No abstract available.
Intubation, Intratracheal*

Postoperative brain damage is one of most serious complications of cardiopulmonary bypass (CPB). To prevent brain damage during CPB, adequate cerebral perfusion for cerebral oxygen demand should be maintained. This study monitored jugular venous oxyhemoglobin saturation (SjO₂), which reflects the overall balance of cerebral oxygen supply and demand, intermittently in 10 patients undergoing cardiac surgery. At the initiation of CPB, in spite of a significant decrease in mean arterial pressure, SjO₂ did not change, and it was stable during the hypothermic period of CPB. But a significan reduction in SjO₂ was observed during the rewarming period, and SjO₂ had an inverse linear correlation with esophageal temperature. Furthermore, the percent decrease of SjO₂ was related to rewarming speed. Therefore, therapeutic approaches for SjO₂ desaturation include slower rewarming, increasing cerebral blood flow, decreasing the cerebral metabolic rate for oxygen, increasing oxygen content, and increasing perfusion flow rate.
Arterial Pressure ; Brain ; Cardiopulmonary Bypass ; Cerebrovascular Circulation ; Humans ; Oxygen ; Oxyhemoglobins* ; Perfusion ; Rewarming ; Thoracic Surgery

BACKGROUND: In previous our retrospective study, we concluded that administered fluid volume, duration of operation, operative procedures and anesthetic techniques were the major factors of postoperative urinary retention. However, the administered fluid volume, age, types and duration of the operation confined to hemorrhoidectomy was questioned as a precipitating factor. The high retention rate in spinal anesthesia is also questioned. METHODS: We investigated these possible precipitating factors of urinary retention in healthy patients (n=154) undergoing hemorrhoidectomy. The patients were randomly divided into three different anesthetic techniques: caudal (2% lidocaine 300 mg with 1 : 200,000 epinephrine), spinal (0.5% tetracaine 5 mg with epinephrine 0.1 mg or 5% lidocaine 40 mg) and general (enflurane, N2O, vecuronium). Urinary retentin was searched according to above factors following surgery. RESULTS: The overall urinary retention rate was 46.1%. The retention rate in patients with spinal anesthesia was higher than that in those with other anesthetic techniques (p<0.05). There was no significant difference between patients with lidocaine and tetracaine spinal anesthesia in urinary retention rate. The administered fluid volume in patients with urinary retention was significantly higher than that of patients without retention (p<0.05). Age, duration and types of hemorrhoidectomy did not significantly affect urinary retention rate. CONCLUSIONS: Restriction of fluid administration and avoidance of spinal anesthesia are necessary in reducing postoperative urinary retention following hemorrhoidectomy.
Anesthesia, Spinal ; Epinephrine ; Hemorrhoidectomy* ; Humans ; Lidocaine ; Precipitating Factors ; Retrospective Studies ; Surgical Procedures, Operative ; Tetracaine ; Urinary Retention*

BACKGROUND: This study examined hemodynamic variables, oxygen delivery, extraction, and consumption in response to acute progressive hypoxia and hypercarbia in the setting of apnea. METHODS: Apnea was induced in 9 healthy mongrel dogs by disconnecting animals from mechanical ventilation of 30 minutes with pure oxygen. Hemodynamic variables, oxygen transport, extraction, and consumption were rapidly and repeatedly measured using pulmonary arterial and arterial catheters until cardiac output was undetectable. RESULTS: The baseline PaO2, PaCO2, pH, base excess were 318 +/- 137 mm Hg, 36 +/- 3.5 mm Hg, 7.30 +/- 0.06, 6.81 +/- 2.65 mmol/l respectively. Hypercarbia and hypoxemia (76 +/- 33 mm Hg) was first noted at 1 and 4 minute respectively. Base excess was not changed. Indices of preload (PCWP and CVP) were increased early in the time course (p<0.05). In contrast, indices of afterload (SVR) increased later, just before cardiac decompensation began (p<0.05). No significant reduction of cardiac output, oxygen delivery, extraction, and consumption was detected just until abrupt cardiac decompensation started, 5 minute. CONCLUSIONS: These data suggest that the early increase in preload was primarily due to hypercarbia whereas the late increase in afterload was due to hypoxemia, but the main cause of acute cardiac decompensation was a critical decrease in arterial oxygen tension with some contribution of increased preload and afterload.
Animals ; Anoxia ; Apnea* ; Cardiac Output ; Catheters ; Dogs* ; Hemodynamics* ; Hydrogen-Ion Concentration ; Oxygen* ; Respiration, Artificial

BACKGROUND: During laryngoscopy, force applied to the soft tissue are assumed to cause circulatory response. The aim of the study was to evaluate this circulatory response and to analyze the relationship between the intensity of the force and the magnitude of the associated circulatory responses. METHODS: Sixty-three healthy patients, aged 17 to 29 years, were randomly allocated to one of three groups according to the three different subjective forces applied intentionally. Subjects in group 1 received minimal force enough to stimulate circulatory response, but not enough to expose the glottis. Group 2 received the optimal force necessary to expose the glottic opening. Group 3 received excessive force to expose the glottic opening. The axial forces of the laryngoscope handle with a Macintosh blade were measured during a ten-second laryngoscopy, and peak force, mean force, and area under the curve were calculated. Then, arterial pressure and heart rate were recorded after the laryngoscopy at 30 seconds intervals for 3 minutes. The data was compared among groups and with the baseline post-induction values. RESULTS: No significant difference was found in heart rate and blood pressure at each interval among the three groups, with increasing arterial pressure and heart rate after the laryngoscopy. Blood pressure and heart rate were maintained high, being progressively higher in the groups receiving a higher force. CONCLUSIONS: We conclude that little association was found between the force and the magnitude of circulatory response although higher forces cause longer circulatory responses.
Arterial Pressure ; Blood Pressure ; Glottis ; Heart Rate ; Humans ; Intention ; Laryngoscopes ; Laryngoscopy*

BACKGROUND: During laryngoscopy, force applied to the soft tissue are assumed to cause circulatory response. The aim of the study was to evaluate this circulatory response and to analyze the relationship between the intensity of the force and the magnitude of the associated circulatory responses. METHODS: Sixty-three healthy patients, aged 17 to 29 years, were randomly allocated to one of three groups according to the three different subjective forces applied intentionally. Subjects in group 1 received minimal force enough to stimulate circulatory response, but not enough to expose the glottis. Group 2 received the optimal force necessary to expose the glottic opening. Group 3 received excessive force to expose the glottic opening. The axial forces of the laryngoscope handle with a Macintosh blade were measured during a ten-second laryngoscopy, and peak force, mean force, and area under the curve were calculated. Then, arterial pressure and heart rate were recorded after the laryngoscopy at 30 seconds intervals for 3 minutes. The data was compared among groups and with the baseline post-induction values. RESULTS: No significant difference was found in heart rate and blood pressure at each interval among the three groups, with increasing arterial pressure and heart rate after the laryngoscopy. Blood pressure and heart rate were maintained high, being progressively higher in the groups receiving a higher force. CONCLUSIONS: We conclude that little association was found between the force and the magnitude of circulatory response although higher forces cause longer circulatory responses.
Arterial Pressure ; Blood Pressure ; Glottis ; Heart Rate ; Humans ; Intention ; Laryngoscopes ; Laryngoscopy*

BACKGROUND: Patients receiving an elective total knee replacement (TKR) are frequently older and immobilized. The related decline in respiratory function and structural changes may place these patients at an increased risk of perioperative pulmonary complications. METHODS: This study reviewed the data of 239 consecutive procedures performed by a single surgeon. The data examined included the patient's characteristics (age, gender, height, weight and body mass index [BMI]); concurrent pulmonary comorbidity (presence vs. absence); anesthetic techniques (general vs. spinal); types of operation (unilateral vs. bilateral); duration of operation (< 4 vs. > or = 4 hr); duration of tourniquet inflation (< 2 vs. > or = 2 hr); number of perioperative transfusions (< or = 4 vs. > or = 5 units); and American society of anesthesiologists (ASA) physical status. Pulmonary complications were grouped together as a single outcome. A Chi-square test and multiple logistic regression analysis were used to identify the risk factors. A P value < 0.05 was considered significant. RESULTS: Pneumonia, pulmonary edema, pulmonary congestion, atelectasis and pulmonary embolism were the pulmonary complications (n = 28; 11.7%) examined. Age, gender, BMI, pulmonary comorbidity, type and duration of surgery, duration of tourniquet inflation, anesthetic technique and ASA physical status were not associated with pulmonary complications. Only the number of packed cells transfused (> or = 5 units) was found to be associated with the pulmonary complications (odds ratio 5.21; P = 0.015). In particular, transfusions were related to pneumonia, pulmonary edema, pulmonary congestion and pulmonary embolism (P < 0.01). However, atelectasis was not related to any of the potential risk factors including the anesthetic technique. CONCLUSIONS: Transfusion requirements may be an important risk factor of the early postoperative pulmonary complications in patients receiving a TKR.
Arthroplasty, Replacement, Knee* ; Body Mass Index ; Comorbidity ; Estrogens, Conjugated (USP) ; Humans ; Inflation, Economic ; Logistic Models ; Pneumonia ; Pulmonary Atelectasis ; Pulmonary Edema ; Pulmonary Embolism ; Risk Factors* ; Tourniquets

Plasma cholinesterase was assayed during the period immediately following IV bolus injection of succinylcholine 1mg/kg to test the effect of succinylcholine on pseudocholinesterase activity. Twenty healthy adult patients scheduled for elective surgery were studied. The resutls were as follows: The mean value of pre-injection pseudocholinesterase activity was 1124.15 IU/L, and the activity following succinylcholin injection was 1159.55IU/L during fasciculation, 982.70 at 1 min, 936.60 at 3 min, 891.25 at 5 min, 926.80 at 7 min, 1015.45 at 10 min, and 1007.70 at 15 min. It was concluded that the tendency to increase pseuducholinesterase activity during fasciculation seems to be due to choline, the metabolite of succinylcholine, however the cause of the significant decrease in pseudocholinesterase activity after fasciculation is uncertain. The only suggested mechanism is due to the inhibition of pseudocholinesterase by succinylcholine and its metabolites.
Adult ; Choline ; Cholinesterases ; Fasciculation ; Humans ; Plasma ; Pseudocholinesterase ; Succinylcholine*

Spinal cord infarction as a complication of spine surgery occurs rarely. Herein, a case of spinal cord infarction, which developed in a 69 year old woman following posterior decompression and internal fixation for a T11 bursting fracture, is descirbed. The anesthetic induction and intraoperative course were uneventful, except at the end of the procedure, where her blood pressure suddenly dropped from 130/90 to 90/60 mmHg. The patient was aggressively treated with a transfusion and vasopressor, the blood pressure then returned to its usual value within 10 minutes. However, during a physical examination in the recovery room, the patient was found to have flaccid lower limbs, with impaired sensory function below the T8 level. Her cord diameter had increased, and a high signal lesion was observed within the thoracic spinal cord, from T9 to T12 level on T2-weighted MR images, which was diagnosing as a spinal cord infarction, was and showed no improvement despite the immediate and aggressive treatment.
Aged ; Blood Pressure ; Decompression ; Female ; Humans ; Infarction* ; Lower Extremity ; Physical Examination ; Recovery Room ; Sensation ; Spinal Cord* ; Spine*

A cardiovascular collapse, due to preoperatively administered intravenous vitamin K (phytonadione), was experienced in a 59-year-old woman who was scheduled to undergo a left upper lung lobectomy. The patient developed sudden facial flushing, an upper torso rash, dyspnea, palpitation, and severe hypotension about 2 min after the intravenous administration of approximately 2 mg of vitamin K. Immediate hydration and an injection of 20 mg ephedrine restored her blood pressure to the preoperative level within 5 min. The patient recovered without any sequelae, but the operation was postponed. The patient's symptoms seemed to be due to an anaphylactoid reaction or anaphylaxis following the intravenous administration of vitamin K. This case report suggests that physicians should carefully review the indications of vitamin K prior to administration, even at low doses.
Administration, Intravenous ; Anaphylaxis ; Blood Pressure ; Dyspnea ; Ephedrine ; Exanthema ; Female ; Flushing ; Humans ; Hypotension ; Lung ; Middle Aged ; Torso ; Vitamin K ; Vitamins*