BACKGROUND: Acute normovolemic hemodilution (ANH) and deliberate hypotension (DH) are methods used for reducing homologous transfusions in cases of massive intraoperative bleeding. Using the technique of combining ANH and DH, we can save more homologous blood than a single use of ANH or DH, but the risk of tissue hypoxia may increase. METHODS: Fourteen male dogs were used for this study and divided into two groups. After performing ANH by 25 ml/kg, mean arterial pressures were reduced to 60 mmHg by sodium nitroprusside (S group) or esmolol (E group). The critical oxygen delivery and the hemoglobin concentration at the critical oxygen delivery were determined by measurements of hemodynamic change, systemic oxygen delivery and systemic oxygen consumption during subsequent hemodilution. RESULTS: After performing ANH by 25 ml/kg, the cardiac output was significantly increased, and systemic vascular resistance and hemoglobin concentration were significantly decreased compared with control values. The critical oxygen deliveries were 179.6 ml/min in the S group and 169.1 ml/min in the E group. There was a difference in mean systemic oxygen consumption between the S group (123.4 +/- 16.7 ml/min) and E group (112.9 +/- 15.4 ml/min) above the critical oxygen delivery point (mean +/- SD). The hemoglobin concentrations at the critical oxygen delivery were 2.6 +/- 0.7 g/dl in S group and 4.0 +/- 1.3 g/dl in E group (mean +/- SD). CONCLSIONS: The critical oxygen delivery during hemodilution under DH by sodium nitroprusside was 179.6 ml/min and by esmolol was 169.1 ml/min. However, esmolol was higher in hemoglobin concentrations at the critical oxygen delivery than sodium nitroprusside. These results suggest thathemodilution under DH by esmolol rather than sodium nitroprusside requires more careful monitoring of systemic oxygen delivery for prevention of tissue hypoxia.
Animals ; Anoxia ; Arterial Pressure ; Cardiac Output ; Dogs* ; Hemodilution* ; Hemodynamics ; Hemorrhage ; Humans ; Hypotension* ; Male ; Nitroprusside* ; Oxygen Consumption ; Oxygen* ; Sodium* ; Vascular Resistance

Intracranial aneurysm in pregnancy imposes special consideration for both mother and fetus. During newborn delivery, the risk of aneurysmal rupture should be avoided by careful management. We experienced a case of cesarean section and the clipping of aneurysm in 37 years old pregnant woman at the gestational age of 35 weeks. She had suffered from headache since 30 weeks of gestational age and the ptosis of left eye since 33 weeks of gestational age. Ten millimeter-sized aneurysm of posterior communicating artery was found on the cerebral angiogram. After radial artery cannulation, we anesthetized the woman with nitroprusside infusion, thiopental, succinylchoine and nitrous oxide-oxygen-isoflurane gas mixture. Soon after intubation, systolic blood pressure increased from 140 to 150 mmHg during the infusion of sodium nitroprusside. The delivery of a newborn was done 8 min after induction and clipping of aneurysm was done successfully after the end of cesarean section.
Adult ; Aneurysm* ; Arteries ; Blood Pressure ; Catheterization ; Cesarean Section* ; Female ; Fetus ; Gestational Age ; Headache ; Humans ; Infant, Newborn ; Intracranial Aneurysm* ; Intubation ; Mothers ; Nitroprusside ; Pregnancy ; Pregnant Women* ; Radial Artery ; Rupture ; Thiopental

We examined the causes of delaying or cancellation of the elective surgery at Seoul National University Children's Hospital. The total numbers of pediatric patient for the elective surgery during September 1, 1994, to November 30, 1994, were 1287 and that of delaying or cancellation of surgery were 135. The fraction of medical causes of delaying of the elective surgery was 62.2%, and that of non-medical causes of the elective surgery was 36.3%, and 1.5% was unknown. The single most frequent cause was upper respiratory infection, 42.2% of total delays, and the second was that patient had not be admitted as 16.3%o of total delays. The third frequent cause was no indication for surgery as 6.7%, the fourths were fever and inadequate preparation for surgery (5.2%), and the sixth was that the patient had refused to give an informed consent (3.7%), etc.
Fever ; Humans ; Informed Consent ; Seoul

BACKGROUND: The analysis of beat-to-beat heart rate variability has become a method of assessing the state and health of the autonomic nervous system. Power spectral analysis(PSA) has become one of the most widely used techniques to describe heart rate variability. METHODS: We analyzed the heart rate variability using PSA before and during general and epidural anesthesia in cesarean section. We anesthetized 12 patients by enflurane, and 15 patients by 2% lidocaine via epidural catheter. Automatic computer analysis provided PSA. The PSA contained two major components, a low frequency(LF) at 0.04~0.15 Hz, and a high frequency(HF) at 0.15-0.50 Hz. RESULTS: Before anesthesia, P(LF)(spectral power of LF-unit; sec2/Hz) is 0.06(0.03, 0.34) {median(5 percentile, 95 percentile)}, P(HF), 0.83(0.22, 1.68), total spectral power(Ps), 1.98(O.86, 3.88), and P(LF)/P(HF), 0.67(0.17,1.67) in general anesthesia group. During anesthesia, P(LF) is 0.06(0.03, 0.34), P(HF), 0.12(0.04, 0.76), Ps, 0.43(0.24, 1.71), P(LF)/P(HF), 0.70(0.24, 2.59). In epidural group, before anesthesia, P(LF) is 0.30(0.11, 1.94), P(HF), 0.78(0.14, 1.94), Ps, 1.81(0.58, 5.23), P(LF)/P(HF) 0.47(0.25, 1.34). During anesthesia, P(LF). is 0.14(0.05, 0.41), P(HF), 0.33(0.07, 0.80), Ps, 0.81(0.34, 1.58), P(LF)/P(HF), 0.58(0.22, 1.08). CONCLUSIONS: In general anesthesia, P(LF) P(HF) and Ps during anesthesia showed significant decrease than pre-anesthetic period, but P(LF)/P(HF) did not change. In epidural anesthesia, P(LF)/P(HF) and Ps during anesthesia also decreased, but P(LF)/P(HF) did not change. There were significant differences in degree of decrease in Ps and P(HF) between general and epidural anesthesia, but no differences in and P(LF)/P(HF).
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Autonomic Nervous System ; Catheters ; Cesarean Section* ; Enflurane ; Female ; Heart Rate* ; Heart* ; Humans ; Lidocaine ; Pregnancy

BACKGROUND: The analysis of beat-to-beat heart rate variability has become a method of assessing the state and health of the autonomic nervous system. Power spectral analysis(PSA) has become one of the most widely used techniques to describe heart rate variability. METHODS: We analyzed the heart rate variability using PSA before and during general and epidural anesthesia in cesarean section. We anesthetized 12 patients by enflurane, and 15 patients by 2% lidocaine via epidural catheter. Automatic computer analysis provided PSA. The PSA contained two major components, a low frequency(LF) at 0.04~0.15 Hz, and a high frequency(HF) at 0.15-0.50 Hz. RESULTS: Before anesthesia, P(LF)(spectral power of LF-unit; sec2/Hz) is 0.06(0.03, 0.34) {median(5 percentile, 95 percentile)}, P(HF), 0.83(0.22, 1.68), total spectral power(Ps), 1.98(O.86, 3.88), and P(LF)/P(HF), 0.67(0.17,1.67) in general anesthesia group. During anesthesia, P(LF) is 0.06(0.03, 0.34), P(HF), 0.12(0.04, 0.76), Ps, 0.43(0.24, 1.71), P(LF)/P(HF), 0.70(0.24, 2.59). In epidural group, before anesthesia, P(LF) is 0.30(0.11, 1.94), P(HF), 0.78(0.14, 1.94), Ps, 1.81(0.58, 5.23), P(LF)/P(HF) 0.47(0.25, 1.34). During anesthesia, P(LF). is 0.14(0.05, 0.41), P(HF), 0.33(0.07, 0.80), Ps, 0.81(0.34, 1.58), P(LF)/P(HF), 0.58(0.22, 1.08). CONCLUSIONS: In general anesthesia, P(LF) P(HF) and Ps during anesthesia showed significant decrease than pre-anesthetic period, but P(LF)/P(HF) did not change. In epidural anesthesia, P(LF)/P(HF) and Ps during anesthesia also decreased, but P(LF)/P(HF) did not change. There were significant differences in degree of decrease in Ps and P(HF) between general and epidural anesthesia, but no differences in and P(LF)/P(HF).
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Autonomic Nervous System ; Catheters ; Cesarean Section* ; Enflurane ; Female ; Heart Rate* ; Heart* ; Humans ; Lidocaine ; Pregnancy

An endotracheal tube provides patent airway during general anesthesia. We experienced the cutting of an endotracheal tube during surgical procedure. The patient with bimaxillary protrusion was operated for cosmetic bimaxillary surgery. The patient was intubated via nasotracheal route with a reinforced endotracheal tube. During surgical procedure, we found air bubbles from the nostril in which the entotracheal tube was inserted. Several milliliters of air was infused into the pilot balloon to inflate the cuff, but air bubbles was noticed continuously. We exchanged the endotracheal tube using a tube exchanger. The removed endotracheal tube was partially cut at 22cm from the tip, probably due to the air-driven saw.
Anesthesia, General ; Humans ; Intubation ; Surgery, Oral*

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

There are several EKG changes in cerebrovascular disease(CVD). The wide prominent of inverted T wave is frequently developed in patients with CVD. There were case reports for CVD in patient with ST-segment elevation without myocardial infarction, but the exact mechanism is unknown. EKG abnormalities associated with subarachnoid hemorrhage were first described by Byer et al, in 1947.1 We report the case of 72 years old female patient who developed subarachnoid hemorrhage and intraventricular hemorrhage with ST-segment elevation.
Aged ; Electrocardiography ; Female ; Hemorrhage ; Humans ; Myocardial Infarction ; Subarachnoid Hemorrhage*

BACKGROUND: In the past patients who needed ventilatory care were treated in the hospital but now, thanks to advanced technology, those patients can be treated at their homes. This study was done to evaluate the clinical course of each patient and the effectiveness of home ventilatory care program. METHODS: We reviewed ten cases of ventilator - dependent children who were discharged from the pediatric intensive care unit since we started a home ventilatory care program. RESULTS: Six patients remained ventilator - dependent, three patients died and one patient cannot be reached. The clinical courses before home ventilatory care was decided were diverse. None of the patients needed hospital care related to complications of mechanical ventilatory care. CONCLUSIONS: Despite the small number of patients and the short follow up duration, we concluded that ventilator-dependent children can be successfully managed at their homes.
Child ; Follow-Up Studies ; Humans ; Intensive Care Units ; Respiration, Artificial* ; Ventilators, Mechanical

BACKGROUND: Although concerns exist as to the safety of placing central venous catheters via the internal jugular or subclavian veins, central venous catheterization is often performed in pediatric patients undergoing cardiac surgery and cardiopulmonary bypass. We hypothesized that central venous pressures (CVP) measured in the inferior vena cava by the femoral venous approach accurately reflect those in the superior vena cava. METHODS: We simultaneously measured CVP at the superior vena cava and at the abdominal vena cava or common iliac vein in 56 children scheduled for cardiac surgery. A total of 133 data pairs were collected. A single lumen, femoral catheter and an intrathoracic catheter, according to patient weight were placed intraoperatively in all patients. RESULTS: The ages of the patients ranged from 5 days to 84 months (mean 13.1 months), and heights from 44 to 111 cm (mean 71.8 cm). Measurements of the central venous pressure in the inferior vena cava and in the superior vena cava correlated well (r = 0.93 for spontaneous ventilation, r = 0.85 for mechanical ventilation with a closed sternum, r = 0.69 for mechanical ventilation with an open sternum). CONCLUSIONS: We conclude that while central venous pressures measured in the inferior and superior vena cava are not statistically identical, that differences between the two are well within clinically acceptable limits.
Cardiopulmonary Bypass ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Central Venous Pressure ; Child ; Humans ; Iliac Vein ; Respiration, Artificial ; Sternum ; Subclavian Vein ; Thoracic Surgery ; Vena Cava, Inferior ; Vena Cava, Superior ; Ventilation