Cell Saver Apparatus was 811+/-273(mean+/-std) ml. Hematologic profile of blood from this apparatus was as follows, 1) Hemoglobin: 18.2+/-2.0(g/dl), 2) Hematocrit: 52.8+/-5.6(%), 3) Platelet: 35K+/-21K (mm). The hank blood utility ratio{No. of patients who used hank blood (No. of patients who used bank blood+who didnt use bank blood)x100(%)) tended to increase in non-salvage group and statistically significant(p< or =0.05) only in CHD group(non-salvage group vs. salvage group= 63% vs. 17%). And the amount of bank blood transfused tended to be higher in non-salvage group than salvage group and statistically significant(p< or =0.05) only in CHD group. This study suggested that intraoperative salvage technique with Cell Saver Apparatus could decrease the use of bank blood in open heart surgery.
Blood Platelets ; Coronary Artery Bypass ; Heart* ; Hematocrit ; Humans ; Thoracic Surgery*