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*

Differential independent lung ventilation is gaining growing attention for management of patients with unilateral pulmonary pathology. This case presents the method for the intraoperative anesthetic management of a patient with empyema and bronchopleural fistula of the left lung which could be controlled by the use of dual-mode asynchronous lung ventilation. The healthy right lung was ventilated by a conventional mechanical ventilator and disessde left lung by a high frequency jet ventilator. The use of endotracheal anesthesia and high frequency ventilation were necessary to prevent drainage of infected secretions into the right side healthy lung and to achieve good gas exchange in the presence of a bronchoplsural fistula. The method used by us, high frequency ventilation for the diseased lung a conventional mechanical ventilation for the other, demonstrated that differential independent lung ventilation using double lumen tube as in this case was suited for handling the problem of a bronchopleural fistula and empyema, further extending the indication for a giant lung bulls, lung cyst, major tracheobronchial disruption and one lung contaminating the other lung with either infected material or blood.
Anesthesia ; Drainage ; Empyema ; Fistula ; High-Frequency Ventilation ; Humans ; Lung* ; Pathology ; Respiration, Artificial ; Ventilation* ; Ventilators, Mechanical

The intensive care unit(ICU) of our hospital is a 12 bed multidisciplinary ICU which is under the auspices of the Department of Anesthesiology. The ICU is essentially a respiratory ICU in which all hospital patients requiring ventilatory support are cared for. The patient population encompasses all causes of respiratory failure, medical and surgical. Another source of referral (surgical and medical) is a large group of critically ill patients with multiorgan failure, especially due to traums. Our experience of intensive care therapy began in the recovery room starting in 1959. Since that time the size and facilities of the ICU have been enlarged. We analyzed 4,514ICU patients admitted between Mar. 1980 and Feb. 1984, to obtain better guidance and management in the ICU. The results of patients was 4,514; 874 patients in 1980, 832 patients in 1981, 895 patients in 1982, 862 patients in 1983 and 1,051 patients in 1984. The ratio of male to female patients was nearly 2:1/ 2) Total Total admission time in the ICU was 17.473 days. The average patient stay was 3.9 days. The number of patients staying in the ICU more than 9 days increased from 54 cases(6%) in 1980 to 101 cases(10%) in 1984. 3) The forty year age group outrumbered the order age group and was 20.5%. The mortality rate of the pre-teen age group was the hightest(19.7%) and the overall mortality was 14.2%(640 cases) during these 5 years. 4) The number of patients admitted to the ICU from the Department of Neurosurgery was 1,218(27%) being the highest among all departments. Oct of 232 patients who died, the Department of Neurosurgery had the highest mortality rate, 19.1%. From the above results, it can be seen that the number of patients admitted to the ICU. the mortality rate and the patients staying more than 9 days in the ICU has increased annually it is claimed that more facilities allowing for monitoring and support, special qualified staffs and a co-ordinated organization will reduce the mortality rate, particularly in the pre-teen age group.
Anesthesiology ; Critical Illness ; Female ; Gangwon-do* ; Humans ; Intensive Care Units* ; Critical Care* ; Male ; Mortality ; Neurosurgery ; Recovery Room ; Referral and Consultation ; Respiratory Insufficiency

Intrapulmonary percussive ventilation(IPV), developed by Forrest M. Bird, M.D., delivers high flow mini-bursts of air along with bronchodilator to the lung at a rate of more than 200 times per minute and has the theoretical potential for aiding in expectoration of secretions through internal percussion. To evaluate effects of IPV on respiratory therapy, we compared IPV with conventional chest physical therapy in patients with excess or retained pulmonary secretions. The results are follows. 1) There were no significant differences among the experimental group with respect to blood pressure, heart rate and respiratory rate. 2) Arterial oxygen tension was significantly increased after IPV. 3) ICU stay was slightly shortened in the experimental group as compared with that in the control group. However, there was no statistical significance. These results indicate that IPV may be effective in respiratory care of patients with excess or retained airway secretions.
Birds ; Blood Pressure ; Heart Rate ; Humans ; Lung ; Oxygen ; Percussion ; Respiratory Rate ; Respiratory Therapy ; Thorax ; Ventilation*

To deterrnine the applicability of the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system in ICU, 552 ICU patients who had been admitted from March 1, 1992 to February 28, 1993 were analysed. The mean APACHE II score of nonsurvivors was significantly higher than that of survivors (p<0.01) and there was significant relationship between mortality rate and APACHE II score [Mortality rate(%) =2.994XAPACHE II score-14.987 (r=0.97, p<0.001)). However, the majority of postoperative patients had scores less than 20 points and the postoperative patients were more unevenly distributed. These results suggest that the APACHE II score may be useful for analyses of ICU patients but its application in postoperative patients must take into consideration the patient's clinical condition.
APACHE* ; Humans ; Intensive Care Units* ; Critical Care* ; Mortality ; Survivors

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