No abstract available.
Heart Arrest* ; Hypothermia* ; Pneumonia*

BACKGROUND: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 µg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). METHODS: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 µg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. RESULTS: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. CONCLUSIONS: For patients under general anesthesia receiving dopamine at 10 µg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Dopamine* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Jugular Veins ; Saphenous Vein ; Vascular Resistance ; Veins*

No abstract available.
Heart Arrest ; Hypothermia ; Pneumonia

BACKGROUND: Although one lung ventilation (OLV) is frequently used for facilitating thoracic surgical procedures, arterial hypoxemia can occur while using one lung anesthesia. Continuous positive airway pressure (CPAP) in 5 or 10 cmH2O to the non-ventilating lung is commonly recommended to prevent hypoxemia. We evaluated the effects of incremental CPAP to the non-ventilating lung on arterial oxygenation and pulmonary shunt without obstruction of the surgical field during OLV. METHODS: Twenty patients that were scheduled for one lung anesthesia were included in this study. Systemic and pulmonary hemodynamic data and blood gas analysis was recorded every fifteen minutes according to the patient's positions and CPAP levels. CPAP was applied from 0 cmH2O by 3 cmH2O increments until a surgeon notifies that the surgical field was obstructed by the expanded lung. Following that, pulmonary shunt fraction (QS/QT) was calculated. RESULTS: There were no significant differences of QS/QT between supine and lateral positions with two lung ventilation (TLV). OLV significantly decreased arterial oxygen partial pressure (PaO2) and increased QS/QT compared to TLV. PaO2 and QS/QT significantly improved at 6 and 9 cmH2O of CPAP compared to 0 cmH2O. However, there were no significant differences of PaO2 and QS/QT between 6 and 9 cmH2O CPAP. In 18 patients (90%), surgical fields were obstructed at 9 cmH2O CPAP. CONCLUSIONS: This study suggests that 6 cmH2O CPAP effectively improved arterial oxygenation without interference of the surgical field during OLV when CPAP was applied from 0 cmH2O in 3 cmH2O increments.
Anesthesia ; Anoxia ; Blood Gas Analysis ; Continuous Positive Airway Pressure ; Hemodynamics ; Humans ; Lung ; One-Lung Ventilation ; Oxygen ; Partial Pressure ; Thoracic Surgical Procedures ; Ventilation

Pheochromocytoma is a rare catecholamine producing tumor. Anesthetic management for the resection of pheochromocytoma is hard and challenging issue to anesthesiologist, because of its potentially lethal cardiovascular complications. It becomes more complicated when the patient is pregnant. Clinicians must keep the safety of both mother and fetus in mind. The timing of surgery for pheochromocytoma in pregnancy is very important for the maternal and fetal safety and depends on the gestational age when diagnosis is made, clinical response to medical treatment, the surgical accessibility of the tumor, and the presence of fetal distress. We report anesthetic experience of a laparoscopic resection for pheochromocytoma in 25th week gestational woman.
Female ; Fetal Distress ; Fetus ; Gestational Age ; Humans ; Laparoscopy ; Mothers ; Pheochromocytoma ; Pregnancy ; Pregnant Women

BACKGROUND: Diabetic cardiovascular autonomic neuropathy (CAN) causes perioperative cardiovascular instability. A rapid increase in the desflurane concentration induces tachycardia and hypertension (HTN). This study examined the effects of the cardiovascular response to desflurane on patients with diabetic CAN. METHODS: Forty diabetes mellitus (DM) patients with CAN were divided two groups: one with HTN (DM+HTN group, n = 17) and one without HTN (DM group, n = 23). The control group (n = 20) was composed of healthy patients without DM or HTN. In each group, the concentration of desflurane inspired was increased abruptly to 12.0 vol% 2 minutes after a thiopental injection. The target was to produce an end-tidal concentration of desflurane of 10.0 vol%, which was maintained until the end of the study by adjusting the vaporizer dial setting. The heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) were measured. RESULTS: The HR, MAP and CI increased significantly in all three groups when compared with the baseline (P<0.05). Additionally, the HR and MAP showed did not differ among the three groups at any of sampling times. However, the CI of the DM group and the DM+HTN group differed when compared with the control group at 90 and 120 seconds after intubation (P<0.05). CONCLUSIONS: In diabetic patients with CAN, the hemodynamic responses to a rapid increase in desflurane concentration are similar to those in non-diabetic patients before endotracheal intubation. However, after endotracheal intubation, increments in CI are blunted in diabetic patients with CAN.
Arterial Pressure ; Diabetes Mellitus ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal ; Isoflurane ; Nebulizers and Vaporizers ; Tachycardia ; Thiopental

Central venous catheterization is often necessary to manage critically ill patients in the intensive care unit and some surgical patients in the operating room. However, this procedure can lead to various complications. We experienced a case of subclavian venous catheterization that was complicated by looping, kinking, knotting, and entrapment of the guidewire. We were able to identify the extravascular looping and knotting of the guidewire under fluoroscopy and consequently removed it successfully. We suggest that a guidewire should be confirmed by fluoroscopic imaging if it has become entrapped.
Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Critical Illness ; Fluoroscopy ; Humans ; Intensive Care Units ; Operating Rooms

BACKGROUND: The Quality of Recovery-40 (QoR-40) is a widely-used, self-rated, and self-completed questionnaire for postoperative patients. The questionnaire is intended to elicit information from each patient regarding the quality of recovery during the postoperative period. It is noteworthy, however, that an official Korean version of the QoR-40 (QoR-40K) has not been established. The purpose of this study was to develop the QoR-40K by translation and cultural adaptation process and to evaluate the validity and reliability of the QoR-40K. METHODS: After pre-authorization from the original author of the QoR-40, the translation procedure was established and carried out based upon Beaton’s recommendation to create a QoR-40K model comparable to the original English QoR-40. Two hundred surgical patients were enrolled, and each completed the questionnaire during the preoperative period, on the third day, and 1 month after surgery. The QoR-40K was compared with the visual analogue scale (VAS) and another health-related questionnaire, the Short-form Health Survery-36 (SF-36). The method of validation for QoR-40K included test-retest reliability, internal consistency, and level of responsiveness. RESULTS: Spearman’s correlation coefficient for test-retest reliability was 0.895 (P < 0.001), and Cronbach’s alpha of the global QoR-40K on the third day after surgery was 0.956. A positive correlation was obtained between the QoR-40K and the mental component summary of SF-36 (ρ = 0.474, P < 0.001), and a negative correlation was observed between QoR-40K and VAS (ρ = −0.341, P < 0.001). The standardized responsive mean of the total QoR-40K was 0.71. CONCLUSIONS: The QoR-40K was found to be as acceptable and reliable as the original English QoR-40 for Korean patients after surgery, despite the apparent differences in the respective patients’ cultural backgrounds.
Cross-Cultural Comparison ; Humans ; Methods ; Postoperative Period ; Preoperative Period ; Quality of Life ; Reproducibility of Results*

BACKGROUND: The proper cuff pressure is important to prevent complications related to the endotracheal tube (ETT). We evaluated the change in ETT cuff pressure by changing the position from supine to prone without head movement. METHODS: Fifty-five patients were enrolled and scheduled for lumbar spine surgery. Neutral angle, which was the angle on the mandibular angle between the neck midline and mandibular inferior border, was measured. The initial neutral pressure of the ETT cuff was measured, and the cuff pressure was subsequently adjusted to 26 cmH2O. Flexed or extended angles and cuff pressure were measured in both supine and prone positions, when the patient's head was flexed or extended. Initial neutral pressure in prone was compared with adjusted neutral pressure (26 cmH2O) in supine. Flexed and extended pressure were compared with adjusted neutral pressure in supine or prone, respectively. RESULTS: There were no differences between supine and prone position for neutral, flexed, and extended angles. The initial neutral pressure increased after changing position from supine to prone (26.0 vs. 31.5 +/- 5.9 cmH2O, P < 0.001). Flexed and extended pressure in supine were increased to 38.7 +/- 6.7 (P < 0.001) and 26.7 +/- 4.7 cmH2O (not statistically significant) than the adjusted neutral pressure. Flexed and extended pressure in prone were increased to 40.5 +/- 8.8 (P < 0.001) and 29.9 +/- 8.7 cmH2O (P = 0.002) than the adjusted neutral pressure. CONCLUSIONS: The position change from supine to prone without head movement can cause a change in ETT cuff pressure.
Head Movements ; Head* ; Humans ; Neck ; Prone Position ; Spine

No abstract available.