BACKGROUND: Fear of dental treatment is a very real problem for many people. Very young patients or children that are mentally or physically handicapped have various problems that preclude routine dental treatment in the office and require general anesthesia for extensive dental restoration. In America, outpatient operations are performed in thousands of dental offices annually, but there is no report about outpatient general anesthesia in Korea. METHOD: A review of forty children treated under outpatient general anesthesia for extensive dental treatment between 1994 and 1996 inclusive was carried out to assess the patient selection, anesthetic method, recovery time and complication. RESULTS: The mean age was 8.4 years, and twenty-five percent of the patients were autism. The length of the postoperative observation period before discharge was 3.2 hours, and postoperative fever was major complication. CONCLUSION: For extensive dental treatment in handicapped children, we suggest that outpatient general anesthesia can provide reasonably safe treatment, while reducing its expense and requiring less hospital bed space.
Americas ; Anesthesia, General* ; Autistic Disorder ; Child* ; Dental Offices ; Disabled Children ; Disabled Persons* ; Fever ; Humans ; Korea ; Outpatients* ; Patient Selection

A 75-year-old male patient with a left intertrochanteric fracture underwent emergency total hip arthroplasty under spinal anesthesia. He had an operation for laryngeal cancer about 10 years ago. Bronchiectasis and atelectasis were noticed in his preoperative roentgenogram. He underwent spinal anesthesia with 13 mg of 0.5% isobaric tetracaine. The level of spinal anesthesia was T7. The SpO2 (oxygen saturation of pulse oxymeter) decreased to 55% at 1 hour after start of operation. Breath sounds on the right lung were diminished. Tracheal intubation was performed for endotracheal suction. A large amount of yellowish secretion was aspirated through suction catheter. The SpO2 returned to 98%. We report a case of severe hypoxemia due to inability of expectoration in patient with bronchiectasis who underwent spinal anesthesia.
Aged ; Anesthesia, Spinal* ; Anoxia* ; Arthroplasty, Replacement, Hip ; Bronchi* ; Bronchiectasis* ; Catheters ; Emergencies ; Humans ; Intubation ; Laryngeal Neoplasms ; Lung ; Male ; Pulmonary Atelectasis ; Suction ; Tetracaine

No Abstract available.
Thrombelastography*

BACKGROUND: Hemodilution reduces the concentration of clotting factors in blood and this may induce some degree of impairment of coagulation. But there are some evidence that hemodilution may induce a hypercoagulable state. The goal of this study is to investigate the changes of coagulation status during progressive hemodilution. METHODS: Whole Blood was diluted by 10% increment to 80% with 0.9% normal saline. At each 10% dilution blood coagulation status was analysed using thrombelastography (TEG) and was compared with that of an undiluted control specimen obtained concurrently from the same patients. RESULTS: Hemodilutions up to 40% decrease r and K times and increase values of MA and angle. Hemodilutions more than 70% increase r and K times and decrease values of MA and angle. CONCLUSIONS: Hemodilutions up to 40% increase coagulability and hemodilutions more than 70% decrease coagulability of whole blood in vitro.
Blood Coagulation ; Hemodilution* ; Humans ; Thrombelastography

BACKGROUND: Clonidine, an 2-adrenergic agonist, shows the analgesic effect and potentiates the analgesic effect of opioid. However, when it is injected with bolus technique, it reveals the short duration of inadequate analgesia and induces hypotension, bradycardia or sedation. We examined the analgesic and side effects of clonidine administered by continuous epidural infusion over 24 hrs, following epidural morphine injection. METHODS: Sixty parturients, scheduled for elective cesarean section under epidural anesthesia were randomly allocated into three groups. They received an infusion of saline alone (group 1, n= 20), clonidine 20 g/hr (group 2, n= 20), or 40 g/hr (group 3, n= 20) respectively, following epidural morphine 3 mg injection at the end of operation. The total doses and number of request for supplemental analgesic, blood pressure, heart rate, and degree of sedation were measured during 24 hrs. RESULTS: There were significant differences in pain relief between clonidine groups and group 1. The total doses and number of patient's request for supplemental analgesic in clonidine groups, compared to group 1 were significantly decreased (p<0.05), but no significant differences between the two clonidine groups. The diastolic pressure of group 3 was significantly lower than that of group 1 over 24 hrs, and that of group 2 at 18 hr, 24 hr (p<0.05). However, there was no severe hypotension, bradycardia or sedation in the three groups. CONCLUSION: Clonidine administered by continuous epidural infusion over 24 hrs enhances the analgesic effect of epidural morphine, and the infusion of clonidine with 20 g/hr rather than 40 g/hr shows minimal changes of blood pressure. Therefore, administration of epidural clonidine (20 g/hr) following epidural morphine may be considered as a regimen for pain management after cesarean section.
Analgesia* ; Anesthesia, Epidural ; Blood Pressure ; Bradycardia ; Cesarean Section* ; Clonidine* ; Female ; Heart Rate ; Hypotension ; Morphine ; Pain Management ; Pregnancy

Background: Familial amyloid polyneuropathy (FAP) is caused by mutation in a gene transcribing transport protein produced mainly by the liver. Liver transplantation is required to stop FAP progression, but the pathology causes anesthetic management challenges.Case: We report a case of domino living donor liver transplantation in an FAP patient. No intraoperative events occurred; however, during postoperative day 1 in the intensive care unit (ICU), the FAP patient underwent multiple cardiopulmonary resuscitation (CPR) sessions due to pulseless electrical activity following a sudden drop in blood pressure and ventricular tachycardia. Despite ICU management, the patient died after the third CPR session. Conclusions Various anesthetic management techniques should be considered for FAP patients. Anesthetic management was carefully assessed with the use of isoflurane, isoproterenol, and an external patch. The cause of deterioration in the ICU is unclear, but further investigation is needed to prevent and better manage postoperative morbidity and mortality.

Since the implementation of the model for end-stage liver disease (MELD) scoring system in 2002, the liver transplantation (LT) society has observed a substantial increase in the number of recipients with renal dysfunction. Intraoperative renal replacement therapy (ioRRT) has emerged as one of the solutions available to manage high-MELD score recipients; however, its usefulness has not yet been proven. To date, we have experienced five cases of simultaneous liver and kidney transplantation (SLKT). Recipients of SLKT tend to have a lower pre-transplant kidney function and the longer operation time mandates a larger amount of fluid than LT alone. Hence, anesthetic care is more prone to be challenged by hyperkalemia, metabolic acidosis, and volume overload, making ioRRT a theoretically valuable intervention. However, in all five cases, recipients were managed without ioRRT, resulting in excellent graft and patient survival. As such, in this case series, we discuss current issues about ioRRT and SLKT.
Acidosis ; Humans ; Hyperkalemia ; Kidney Transplantation* ; Kidney* ; Liver Diseases ; Liver Transplantation ; Liver* ; Renal Replacement Therapy* ; Transplants

BACKGROUND: It is invasive and accompanies various risks to insert pulmonary artery catheter in order to measure mixed venous oxygen saturation (SvO2) that is associated with patients clinical course and prognosis. If there is relationship between central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation, we can use the central venous oxygen saturation instead of mixed venous oxygen saturation to monitor and treat patients. METHODS: We inserted the Swan-Ganz catheter in 20 patients (male 8, female l2) scheduled for undergoing open heart surgery and accomplished the blood gas analysis of the radial arterial blood, central venous blood and mixed venous blood during postoperative respiratory care in intensive care unit at F1O2 1.0, 0.6 and 0.4 in order. RESULTS: There was no significant difference between central venous blood and mixed venous blood in respect to pH, PCO2, PO2. except the mixed venous blood pH at F1O2 0.6 that is greater than the central venous blood pH at F1O2 0.6. Central venous oxygen saturation and mixed venous saturation were not significantly different and showed the following close relationship: SvO2(%)=15.41+0.80XScvO2 (R=0.88, p<0.05). In respect to the difference according to the variation of F1O2, the SO2 and PO2 at F1O2. 1.0 were higher than the SO2 and PO2 at F1O2 0.6 and 0.4, but the differnce between F1O2 0.6 and 0.4 was not significant. CONCLUSIONS: We might conclude that central venous oxygen saturation might be replaced for the mixed venous oxygen saturation in respiratory care after open heart surgery in adults.
Adult ; Blood Gas Analysis ; Catheters ; Female ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Intermittent Positive-Pressure Breathing ; Oxygen* ; Prognosis ; Pulmonary Artery ; Respiration, Artificial* ; Thoracic Surgery ; Ventilation

"Background: In using the Double-lumen tube (DLT), knowing the minimum bronchial cuff volume (MCV) for an effective air-tight seal will be useful; to provide a collapse of the lung; and to avoid pressure damage. The aims of the present study are thus three-fold: to measure the MCV; to measure the diameter of left main bronchus (LMBD); and to prove any relationships between two parameters. METHODS: One hundred men and forty women who needed intubation of left-sided DLT were enrolled in this study. 37 Fr DLTs were used in male patients, and 35 Fr DLTs were used in female patients. We evaluated the MCV by air bubble method and measured the LMBD in chest PA. We also evaluated the pressure/volume characteristics of the bronchial cuffs by control inflator. RESULTS: 29 patients of 100 patients (29%) exhibited persistent air leakage in 2.5 ml cuff volume in male patients (group of MCV >2.5). On the contrary, 18 patients of 40 patients (45%) did not require any cuff volume in female patients (group of MCV 0). The mean LMBD were 13.23 1.45 mm in male and 11.09 0.96 mm in female. There were significant positive correlations between MCV and LMBD in both sex and their respective correlation coefficients were 0.264 (P=0.008) in male and 0.484 (P=0.002) in female. The equations of linear regression were: LMBD = 12.394 0.429xMCV in male, LMBD = 10.725 0.438xMCV in female. CONCLUSIONS: The MCV of the brochial cuffs in left-sided DLTs has significant relationships with the LMBD measured in chest PA.
Bronchi ; Female ; Humans ; Intubation ; Linear Models ; Lung ; Male ; Thorax

There has existed controversies concerning the relationship between hypokalemia and perioperative dysrhythmia. Definite lowest serum potassium level that guarantee safety has not been determined. We found accidentally severe hypokalemia (below than 2 mmol/L) after the induction of anesthesia in a 51-year-old man who had no systemic disease. This patient suffered from a traffic accident 18 years ago and has bed-ridden up to now. In addition, recently he had poor oral intake. The patient's serum potassium level was within normal range in blood chemistry taken 5 days before operation. Although no dysrhythmia developed, we administered potassium during operation. With the continuous potassium and magnesium replacement postoperatively, the serum potassium level returned to normal range. With the experience of this case, we had a chance to review the effect of hypokalemia on dysrhythmia and causes of hypokalemia.
Accidents, Traffic ; Anesthesia ; Chemistry ; Humans ; Hypokalemia* ; Magnesium ; Middle Aged ; Potassium ; Reference Values