Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation

The Humphrey circuit system function with the efficiency of the Lack system for spontaneous respiration and of the Bain system for controlled ventilation. It is designed to incorporate into a single system the advantages of the Mapleson A, D, and E type systems and to be available in coaxial and non-coaxial forms. This study was done to study the functions of a new anesthetic breathing system and to evaluate the adequacy of the recommended fresh gas flow. For spontaneous and controlled ventilation the system required a low fresh gas flow to achieve normocarbia(In the Lack circuit system, 60ml/min., is useded and in the Bain circuit system, 70ml/min.). The advantage of this system was that it was simple to operate and maintain, more easily sterilized and applicable in academic use. Further more the non-coaxial form of the circuit overcame the hazard of the inner tube complication. But this form was thought to have the problem of humidifying the inspired gas which still has to be sutdied. This multicircuit system was used satisfactorily with low fresh gas flow under spontaneous and controlled ventilation maintaining normal range of arterial carbon dioxide. It may become one of the preferred semiclosed breathing systems because of simplicity, multipurpose usefulness and other advantages.
Carbon Dioxide ; Reference Values ; Respiration ; Ventilation

BACKGROUND: Malpositioning of the endotracheal tube within airway after intubation may results in serious complications, such as accidental extubation and inadvertent endobronchial intubation. Therefore, early detection of malposioning of the endotracheal tube is very impotant for deciding patient's prognosis. METHODS: We assessed the distance from the tip of the endotracheal tube to the carina according to the patient's age, sex, and the time, the location, and the route of intubation. The chest x-ray was taken for 333 patients (men, 226: women, 107) who were admitted to the intensive care unit of Wonju Christian Hospital from march 1, 1995 to February 28, 1996. Chest x-ray was obtained after intubation to verify endotracheal tube position. Appropriate endotracheal tube position on chest x-ray was defined as between 2 and 6 cm above the carina. RESULTS: Of the 333 intubations, 106 (31.8%) endotracheal tubes were inappropriately placed according to the chest x-ray. The percentage of malpositioned endotracheal tubes (<2 cm) was higher in women than in men (11.2% vs. 5.3%, p<0.05), with higher in night (7 PM to 7 AM) than in day (7 AM to 7 PM) (42% vs. 24%, p<0.05). Distance from the carina to the tip of endotracheal tube is 4.34 +/- 1.77cm in women and 5.23 +/- 1.64cm in men. Thus, position of the endotracheal tube in women is deeper than men (p<0.001). CONCLUSIONS: We conclude that the chest x-ray for confirmation of endotracheal tube position after endotracheal intubation may remain the standard of practice. And endotracheal tube position should be carefully assessed immediately after tracheal intubation, particularly in women and at night.
Female ; Gangwon-do ; Humans ; Incidence* ; Intensive Care Units ; Intubation ; Intubation, Intratracheal* ; Male ; Prognosis ; Thorax*

To evaluate the importance of enflurane metabolism, we selected eleven hepatitis B surface antigen positive, special antigen, antibody negative patients who were schedule for elective surgery. Their physical status were ASA class I or II, liver function tests shoused normal state, and they had no previous history of operation or liver disease. The result were concluded that the influence of enflurane anesthesia on liver function was not significant for anesthesia & surgery.
Anesthesia* ; Appointments and Schedules ; Enflurane* ; Hepatitis B Surface Antigens ; Humans ; Liver ; Liver Diseases ; Liver Function Tests ; Metabolism

It is well known that some inhalation anesthetics and ancillary drugs are metabolized in the liver. Since this fact was reported (Read, 1672: Dripps, 1977) the influence of different anesthetics on the liver has been of great interest up to date. The most cause of postoperative hepatic dysfunction seems to be acute viral hepatitis, but there are some other causes such as anesthetic damage and untoward reactions to the drugs used in the intraoperative or postoperative periods(Bahior & Davidson, 1967: Bruce, 1972). Halothane is usually a safe and effective inhalation anesthetic agent but on occation it has damaged the liver. Many papers have reported these untoward reactions, and then attention began to be paid to other anesthetic agents. The author selected random samples of 100 adult femal patients who had lower abdominal operations at Wonju Christian Hospital between May 1982 to August 1982. Their physical status was ASA class l & ll, liver function tests were within normal limits and they had no previous history of operation or liver disease. They were divided into five groups according to the anesthetic agent used(halothane, ethrane, ether, Thalsmonal neuroleptanesthesia and lidocaine epidural anesthesia). The liver function tests were performed before surgery, and on the 1st, 3rd, 5th, and 7th postoperative days. The results were as follows. 1) BUN, total protein, albumin, globulin and total cholesterol were not significantly changed. 2) The values of SGOT &SGPT were slightly increased elevated on the first postopday, and on the 3rd day after operation and then gradually decreased. On the 7th day after operation they had returned to the preoperative levels. The changes of the values were within normal limits. 3) Alkaline phosphatase, total bilirubin and direct bilirubin were not significantly influenced by the anesthetic agents. It is suggested that the influence of variable anesthetic agent on the liver is not significant, and that the changes of the liver function tests were minimal, and the values of the tests have usually returned to normal by the 7th day after operation.
Adult ; Alkaline Phosphatase ; Anesthetics* ; Anesthetics, Inhalation ; Aspartate Aminotransferases ; Bilirubin ; Cholesterol ; Enflurane ; Ether ; Gangwon-do ; Halothane ; Hepatitis ; Humans ; Inhalation ; Lidocaine ; Liver Diseases ; Liver Function Tests ; Liver*

Spinal anesthesia is a relatively ease and useful technique and provides excellent analge-sia and relaxation for a great number of surgical procedures. It has been used widelr until the introduction of Muscle relaxant to the general anesthesia. However, complications, including hypotension, nausea, postspinal headache, neurologic sequelae, and death have been reported. In addition to those problems, number of failures after administration of spinal anesthetic haute been reported. We collected the 316 cases of spinal anesthesia given between January to May, 1986.the incidence of failure and the int-errelationships between the incidence and technical factors were reuiewed. Variables exam-ined including the patient population, the technical aspects of performing subarachnoid tap and subsequent blockade, and the level 7f training of anesthetist. Total number of patients with administration of anesthesia for 5 monthes was 2075; 316 patients in spinal anesthesia(15.237). We found a 4, l1% incidence of spinal failure, defined as the need to use general anesthesia or frequent administration of anlgesics during the surgical procedures. The technical factors(position of patients, approach method, puncture sites, needle gauge, agents type, and the performer) were insignificantlr contributed to the failure rate, but the amount of local anesthetic was showed statistical significance.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Headache ; Humans ; Hypotension ; Incidence* ; Nausea ; Needles ; Punctures ; Relaxation

In recent years the use of epidural opiates has increased and although this method of pain relief has shown good results in clinical practice it is still subject to certain drowba-cks, the most serious of which appears to be delayed respiratory depression. Since ketamine administered systemically is unlikely to produce respiratory depression it seemed worthwhile to investigate the possibility of exploiting the potent analgesic property to ketarnine by its epidural administration. The analgesic effect of ketamine 4 mg, administered epidural space, was evaluated. The duration of pain relief varied from less than 3 hours in 20% to over 24 hours in 30 % of the cases. In 62.5% of the cases pain relief exceeded 6 hours. There was no evidence of respiratery depression, and there no postoperative neurologic sequelae. The present results indicated the need for farther studios to compare the efficacy and safety of epidural ketamine with the response to epidural opioids for the relief of posto- peratiue pain.
Analgesics, Opioid ; Depression ; Epidural Space ; Ketamine* ; Pain, Postoperative* ; Respiratory Insufficiency

The MERA-F breathing circuit is a light in weight, disposable, multi-purpose breathing system corsisting of double coaxial tubes ; inner tube for inspiration and outer corrugate tube for expiration. This circuit is especially effective on head and neck operations that may lead to :Iccidental disconnection or extubation. And the circuit provides effective carbon dioxide elimination with only conventional total fresh gas flow(70 ml/kg/minute) and appropriate maintenance of heat and humidity of the airway mucosa.
Carbon Dioxide ; Head ; Hot Temperature ; Humidity ; Mucous Membrane ; Neck ; Respiration*

Primary aldosteronism is typically characterized by hypertension, hypokalemia, elevated plasma aldosterone concentration, and suppressed plasma renin activity. Surgieal excision of the tumor mostly cures hypertension as well as electrolyte and hormonal abnormalities in patient with aldosterone-producing adenoma. We have experienced the anesthetic management of unilateral adrenalectomy in a 32 years old male, who was diagnosed as aldosterone-producing adenoma, under the general anesthesia with careful monitoring. Postoperative recovery was uncomplicated.
Adenoma ; Adrenalectomy ; Adult ; Aldosterone ; Anesthesia, General ; Humans ; Hyperaldosteronism* ; Hypertension ; Hypokalemia ; Male ; Plasma ; Renin

The transcutaneous technique of measuring oxygen(tcPO2) and carbon dioxide(tcPCO2) was studied in 25 adults, without cardiopulmonary dysfunction, undergoing enflurane-nitrous oixde or pethidine-diazepam-ditrous oxide anesthesia, to determine the relationship between tcPO2, and PaO2, tcPCO2 and PaCO2. Transcutaneous measuring values were accurate clinically useful trend indicators of arterial blood gas changes under general anesthesia(tcPO2: r=0.93, tcPCO2: r=0.86). Although such a technique was less predictable of absolute arterial values in anesthetized subjets, because of many variables, it was a noninvasive, continuous method for monitoring. It is suggested that more widespread application of such monitoring awaits definitive development of a precise electrode and technique.
Adult* ; Anesthesia ; Anesthesia, General* ; Blood Gas Monitoring, Transcutaneous ; Carbon ; Electrodes ; Humans