A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
Anesthesia, General ; Cardiopulmonary Resuscitation ; Catheterization* ; Catheters* ; Central Venous Catheters ; Child* ; Drug Therapy ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Infant ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Pulmonary Circulation ; Pulmonary Embolism* ; Subclavian Vein ; Thrombosis

BACKGROUND: To test whether smokers have exaggerated hemodynamic responses to induction and intubation, we investigated the changes in blood pressure (BP) and heart rate (HR) on induction and intubation in smokers and nonsmokers. METHODS: Healthy male patients (25 smokers and 25 nonsmokers, aged 20 to 29 yrs) for elective surgery were studied. Anesthesia was induced with thiopental 3 mg/kg, fentanyl 1.5 microgram/kg, vecuronium 0.1 mg/kg and maintained with enflurane 1 % in N2O and O2 for the period of observation. After three minutes, orotracheal intubation was performed. Noninvasive BP and HR were recorded one minute before induction (baseline), immediately before intubation, and then every minute until five minutes after intubation. RESULTS: Systolic BP of smokers decreased significantly immediately before intubation, and at 4 and 5 min after intubation as compared to that of nonsmokers (Mean +/- SEM, 120.8 +/- 3.0 vs. 109.9 +/- 2.8, 116.7 +/- 2.4 vs. 108.9 +/- 2.3, and 114.8 +/- 2.2 vs. 106.7 +/- 2.3 mmHg, respectively, P < 0.05). Diastolic BP of smokers decreased only immediately before intubation compared with that of nonsmokers (Mean +/- SEM, nonsmoker 64.6 +/- 2.4 vs. smoker 58.6 +/- 1.8 mmHg, P < 0.05). However, there was no significant difference of HR between smokers and nonsmokers during the observational period. CONCLUSIONS: Hemodynamic response is different in smokers compared with nonsmokers. Our results indicate that smoking affects the hemodynamic response to induction and intubation.
Anesthesia ; Blood Pressure ; Enflurane ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Male ; Smoke ; Smoking ; Thiopental ; Vecuronium Bromide

A 78-year-old female patient was undergone general anesthesia for total abdominal hysterectomy with bilateral salpingo-oopherectomy. Arterial blood pressure dropped 20 minutes after beginning of the surgery when uterine manipulation was started. From then, excessive sweating was found in the face and whole body and core temperature decreased to 34.3degrees C. Sweating and low body temperature were sustained despite of various aggressive warming efforts. Anticholinergic medication immediately put an end to an hour of excessive sweating and prevented further body temperature decline. Several possibilities of excessive sweating were discussed in this case: uterine manipulation during the light plane of general anesthesia, age related autonomic changes, use of intraoperative opioid and antihypertensive medications.
Aged ; Anesthesia, General* ; Arterial Pressure ; Body Temperature ; Female ; Humans ; Hypothermia* ; Hysterectomy* ; Sweat* ; Sweating*

A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
Anesthesia, General ; Cardiopulmonary Resuscitation ; Catheterization ; Catheters ; Central Venous Catheters ; Child ; Drug Therapy ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Infant ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Pulmonary Circulation ; Pulmonary Embolism ; Subclavian Vein ; Thrombosis

BACKGROUND: Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. MATERIALS AND METHODS: Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. RESULTS: The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). CONCLUSION: Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.
Academic Medical Centers ; Acute Kidney Injury* ; Classification ; Colorectal Surgery* ; Diuretics ; Humans ; Hypotension ; Hypovolemia ; Mortality ; Postoperative Care ; Reoperation ; Risk Factors*